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Olaimat AR, Jafarzadehbalagafsheh P, Gol M, Costa AM, Biagini G, Lucchi C. Trilostane: Beyond Cushing's Syndrome. Animals (Basel) 2025; 15:415. [PMID: 39943185 PMCID: PMC11816184 DOI: 10.3390/ani15030415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Revised: 01/29/2025] [Accepted: 01/30/2025] [Indexed: 02/16/2025] Open
Abstract
Trilostane is a drug able to block the synthesis of progesterone from pregnenolone, dependent on the enzyme 3β-hydroxysteroid dehydrogenase/Δ5-4 isomerase. As a consequence of this effect, it is used to treat endocrinological diseases such as Cushing's syndrome, especially in dogs. Because of the modulatory effects of trilostane on the hypothalamic-pituitary-adrenal axis, trilostane administration causes an increase in brain levels of neurosteroids with anticonvulsant properties, as in the case of allopregnanolone. Allopregnanolone is also of interest in curing depression, suggesting that trilostane might represent a tool to address neurological and psychiatric disorders. In this review, we investigated the historical development of this drug and its current use, mechanisms, and possible developments. By searching the literature from 1978 to 2025, we identified 101 papers describing studies with trilostane. Precisely, 55 were about dogs and trilostane, 3 were on cats, and 23 were with other animals. Some studies (15) were also designed with human patients. The main disease treatment with trilostane was hyperadrenocorticism. However, we also found two preclinical papers on trilostane's potential use in psychiatric diseases and three on trilostane's potential use in neurological disorders. Moreover, few clinical and preclinical studies suggested the involvement of neurosteroids modulated by trilostane in different neurological disorders, thus opening a possible new perspective for the use of this drug.
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Affiliation(s)
- Ali R. Olaimat
- Laboratory of Experimental Epilepsy, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (A.R.O.); (P.J.); (A.-M.C.); (C.L.)
- Health Innovative Products and Technologies (HIP-TECH) Ph.D. Program, Department of Life Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Parastoo Jafarzadehbalagafsheh
- Laboratory of Experimental Epilepsy, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (A.R.O.); (P.J.); (A.-M.C.); (C.L.)
| | - Mohammad Gol
- Radiology Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR4 7TP, UK;
| | - Anna-Maria Costa
- Laboratory of Experimental Epilepsy, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (A.R.O.); (P.J.); (A.-M.C.); (C.L.)
| | - Giuseppe Biagini
- Laboratory of Experimental Epilepsy, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (A.R.O.); (P.J.); (A.-M.C.); (C.L.)
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Chiara Lucchi
- Laboratory of Experimental Epilepsy, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (A.R.O.); (P.J.); (A.-M.C.); (C.L.)
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de Carvalho GLC, Meirelles L, da Silva CC, Neto WS, Furtado PV, Machado L, de Moura Martins FS, da Silva Mello FP, de Faria Valle S, Pöppl ÁG. Assessment of selegiline and trilostane combined therapy efficacy for canine pituitary-dependent hypercortisolism treatment: A pilot randomized clinical trial. Res Vet Sci 2022; 150:107-114. [DOI: 10.1016/j.rvsc.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/07/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
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Golinelli S, de Marco V, Leal RO, Barbarossa A, Aniballi C, Maietti E, Tardo AM, Galac S, Fracassi F. Comparison of methods to monitor dogs with hypercortisolism treated with trilostane. J Vet Intern Med 2021; 35:2616-2627. [PMID: 34672018 PMCID: PMC8692213 DOI: 10.1111/jvim.16269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background The use of adrenocorticotropic hormone stimulation test as method to monitor efficacy of trilostane treatment of hypercortisolism (HC) in dogs has been questioned. Objectives To evaluate and compare 12 methods with which to monitor efficacy of trilostane treatment in dogs with HC. Animals Forty‐five client‐owned dogs with HC treated with trilostane q12h. Methods Prospective cross‐sectional observational study. The dogs were categorized as well‐controlled, undercontrolled, and unwell through a clinical score obtained from an owner questionnaire. The ability to correctly identify trilostane‐treatment control of dogs with HC with the following variables was evaluated: before trilostane serum cortisol (prepill), before‐ACTH serum cortisol, post‐ACTH serum cortisol, plasma endogenous ACTH concentrations, prepill/eACTH ratio, serum haptoglobin (Hp) concentration, serum alanine aminotransferase (ALT), gamma‐glutamyl transferase (γGT) and alkaline phosphatase activity, urine specific gravity, and urinary cortisol : creatinine ratio. Results Ninety‐four re‐evaluations of 44 dogs were included; 5 re‐evaluations of 5 unwell dogs were excluded. Haptoglobin was significantly associated with the clinical score (P < .001) and in the receiver operating characteristic analysis, Hp cutoff of 151 mg/dL correctly identified 90.0% of well‐controlled dogs (specificity) and 65.6% of undercontrolled dogs (sensitivity). Alanine aminotransferase (P = .01) and γGT (P = .009) were significantly higher in undercontrolled dogs. Cutoff of ALT and γGT greater than or equal to 86 U/L and 5.8 U/L, respectively, were significantly associated with poor control of HC by trilostane. Conclusions and Clinical Importance Of all the 12 variables, Hp, and to a lesser degree ALT and γGT, could be considered additional tools to the clinical picture to identify well‐controlled and undercontrolled trilostane‐treated dogs.
