Central Cushing’s disease in a cat.

No trouble finding the adrenals on this feline as our SonoPath collaborator and fellow Dip. ABVP, Dr. Doug Casey of English Bay Ultrasound Services in Vancouver, BC, Canada, shows us in this SonoPath case of the month. Now we bring you a cat with central Cushing’s and, of course, a little lipidosis and pancreatitis to round the clinical profile in this patient. In October 2011 we brought you a Cushing’s cat with an invasive adrenal mass that you may compare this case to from our past cases of the month line-up. Also check out Doug’s folder of utility medicine full of things that are easy and for practical use in small animal medicine that is now live with the rest of our specialty folders.

Sonogram (ADR): Altan

History (Kohmescer): A10-year-old SF Burmese cat was presented for evaluation of possible Cushing’s disease as there was chronic skin disease, hyperglycemia, and glucosuria but normal fructosamine. 

Clinical Differential Diagnosis (Remo Lobetti PhD, DECVIM):

Early diabetes mellitus, acromegaly, hyperthyroidism, Cushing’s disease, drugs, chronic disease stress (skin, liver, neoplasia)

Sonographic Interpretation (Lindquist DABVP):

Images 1-5: The left adrenal gland was moderately enlarged at 1.4 x 0.9 cm with increased blood flow. The right adrenal gland was also uniformly enlarged and measured 1.35 x 0.82 cm. Minor parenchyma heterogenicity was noted in both glands without mass effects on the adrenal capsules. Adrenal hyperplasia is suspected.

Image 6: The pancreas presented heterogenic mixed hypoechoic nodular changes with minor capsular expansion. Echogenic remodeling is also noted with undulating capsular contour.

Clinical Differential Diagnosis (Lindquist DABVP):

Bilateral adrenal gland enlargement. Suspect central Cushing’s disease, potential underlying acromegaly. Less potential for stress induced hyperplasia. Concurrent low-grade chronic active pancreatitis, nodular hyperplasia with mild potential for emerging pancreatic neoplasia. Hyperechoic liver consistent with lipidosis, biliary calculosis and potential low-grade inflammatory hepatopathy.

Sampling (Casey): Low dose dexamethasone test consistent with hyperadrenocorticism. Histopathology of both adrenal glands revealed marked nodular cortical hyperplasia with vacuolar degeneration consistent with Cushing’s disease. Pancreas: Mild eosinophilic interstitial pancreatitis and localized fibrosis. Liver: Hepatic lipidosis with periportal inflammation

Outcome: Trilostane and primary diabetic management was recommended.

Special thanks to: Dr. Jangi Bajwa (Hastings Animal Hospital)