Laparoscopic adrenalectomy for management of a functional adrenal tumor in a cat

Rebecca R. Smith Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, PA 19104.

Search for other papers by Rebecca R. Smith in
Current site
Google Scholar
PubMed Close
 BS
,
Philipp D. Mayhew Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, PA 19104.

Search for other papers by Philipp D. Mayhew in
Current site
Google Scholar
PubMed Close
 BVM&S, DACVS
, and
Allyson C. Berent Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, PA 19104.

Search for other papers by Allyson C. Berent in
Current site
Google Scholar
PubMed Close
 DVM, DACVIM
DOI:
https://doi.org/10.2460/javma.241.3.368
Volume/Issue:
Volume 241: Issue 3
Online Publication Date:
01 Aug 2012
Restricted access
Sign In Reprints and Permissions Purchase Article

Abstract

Case Description—A 9-year-old castrated male domestic shorthair cat was examined because of hypertension that persisted after resolution of the patient's hyperthyroidism. Bilateral hypertensive retinopathy, a systolic heart murmur, left ventricular hypertrophy, and tachycardia were present.

Clinical Findings—Biochemical analysis revealed mild hypokalemia, normonatremia, high serum creatine kinase activity, high serum aldosterone concentration, and low plasma renin activity consistent with hyperaldosteronism. Hypercalcemia with an associated high serum parathyroid hormone concentration and an exaggerated low-dose dexamethasone suppression test result were consistent with concurrent hyperparathyroidism and hyperadrenocorticism, respectively. Ultrasonographic examination revealed a markedly enlarged left adrenal gland, an abnormally small right adrenal gland, and 2 nodules in the right thyroid and parathyroid glands.

Treatment and Outcome—Laparoscopic left adrenalectomy was performed concurrently with right thyroidectomy and parathyroidectomy. Histologic evaluation revealed an adrenal cortical adenoma, thyroid adenoma, and parathyroid adenoma. The cat recovered from surgery without complications. The hypercalcemia and hypertension resolved after surgery. Follow-up echocardiography revealed improvement in the left ventricular hypertrophy. Ultrasonographic examinations performed up to 26 months after adrenalectomy showed no evidence of regrowth of the adrenal mass. The patient survived for 44 months after adrenalectomy with no signs of recurrent hyperaldosteronism or hyperadrenocorticism.

Clinical Relevance—Laparoscopic adrenalectomy may be a plausible method for the treatment of unilateral functional adrenal neoplasia in feline patients when diagnostic imaging has ruled out intravascular invasion and metastatic disease. In addition, in a feline patient with hyperthyroidism and hypertension, other endocrine glands should be investigated.

Abstract

Case Description—A 9-year-old castrated male domestic shorthair cat was examined because of hypertension that persisted after resolution of the patient's hyperthyroidism. Bilateral hypertensive retinopathy, a systolic heart murmur, left ventricular hypertrophy, and tachycardia were present.

Clinical Findings—Biochemical analysis revealed mild hypokalemia, normonatremia, high serum creatine kinase activity, high serum aldosterone concentration, and low plasma renin activity consistent with hyperaldosteronism. Hypercalcemia with an associated high serum parathyroid hormone concentration and an exaggerated low-dose dexamethasone suppression test result were consistent with concurrent hyperparathyroidism and hyperadrenocorticism, respectively. Ultrasonographic examination revealed a markedly enlarged left adrenal gland, an abnormally small right adrenal gland, and 2 nodules in the right thyroid and parathyroid glands.

Treatment and Outcome—Laparoscopic left adrenalectomy was performed concurrently with right thyroidectomy and parathyroidectomy. Histologic evaluation revealed an adrenal cortical adenoma, thyroid adenoma, and parathyroid adenoma. The cat recovered from surgery without complications. The hypercalcemia and hypertension resolved after surgery. Follow-up echocardiography revealed improvement in the left ventricular hypertrophy. Ultrasonographic examinations performed up to 26 months after adrenalectomy showed no evidence of regrowth of the adrenal mass. The patient survived for 44 months after adrenalectomy with no signs of recurrent hyperaldosteronism or hyperadrenocorticism.

Clinical Relevance—Laparoscopic adrenalectomy may be a plausible method for the treatment of unilateral functional adrenal neoplasia in feline patients when diagnostic imaging has ruled out intravascular invasion and metastatic disease. In addition, in a feline patient with hyperthyroidism and hypertension, other endocrine glands should be investigated.

Contributor Notes

Rebecca Smith and Dr. Mayhew's present address is Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

Dr. Berent's present address is Department of Diagnostic Imaging and Interventional Radiology, The Animal Medical Center, 510 E 62nd St, New York, NY 10065.

Address correspondence to Dr. Mayhew (philmayhew@gmail.com).
Cover Journal of the American Veterinary Medical Association
Journal of the American Veterinary Medical Association
Publication Date:
01 Aug 2012

  • 1 Mayhew PD, Brown DC. Comparison of three techniques for ovarian pedicle hemostasis during laparoscopic-assisted ovariohysterectomy. Vet Surg 2007; 36:541–547.

    • Search Google Scholar
    • Export Citation

  • 2 Gett R & Johnson M. Appendix retrieval after laparoscopic appendectomy: a safe and inexpensive technique (lett). Surg Laparosc Endosc Percutan Tech 2006; 5:378.

    • Search Google Scholar
    • Export Citation

  • 3 Eger CE, Robinson WF, Huxtable CR. Primary aldosteronism (Conn's syndrome) in a cat; a case report and review of comparative aspects. J Small Anim Pract 1983; 24:293–307.

    • Search Google Scholar
    • Export Citation

  • 4 Dow SW, LeCouteur RA, Fettman MJ, et al. Potassium depletion in cats: hypokalemic polymyopathy. J Am Vet Med Assoc 1987; 191:1563–1568.

