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Thumphy Carter (Acc#153311 )

Thumphy Carter (Acc#153311 ). Trisha Oura September 26, 2011. Thumphy. 15 yo MC DLH presenting for vomiting, neck ventroflexion , lethargy rDVM bloodwork : ↓K, Azotemic At NCSU: IV/VI heart murmur, generalized weakness, ataxia, enlarged thyroid

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Thumphy Carter (Acc#153311 )

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  1. Thumphy Carter(Acc#153311) Trisha Oura September 26, 2011

  2. Thumphy • 15 yo MC DLH presenting for vomiting, neck ventroflexion, lethargy • rDVMbloodwork: ↓K, Azotemic • At NCSU: • IV/VI heart murmur, generalized weakness, ataxia, enlarged thyroid • Bloodwork: ↓K+, metabolic alkalosis, hyposthenuria

  3. Ultrasound

  4. Aldosterone • Function: BP & ECF volume homeostasis • Action: K+ & H+ secretion, Na+ & Cl- resorption (collecting ducts/distal tubules) • Physiology:

  5.  blood volume (RBF) JG appartus Renin Angiotensinogen ATI (liver)  ATII (lungs) Extracellular [K+] ZonaGlomerulosa Aldosterone

  6. Primary Hyperaldosteronism in Cats • Older, no sex/breed predilection • Clinical signs: weakness, cervical ventroflexion, lethargy, +/- changes secondary to BP • Bloodwork: azotemia, isosthenuria, +/- hypokalemia, [renin] due to negative feedback,[aldosterone] • Usually unilateral adenoma or carcinoma • (11/23 = carcinoma, 9 = adenoma, 3 = hyperplasia) • Can be part of multiple endocrine neoplasia (MEN)

  7. Other DDX: • Secondary hyperaldosteronism • Primary increases in renin: renal disease, heart disease • Hypokalemiaddx: renal failure, liver failure, GI disease, hyperthyroidism, DM • FYI: rare in dogs, as of 2004 only 2 case reports in the literature

  8. Treatment • Surgical (treatment of choice) • Good prognosis (if no vascular invasion/thrombus) • Survival of several years • No change in prognosis with carcinoma vs. adenoma • Medical • Spironolactone (aldosterone antagonist at DCT) • K+ supplement • Anti-hypertensive drugs • Survival months-years

  9. Thumphy • Discharged • Rx: Spironolactone, potassium supplements • Recommend return for adrenalectomy • Improved with Rx, no new follow-up

  10. References • Ash RA, et al. Primary hyperaldosteronism in the cat: a series of 13 cases. J Fel Med Surg 2005;7:173-182. • Flood SM, et al. Primary hyperaldosteronism in two cats. J AmerAnim Hosp Assoc 1999;35:411-416 • Moore LE, DS Biller, TA Smith. Use of abdominal ultrasonography in the diagnosis of primary hyperaldosteronism in a cat. JAVMA 2000;217:213-215. • Shculman RL. Feline primary hyperaldosteronism. Vet Clin Small Anim 2010;40:353-359.

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