Dorsal alopecia in a male crossbred dog Author: Ewan Ferguson Editor: David Lloyd © European Society of Veterinary Dermatology

History - 1 Dorsal alopecia and mild pruritus of 9 months duration in a male crossbred dog Weight 25 kg Click to reveal the text on this screen Click the forward arrow to jump to the next screen History

History - 2 Mild papular rash on dorsum and ventrum. Comedones on dorsum and ventrum. Ventral coat thin but skin “normal” History

History - 3 Coat has become longer and finer in texture in recent months Polyuria and polydipsia (3 litres per day) reported Good appetite. Poor exercise tolerance No previous history of dermatological disease 2 cats in the house, both healthy Diagnosed by the referring veterinarian as flea allergy dermatitis History

History - 4 Ectoparasite control Dog and both cats treated with fipronil (Frontline Spot-On, Merial) monthly Home environment treated annually with pyroxyfen and permethrin spray (Indorex, Virbac) No improvement History

History - 5 Pruritus now reported to be controlled with 10 mg prednisolone orally once daily, over the last 4 months No hair re-growth seen All therapy stopped 2 weeks before referral appointment History

Clinical signs - 1 The ventral abdominal skin A few scattered papules, epidermal collarettes & crusts on dorsum & ventrum Signs

Clinical signs - 2 Alopecia & hyperpigmentation in dorsal lumbar region No visual evidence of ectoparasitism Pendulous abdomen & ventral liver lobes palpably enlarged Testes normal on palpation Signs

How would you approach this case? What are the next steps you would take? Make a list of your principle differential diagnoses List any samples you would collect List any tests you would perform to assist in making a definitive diagnosis Signs

Differential diagnoses Principle differential diagnoses Allergy (fleas, atopy, ?food), Hormonal imbalance including iatrogenic Cushings syndrome, ectoparasitic infestation, dermatophytosis Secondary pyoderma, Malassezia dermatitis Differentials

Tests - 1 Skin scrapings, tape strips, hair plucks and coat brushings - no evidence of ectoparasites or fungi Fasted blood sample Biochemistry: Alkaline phosphatase - 1850 iu/l; Alanine aminotransferase - 170 iu/l; Glucose - 8.4 mmol/l; Cholesterol - 9.1 mmol/l Haematology: Mild mature neutrophilia & eosinopenia Urianalysis: Specific gravity - 1.005; No glycosuria Tests

What now? What are the next steps you would take? What are now your principle differential diagnoses? Are there any other samples you would collect? List any tests you would perform to assist in making a definitive diagnosis Tests

Tests - 2 Principal differential diagnosis Tests Hormonal imbalance particularly natural and iatrogenic Cushings syndrome Secondary folliculitis Tests ACTH response test to provide evidence of possible Cushings syndrome and to identify iatrogenic disease Tests

Results - 1 What is the significance of this test? Tests

Results - 2 Tests

Results - 3 What do these tests tell us? Tests

What is your diagnosis? Do the investigations permit a definitive diagnosis? List any additional investigations which you think may need to be done Tests

Tests - 3 Radiography Ultrasonography Mass suspected in the left adrenal region Ultrasonography Hypoechoic foci in the liver suggestive of metastases Tests

How would you deal with this case? What is your prognosis? How will you advise the owner? What treatment would you consider? Therapy

Diagnosis Hyperadrenocorticism resulting from adrenal neoplasia Likely metastasis Therapy

Prognosis Prognosis is guarded Surgery is not indicated in view of likely metastasis Medical management with trilstane (Vetoryl, Arnolds) recommended Notes

Conclusion The owner requested euthanasia. At post mortem examination an adrenal neoplasm and multifocal metastases were demonstrated. The adrenal tumour can be seen in the centre of the photograph, the kidney is on the left side Notes

Review If you would like to review this case, please use the navigation buttons below Notes