Ella, a 12-year-old desexed female Keeshond, had been treated for 6 years for Cushing’s Disease with a high dose of Trilostane (120mg once a day). She had been doing very well until recently when she started drinking more and her coat started falling out in big clumps.
The thought of having to increase the dose of Trilostane was worrying, as it is a very expensive drug to use.
Mark examined Ella and found a large firm mass in the front part of her abdomen that was the size of a orange. Blood tests showed normal kidney and liver function, but a test on her Adrenal Glands (ACTH Stimulation Test) showed uncontrolled Cushing's Disease despite being on the high doses of Trilostane.
X-rays showed a large mass in the front half of her abdomen adjacent to the left kidney and just behind the liver. Her lungs appeared clear. An ultrasound exam confirmed the x-ray findings, and the liver did not show any sign of spread from the main tumour.
Mark and Ella’s owners decided to operate to see what the mass was. Ella was placed on an IV drip and anesthetised.
Upon opening the abdomen, Mark found a very large firm tumour with a smaller peach stone sized tumour attached to it. The tumour had a thin transparent capsule around it which had several very big blood vessels in it.
Using a cautery unit and suction, Mark slowly shelled out the tumour and its smaller appendage. It was attached to the left kidney, a section of small intestine, and the pancreas. The whole dissection took approx. 1 hour.
Mark suspected an Adrenal Carcinoma at this stage.
The caudal vena cava was checked and no sign of tumour spread was seen. Occasionally, adrenal carcinomas can invade this big blood vessel, which returns blood to the heart, making surgery very difficult (if not impossible).
Mark checked the other kidney, liver, spleen and intestines and found no evidence of spread.
Ella was kept on an IV drip overnight and made a great recovery. She went home the very next day.
Pathology confirmed a diagnosis of Adrenal Carcinoma which is a pretty rare finding in dogs with Cushing’s Disease.
The fact that we had been able to remove it meant Ella no longer had to be on Trilostane. In fact, her owners mentioned her thirst had already gone by day 4.
We are going to be keeping a very close eye on Ella for any sign of tumour spread but at this stage of her old life, it’s a great result.