Adrenocorticotropic hormone-producing pituitary adenoma with pituitary apoplexy treated by surgical decompression: a case report
Abstract Background Pituitary-dependent hypercortisolism (PDH) is one of the most common endocrine disorders in veterinary medicine. However, there are few reports on pituitary tumor apoplexy (PTA) in dogs and no reports on its surgical intervention in veterinary medicine. Accordingly, the appropria...
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | BMC Veterinary Research |
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| Online Access: | https://doi.org/10.1186/s12917-022-03502-2 |
| _version_ | 1797988386284240896 |
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| author | Sachiyo Tanaka Shuji Suzuki Mana Oishi Satoshi Soeta Ryosuke Namiki Yasushi Hara |
| author_facet | Sachiyo Tanaka Shuji Suzuki Mana Oishi Satoshi Soeta Ryosuke Namiki Yasushi Hara |
| author_sort | Sachiyo Tanaka |
| collection | DOAJ |
| description | Abstract Background Pituitary-dependent hypercortisolism (PDH) is one of the most common endocrine disorders in veterinary medicine. However, there are few reports on pituitary tumor apoplexy (PTA) in dogs and no reports on its surgical intervention in veterinary medicine. Accordingly, the appropriate treatment is unknown. Herein, a case of PDH and PTA in a dog treated surgically is described. Case presentation A mongrel female dog (spayed; age, 8 years and 8 months; weight, 6.1 kg) with persistently elevated alkaline phosphatase underwent adrenocorticotropic hormone (ACTH) stimulation testing (post-stimulation cortisol: 20.5 μg/dL), abdominal ultrasonography (adrenal gland thickness: left, 5.7 mm; right, 8.1 mm), and brain magnetic resonance imaging (MRI) (pituitary-to-brain ratio [PBR], 0.61) at the referral hospital, resulting in a diagnosis of PDH (day 0). On day 9, the dog visited XXXX for the preparation of pituitary surgery to treat PDH. However, on days 10–15, the dog developed a loss of energy and appetite, bloody diarrhea, vomiting, and a decreased level of consciousness. However, on day 16, the dog’s condition recovered. A preoperative MRI scan performed on day 52 (the day of surgery) showed apoplexy in the dorsal pituitary region (PBR, 0.68). Based on the PTA findings, the risks of surgery were described to the owner, and approval was obtained. At the time of trans-sphenoidal surgery, a partial pituitary resection was performed with preservation of the PTA area due to adhesions between the PTA area of the right side of the pituitary and surrounding tissues. The resected pituitary tissue was diagnosed as an ACTH-producing adenoma, with necrotic and hemorrhagic findings. As of day 290, endogenous ACTH and cortisol levels did not exceed the reference range. Conclusions The acute signs that occurred on days 10–15 were most likely caused by PTA. Therefore, when signs similar to those detected in acute hypoadrenocorticism are observed in dogs with PDH, it is necessary to include PTA as a differential diagnosis. Trans-sphenoidal surgery may be effective in PDH-affected dogs that develop PTA, but careful attention should be paid to tissue adhesions secondary to hemorrhage that may occur after PTA. |
| first_indexed | 2024-04-11T08:03:17Z |
| format | Article |
| id | doaj.art-123d6c70ea9a4749b5138acdca43b579 |
| institution | Directory Open Access Journal |
| issn | 1746-6148 |
| language | English |
| last_indexed | 2024-04-11T08:03:17Z |
| publishDate | 2022-11-01 |
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| spelling | doaj.art-123d6c70ea9a4749b5138acdca43b5792022-12-22T04:35:38ZengBMCBMC Veterinary Research1746-61482022-11-011811810.1186/s12917-022-03502-2Adrenocorticotropic hormone-producing pituitary adenoma with pituitary apoplexy treated by surgical decompression: a case reportSachiyo Tanaka0Shuji Suzuki1Mana Oishi2Satoshi Soeta3Ryosuke Namiki4Yasushi Hara5Laboratory of Veterinary Surgery, Faculty of Veterinary Science, Nippon Veterinary and Life Science UniversityLaboratory of Veterinary Surgery, Faculty of Veterinary Science, Nippon Veterinary and Life Science UniversityVeterinary Medical Teaching Hospital, Nippon