    • Search Google Scholar
    • Export Citation

  • 5 Reusch CE, Schellenberg S & Wenger M. Endocrine hypertension in small animals. Vet Clin North Am Small Anim Pract 2010; 40:335–352.

  • 6 Schulman RL. Feline primary hyperaldosteronism, a literature review. Vet Clin North Am Small Anim Pract 2010; 40:353–359.

  • 7 Ash RA, Harvey AM & Tasker S. Primary hyperaldosteronism in the cat: a series of 13 cases. J Feline Med Surg 2005; 7:173–182.

  • 8 Flood SM, Randolph JF, Gelzer AR, et al. Primary hyperaldosteronism in two cats. J Am Anim Hosp Assoc 1999; 35:411–416.

  • 9 Rose SA, Kyles AE, Labelle P, et al. Adrenalectomy and caval thrombectomy in a cat with primary hyperaldosteronism. J Am Anim Hosp Assoc 2007; 43:209–214.

    • Search Google Scholar
    • Export Citation

  • 10 DeClue AE, Breshears LA, Pardo ID, et al. Hyperaldosteronism and hyperprogesteronism in a cat with an adrenal cortical carcinoma. J Vet Intern Med 2005; 19:355–358.

    • Search Google Scholar
    • Export Citation

  • 11 Rijnberk A, Voorhout G, Kooistra HS, et al. Hyperaldosteronism in a cat with metastasized adrenocortical tumour. Vet Q 2001; 23:38–43.

    • Search Google Scholar
    • Export Citation

  • 12 MacKay AD, Holt PE, Sparkes AH. Successful surgical treatment of a cat with primary hyperaldosteronism. J Feline Med Surg 1999; 1:117–122.

    • Search Google Scholar
    • Export Citation

  • 13 Javadi S, Djajadiningrat-Laanen SC, Kooistra HS, et al. Primary hyperaldosteronism, a mediator of progressive renal disease in cats. Domest Anim Endocrinol 2005; 28:85–104.

    • Search Google Scholar
    • Export Citation

  • 14 Reimer SB, Pelosi A, Frank JD, et al. Multiple endocrine neoplasia type 1 in a cat. J Am Vet Med Assoc 2005; 227:101–104.

  • 15 Renschler JS, Dean GA. What is your diagnosis? Abdominal mass aspirate in a cat with an increased Na:K ratio. Vet Clin Pathol 2009; 38:69–72.

    • Search Google Scholar
    • Export Citation

  • 16 Moore LE, Biller DS, Smith TA. Use of abdominal ultrasonography in the diagnosis of primary hyperaldosteronism in a cat. J Am Vet Med Assoc 2000; 217:213–215.

    • Search Google Scholar
    • Export Citation

  • 17 Duncan JL, Fuhrman GM, Bolton JS, et al. Laparoscopic adrenalectomy is superior to an open approach to treat hyperaldosteronism. Am Surg 2000; 66:932–936.

    • Search Google Scholar
    • Export Citation

  • 18 Smith CD, Weber CJ, Amerson JR. Laparoscopic adrenalectomy: new gold standard. World J Surg 1999; 23:389–396.

  • 19 Ishikawa T, Sowa M, Nagayama M, et al. Laparoscopic adrenalectomy: comparison with the conventional approach. Surg Laparosc Endosc 1997; 7:275–280.

    • Search Google Scholar
    • Export Citation

  • 20 Devitt CM, Cox RE, Hailey JJ. Duration, complications, stress, and pain of open ovariohysterectomy versus a simple method of laparoscopic-assisted ovariohysterectomy in dogs. J Am Vet Med Assoc 2005; 227:921–927.

    • Search Google Scholar
    • Export Citation

  • 21 Culp W, Mayhew PD, Brown DC. The effect of laparoscopic versus open ovariectomy on postsurgical activity in small dogs. Vet Surg 2009; 38:811–817.

    • Search Google Scholar
    • Export Citation

  • 22 Mayhew PD, Brown DC. Prospective evaluation of two intracorporeally sutured prophylactic laparoscopic gastropexy techniques compared with laparoscopic-assisted gastropexy in dogs. Vet Surg 2009; 38:738–746.

    • Search Google Scholar
    • Export Citation

  • 23 Jiménez Peléez M, Bouvy BM, Dupré GP. Laparoscopic adrenalectomy for treatment of unilateral adrenocortical carcinomas: technique, complications, and results in seven dogs. Vet Surg 2008; 37:444–453.

    • Search Google Scholar
    • Export Citation

  • 24 Mayhew PD. Advanced laparoscopic procedures (hepatobiliary, endocrine) in dogs and cats. Vet Clin North Am Small Anim Pract 2009; 39:925–939.

    • Search Google Scholar
    • Export Citation

  • 25 Dubiel B, Shires PK, Korvick D, et al. Electromagnetic energy sources in surgery. Vet Surg 2010; 39:909–924.

  • 26 Kyles AE, Feldman EC, De Cock H, et al. Surgical management of adrenal gland tumors with and without associated tumor thrombi in dogs: 40 cases (1994-2001). J Am Vet Med Assoc 2003; 223:654–662.

    • Search Google Scholar
    • Export Citation

  • 27 Schultz RM, Wisner ER, Johnson EG, et al. Contrast-enhanced computed tomography as a pre-operative indicator of vascular invasion from adrenal masses in dogs. Vet Radiol Ultrasound 2009; 38:738–746.

    • Search Google Scholar
    • Export Citation

  • 28 Tidwell RS, Penninick DG, Besso JG. Imaging of adrenal gland disorders. Vet Clin North Am Small Anim Pract 1997; 27:237–254.

Advertisement