Veterinary school teaches us about so many diseases and one in particular was a difficult one for me to grasp. Unfortunately years later I would have to learn it really well since my Doberman Neo had it – that is Hyperadrenocorticism (HAC), also known as Cushing’s
This is a disorder in which excessive adrenal hormones are produced. The adrenal glands are these wee little organs nestled near the kidneys. They really don’t get much attention in life – but boy – are they important. They produce a variety of hormones and when there is something wrong with them – it’s not good!
One of the main hormones the adrenal gland produces is steroids. The adrenal glands work in concert with the pituitary gland which tells the adrenals if they need to produce more – or if they can take a rest.
Cushing’s can be caused by abnormal pituitary gland function, tumors of the adrenal gland, or by high levels of doctor prescribed steroid use.
Pituitary dependent HAC accounts for about 80% of all cases. This is when the pituitary gland doesn’t properly regulate the adrenal gland and the adrenals keep pumping out excessive amounts of steroids even though there is enough in circulation.
Tumors of the adrenal gland can be benign or malignant and in both cases, the adrenal gland produces too much steroids – even if the pituitary gland is ‘telling’ them to take a break. This is the type of Cushing’s Neo had.
It is a slowly progressive disease and the early signs are often unnoticed. These include increased appetite, increased drinking and urination, reduced activity, and a swollen abdomen (although not every pet will show each symptom. Neo did not have a swollen abdomen and the only thing unusual was that he was having accidents in the house). Extensive laboratory tests, radiographs (x-rays), or ultrasound may be needed to diagnose the condition, find its cause, and plan treatment.
How is it treated?
Some animals respond to medical management alone while others need both surgical and medical treatment. Control, rather than cure, is the outcome of treatment in most cases of HAC. Medical treatment depends on the type of HAC the pet has and consists of either mitotane (Lysodren) or (Lysodren) or trilostane. Patients on these medications must be closely monitored. Non-invasive adrenal tumors are best removed surgically. If adrenal hormones are suppressed too much, a condition called Addison’s disease develops and can be life threatening if untreated.
Neo had surgery to remove his adrenal gland which was one gnarly tumor. (Unfortunately it was a malignant tumor)
What is the prognosis for Hyperadrenocorticism (HAC)?
The average life expectancy with HAC ranges from 36 months to longer with good regulation. However, clinical signs and the development of concurrent disease like diabetes may reduce this time. If HAC is caused by a pituitary tumor, the tumor may expand and put pressure on other parts of the brain causing neurologic signs and ultimately death. Infections of the skin, urinary tract, and liver are common due to the high levels of circulating steroids that suppress the immune system. Many dogs ultimately die or are euthanized due to these complications. A personalized treatment plan is important to slow the progression of HAC.
|Neo after a CT scan|
To read more about Neo's story and my battle with his cancer - click here!
Dr. Mary Gardner
Vet Mary Gardner (click here for bio) provides In Home Hospice Care and Euthanasia services in North East Broward county Florida including: Pompano Beach, Lighthouse Point, Hillsboro Beach, Coconut Creek, Oakland Park and Wilton Manors
Dr. Nicole Sabo covers all other towns in Broward county and North Miami-Dade.
Dr. Kim Simons covers all towns in Palm Beach county.
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