Cheung Chloe, Giori Luca, Griebsch Christine, Courtman Natalie, Podadera Juan, Thompson Mary
University Veterinary Teaching Hospital Sydney, Sydney School of Veterinary Science, The University of Sydney, Camperdown, NSW, Australia.
Diagnostic Endocrinology Service, Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States.
Front Vet Sci. 2025 Sep 10;12:1632432. doi: 10.3389/fvets.2025.1632432. eCollection 2025.
A 10-year-old neutered male poodle-cross was presented with signs of progressive hyporexia and marked polyuria and polydipsia (PU/PD) of 2 months' duration. Right unilateral adrenalectomy was performed 24 months prior, and adrenocortical carcinoma with no evidence of metastatic disease was diagnosed. Tumor aldosterone secretion was suspected due to persistent hypokalaemia and systemic hypertension. Upon re-presentation, the dog had a pot-bellied appearance, dermatological changes (symmetrical alopecia along the trunk, elbows, and hocks, with decubital ulcers), systemic hypertension, and marked hypokalaemia unresponsive to oral potassium supplementation, raising concerns for an endocrine disorder. Abdominal CT confirmed mass lesions in multiple liver lobes near the previous adrenalectomy site, and cytology confirmed adrenocortical carcinoma metastases. Regional and cranial mediastinal lymphadenomegaly, as well as prostatomegaly, were observed, while no abnormalities were detected in the left adrenal gland. A serum adrenal profile identified marked elevations in progesterone, androstenedione, estradiol, and testosterone concentrations pre- and post-ACTH. Serum aldosterone and cortisol concentrations pre- and post-ACTH were within reference intervals, noting the dog had been treated with spironolactone for 8 weeks at measurement. Trilostane therapy was initiated with an initial positive response, including reduced PU/PD and resolution of pot-bellied appearance. A significant reduction of steroid hormones was documented later. Signs returned about 4 months into trilostane treatment with evidence of progressive disease on repeat CT and adrenal profile. The dog is managed with palliative trilostane, 14 months since liver metastasis diagnosis.
This case highlights an initial clinical response to trilostane in a dog with metastatic, functional adrenocortical carcinoma (ACC), demonstrating short-term control of clinical signs. The variation in presentation between initial diagnosis and relapse prompted a hypothesis of a shift in tumor steroidogenic activity-a phenomenon rarely documented in veterinary literature. It underscores the diverse manifestations arising from excess production of multiple steroid hormones, including precursors. It also supports adrenal profiling in complex cases and confirms trilostane's utility as a palliative therapy in non-resectable or metastatic ACC.
一只10岁已绝育的雄性贵宾犬杂交犬出现进行性食欲减退以及持续2个月的显著多尿多饮（PU/PD）症状。24个月前进行了右侧单侧肾上腺切除术，诊断为肾上腺皮质癌且无转移疾病证据。由于持续低钾血症和全身性高血压，怀疑肿瘤分泌醛固酮。再次就诊时，该犬呈大腹便便外观，有皮肤变化（躯干、肘部和跗关节处对称性脱毛，伴有褥疮性溃疡）、全身性高血压以及口服补钾无效的显著低钾血症，引发了对内分泌紊乱的担忧。腹部CT证实了先前肾上腺切除部位附近多个肝叶存在肿块病变，细胞学检查证实为肾上腺皮质癌转移。观察到区域性和纵隔前部淋巴结肿大以及前列腺肿大，而左侧肾上腺未发现异常。血清肾上腺激素谱显示促肾上腺皮质激素（ACTH）前后孕酮、雄烯二酮、雌二醇和睾酮浓度显著升高。ACTH前后血清醛固酮和皮质醇浓度在参考区间内，注意到测量时该犬已接受螺内酯治疗8周。开始使用曲洛司坦治疗，初期有积极反应，包括多尿多饮减少和大腹便便外观消失。后来记录到类固醇激素显著降低。曲洛司坦治疗约4个月后症状复发，重复CT和肾上腺激素谱显示有疾病进展迹象。自肝转移诊断以来，该犬已接受姑息性曲洛司坦治疗14个月。
本病例突出了曲洛司坦对一只患有转移性、功能性肾上腺皮质癌（ACC）犬的初始临床反应，证明了对临床症状的短期控制。初始诊断和复发之间表现的差异促使提出肿瘤类固醇生成活性转变的假说——这一现象在兽医文献中鲜有记载。它强调了多种类固醇激素（包括前体）过量产生所导致的多种表现。它还支持在复杂病例中进行肾上腺激素谱分析，并证实曲洛司坦作为不可切除或转移性ACC姑息治疗的效用。