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Affiliation(s)
- Stefania Golinelli
- Department of Veterinary Medical Science, University of Bologna, Bologna, Italy
| | | | - Rodolfo Oliveira Leal
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
| | - Andrea Barbarossa
- Department of Veterinary Medical Science, University of Bologna, Bologna, Italy
| | - Camilla Aniballi
- Department of Veterinary Medical Science, University of Bologna, Bologna, Italy
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Antonio Maria Tardo
- Department of Veterinary Medical Science, University of Bologna, Bologna, Italy
| | - Sara Galac
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Federico Fracassi
- Department of Veterinary Medical Science, University of Bologna, Bologna, Italy
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Machado L, de Oliveira MC, Barbieri CR, Riboldi CI, Leotti VB, González FHD, Valle SDF, Siqueira FM, Pöppl ÁG. Clinical and microbiological characterization of subclinical bacteriuria and sporadic bacterial cystitis in dogs with spontaneous hypercortisolism. Comp Immunol Microbiol Infect Dis 2021; 75:101624. [PMID: 33609989 DOI: 10.1016/j.cimid.2021.101624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 12/25/2022]
Abstract
Study's aims were to characterize subclinical bacteriuria (SB) and sporadic bacterial cystitis (SBC) in dogs with spontaneous hypercortisolism (HC). Prospective cross-sectional design divided patients as newly diagnosed (n = 27), poorly controlled (n = 21), well controlled (n = 34), and controls (n = 19). Urine culture positive results were identified by MALDI-TOF and submitted to antibiogram. Escherichia coli was the most common microorganism (36%). The majority of positive cultures in HC were SB (12.2%). All 4.1% SBC cases were in well controlled HC cases. Bacteriuria correlated with low urine specific gravity and low lymphocyte count. HC degree of control correlated with leukocyturia. SB/SBC cases were treated based in antimicrobial susceptibility leading to microbiological cure in 75% of HC cases. Persistent infections occurred only in SB cases, all by E. coli which became more resistant. SB/SBC prevalence in canine HC is actually lower. Further evidence for current ISCAID guideline contraindication for SB treatment due to HC were provided.
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Affiliation(s)
- Letícia Machado
- Veterinary Sciences Post-Graduation Program, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Milena Cleff de Oliveira
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Cláudia Ruga Barbieri
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Camila Impérico Riboldi
- Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Vanessa Bielefeldt Leotti
- Department of Statistics, Mathematics and Statistics Institute, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9500, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Félix Hilário Díaz González
- Veterinary Sciences Post-Graduation Program, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil; Department of Veterinary Clinical Pathology, School of Veterinary Medicine, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Stella de Faria Valle
- Veterinary Sciences Post-Graduation Program, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil; Department of Veterinary Clinical Pathology, School of Veterinary Medicine, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Franciele Maboni Siqueira
- Veterinary Sciences Post-Graduation Program, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil; Department of Veterinary Clinical Pathology, School of Veterinary Medicine, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil
| | - Álan Gomes Pöppl
- Veterinary Sciences Post-Graduation Program, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil; Department of Animal Medicine, School of Veterinary Medicine, Federal University of Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, Rio Grande do Sul, CEP 91540-000, Brazil.
