Atypisches Cushing-Syndrom bei einem Hund

Zusammenfassung

Bei einem aus anderen Gründen vorgestellten 12 Jahre alten Labrador-Retriever-Rüden bestand als Nebenbefund eine Hyperadrenokortizismus-Symptomatik (Polyurie/Polydipsie, tonniges Abdomen, Muskelatrophie). Abweichende Laborbefunde und sonographische Veränderungen der Nebennieren, aber negative Befunde in Low-Dose-Dexamethason-Suppressionstests bei niedriger Basalkortisolkonzentration, ein negativer ACTH-Stimulationstest und Ausschluss eines iatrogenen Hyperadrenokortizismus ließen den Verdacht auf einen atypischen Hype radrenokortizismus (AHAC) aufkommen. Die Ergebnisse weiterführender Untersuchungen, insbesondere die Stimulation der Progesteronbildung durch ACTH (0-h-Wert: 0,21 ng/ml; 1-h-Wert: 4,9 ng/ml), und das Ansprechen auf die Trilostan-Therapie sprachen ebenfalls für diese Diagnose. Es muss jedoch kritisch hinterfragt werden, ob und inwiefern zusätzlich vorliegende Erkrankungen (Arthrosen, Umfangsvermehrung in einem Hoden) hinsichtlich Symptomatik und Laborbefunden eine Rolle gespielt haben. Dieser Fall verdeutlicht die Schwierigkeiten bei der Diagnostik eines AHAC.

Summary

In a 12-year-old male Labrador Retriever, presented due to other disease symptoms, clinical signs of hyperadrenocorticism (polyuria, polydipsia, abdominal distention, muscle atrophy) were an incidental finding. Abnormal laboratory results and sonographic findings of the adre nal glands, but negative low-dose dexamethasone suppression tests with low basal cortisol concentrations, a negative andrenocorticotropic hormone (ACTH)-stimulation test and exclusion of iatrogenic hyperadrenocor ticism, suggested an atypical hyperadrenocorticism (AHAC). Results of further examinations, particularly stimulation of progesterone production by ACTH (0 h value: 0.21 ng/ml; 1 h value: 4.9 ng/ml) and good respon se to therapy with trilostane, supported this diagnosis. However, it has to be critically considered, whether and to what extent additionally present diseases (arthroses, testicular tumour) played a role regarding the symptoms and laboratory results in this dog. This case illus trates the difficulties with the diagnosis of AHAC.

Schlüsselwörter

Hyperadrenokortizismus - Polyurie/Polydipsie - Kortisol - Progesteron - Dexamethason-Suppressionstest - Trilostan

Keywords

Hyperadrenocorticism - polyuria/polydipsia - cortisol - progesterone - dexamethasone suppression test - trilostane

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