adrenal tumours

• a phaeochromocytoma is a medullary tumour that produces the catecholamines e.g., adrenaline stimulating a fight or flight response, hence this causes…

  • Weakness/Collapse
  • Weight loss
  • Poor appetite
  • Tachypnoea
  • Polyuria/Polydipsia
  • Tachycardia
  • Hypertension
  • Panting
  • Restlessness
  • High blood glucose-insulin resistance
• a phaeochromocytoma can be mistaken as HAC as there is PU/PD hyperglycaemia and an adrenal mass on imaging. However, if adrenalectomy is part of your HAC treatment plan then misdiagnosis is not detrimental as an adrenalectomy is the treatment for this tumour too. Commonly these tumours are diagnosed once removed and sent off the histology.

  • There may be local vessel invasion
• Pre-surgical Phaeochromocytoma diagnosis is possibly by assessing urinary catecholamine metabolites. If surgery is unwanted then you can do symptomatic medical treatment (which is also useful pre-surgical) and this includes…

  • Adrenoceptor antagonists (Sympatholytic)
  • Phenoxybenzamine (alpha)
  • Propranolol (Beta blocker)
• glucocorticoid like tumours of the cortex have a similar presentation to HAC including stress leukogram, ACTH suppression etc.

  Diagnosis...

  • ACTH stim, 17OP, androstenedione
  • Mid-range or low cortisol with minimal change

  Treatment...

  • Surgical (preferred)
  • Medical
• mineralocorticoid like tumours of the cortex presentation...

  • Related to hypokalaemia
  • Muscle weakness
  • Cats ventro-flexion of neck

  Diagnosis...

  • ACTH stim, aldosterone

  Treatment...

  • Surgical (preferred)
  • Medical e.g., Spironolactone
• What can go wrong with trilostane therapy...

  • Suppress cortisol too much causing hypoadrenocorticism.
  • Over-suppression can also cause electrolyte imbalances e.g., hyponatremia and hyperkalemia.
  • It may not effectively control cortisol production requiring adjustments to the dose or alternative therapies e.g., radiation.
  • There is a risk of adverse reactions e.g., GI concerns and decreased appetite.
  • In rare cases, adrenal necrosis, sudden death and ataxia can occur.