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Arenas Bermejo C, Pérez Alenza D, García San José P, Llauet L, Pérez-López L, Melián C, C Feldman E. Laboratory assessment of trilostane treatment in dogs with pituitary-dependent hyperadrenocorticism. J Vet Intern Med 2020; 34:1413-1422. [PMID: 32533623 PMCID: PMC7379015 DOI: 10.1111/jvim.15830] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/17/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022] Open
Abstract
Background Results of ACTH stimulation test (ACTHst), pre‐ and post‐trilostane serum cortisol concentrations (SCCs), urine concentration (urine‐specific gravity [USG]), and urine cortisol : creatinine ratios (UCCRs) are common variables used to monitor trilostane treatment of dogs with pituitary‐dependent hyperadrenocorticism (PDH). However, none has consistently discriminated dogs receiving an adequate dose (A) from those overdosed (O) or underdosed (U). Objectives To assess and compare recommended monitoring variables, including serial SCCs in a cohort of dogs with PDH treated with trilostane. Animals Privately owned dogs with PDH (n = 22) and 3 healthy dogs (controls). Methods Prospective, multicenter, 2‐day study. On day “a” (randomized): ACTHst was completed. Day “b” (>2 to <7 days later): SCCs were assessed −0.5 hours, immediately before, and 1, 2, 2.5, 3, 3.5, 4, 6, 8, and 12 hours after trilostane administration. On the first study day, urine collected at home was assessed for USG, UCCR and owner opinions regarding PDH were categorized as: A (clinical signs resolved), U (remains symptomatic), or ill (possible O). Results At 27 pairs of evaluations, 7 dogs were categorized as A, 19 U, and 1 possible O (excluded from the study). There was overlap in SCC results from the A and U dogs at every time point. Results of USG, UCCR, and ACTHst did not discriminate A from U dogs. Trilostane suppresses SCC within 1 hour of administration and its duration of action in most PDH dogs is <8 hours. Conclusions and Clinical Importance No single variable or group of variables reliably discriminated A dogs from U dogs during trilostane treatment for PDH.
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Affiliation(s)
| | - Dolores Pérez Alenza
- Department of Animal Medicine and Surgery, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Paula García San José
- Department of Animal Medicine and Surgery, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Lidia Llauet
- Internal Medicine Service, Hospital Veterinari Catalunya, Odena, Spain
| | - Laura Pérez-López
- Department of Animal Pathology, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Carlos Melián
- Department of Animal Pathology, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Edward C Feldman
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
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Boretti F, Musella C, Burkhardt W, Kuemmerle-Fraune C, Riond B, Reusch C, Sieber-Ruckstuhl N. Comparison of two prepill cortisol concentrations in dogs with hypercortisolism treated with trilostane. BMC Vet Res 2018; 14:417. [PMID: 30591042 PMCID: PMC6307252 DOI: 10.1186/s12917-018-1750-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022] Open
Abstract
Background The ideal method for monitoring trilostane therapy in dogs with hypercortisolism is still open to debate. Recently, determination of the pre-trilostane (prepill) cortisol concentration has been proposed to be more repeatable than either post-trilostane or post-ACTH cortisol. The aim of this study was to compare two prepill cortisol concentrations in dogs with hypercortisolism during trilostane therapy. Sixteen client-owned dogs with naturally occurring hypercortisolism were prospectively included and cortisol concentrations were measured twice, 1 h apart, before the morning trilostane dose (prepill 1 and 2 cortisol). Results A total of 47 prepill cortisol measurement pairs were included. Compared to prepill 1, prepill 2 cortisol was higher in 15, equal in 8 and lower in 24 pairs. Group agreement between prepill 1 and 2 cortisol was 70% (moderate agreement - weighted kappa 0.55). In 30% of the pairs, group assignment was discrepant, implying a different therapeutic decision. In some dogs certain circumstances (e.g. excessive barking, difficulties during blood collection, excitement at arrival) were identified as potential factors explaining the discrepancy between prepill 1 and 2 cortisol measurements. Conclusions In a substantial number of dogs treated with trilostane, the two prepill cortisol concentrations differed. Part of this difference might be ascribable to stressful events during test performance. When using prepill cortisol measurements to monitor trilostane therapy, recording of any incident during handling that might affect cortisol release might be helpful to make a reliable decision about a trilostane dose adaptation.
