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      Comparison of Adrenocorticotropic Hormone Stimulation Test Results Started 2 versus 4 Hours after Trilostane Administration in Dogs with Naturally Occurring Hyperadrenocorticism

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          Abstract

          Background

          Trilostane medical treatment of naturally occurring hyperadrenocorticism ( NOH) in dogs is common, as is use of the adrenocorticotropic hormone ( ACTH) stimulation test ( ACTHst) in monitoring response to treatment. There is uncertainty regarding when the ACTHst should be started relative to time of trilostane administration.

          Objective

          To compare ACTHst results in dogs being treated for NOH with trilostane when the test is begun 2 versus 4 hours after trilostane administration.

          Animals

          Twenty‐one privately owned dogs with NOH, each treated with trilostane for at least 30 days.

          Methods

          Each dog had 2 ACTHst completed, 1 started 2 hours and the other 4 hours after trilostane administration. The second test was started no sooner than 46 hours and no later than 74 hours after the first.

          Results

          For all 21 dogs, the mean post‐ ACTH serum cortisol concentration from tests started 2 hours after trilostane administration (5.4 ± 3.7 μg/dL) was significantly lower ( P = .03) as compared with results from the tests started 4 hours after administration (6.5 ± 4.5 μg/dL).

          Conclusions

          Results of ACTHst started at different times yield significantly different results. Dogs with NOH, treated with trilostane, and monitored with ACTHst results should have all of their subsequent ACTHst tests begun at or about the same time after trilostane administration.

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          Most cited references14

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          Trilostane, an orally active inhibitor of steroid biosynthesis.

          Trilostane is a competitive inhibitor of 3beta-hydroxysteroid dehydrogenase. In vitro, the drug inhibits conversion of pregnenolone to progesterone but does not alter conversion of cholesterol to pregnenolone nor progesterone to corticoid hormones. When given orally to rats, trilostane inhibits corticosterone and aldosterone production and elevates circulating levels of pregnenolone at doses lower than those that produce adrenal hypertrophy or inhibit gonadal steroidogenesis.
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            Canine hyperadrenocorticism due to adrenocortical neoplasia. Pretreatment evaluation of 41 dogs.

            This retrospective study identifies parameters that might separate dogs with hyperadrenocorticism caused by adrenocortical tumors from dogs with pituitary-dependent hyperadrenocorticism. Further, an attempt was made to identify factors that could separate dogs with adrenocortical adenomas from dogs with carcinomas. The records of 41 dogs with hyperadrenocorticism caused by adrenocortical neoplasia were reviewed. The history, physical examination, urinalysis, hemogram (CBC), chemistry profile adrenocorticotrophic hormone (ACTH) stimulation and low dose dexamethasone test results were typical of the nonspecific diagnosis of hyperadrenocorticism. The preceding information on the 41 dogs with adrenocortical tumors was compared with that from 44 previously diagnosed pituitary-dependent hyperadrenocorticoid dogs. There was no parameter which aided in separating these two groups of dogs. Thirty dogs with adrenocortical tumors were tested with a high-dose dexamethasone test and none had suppressed plasma cortisol concentrations 8 hours after IV administration of 0.1 mg/kg of dexamethasone. In 29 of the 41 adrenal tumor dogs, plasma endogenous ACTH was not detectable on at least one measurement (less than 20 pg/ml). The remaining 12 dogs from this group had nondiagnostic concentrations (20-45 pg/ml). Thirteen of 22 dogs (59%) with adrenocortical carcinomas had adrenal masses identified on abdominal radiographs and seven of 13 dogs (54%) with adrenocortical adenomas had radiographically visible adrenal masses. Thirteen of 17 adrenocortical carcinomas (76%) and five of eight adenomas (62%) were identified with ultrasonography. Radiographs of the thorax and ultrasonography of the abdomen identified most of the dogs (8 of 11) with metastatic lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
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              Results of clinical examinations, laboratory tests, and ultrasonography in dogs with pituitary-dependent hyperadrenocorticism treated with trilostane.

              To determine the efficacy of trilostane, a 3beta-hydroxysteroid dehydrogenase inhibitor, in dogs with pituitary-dependent hyperadrenocorticism (PDH).
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                Author and article information

                Journal
                J Vet Intern Med
                J. Vet. Intern. Med
                10.1111/(ISSN)1939-1676
                JVIM
                Journal of Veterinary Internal Medicine
                John Wiley and Sons Inc. (Hoboken )
                0891-6640
                1939-1676
                26 May 2014
                Jul-Aug 2014
                : 28
                : 4 ( doiID: 10.1111/jvim.2014.28.issue-4 )
                : 1239-1243
                Affiliations
                [ 1 ] Department of Medicine and Epidemiology School of Veterinary MedicineUniversity of California Davis CA
                [ 2 ]The Animal Specialty and Emergency Center Los Angeles CA
                [ 3 ] Department of Population Health and Reproduction School of Veterinary MedicineUniversity of California Davis CA
                Author notes
                [*] [* ]Corresponding author: Edward C. Feldman, DVM, DipACVIM (SA), School of Veterinary Medicine, University of California, 1 Shields Ave, Davis, CA 95616; e‐mail: ecfeldman@ 123456ucdavis.edu .
                Article
                JVIM12357
                10.1111/jvim.12357
                4857938
                24863172
                d6cf3331-7e20-44cb-aabd-cd361ed5e882
                Copyright © 2014 by the American College of Veterinary Internal Medicine
                History
                : 12 November 2013
                : 09 February 2014
                : 11 March 2014
                Page count
                Pages: 5
                Funding
                Funded by: Ruth Johnston
                Categories
                Original Article
                Standard Articles
                Custom metadata
                2.0
                jvim12357
                July/August 2014
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.8.8 mode:remove_FC converted:25.04.2016

                Veterinary medicine
                hyperadrenocorticism,trilostane
                Veterinary medicine
                hyperadrenocorticism, trilostane

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