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Aldosterone Secreting Adrenal Tumor in an 11-Year-Old FS DSH Cat: Our Case Of the Month June 2019

Patient Information

Age
11 Years
Gender
Female, Spayed
Species
Feline

Images

Chronic interstitial pattern, left kidney.
Chronic interstitial pattern, right kidney.
Enlarged right adrenal gland.

Adrenal tumors are rare in cats and there are not a lot of reports in the veterinary literature. A journal article from JVIM in 2014 reported on Aldosterone secreting tumors in only 10 cats.  Leave it to Dr Jennifer Todd, owner of Lambs Gap Animal Hospital in Mechanicsburg PA to find one! Recently SDEP™ Abdomen certified and using her Mindray Elite 8 ultrasound machine purchased from Sonopath, Dr Todd performed a stellar sonogram and identified an enlarged right adrenal gland as well as other pathology.  Surgery was performed by Dr Jacqui Niles. BVetMed, Cert SAS, DACVS-SA and her team at Metropolitan Veterinary Associates in Norristown, PA. Thanks to Dr Todd and Dr Laura Campbell for thorough management of this case from diagnosis to monitoring to surgery and happy followup. 

All adrenals are important! See our educational series "No Adrenal Gland Left Behind" for techniques for locating both cat and dog adrenals. Interested in an ultrasound unit with terrific resolution that enables you to visualize the smallest cat adrenals? Click here: Mindray Elite 8

 

History

The patient was presented for annual exam with a 1-2 month history of decreased appetite. Blood chemistry and CBC found a potassium low at 3.2, chloride low 113, AST high 70, monocytes high 684, and T4/fPL both normal. Repeat bloodwork a month later showed potassium even lower at 2.6. The patient was started on Renacare potassium supplement and abdominal ultrasound was scheduled.  The day of the ultrasound, potassium was rechecked and still low at 2.7; Renacare dose was increased and a month later the potassium level was normal. Post-ultrasound Aldosterone baseline level was high at 1194 (194-388). Prior to surgery she had a normal appetite and energy level, and CBC and chem were normal other than a mildly elevated ALT.

Image Interpretation

The right adrenal gland was enlarged in this patient, rounded and mildly heterogeneous, measuring approximately 1.5 cm x 1.5 cm. Strong potential for carcinoma. Capsular expansion was noted without capsular invasion. Both kidneys presented chronic interstitial nephrosis pattern with hyperechhoic, idiopathic medullary rim sign. 

Sampling

A Tru-cut biopsy of the liver was obtained during right adrenalectomy.

DX

Enlarged, irregular right adrenal gland.

Outcome

Recommendations based of the ultrasound findings were as follows: Sodium potassium ratio should be evaluated. Blood pressure measurements are also warranted. If hypokalemia is present, Conn’s syndrome may be playing a role in this patient. Right adrenalectomy is recommended. Aldosterone levels warranted given the subnormal potassium. If any inflammatory sediment is present in the urine or proteinuria, renal biopsy could be performed at the time of right adrenalectomy. The patient had surgery and the right adrenal gland was removed; a Tru-cut biopsy of the liver was sampled as well. During right adrenalectomy the right adrenal gland was found to be grossly enlarged, discolored, and adherent to the dorsal surface of the vena cava. The patient was given a Convenia injection and discharged two days after surgery on Onsior and Buprenex along with instructions to discontinue the Renacare, Spironalactone, and Amlodipine. Potassium levels were normal prior to discharge. Biopsy report: Right adrenal gland: adrenal cortical carcinoma. Liver: moderate to marked diffuse hepatocellular swelling. Following surgery, the patient's blood pressure improved and potassium levels normalized. No chemotherapy was recommended. Blood pressure and potassium levels should be checked every 4 months. Owner reports the patient is doing well at home.

Videos

Chronic interstitial pattern, left kidney.
Right kidney and enlarged right adrenal gland.
Enlarged, irregular right adrenal gland.