Ford S L, Feldman E C, Nelson R W
Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis 95616.
J Am Vet Med Assoc. 1993 Mar 1;202(5):789-92.
Hyperadrenocorticism caused by bilateral adrenocortical neoplasia was diagnosed in 4 dogs. Three dogs had bilateral adrenocortical adenomas, and 1 dog had bilateral adrenocortical carcinomas. The history, physical findings, clinicopathologic abnormalities, and results of ACTH stimulation and low-dose dexamethasone suppression tests were compatible with diagnosis of hyperadrenocorticism. Adrenocortical neoplasia was differentiated from pituitary-dependent hyperadrenocorticism on the basis of a combination of test results, including lack of suppression of plasma cortisol after being given a high dose dexamethasone (n = 4), undetectable (< 20 pg/ml) plasma endogenous ACTH concentration (n = 4), identification of a single mineralized adrenal mass by abdominal radiography (n = 2) and abdominal ultrasonography (n = 1), and identification of bilateral nonmineralized adrenal masses by ultrasonography (n = 1). A left adrenal mass was excised from 1 dog. Clinical signs persisted and administration of mitotane was initiated. One dog was treated only with mitotane. Treatment with ketoconazole was attempted in 2 dogs. All dogs died or were euthanatized because of persistent hyperadrenocorticism. Necropsy and histologic evaluation of the pituitary and adrenal tissue confirmed bilateral adrenocortical neoplasia in all dogs. Bilateral adrenocortical neoplasia should be considered as an uncommon, but possible, cause of bilaterally large adrenal glands in dogs with hyperadrenocorticism.
4只犬被诊断为双侧肾上腺皮质肿瘤引起的肾上腺皮质功能亢进。3只犬患有双侧肾上腺皮质腺瘤，1只犬患有双侧肾上腺皮质癌。病史、体格检查结果、临床病理异常以及促肾上腺皮质激素（ACTH）刺激试验和小剂量地塞米松抑制试验结果均与肾上腺皮质功能亢进的诊断相符。根据多项检查结果综合判断，将肾上腺皮质肿瘤与垂体依赖性肾上腺皮质功能亢进区分开来，这些检查结果包括：给予高剂量地塞米松后血浆皮质醇未被抑制（n = 4）、血浆内源性ACTH浓度检测不到（< 20 pg/ml，n = 4）、通过腹部X线摄影发现单个钙化肾上腺肿块（n = 2）以及通过腹部超声发现单个钙化肾上腺肿块（n = 1）、通过超声发现双侧非钙化肾上腺肿块（n = 1）。从1只犬身上切除了左侧肾上腺肿块。临床症状持续存在，开始使用米托坦治疗。1只犬仅接受米托坦治疗。对2只犬尝试使用酮康唑治疗。所有犬均因持续性肾上腺皮质功能亢进死亡或被安乐死。对垂体和肾上腺组织进行尸检和组织学评估，证实所有犬均患有双侧肾上腺皮质肿瘤。双侧肾上腺皮质肿瘤应被视为肾上腺皮质功能亢进犬双侧肾上腺肿大的一种罕见但可能的病因。
