Favorable outcome of pheochromocytoma in a dog with atypical Cushing's syndrome and diabetes mellitus following medical treatment: a case report

• Published in: BMC veterinary research Vol. 16; no. 1; p. 3
• Main Authors: Lee, Ga-Won, Yoo, Cho-Rong, Lee, Dan, Park, Hee-Myung
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03.01.2020; BioMed Central; BMC
• Subjects: 17β-Estradiol; Adrenal glands; Adrenal tumor; Adrenalectomy; Adrenocorticotropic hormone; Adrenocorticotropin (ACTH); Alopecia; Androstenedione; Atypical Cushing’s syndrome; Calcinosis; Care and treatment; Case Report; Case reports; Case studies; CAT scans; Cellular biology; Clopidogrel; Computed tomography; Corticotropin; Cushing syndrome; Diabetes; Diabetes mellitus; Diabetes therapy; Diagnostic imaging; Dog; Dog diseases; Dogs; Enzymes; Estradiol; Estrogens; Glucocorticoids; Glycosylated hemoglobin; Health screening; Hemoglobin; Hemoglobins; Hormones; Hydrocortisone; Hypercholesterolemia; Hyperglycemia; Hypertension; Insulin; Insulin resistance; Liver; Medical tests; Medical treatment; Melanocyte stimulating hormone; Metastasis; Nervous system diseases; Opacity; Patient outcomes; Phenols (Class of compounds); Phenoxybenzamine; Pheochromocytoma; Pituitary; Progesterone; Sex hormones; Tomography; Tumors; Ultrasound; Ultrasound imaging; Urinalysis; Veterinary research; South Korea; United States > US; Atypical Cushing’s syndrome; Pheochromocytoma; Adrenal tumor; Dog; Diabetes mellitus
• ISSN: 1746-6148; 1746-6148
• DOI: 10.1186/s12917-019-2225-x

Pheochromocytoma (PCC) has poor prognosis and adrenalectomy is hard to be performed, in case of caudal vena cava invasion. The long-term administration of phenoxybenzamine in PCC has not been reported in dogs. A 14-year-old castrated male Poodle dog presented with an abdominal mass. On physical examination, hypertension, increased lens opacity, calcinosis cutis, generalized alopecia, and systolic murmur were observed. Serum chemistry and urinalysis profiles revealed hyperglycemia, hypercholesterolemia, elevated liver enzymes, and glucosuria. Abdominal ultrasonography showed a right adrenal mass with invasion of the caudal vena cava, which was cytologically diagnosed as suspected PCC. An adrenal mass (width × height × length, 28 × 26 × 48 mm ) was found on computed tomography and diagnosed as PCC with increased plasma metanephrines and normetanephrines. An adrenocorticotropin hormone stimulation test showed elevated adrenal hormones (androstenedione, estradiol, progesterone, and 17-OH progesterone) with normal cortisol, compatible with atypical Cushing's syndrome. The dog was managed with trilostane, phenoxybenzamine, and insulin therapy. Glycosylated hemoglobin and fructosamine levels gradually decreased, and hypertension resolved. In the 10-month follow-up period, the liver enzymes levels gradually decreased, and the clinical signs of the dog were well-controlled without deterioration. This case report describes long-term medical management without adrenalectomy of PCC complicated with atypical Cushing's syndrome and DM.