Veterinary and Life Science UniversityLaboratory of Veterinary Anatomy, Faculty of Veterinary Science, Nippon Veterinary and Life Science UniversityGotokuji Namiki Animal ClinicLaboratory of Veterinary Surgery, Faculty of Veterinary Science, Nippon Veterinary and Life Science UniversityAbstract Background Pituitary-dependent hypercortisolism (PDH) is one of the most common endocrine disorders in veterinary medicine. However, there are few reports on pituitary tumor apoplexy (PTA) in dogs and no reports on its surgical intervention in veterinary medicine. Accordingly, the appropriate treatment is unknown. Herein, a case of PDH and PTA in a dog treated surgically is described. Case presentation A mongrel female dog (spayed; age, 8 years and 8 months; weight, 6.1 kg) with persistently elevated alkaline phosphatase underwent adrenocorticotropic hormone (ACTH) stimulation testing (post-stimulation cortisol: 20.5 μg/dL), abdominal ultrasonography (adrenal gland thickness: left, 5.7 mm; right, 8.1 mm), and brain magnetic resonance imaging (MRI) (pituitary-to-brain ratio [PBR], 0.61) at the referral hospital, resulting in a diagnosis of PDH (day 0). On day 9, the dog visited XXXX for the preparation of pituitary surgery to treat PDH. However, on days 10–15, the dog developed a loss of energy and appetite, bloody diarrhea, vomiting, and a decreased level of consciousness. However, on day 16, the dog’s condition recovered. A preoperative MRI scan performed on day 52 (the day of surgery) showed apoplexy in the dorsal pituitary region (PBR, 0.68). Based on the PTA findings, the risks of surgery were described to the owner, and approval was obtained. At the time of trans-sphenoidal surgery, a partial pituitary resection was performed with preservation of the PTA area due to adhesions between the PTA area of the right side of the pituitary and surrounding tissues. The resected pituitary tissue was diagnosed as an ACTH-producing adenoma, with necrotic and hemorrhagic findings. As of day 290, endogenous ACTH and cortisol levels did not exceed the reference range. Conclusions The acute signs that occurred on days 10–15 were most likely caused by PTA. Therefore, when signs similar to those detected in acute hypoadrenocorticism are observed in dogs with PDH, it is necessary to include PTA as a differential diagnosis. Trans-sphenoidal surgery may be effective in PDH-affected dogs that develop PTA, but careful attention should be paid to tissue adhesions secondary to hemorrhage that may occur after PTA.https://doi.org/10.1186/s12917-022-03502-2Pituitary-dependent hypercortisolismTrans-sphenoidal surgeryCanineComplicationsAddison’s diseaseHypoadrenocorticism |
| spellingShingle | Sachiyo Tanaka Shuji Suzuki Mana Oishi Satoshi Soeta Ryosuke Namiki Yasushi Hara Adrenocorticotropic hormone-producing pituitary adenoma with pituitary apoplexy treated by surgical decompression: a case report BMC Veterinary Research Pituitary-dependent hypercortisolism Trans-sphenoidal surgery Canine Complications Addison’s disease Hypoadrenocorticism |
| title | Adrenocorticotropic hormone-producing pituitary adenoma with pituitary apoplexy treated by surgical decompression: a case report |
| title_full | Adrenocorticotropic hormone-producing pituitary adenoma with pituitary apoplexy treated by surgical decompression: a case report |
| title_fullStr | Adrenocorticotropic hormone-producing pituitary adenoma with pituitary apoplexy treated by surgical decompression: a case report |
| title_full_unstemmed | Adrenocorticotropic hormone-producing pituitary adenoma with pituitary apoplexy treated by surgical decompression: a case report |
| title_short | Adrenocorticotropic hormone-producing pituitary adenoma with pituitary apoplexy treated by surgical decompression: a case report |
| title_sort | adrenocorticotropic hormone producing pituitary adenoma with pituitary apoplexy treated by surgical decompression a case report |
| topic | Pituitary-dependent hypercortisolism Trans-sphenoidal surgery Canine Complications Addison’s disease Hypoadrenocorticism |
| url | https://doi.org/10.1186/s12917-022-03502-2 |
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