1. Wojo Alcala Diagnosing Adrenal Tumors and Retinal Detachment via Ultrasound

2. Signalment  8 ½ year old male castrated Shih Tzu

3. History  NCSU Emergency Service  For evaluation of acute blindness  Episodes of exercise intolerance  No V, D, Coughing, Sneezing  Previous Hx of patellar luxation (treated with Rimadyl

4. Pertinent Clinical and Laboratory Findings  Distended abdomen, difficult to palpate  BP on admission 220 (systolic), later no BP>170 was reported  Elevated ALP (579)  USG 1.041, 3+ protein  Urine Protein:Creatinine Ratio=slightly elevated  ACTH Stim: 50 ug/dl (very suggestive of Cushings)

5. Wojo headed to Radiology for …  Abdominal and Chest Radiographs  Abdominal Ultrasound

6. Here is what we found…

7. Radiographic Findings

8. Ultrasound Findings

15. Problems Identified  Radiographs 1. Hepatomegaly 1. Hepatomegaly  Abdominal Ultrasound 1. Bilaterally enlarged adrenal glands (each adrenal appears to contain a nodule) nodule) 2. Bilateral retinal detachment 2. Bilateral retinal detachment

16. Differentials  Cushings  Due to presence of nodules= may be more consistent with  Adenoma, adenocarcinoma or pheochromocytoma  Rather than pituitary dependent Cushings (in which we would see bilateral uniform hypertrophy more likely)

17. Differentials  Signs consistent with Cushings (Incr. ALP and hepatomegaly)  However, dogs with Cushings do not typically experience hypertension great enough to cause bilateral retinal detachment  Therefore why we suspect pheochromocytoma may be involved

18. Ultrasound  Could not differentiate which type of adrenal tumor Wojo had  We needed to explore other options…

19. Wojo’s Options  Nuclear Scintigraphy with MIBG (metaiodobenzylguanidine)  Can be used to localize pheochromocytomas,  Better surgical plan  Possible Lysodren treatment and evaluation of response.

20. What happened?  I called Wojo’s parents three days after discharge to see how he was adapting to his blindness at home.  They had elected Euthanasia the previous night at the rDVM.