Veterinary Medicine - February 2008 - (Page 117) CE Article #2 You can earn two hours of Continuing Education credit from Kansas State University by answering the following questions on hyperadrenocorticism and trilostane. Circle only the best answer for each question, and transfer your answers to the form on page 118 or take the test online at https://www.dce.ksu.edu/ce/vetmed/. This test expires March 1, 2009. 1. Which clinical sign is not consistent with hyperadrenocorticism? a. Polydipsia b. Abdominal distention c. Pyoderma d. Anorexia e. Panting 5. Which statement about trilostane is true? a. It is slowly absorbed after oral ingestion. b. It undergoes hepatic metabolism. c. It may be safely used in pregnant or nursing bitches. d. Peak serum concentrations occur 24 hours after administration. e. It preferentially inhibits aldosterone production. d. Continue trilostane, but give prednisone. e. Switch to mitotane. 8. The target result for the post-ACTH stimulation test cortisol concentration in patients receiving trilostane is: a. < 1.5 µg/dl b. 1.5 to 5.5 µg/dl c. 9 µg/dl e. Lower than the resting cortisol concentration 2. Which laboratory finding is not consistent with hyperadrenocorticism? a. Neutrophilia b. Anemia c. Thrombocytosis d. Increased ALP activity e. Proteinuria 6. Which tests are most appropriate when monitoring a patient receiving trilostane? a. A serum chemistry profile and an ACTH stimulation test b. A complete blood count and an ACTH stimulation test c. A serum chemistry profile and a lowdose dexamethasone suppression test d. A serum chemistry profile and a high-dose suppression dexamethasone test e. A complete blood count and a serum chemistry profile 9. Which statement about alopecia X is false? a. It is due to an arrest in the hair growth cycle. b. It is most often reported in Pomeranians, poodles, and huskies. c. It may respond to trilostane therapy. d. It is usually caused by an adrenal tumor. e. It may be related to changes in growth hormone synthesis. 3. Which is not a recognized therapy for PDH? a. Mitotane b. Ketoconazole c. Trilostane d. Hypophysectomy e. Unilateral adrenalectomy 4. Trilostane lowers the serum cortisol concentration by: a. Inhibiting cytochrome P450 enzymes b. Competitive inhibition of 3-betahydroxysteroid dehydrogenase c. Destruction of 3-beta-hydroxysteroid dehydrogenase d. Direct damage to the cells of the zona fasciculata e. Direct damage to the cells of the zona glomerulosa 10. Trilostane can be imported 7. If a patient receiving trilostane becomes hyperkalemic, which of the following is the best option? a. Increase the dose by 50%. b. Decrease the dose by 50%. c. Stop trilostane, provide fluid support, perform an ACTH stimulation test, and consider glucocorticoid and mineralocorticoid supplementation. legally if: a. The veterinarian contacts the FDA for approval b. The veterinarian writes a prescription c. The drug is provided by an authorized supplier d. The drug is only given to the animal named in the FDA application e. All of the above dog receiving trilostane for the treatment of hyperadrenocorticism. J Small Anim Pract 2004;45(6):307-310. 17. Reusch CE, Sieber-Ruckstuhl N, Wenger M, et al. Histological evaluation of the adrenal glands of seven dogs with hyperadrenocorticism treated with trilostane. Vet Rec 2007;160(7):219-224. 18. Feldman EC, Nelson RW, Feldman MS, et al. Comparison of mitotane treatment for adrenal tumor versus pituitary-dependent hyperadrenocorticism in dogs. J Am Vet Med Assoc 1992;200(11):1642-1647. 19. Plumb DC. Plumb’s veterinary drug handbook. 5th ed. Ames, Iowa: Blackwell Publishing, 2005;537-539. 20. Behrend EN, Kemppainen RJ. Medical therapy of canine Cushing’s syndrome. Compend Contin Educ Pract Vet 1998;20:679-697. 21. Eastwood JM, Elwood CE, Hurley KJ. Trilostane treatment of a dog with functional adrenocortical neoplasia. J Small Anim Pract 2003;44(3):126-131. 22. Benchekroun G, de Fornel-Thibaud P, Lafarge S, et al. Trilostane therapy of four dogs with metastatic secreting adrenocortical tumor, in Proceedings. Forum Am Coll Vet Intern Med 2007. 23. Frank LA, Hnilica KA, Oliver JW. Adrenal steroid hormone concentrations in dogs with hair cycle arrest (Alopecia X) before and during treatment with melatonin and mitotane. Vet Dermatol 2004;15(5):278-284. 24. Cerundolo R, Lloyd DH, Persechino A, et al. Treatment of canine Alopecia X with trilostane. Vet Dermatol 2004;15(5):285-293. 25. Leone F, Cerundolo R, Vercelli A, et al. The use of trilostane for the treatment of alopecia X in Alaskan malamutes. J Am Anim Hosp Assoc 2005;41(5):336-342. 26. Ristic JME, Ramsey IK, Heath EM, et al. The use of 17hydroxyprogesterone in the diagnosis of canine hyperadrenocorticism. J Vet Intern Med 2002;16(4):433-439. EXTRAS See related content on including a client handout on canine hyperadrenocorticism and information about steroid hepatopathy in dogs. VETERINARY MEDICINE February 2008 117 https://www.dce.ksu.edu/ce/vetmed/ http://www.vetstreamcanis.com/ACI/February08/VMD2/FactSheet052.asp http://www.vetstreamcanis.com/ACI/February08/VMD2/FactSheet052.asp http://www.vetstreamcanis.com/ACI/February08/VMD1/dis01096.asp http://www.vetstreamcanis.com/ACI/February08/VMD1/dis01096.asp
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