A Festive Feast of Cushing’s Disease

Presenter – Professor Ian Ramsey BVSc Phd DSAM FHEA MRVCS DipECVIM-CA, University of Glasgow Small Animal Hospital

The Webinar Vet’s pre-Christmas webinar came in the form of an interactive session covering hyperadrenocorticism(HAC) and if you are the sort of vet who really benefits from the use of case studies in CPD, this is the veterinary webinar for you.

Professor Ian Ramsey led this interactive webinar and encouraged the audience to commit to what they would do in practice if the cases presented were in their care. Right from the start Prof. Ramsey got us to consider why we do the things we do with these cases. For example if we have a classic case of HAC as per Tyson, the first case presented, why don’t we just go ahead and perform an ACTH stimulation test or low dose dexamethasone suppression test (LDDST)without performing other diagnostics? Do we really need to perform full bloods, X-rays and urinalysis on these really obvious cases? Of course the answer is ‘yes’ and the majority of the audience agreed but Prof. Ramsey really made us think about why we need to perform these tests.

The aim of these additional diagnostics is to rule out other concurrent disease such as diabetes and also what we find may dramatically alter how we treat a case. For example if a calcified mass is noted close to the kidney on an X-ray , it may be assumed this is a calcified adrenal tumour which will alter the way we manage this particular case.

Other questions asked by Prof. Ramsey included how to differentiate between pituitary dependant and adrenal dependant HAC. 49% of the audience plumped for the high dose dexamethasone suppression test as the test of choice but Prof. Ramsey went on to explain the majority of endocrinologists no longer use this method as it is not considered reliable enough. Prof. Ramsey now advocates either the use of ultrasonography if in experienced hands or measuring endogenouse ACTH for those of us not confident enough to find the adrenals on ultrasound.

Prof. Ramsey also went on to discuss TJ, a seven year old MN Irish setter with clinical signs and laboratory results indicative of both hypothyroidism and hyperadrenocorticism. In this particular case he considered the clinical picture in this dog leaned towards HAC and treated accordingly. On re testing the thyroid results, previously abnormal, had completely normalised. Prof. Ramsey stressed that HAC can literally do anything to thyroid levels in the dog and therefore no assumptions should be made about thyroid disease until the HAC has been treated.

These were just some of the points emphasized during this veterinary webinar and there were several more useful tips and advice to be gained from this interactive session. So if you need a small break from the seasonal chaos, grab yourself a mince pie, log into The Webinar Vet and enjoy this festive treat.

The Stethoscope (MRCVS)

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