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Affiliation(s)
- Felicitas Boretti
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Caterina Musella
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Wanda Burkhardt
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Claudia Kuemmerle-Fraune
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Barbara Riond
- Clinical Laboratory, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Claudia Reusch
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Nadja Sieber-Ruckstuhl
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
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Sanders K, Kooistra HS, Galac S. Treating canine Cushing's syndrome: Current options and future prospects. Vet J 2018; 241:42-51. [PMID: 30340659 DOI: 10.1016/j.tvjl.2018.09.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 12/17/2022]
Abstract
Naturally occurring hypercortisolism, also known as Cushing's syndrome, is a common endocrine disorder in dogs that can be caused by an adenocorticotrophic hormone (ACTH)-producing pituitary adenoma (pituitary-dependent hypercortisolism, PDH; 80-85% of cases), or by an adrenocortical tumor (ACT; 15-20% of cases). To determine the optimal treatment strategy, differentiating between these two main causes is essential. Good treatment options are surgical removal of the causal tumor, i.e. hypophysectomy for PDH and adrenalectomy for an ACT, or radiotherapy in cases with PDH. Because these options are not without risks, not widely available and not suitable for every patient, pharmacotherapy is often used. In cases with PDH, the steroidogenesis inhibitor trilostane is most often used. In cases with an ACT, either trilostane or the adrenocorticolytic drug mitotane can be used. Although mostly effective, both treatments have disadvantages. This review discusses the current treatment options for canine hypercortisolism, and considers their mechanism of action, efficacy, adverse effects, and effect on survival. In addition, developments in both adrenal-targeting and pituitary-targeting drugs that have the potential to become future treatment options are discussed, as a more selective and preferably also tumor-targeted approach could have many advantages for both PDH and ACTs.
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Affiliation(s)
- K Sanders
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - H S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands
| | - S Galac
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, The Netherlands.
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Lemetayer J, Blois S. Update on the use of trilostane in dogs. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2018; 59:397-407. [PMID: 29606727 PMCID: PMC5855282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Many articles published in the past few years have contributed to a better understanding of the use of trilostane in dogs. Trilostane is a competitive inhibitor of 3β-hydroxysteroid dehydrogenase, the enzyme essential for synthesis of cortisol and all other steroids. Trilostane is reported to be safe and effective in the treatment of pituitary-dependent hyperadrenocorticism (HAC), adrenal-dependent HAC, and alopecia X. While trilostane controls most of the clinical signs associated with HAC, abnormalities such as hypertension, hypercoagulability, and proteinuria may persist despite therapy. Because the duration of cortisol suppression after a dose of trilostane is often less than 12 hours, many dogs with HAC could benefit from low dose trilostane treatment every 12 hours. Many controversies regarding trilostane still exist. This review provides a comprehensive commentary on trilostane's indications, mode of action, dose, monitoring, efficacy, and adverse effects.
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Affiliation(s)
- Julie Lemetayer
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1C 1G9
| | - Shauna Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1C 1G9
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Johnson CM, Kass PH, Cohen TA, Feldman EC. Effect of Intravenous or Perivascular Injection of Synthetic Adrenocorticotropic Hormone on Stimulation Test Results in Dogs. J Vet Intern Med 2017; 31:730-733. [PMID: 28407319 PMCID: PMC5435047 DOI: 10.1111/jvim.14708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/22/2017] [Accepted: 03/02/2017] [Indexed: 11/28/2022] Open
Abstract
Background Standard protocols for adrenocorticotropic hormone (ACTH) stimulation testing (ACTHst) often involve intravenous (IV) injection of corticotropin. ACTH might be unintentionally injected into the perivascular (PV) space. Objective To compare stimulation test results after IV and PV injections of ACTH. Animals Twenty privately owned dogs were studied: 10 healthy and 10 with trilostane‐treated naturally occurring hyperadrenocorticism (HAC). Methods Prospective study. Each of 20 dogs underwent 2 ACTHst not <4 nor more than 14 days apart. Five healthy and 5 HAC dogs had an IV ACTHst first and PV second; 5 healthy and 5 HAC dogs had a PV ACTHst first and IV second. Blood samples for measurement of serum cortisol concentration were collected before and 1 hour after ACTH administration. Results No significant difference in results was demonstrated when comparing serum cortisol concentrations after IV and PV ACTH administration in all 20 dogs (median μg/dL; interval μg/dL: 8.2; 1.4–17.4 versus 7.8; 0.9–16.9; P = .23). No significant difference in results was demonstrated when comparing serum cortisol concentrations after IV and PV ACTH administration in the 10 healthy dogs (median μg/dL; interval μg/dL: 10.9; 7.3–17.4 versus 10.6; 7.1–16.9; P = .54) or in the 10 HAC dogs (median μg/dL; interval μg/dL: 6.3; 1.4–8.6 versus 5.2; 0.9–8.7; P = .061). Conclusions and Clinical Importance Perivascular administration of ACTH does not significantly alter stimulation test results in healthy dogs or in dogs with HAC undergoing therapy with trilostane.
