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Tierarztl Prax Ausg K Kleintiere Heimtiere 2020; 48(02): 132-138
DOI: 10.1055/a-1122-7837
Case Report

Suspected bilateral adrenal gland tumour causing primary Addison’s disease in a dog

Bilaterale Nebennierenmasse als Ursache eines primären Hypoadrenokortizismus beim Hund
Anna-Lena Proksch
1   Clinic of Small Animals – Internal Medicine, Justus-Liebig-University Giessen, Giessen, Germany
,
Andreas Brühschwein
2   Clinic of Small Animal Surgery and Reproduction, Centre for Clinical Veterinary Medicine, Ludwig-Maximilian-University, Munich, Germany
,
Katrin Hartmann
3   Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilian-University, Munich, Germany
,
Astrid Wehner
3   Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilian-University, Munich, Germany
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Abstract

A 13-year old miniature poodle presented with a 3-day episode of vomiting, anorexia, and lethargy. Lack of micturition had been noted for 2 days. Clinical examination indicated dehydration and a tense, painful abdomen. Laboratory parameters (severe azotaemia, hyperkalaemia, severe hyponatraemia, hypochloraemia, and hyperphosphataemia with glucosuria and proteinuria) were consistent with anuric acute kidney injury (AKI). Abdominal ultrasound revealed bilateral adrenal masses. ACTH stimulation test was diagnostic for Addison’s disease. Computed tomography confirmed bilateral adrenal masses and indicated multifocal liver nodules. Additionally, infiltration of the caudal vena cava with partial luminal occlusion was demonstrated. Surgical removal of the adrenal masses with venous plasty intervention and stenting of the vessels deemed unrewarding in this patient in respect to progressed tumour growth with assumed metastatic spread. The dog was treated for Addison’s disease and discharged with good overall condition. Eight weeks later, the dog was euthanized due to progressive caudal vena cava occlusion. Whilst hypoadrenocoticism typically affects young to middle aged dogs, in old dogs primary Addison’s disease might be caused by neoplastic bilateral adrenal gland destruction. This is the first case report of hypovolaemia leading to AKI secondary to bilateral adrenal masses causing Addison’s disease in a dog.

Zusammenfassung

Ein 13-jähriger Zwergpudel wurde aufgrund einer 3-tägigen Episode mit Erbrechen, Anorexie und Lethargie vorgestellt. Der letzte Urinabsatz war 2 Tage vor Vorstellung beobachtet worden. In der klinischen Untersuchung fielen eine Dehydratation und ein angespanntes, schmerzhaftes Abdomen auf. Anamnese, Harnblasengröße und Laborparameter (schwere Azotämie sowie Hyperkaliämie, Hyponatriämie, Hypochloridämie, Hyperphosphatämie, Glukosurie und Proteinurie) sprachen für eine akute anurische Nierenschädigung. Sonografisch ließen sich bilateral Nebennierenmassen darstellen. Mittels ACTH-Stimulationstest wurde ein Hypoadrenokortizismus nachgewiesen. Nach der Stabilisierung des Patienten erfolgte eine computertomografische Untersuchung des Abdomens, die bilaterale Nebennierenmassen mit Invasion in die Vena cava caudalis und Nierenarterien bestätigte und zudem multifokale Herde in der Leber zeigte. Die Invasion hatte bereits zu einer partiellen Verlegung des Lumens der genannten Gefäße geführt. In Anbetracht der Tumorausbreitung und der anzunehmenden Metastasierung erschien eine chirurgische Intervention als nicht erfolgversprechend. Der Patient wurde mit medikamentöser Therapie des Hypoadrenokortizismus bei gutem Allgemeinbefinden entlassen. Aufgrund eines progressiven tumorbedingten Verschlusses der Vena cava caudalis wurde der Patient 8 Wochen später euthanasiert. Wenngleich ein Hypoadrenokortizismus vornehmlich bei jüngeren und mittelalten Hunden auftritt, kann diese Erkrankung bei älteren Hunden die Folge eines bilateralen Nebennierentumors mit Zerstörung beider Nebennierenrinden sein. Dies ist der erste Fallbericht eines bilateralen Nebennierentumors, in dessen Folge eine Morbus-Addison-bedingte Hypovolämie zu einer akuten Nierenschädigung führte.

Key words

Hypoadrenocorticism - neoplasia - canine - acute kidney injury - renal failure

Schlüsselwörter

Hypoadrenokortizismus - Neoplasie - kanin - akute Nierenschädigung - Nierenversagen


Publication History

Received: 02 August 2019

Accepted: 07 January 2020

Article published online:
23 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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