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Wojo Alcala. Diagnosing Adrenal Tumors and Retinal Detachment via Ultrasound. Signalment. 8 ½ year old male castrated Shih Tzu. History. NCSU Emergency Service For evaluation of acute blindness Episodes of exercise intolerance No V, D, Coughing, Sneezing
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Wojo Alcala Diagnosing Adrenal Tumors and Retinal Detachment via Ultrasound
Signalment • 8 ½ year old male castrated Shih Tzu
History • NCSU Emergency Service • For evaluation of acute blindness • Episodes of exercise intolerance • No V, D, Coughing, Sneezing • Previous Hx of patellar luxation (treated with Rimadyl
Pertinent Clinical and Laboratory Findings • Distended abdomen, difficult to palpate • BP on admission 220 (systolic), later no BP>170 was reported • Elevated ALP (579) • USG 1.041, 3+ protein • Urine Protein:Creatinine Ratio=slightly elevated • ACTH Stim: 50 ug/dl (very suggestive of Cushings)
Wojo headed to Radiology for … • Abdominal and Chest Radiographs • Abdominal Ultrasound
Problems Identified • Radiographs 1. Hepatomegaly • Abdominal Ultrasound 1. Bilaterally enlarged adrenal glands (each adrenal appears to contain a nodule) 2. Bilateral retinal detachment
Differentials • Cushings • Due to presence of nodules= may be more consistent with • Adenoma, adenocarcinoma or pheochromocytoma • Rather than pituitary dependent Cushings (in which we would see bilateral uniform hypertrophy more likely)
Differentials • Signs consistent with Cushings (Incr. ALP and hepatomegaly) • However, dogs with Cushings do not typically experience hypertension great enough to cause bilateral retinal detachment • Therefore why we suspect pheochromocytoma may be involved
Ultrasound • Could not differentiate which type of adrenal tumor Wojo had • We needed to explore other options…
Wojo’s Options • Nuclear Scintigraphy with MIBG (metaiodobenzylguanidine) • Can be used to localize pheochromocytomas, • Better surgical plan • Possible Lysodren treatment and evaluation of response.
What happened? • I called Wojo’s parents three days after discharge to see how he was adapting to his blindness at home. • They had elected Euthanasia the previous night at the rDVM.