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Affiliation(s)
- C M Johnson
- Department of Small Animal Internal Medicine, Animal Specialty and Emergency Center, Los Angeles, CA
| | - P H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine and School of Medicine, University of California, Davis, CA
| | - T A Cohen
- Department of Small Animal Internal Medicine, Animal Specialty and Emergency Center, Los Angeles, CA
| | - E C Feldman
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
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Martins RC, Jericó MM. Uso de baixa dose de ACTH sintético no teste de estimulação da função adrenal para o diagnóstico e controle do hiperadrenocorticismo canino: avaliação da eficácia diagnóstica. PESQUISA VETERINÁRIA BRASILEIRA 2017. [DOI: 10.1590/s0100-736x2017000300007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO: O teste de estimulação com ACTH é o teste de escolha para realizar o controle dos valores de cortisol endógeno em pacientes sob tratamento para o hiperadrenocorticismo canino, podendo ser utilizado também para diagnosticar a doença. Os protocolos atuais utilizam doses que variam entre 5ug/kg a 250ug/animal por administração intravenosa ou intramuscular. Não se constatam estudos com doses menores que as de 5ug/kg em pacientes portadores de hiperadrenocorticismo. No presente estudo, foi testada a dose de 1ug/kg/IV; comparada à dose consagrada de 5ug/kg/IV, em grupos de animais suspeitos de HAC (HAC Diag), animais portadores de HAC e em tratamento (HAC Control) e animais sadios (Sadios). Na dose de 1ug/kg/IV, os valores basais de cortisol dos Sadios foram iguais à média 2,40ug/dL(+/-1,57ug/dL), dos HAC control foi de média 1,53ug/dL(+/-0,93,ug/dL) e dos HAC diag foi média 3,37ug/dL(+/-1,57ug/dL). Os valores pós-ACTH na dose de 1ug/kg foram de média 11,43ug/dL(+/-2,46ug/dL) para animais sadios, 2,67ug/dL(+/-1,39ug/dL) para o grupo HAC Control e média 16,56ug/dL(+/-7,62ug/dL) para o grupo HAC Diag. Os valores basais de cortisol na dose de 5ug/kg foram 0,89ug/dL(+/-0,23ug/dL) para o grupo HAC Control; média 3,08ug/dL(+/-1,99 ug/dL) para o grupo HAC Diag. Os valores pós-ACTH na dose de 5ug/kg foram de média 3,71ug/dL(+/-1,57ug/dL), para o grupo HAC control e média 22,52ug/dL (+/-8,75ug/dL) para o grupo HAC diag. Analisando-se os resultados obtidos, constatou-se que as doses 1 e 5ug/kg de ACTH sintético não diferem entre si, promovendo o mesmo tipo de variação nos valores de cortisol (ANOVA; p=0,225). Também, que a dose de 1ug/kg de ACTH foi igualmente eficaz na elevação dos níveis de cortisol nos três grupo testados (Sadios, HAC Control e HAC Diag; ANOVA, p<0,05). E, pelo teste de Dunn observamos que o grupo HAC control apresenta Δ-cortisol (delta =diferença entre cortisol após estimulo e o cortisol basal) significativamente menor que o dos grupos diagnóstico (p<0,05) e animais sadios (p<0,05). Concluiu-se que a dose de 1ug/kg de ACTH sintético pode ser utilizada com eficácia para a realização do teste de estimulação com ACTH.
