ATYPICAL CUSHING'S DISEASE: IS IT REALLY ATYPICAL

摘要

In 2002, clinical researchers from the UK described the first cases of what is often referred to as atypical dishing's disease (I). Dogs with atypical Cushing's disease (ACD) have a history, physical examination findings, CBC, biochemical chemistry profile and urinalysis results, and adrenal imaging consistent with hyperadrenocorticism (HAC), however, routine screening tests (i.e., the ]ow-dose dexamethasone suppression test (LDDST) and ACTH response test are both negative. In addition, one or more sex steroids are elevated (e.g., androstenedione, progesterone, or 17-hydroxyprogesteone [17-OHP]) following administration of ACTH. The UK study evaluated 24 dogs with HAC; the cause of the HAC was not determined in 2 dogs. In the remaining 22 dogs, pituitary-dependent Cushing's disease (PDH) was diagnosed in 16 dogs and 6 dogs had an adrenal tumor (AT). Of the 16 dogs with PDH, 3 dogs had ACD; of the 6 dogs with an AT, 4 dogs had ACD. All the dogs with ACD had elevated post-ACTH 17-OHP concentrations.In addition, all dogs in this study treated with standard therapeutic regimes of trilostane or mitotane showed resolution of clinical signs.