Probleme mit der Cushing-Therapie – Iatrogener Addison unter Behandlung mit Trilostan

Klinische Symptome wie Lethargie, Inappetenz, Vomitus und Diarrhoe rufen zahlreiche Differenzialdiagnosen auf den Plan. Bei einem Patienten, der unter Behandlung eines Hyperadrenokortizismus steht, sollten jedoch bei jedem Kliniker die Alarmglocken läuten.

• Literatur

• 1 Sanders K, Kooistra HS, Galac S. Treating canine Cushingʼs syndrome: Current options and future prospects. Vet J 2018; 241: 42-51
• 2 King JB, Morton JM. Incidence and risk factors for hypoadrenocorticism in dogs treated with trilostane. Vet J 2017; 230: 24-29
• 3 Lemetayer J, Blois S. Update on the use of trilostane in dogs. Can Vet J 2018; 59 (04) 397-407
• 4 Ramsey IK, Richardson J, Lenard Z. et al. Persistent isolated hypocortisolism following brief treatment with trilostane. Aust Vet J 2008; 86 (12) 491-495
• 5 Chapman PS, Kelly DF, Archer J. et al. Adrenal necrosis in a dog receiving trilostane for the treatment of hyperadrenocorticism. J Small Anim Pract 2004; 45 (06) 307-310
• 6 Pérez-Alenza D, Melián C. Hyperadrenocorticism in Dogs. In: Feldman EC, Côté E, Ettinger SJ. Hrsg. Textbook of veterinary internal medicine. 8. Aufl.. St. Louis (MO): Elsevier; 2017: 1795-1811
• 7 Braddock JA, Church DB, Robertson ID, Watson AD. Trilostane treatment in dogs with pituitary-dependent hyperadrenocorticism. Aust Vet J 2003; 81 (10) 600-607
• 8 He X, Findling JW, Auchus RJ. Glucocorticoid Withdrawal Syndrome following treatment of endogenous Cushing Syndrome. Pituitary 2022; 25 (03) 393-403
• 9 Boretti FS, Holzthüm J, Reusch CE, Sieber-Ruckstuhl NS. Lack of association between clinical signs and laboratory parameters in dogs with hyperadrenocorticism before and during trilostane treatment. Schweiz Arch Tierheilkd 2016; 158 (09) 631-638
• 10 Wehner A, Glöckner S, Weiss B. et al. Association between ACTH stimulation test results and clinical signs in dogs with hyperadrenocorticism treated with trilostane. Vet J 2021; 276: 105740
• 11 Ramsey IK. Trilostane in dogs. Vet Clin North Am Small Anim Pract 2010; 40 (02) 269-283
• 12 Lathan P, Thompson AL. Management of hypoadrenocorticism (Addisonʼs disease) in dogs. Vet Med (Auckl) 2018; 9: 1-10
• 13 DeFelice AF, Brousseau AC, OʼConnor B. Potassium-sparing effect of trilostane in hydrochlorothiazide-treated rats and dogs. Proc Soc Exp Biol Med 1987; 184 (01) 1-6
• 14 Wenger M, Sieber-Ruckstuhl NS, Müller C, Reusch CE. Effect of trilostane on serum concentrations of aldosterone, cortisol, and potassium in dogs with pituitary-dependent hyperadrenocorticism. Am J Vet Res 2004; 65 (09) 1245-1250
• 15 Appleman E, Schrage A, Lamb KE, Langston C. Evaluation of Iatrogenic Hypocortisolemia Following Trilostane Therapy in 48 Dogs with Pituitary-Dependent Hyperadrenocorticism. J Am Anim Hosp Assoc 2021; 57 (05) 217-224
• 16 Foster S, Fleeman LM, Langner KFA, Braddock JA. Efficacy and safety of tightly controlled hyperadrenocorticism in dogs treated with trilostane in general practice. J Vet Intern Med 2020; 34 (06) 3058-3166
• 17 Macfarlane L, Parkin T, Ramsey I. Pre-trilostane and three-hour post-trilostane cortisol to monitor trilostane therapy in dogs. Vet Rec 2016; 179 (23) 597
• 18 Burkhardt WA, Boretti FS, Reusch CE, Sieber-Ruckstuhl NS. Evaluation of baseline cortisol, endogenous ACTH, and cortisol/ACTH ratio to monitor trilostane treatment in dogs with pituitary-dependent hypercortisolism. J Vet Intern Med 2013; 27 (04) 919-923
• 19 Midence JN, Drobatz KJ, Hess RS. Cortisol Concentrations in Well-Regulated Dogs with Hyperadrenocorticism Treated with Trilostane. J Vet Intern Med 2015; 29 (06) 1529-1533