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Macfarlane L, Parkin T, Ramsey I. Pre-trilostane and three-hour post-trilostane cortisol to monitor trilostane therapy in dogs. Vet Rec 2016; 179:597. [PMID: 27803375 PMCID: PMC5256409 DOI: 10.1136/vr.103744] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2016] [Indexed: 11/18/2022]
Abstract
It is recommended that trilostane therapy of canine hyperadrenocorticism is monitored using an ACTH stimulation test, however this has never been validated. Three cortisol concentrations (pre-trilostane, 3-hour posttrilostane and 1-hour post-ACTH stimulation) were compared to a clinical score obtained from an owner questionnaire. There were 110 sets of 3 cortisol measurements and questionnaires obtained from 67 trilostane treated dogs. Questionnaire results were used to classify each dog as well or unwell. Well dogs were then categorised as having excellent, moderate or poor hyperadrenocorticism control, using thresholds produced by 14 independent veterinarians. Correlation co-efficients were used to compare the three cortisol concentrations to the owner score and the Kruskal Wallis and Mann-Whitney U tests were used to compare the three cortisol concentrations between categories of control. Cortisol cut-off values between significantly different categories were determined using ROC curves. Pre-trilostane and 3-hour post-trilostane cortisol were better correlated to the owner score and had cut-offs to differentiate between categories of control that had superior sensitivity and specificity results, than the post-ACTH cortisol. Iatrogenic hypoadrenocorticism was not detected in any unwell dog. This study shows that the pre-trilostane and 3-hour post-trilostane cortisol are potentially better monitoring methods than the ACTH stimulation test.
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Affiliation(s)
- L Macfarlane
- North Downs Specialist Referral, Friesian Buildings 3&4, The Brewerstreet Dairy Business Park, Brewer Street, Bletchingley, Surrey RH1 4QP, UK
| | - T Parkin
- Weipers Centre Equine Hospital, University of Glasgow, Glasgow, UK
| | - I Ramsey
- Small Animal Hospital, University of Glasgow, Glasgow, UK
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Aldridge C, Behrend EN, Kemppainen RJ, Lee-Fowler TM, Martin LG, Ward CR, Bruyette D, Pannu J, Gaillard P, Lee HP. Comparison of 2 Doses for ACTH Stimulation Testing in Dogs Suspected of or Treated for Hyperadrenocorticism. J Vet Intern Med 2016; 30:1637-1641. [PMID: 27425787 PMCID: PMC5032869 DOI: 10.1111/jvim.14528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/10/2016] [Accepted: 06/28/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Lowering the cosyntropin dose needed for ACTH stimulation would make the test more economical. OBJECTIVES To compare the cortisol response to 1 and 5 μg/kg cosyntropin IV in dogs being screened for hyperadrenocorticism (HAC) and in dogs receiving trilostane or mitotane for pituitary-dependent HAC. ANIMALS Healthy dogs (n = 10); client-owned dogs suspected of having HAC (n = 39) or being treated for pituitary-dependent HAC with mitotane (n = 12) or trilostane (n = 15). PROCEDURES In this prospective study, healthy dogs had consecutive ACTH stimulation tests to ensure 2 tests could be performed in sequence. For the first test, cosyntropin (1 μg/kg IV) was administered; the second test was initiated 4 hours after the start of the first (5 μg/kg cosyntropin IV). Dogs suspected of having HAC or being treated with mitotane were tested as the healthy dogs. Dogs receiving trilostane treatment were tested on consecutive days at the same time post pill using the low dose on day 1. RESULTS In dogs being treated with mitotane or trilostane, the 2 doses were pharmacodynamically equivalent (90% confidence interval, 85.1-108.2%; P = 0.014). However, in dogs suspected of having HAC, the doses were not pharmacodynamically equivalent (90% confidence interval, 73.2-92.8%; P = 0.37); furthermore, in 23% of the dogs, clinical interpretation of test results was different between the doses. CONCLUSIONS AND CLINICAL RELEVANCE For dogs suspected of having HAC, 5 μg/kg cosyntropin IV is still recommended for ACTH stimulation testing. For dogs receiving mitotane or trilostane treatment, a dose of 1 μg/kg cosyntropin IV can be used.
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Affiliation(s)
- C Aldridge
- Department of Clinical Sciences, Auburn University, Auburn, AL
| | - E N Behrend
- Department of Clinical Sciences, Auburn University, Auburn, AL.
