den Hertog E, Braakman J C, Teske E, Kooistra H S, Rijnberk A
Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, The Netherlands.
Vet Rec. 1999 Jan 2;144(1):12-7. doi: 10.1136/vr.144.1.12.
One hundred and twenty-nine dogs with pituitary-dependent hyperadrenocorticism were treated according to a protocol aimed at the complete destruction of the adrenal cortices by the administration of o,p'-DDD (mitotane) at a daily dose of 50 to 75 mg/kg bodyweight for 25 days. On the third day, glucocorticoid and mineralocorticoid supplementation was begun for the induced adrenocortical insufficiency. The first followup examination after completion of the 25-day course and the subsequent twice-yearly follow-up examinations included physical examination and measurements of plasma concentrations of sodium and potassium to optimise substitution therapy. In 19 dogs the full course of 25 days treatment could not be completed. Of the 110 dogs which received the full course of treatment, the administration had to be stopped temporarily in 32 because of side-effects, such as anorexia and vomiting. The actual dose of o,p'-DDD administered was not significantly different in the dogs with and without these side-effects. Clinical remission occurred in 111 dogs (86 per cent), of which 43 (39 per cent) had a relapse. The estimated one-year disease-free fraction was 77 per cent (95 per cent confidence interval [CI]: 67 to 85 per cent). The estimated one-year survival fraction was 80 per cent (95 per cent CI: 71 to 87 per cent), the two-year survival was 69 per cent (95 per cent CI: 59 to 78 per cent), and the three-year survival was 61 per cent (95 per cent CI: 49 to 71 per cent). The bodyweight and age of the dog, and vomiting occurring during the period of treatment, were positively correlated with the length of the disease-free period, whereas weakness during the treatment and resistance to dexamethasone suppression of the urinary corticoid/creatinine ratios at the start of the treatment were associated with a relatively short survival time.
129只患有垂体依赖性肾上腺皮质功能亢进的犬按照一项方案进行治疗，该方案旨在通过每天以50至75毫克/千克体重的剂量给予邻，对'-滴滴滴（米托坦）25天来完全破坏肾上腺皮质。在第三天，开始补充糖皮质激素和盐皮质激素以应对诱导的肾上腺皮质功能不全。在25天疗程结束后的首次随访检查以及随后的每年两次随访检查包括体格检查和血浆钠和钾浓度的测量，以优化替代疗法。19只犬无法完成25天的完整疗程。在接受完整疗程治疗的110只犬中，32只因厌食和呕吐等副作用而不得不暂时停止给药。有这些副作用和没有这些副作用的犬所给予的邻，对'-滴滴滴的实际剂量没有显著差异。111只犬（86%）出现临床缓解，其中43只（39%）复发。估计的一年无病率为77%（95%置信区间[CI]：67%至85%）。估计的一年生存率为80%（95%CI：71%至87%），两年生存率为69%（95%CI：59%至78%），三年生存率为61%（95%CI：49%至71%）。犬的体重和年龄以及治疗期间出现的呕吐与无病期的长短呈正相关，而治疗期间的虚弱以及治疗开始时对尿皮质醇/肌酐比值地塞米松抑制的抵抗与相对较短的生存时间相关。
