Wojo AlcalaWojo Alcala

Diagnosing Adrenal Tumors and Diagnosing Adrenal Tumors and Retinal Detachment via UltrasoundRetinal Detachment via Ultrasound

SignalmentSignalment

8 ½ year old male castrated Shih Tzu8 ½ year old male castrated Shih Tzu

HistoryHistory

NCSU Emergency ServiceNCSU Emergency Service For evaluation of acute blindnessFor evaluation of acute blindness Episodes of exercise intoleranceEpisodes of exercise intolerance No V, D, Coughing, SneezingNo V, D, Coughing, Sneezing Previous Hx of patellar luxation (treated Previous Hx of patellar luxation (treated

with Rimadylwith Rimadyl

Pertinent Clinical and Pertinent Clinical and Laboratory FindingsLaboratory Findings

Distended abdomen, difficult to palpateDistended abdomen, difficult to palpate BP on admission 220 (systolic), later no BP on admission 220 (systolic), later no

BP>170 was reportedBP>170 was reported Elevated ALP (579)Elevated ALP (579) USG 1.041, 3+ proteinUSG 1.041, 3+ protein Urine Protein:Creatinine Ratio=slightly elevatedUrine Protein:Creatinine Ratio=slightly elevated ACTH Stim: 50 ug/dl (very suggestive of ACTH Stim: 50 ug/dl (very suggestive of

Cushings)Cushings)

Wojo headed to Wojo headed to Radiology for …Radiology for …

Abdominal and Chest RadiographsAbdominal and Chest Radiographs Abdominal UltrasoundAbdominal Ultrasound

Here is what we Here is what we found…found…

Radiographic FindingsRadiographic Findings

Ultrasound FindingsUltrasound Findings

Ultrasound FindingsUltrasound Findings

Ultrasound FindingsUltrasound Findings

Ultrasound FindingsUltrasound Findings

Ultrasound FindingsUltrasound Findings

Ultrasound FindingsUltrasound Findings

Ultrasound FindingsUltrasound Findings

Problems IdentifiedProblems Identified

RadiographsRadiographs 1. Hepatomegaly1. Hepatomegaly

Abdominal UltrasoundAbdominal Ultrasound1. Bilaterally enlarged adrenal glands 1. Bilaterally enlarged adrenal glands

(each adrenal appears to (each adrenal appears to contain acontain a nodule)nodule)

2. Bilateral retinal detachment2. Bilateral retinal detachment

DifferentialsDifferentials

CushingsCushings Due to presence of nodules= may be Due to presence of nodules= may be

more consistent with more consistent with Adenoma, adenocarcinoma or Adenoma, adenocarcinoma or

pheochromocytoma pheochromocytoma Rather than pituitary dependent Cushings (in Rather than pituitary dependent Cushings (in

which we would see bilateral uniform which we would see bilateral uniform hypertrophy more likely)hypertrophy more likely)

DifferentialsDifferentials

Signs consistent with Cushings (Incr. Signs consistent with Cushings (Incr. ALP and hepatomegaly)ALP and hepatomegaly)

However, dogs with Cushings do not However, dogs with Cushings do not typically experience hypertension great typically experience hypertension great enough to cause bilateral retinal enough to cause bilateral retinal detachmentdetachment

Therefore why we suspect Therefore why we suspect pheochromocytoma may be involvedpheochromocytoma may be involved

UltrasoundUltrasound

Could not differentiate which type of Could not differentiate which type of adrenal tumor Wojo hadadrenal tumor Wojo had

We needed to explore other options…We needed to explore other options…

Wojo’s OptionsWojo’s Options

Nuclear Scintigraphy with MIBG Nuclear Scintigraphy with MIBG (metaiodobenzylguanidine)(metaiodobenzylguanidine) Can be used to localize Can be used to localize

pheochromocytomas,pheochromocytomas, Better surgical planBetter surgical plan

Possible Lysodren treatment and Possible Lysodren treatment and evaluation of response.evaluation of response.

What happened?What happened?

I called Wojo’s parents three days after I called Wojo’s parents three days after discharge to see how he was adapting to discharge to see how he was adapting to his blindness at home.his blindness at home.

They had elected Euthanasia the They had elected Euthanasia the previous night at the rDVM.previous night at the rDVM.