Changes

== Diagnosis ==

== Diagnosis ==

'''Clinical pathology''' results may lead to an indicative diagnosis. Roughly 85- 95% of cases will show lymphocytopenia and eosinopenia and marked elevation of plasma alkaline phosphatase (ALP). Hypercholoesterolaemina has also been identified in 90% of dogs with this condition. Hyperglycaemia and hypernatraemia are sometimes noted, as is an increased urinary cortisol: creatinine ratio.

'''Clinical pathology''' results may lead to an indicative diagnosis. Roughly 85 - 95% of cases will show [[Lymphopenia|lymphocytopenia]] and [[eosinopenia]] and marked elevation of plasma alkaline phosphatase (ALP). Hypercholoesterolaemia has also been identified in 90% of dogs with this condition. Hyperglycaemia and hypernatraemia are sometimes noted, as is an increased urinary cortisol : creatinine ratio.

Other specific diagnostic procedures include: '''ACTH Stimulation test''': measure cortisol before and 30-60 mins after i/v ''Synacthen'' administration. A positive result is initially high cortisol followed by a markedly elevated cortisol after stimulation (>600nmol/l).  

Other specific diagnostic procedures include: '''ACTH Stimulation test''': measure cortisol before and 30-60 mins after i/v ''Synacthen'' administration. A positive result is initially high cortisol followed by a markedly elevated cortisol after stimulation (>600nmol/l).  

== Treatment ==

== Treatment ==

'''Mitotane'''electively destroys the zona fasciculata and zona reticularis while sparing the zona glomerulosa. Mitotane will detroy the hyperplastic adrenal cortex  and the remaining tissue will then provide normal plasma cortisol concentrations. The animal will no longer be able to raise its plasma cortisol above around 20- 50 nmol/L, which will provide significant clinical improvement. You may need to use an induction dose for 5- 7 days follwed then by a maintenence dose of twice a week administration.  

'''Mitotane''' electively destroys the zona fasciculata and zona reticularis while sparing the zona glomerulosa. Mitotane will destroy the hyperplastic adrenal cortex  and the remaining tissue will then provide normal plasma cortisol concentrations. The animal will no longer be able to raise its plasma cortisol above around 20-50 nmol/L, which will provide significant clinical improvement. You may need to use an induction dose for 5-7 days followed by a maintenance dose of twice a week administration.  

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Animals that are treated with mitotane cannot mount a sufficient immune response in cases of stress, trauma or illness. As a consequence, from the onset of mitotane treatment, prednisolone should always be prescribed so that in these cases the owner can administer the prednisolone whilst awaiting veterinary assistance.

Animals that are treated with mitotane cannot mount a sufficient immune response in cases of stress, trauma or illness. As a consequence, from the onset of mitotane treatment, prednisolone should always be prescribed so that in these cases the owner can administer the prednisolone whilst awaiting veterinary assistance.

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'''L-Deprenyl'''is a monoamine oxidase inhibitor. Increases dopamine input to hypothalamus and pituitary and so inhibits ACTH secretion.  

'''L-Deprenyl''' is a monoamine oxidase inhibitor. Increases dopamine input to hypothalamus and pituitary and so inhibits ACTH secretion.  

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[[Category:Bones_-_Metabolic_Pathology]] [[Category:To_Do_-_Review]] [[Category:Neurological_Diseases_-_Dog]] [[Category:Endocrine_Diseases_-_Dog]] [[Category:Adrenal_Glands_-_Pathology]]

[[Category:Bones_-_Metabolic_Pathology]] [[Category:Expert_Review]] [[Category:Neurological_Diseases_-_Dog]] [[Category:Endocrine_Diseases_-_Dog]] [[Category:Adrenal_Glands_-_Pathology]]