| | - R J Kemppainen
- Department of Anatomy, Physiology, and Pharmacology, Auburn University, Auburn, AL
| | - T M Lee-Fowler
- Department of Clinical Sciences, Auburn University, Auburn, AL
| | - L G Martin
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, WA
| | - C R Ward
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA
| | - D Bruyette
- VCA West Los Angeles Animal Hospital, Los Angeles, CA
| | - J Pannu
- Department of Mathematics and Statistics, Auburn University, Auburn, AL
| | - P Gaillard
- Department of Mathematics and Statistics, Auburn University, Auburn, AL
| | - H P Lee
- Department of Clinical Sciences, Auburn University, Auburn, AL
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Woolcock AD, Bugbee AC, Creevy KE. Evaluation of baseline cortisol concentration to monitor efficacy of twice-daily administration of trilostane to dogs with pituitary-dependent hyperadrenocorticism: 22 cases (2008-2012). J Am Vet Med Assoc 2016; 248:814-21. [PMID: 27003023 DOI: 10.2460/javma.248.7.814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate use of cortisol concentration prior to ACTH stimulation (baseline) to monitor efficacy of twice-daily administration of trilostane to dogs with pituitary-dependent hyperadrenocorticism (PDH). DESIGN Retrospective case series. ANIMALS 22 dogs with PDH. PROCEDURES The database of a veterinary hospital was searched to identify dogs with PDH that were treated with the FDA-approved veterinary formulation of trilostane twice daily between January 1, 2008, and December 31, 2012. For each dog, signalment and details regarding each hospital visit including comorbidities, electrolyte concentrations, and clinical signs were extracted from the record. For each ACTH stimulation test performed, the respective correlations between baseline cortisol concentration and the cortisol concentration after ACTH stimulation (ACTH-stimulated cortisol concentration) and resultant decision regarding trilostane dose adjustment were determined. Excessive suppression of cortisol production was defined as an ACTH-stimulated cortisol concentration < 2.0 μg/dL. The ability of various baseline cortisol concentrations to predict whether a dog had excessive suppression of cortisol production was determined. RESULTS 109 ACTH stimulation tests were performed for the 22 dogs. A baseline cortisol concentration > 3.2 μg/dL predicted that ACTH-stimulated cortisol concentration would be ≥ 2.0 μg/dL with 100% certainty; however, 14 of 64 tests with a baseline cortisol concentration > 3.2 μg/dL had an ACTH-stimulated cortisol concentration ≤ 3.2 μg/dL, which was suggestive of inadequate adrenocortical cortisol reserves. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that baseline cortisol concentration should not be used as the sole monitoring tool for management of dogs with PDH treated with trilostane twice daily.
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Midence JN, Drobatz KJ, Hess RS. Cortisol Concentrations in Well-Regulated Dogs with Hyperadrenocorticism Treated with Trilostane. J Vet Intern Med 2015; 29:1529-33. [PMID: 26374943 PMCID: PMC4895678 DOI: 10.1111/jvim.13615] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/29/2015] [Accepted: 08/10/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There are no clear treatment guidelines for dogs with clinically well-regulated hyperadrenocorticism in which serum cortisol concentrations before and after an ACTH stimulation test performed 3-6 hours after trilostane administration are < 2.0 μg/dL. OBJECTIVE To determine if serum cortisol concentrations measured before (Pre1) and after (Post1) ACTH stimulation at 3-6 hours after trilostane administration are significantly lower than cortisol concentrations measured before (Pre2) and after (Post2) ACTH stimulation 9-12 hours after trilostane administration, in a specific population of dogs with clinically well-regulated hyperadrenocorticism and Pre1 and Post1 <2 μg/dL. ANIMALS Thirteen client-owned dogs with clinically well-regulated hyperadrenocorticism and Pre1 and Post1 serum cortisol concentrations <2.0 μg/dL 3-6 hours after trilostane administration. METHODS Prospective study. Dogs had a second ACTH stimulation test performed 9-12 hours after trilostane administration, on the same day of the first ACTH stimulation test. Cortisol concentrations before and after ACTH stimulation were compared using a paired t-test. RESULTS Cortisol concentrations before (1.4 ± 0.3 μg/dL) and after the first stimulation (1.5 ± 0.3 μg/dL, mean ± SD) were significantly lower than cortisol concentration before the second stimulation (3.3 ± 1.6 μg/dL, P = .0012 each). Cortisol concentration before the first stimulation was also significantly lower than cortisol concentration after the second stimulation (5.3 ± 2.4 μg/dL, P = .0001). CONCLUSIONS AND CLINICAL IMPORTANCE In dogs with clinically well-regulated, trilostane-treated, hyperadrenocorticism, and cortisol concentrations <2 μg/dL before and after the first stimulation, a second ACTH stimulation test performed 9-12 hours after treatment can result in higher cortisol concentrations that could support continued trilostane treatment.
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Affiliation(s)
- J N Midence
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - K J Drobatz
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - R S Hess
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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