Frankot Jennifer L, Behrend Ellen N, Sebestyen Peter, Powers Barbara E
Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, AL, USA.
J Am Anim Hosp Assoc. 2012 Nov-Dec;48(6):417-23. doi: 10.5326/JAAHA-MS-5800. Epub 2012 Oct 1.
A 10 yr old bichon frise presented with a 3 mo history of polyuria, polydipsia, and hind limb weakness. Serum biochemistry revealed persistent hypokalemia. A left adrenal gland mass with right adrenal atrophy was detected ultrasonographically. Basal serum cortisol concentration was at the low end of normal (30 nmol/L; reference range, 30-140 nmol/L) and adrenocorticotropic hormone (ACTH)-stimulated cortisol concentration was low (199 nmol/L; reference range, 220-470 nmol/L). Basal serum 17-α-OH progesterone concentration was also low (0.03 ng/mL; reference range, 0.06-0.30 ng/mL), but the aldosterone concentration 2 hr after the ACTH stimulation was elevated (> 3,000 pmol/L; reference range, 197-2,103 pmol/L). A left adrenalectomy and nephrectomy were performed. Histopathology revealed an adrenocortical zona glomerulosa carcinoma. Surgical excision was considered incomplete; however, clinical signs resolved. Two years later, basal and ACTH-stimulated aldosterone concentrations were elevated. Computed tomography demonstrated a mass effect in the liver. The left lateral and left medial hepatic lobes were removed. Histopathology confirmed metastatic endocrine carcinoma. The patient was stable 1,353 days postsurgically (when this report was prepared). This is the first case report of a metastatic adrenal carcinoma that was successfully managed surgically for > 3 yr.
一只10岁的比熊犬出现了3个月的多尿、多饮和后肢无力病史。血清生化检查显示持续性低钾血症。超声检查发现左肾上腺有肿块，右肾上腺萎缩。基础血清皮质醇浓度处于正常范围下限（30 nmol/L；参考范围30 - 140 nmol/L），促肾上腺皮质激素（ACTH）刺激后的皮质醇浓度较低（199 nmol/L；参考范围220 - 470 nmol/L）。基础血清17-α-羟孕酮浓度也较低（0.03 ng/mL；参考范围0.06 - 0.30 ng/mL），但ACTH刺激后2小时的醛固酮浓度升高（> 3000 pmol/L；参考范围197 - 2103 pmol/L）。进行了左肾上腺切除术和肾切除术。组织病理学显示为肾上腺皮质球状带癌。手术切除被认为不完全；然而，临床症状得到缓解。两年后，基础和ACTH刺激后的醛固酮浓度升高。计算机断层扫描显示肝脏有占位效应。切除了左外侧和左内侧肝叶。组织病理学证实为转移性内分泌癌。患者术后1353天（撰写本报告时）病情稳定。这是首例成功接受手术治疗超过3年的转移性肾上腺癌病例报告。
