Thumphy Carter (Acc#153311 )
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Transcript of Thumphy Carter (Acc#153311 )
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S
Thumphy Carter
(Acc#153311)
Trisha OuraSeptember 26, 2011
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Thumphy
15 yo MC DLH presenting for vomiting, neck ventroflexion, lethargy rDVM bloodwork: ↓K, Azotemic
At NCSU: IV/VI heart murmur, generalized
weakness, ataxia, enlarged thyroid
Bloodwork: ↓K+, metabolic alkalosis, hyposthenuria
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Ultrasound
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Aldosterone
Function: BP & ECF volume homeostasis Action: K+ & H+ secretion, Na+ & Cl- resorption
(collecting ducts/distal tubules) Physiology:
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Zona Glomerulosa
Aldosterone
Extracellular [K+]
blood volume (RBF)
JG appartu
s
Renin
Angiotensinogen ATI (liver) ATII (lungs)
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Primary Hyperaldosteronism in
Cats Older, no sex/breed predilection Clinical signs: weakness, cervical ventroflexion,
lethargy, +/- changes secondary to BP Bloodwork: azotemia, isosthenuria, +/- hypokalemia,
[renin] due to negative feedback, [aldosterone] Usually unilateral adenoma or carcinoma
(11/23 = carcinoma, 9 = adenoma, 3 = hyperplasia) Can be part of multiple endocrine neoplasia (MEN)
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Other DDX:
Secondary hyperaldosteronism Primary increases in renin: renal
disease, heart disease Hypokalemia ddx: renal failure, liver
failure, GI disease, hyperthyroidism, DM FYI: rare in dogs, as of 2004 only 2 case
reports in the literature
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Treatment
Surgical (treatment of choice) Good prognosis (if no vascular invasion/thrombus) Survival of several years No change in prognosis with carcinoma vs.
adenoma Medical
Spironolactone (aldosterone antagonist at DCT) K+ supplement Anti-hypertensive drugs Survival months-years
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Thumphy
Discharged Rx:
Spironolactone, potassium supplements
Recommend return for adrenalectomy
Improved with Rx, no new follow-up
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References
Ash RA, et al. Primary hyperaldosteronism in the cat: a series of 13 cases. J Fel Med Surg 2005;7:173-182.
Flood SM, et al. Primary hyperaldosteronism in two cats. J Amer Anim Hosp Assoc 1999;35:411-416
Moore LE, DS Biller, TA Smith. Use of abdominal ultrasonography in the diagnosis of primary hyperaldosteronism in a cat. JAVMA 2000;217:213-215.
Shculman RL. Feline primary hyperaldosteronism. Vet Clin Small Anim 2010;40:353-359.