Ramsey I K, Richardson J, Lenard Z, Tebb A J, Irwin P J
Faculty of Veterinary Medicine, University of Glasgow, Bearsden, Glasgow, UK.
Aust Vet J. 2008 Dec;86(12):491-5. doi: 10.1111/j.1751-0813.2008.00373.x.
A 12-year-old male neutered Miniature Poodle with confirmed pituitary-dependent hyperadrenocorticism was treated with trilostane. After three doses, it developed clinical and laboratory changes suggestive of isolated hypocortisolism ('atypical hypoadrenocorticism'), which persisted and progressed for more than 3 months despite immediate withdrawal of the trilostane. The clinical signs of hyperadrenocorticism resolved without further trilostane. After 3 months, prednisolone treatment was started and the clinical signs of hypocortisolism resolved. Prednisolone therapy was required for more than 1 year. Ultrasonography initially demonstrated large hypoechoic adrenal cortices, typical of dogs with hyperadrenocorticism, which then became small and heteroechoic, consistent with the development of adrenal necrosis. Persistent isolated hypocortisolism has not been reported previously as a complication of trilostane therapy. The case is also remarkable for the very short duration of trilostane therapy that elicited this complication. Clinicians should be aware that trilostane therapy may result in adrenal necrosis, even in the very earliest stages of therapy, but prompt action can prevent a life-threatening situation.
一只12岁已绝育的雄性迷你贵宾犬，确诊为垂体依赖性肾上腺皮质功能亢进，接受曲洛司坦治疗。在服用三剂后，它出现了临床和实验室变化，提示孤立性皮质醇缺乏症（“非典型肾上腺皮质功能减退症”），尽管立即停用曲洛司坦，但这种情况持续并进展了3个多月。肾上腺皮质功能亢进的临床症状在未进一步使用曲洛司坦的情况下得到缓解。3个月后，开始使用泼尼松龙治疗，皮质醇缺乏症的临床症状得到缓解。泼尼松龙治疗需要超过1年的时间。超声检查最初显示肾上腺皮质呈大的低回声，这是肾上腺皮质功能亢进犬的典型表现，随后肾上腺皮质变小且回声不均匀，这与肾上腺坏死的发展一致。以前尚未报道过持续性孤立性皮质醇缺乏症是曲洛司坦治疗的并发症。该病例还因引发这种并发症的曲洛司坦治疗时间非常短而引人注目。临床医生应意识到，即使在治疗的最早阶段，曲洛司坦治疗也可能导致肾上腺坏死，但及时采取行动可以防止危及生命的情况发生。
