Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea.
Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Jeju National University, Jeju, Republic of Korea.
Vet Med Sci. 2021 Jul;7(4):1150-1153. doi: 10.1002/vms3.482. Epub 2021 Mar 23.
Occult (or atypical) hyperadrenocorticism (HAC) shows clinical signs and laboratory abnormalities similar to classic hyperadrenocorticism, but normal signs in routine screening tests such as the corticotropin (ACTH) stimulation test and low-dose dexamethasone suppression test (LDDST). Here, we describe a case of occult HAC in a Yorkshire terrier treated with mitotane.
An 11-year-old spayed female presented to the Veterinary Teaching Hospital of Seoul National University because of respiratory distress symptoms, polyphagia, and polydipsia, suggestive of HAC. In abdominal sonography, enlargement of the caudal pole of the left adrenal gland was found, but the cortisol level of post-ACTH stimulation test was below the cut-off value, and LDDST was negative. To finalise the diagnosis of occult HAC, 17-hydroxyprogesterone (17-OHP) was examined. The concentrations of 17-OHP (pre- and post-ACTH stimulation) were found to be elevated. As occult HAC was highly suspected, we prescribed trilostane for trial therapy. At first, the clinical signs improved, but they later worsened. We changed medication as trilostane to mitotane, and the symptoms were relieved after mitotane administration.
This is a unique case of occult HAC in which the response to mitotane was better than trilostane.
隐匿性（或非典型）库欣病（HAC）表现出与经典库欣病相似的临床症状和实验室异常，但在促肾上腺皮质激素（ACTH）刺激试验和小剂量地塞米松抑制试验（LDDST）等常规筛查试验中无正常迹象。在这里，我们描述了一例用米托坦治疗的约克夏梗犬隐匿性 HAC 病例。
一只 11 岁已绝育的雌性约克夏梗因呼吸窘迫症状、多食和多饮而到首尔国立大学兽医教学医院就诊，提示 HAC。在腹部超声检查中，发现左侧肾上腺尾部增大，但 ACTH 刺激后皮质醇水平低于临界值，LDDST 为阴性。为了最终诊断隐匿性 HAC，检查了 17-羟孕酮（17-OHP）。发现 17-OHP（ACTH 刺激前后）的浓度升高。由于高度怀疑隐匿性 HAC，我们开了曲洛司坦进行试验性治疗。起初，临床症状有所改善，但后来又恶化了。我们将药物从曲洛司坦改为米托坦，米托坦给药后症状缓解。
这是一例独特的隐匿性 HAC 病例，米托坦的反应优于曲洛司坦。
