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Today's VeTerinary PracTice | January/February 2016 | tvpjournal.com canine PiTuiTary dePendenT HyPeradrenocorTicism series Peer reviewed 44 10. Foster SF, Church DB, Watson ADJ. Effect of phenobarbitone on the low-dose dexamethasone suppression test and the urinary corticoid:creatinine ratio in dogs. Aust Vet J 2000; 78:19-23. 11. Monroe WE, Panciera DL, Zimmerman KL. Concentrations of noncortisol adrenal steroids in response to ACTH in dogs with adrenal-dependent hyperadrenocorticism, pituitary-dependent hyperadrenocorticism, and nonadrenal illness. J Vet Intern Med 2012; 26:945-952. 12. Cohen TA, Feldman EC. Comparison of IV and IM formulations of synthetic ACTH for ACTH stimulation tests in healthy dogs. J Vet Intern Med 2012; 26:412-414. 13. Kemppainen RJ, Behrend EN, Busch KA. Use of compounded adrenocorticotropic hormone (ACTH) for adrenal function testing in dogs. JAAHA 2005; 41:368-372. 14. Behrend EN, Kemppainen RJ, Bruyette DS. Intramuscular administration of a low dose of ACTH for ACTH stimulation testing in dogs. JAVMA 2006; 229:528-530. 15. Kerl ME, Peterson ME, Wallace MS, et al. Evaluation of a low-dose synthetic adrenocorticotropic hormone stimulation test in clinically normal dogs and dogs with naturally developing hyperadrenocorticism. JAVMA 1999; 214:1497-1501. 16. Frank LA, DeNovo RC, Kraje AC, Oliver J. Cortisol concentrations following stimulation of healthy and adrenopathic dogs with two doses of tetracosactrin. J Small Anim Pract 2000; 41:308-311. 17. Martin LG, Behrend EN, Mealey KL, et al. Effect of low doses of cosyntropin on serum cortisol concentrations in clinically normal dogs. Am J Vet Res 2007; 68:555-560. 18. Ginel PJ, Sileo PJ, Blanco B, et al. Evaluation of serum concentrations of cortisol and sex hormones of adrenal gland origin after stimulation with two synthetic ACTH preparations in clinically normal dogs. Am J Vet Res 2012; 73:237-241. 19. Frank LA, Oliver J. Comparison of serum cortisol concentrations in clinically normal dogs after administration of freshly reconsti - tuted versus reconstituted and stored frozen cosyntropin. JAVMA 1998; 212:1569-1571. 20. Stolp R, Rijnberk A, Meijer JC, Croughs JM. Urinary corticoids in the diagnosis of canine hyperadrenocorticism. Res Vet Sci 1983; 34:141-144. 21. Jensen AL, Iverson L, Koch J, et al. Evaluation of the urinary cortisol:creatinine ratio in the diagnosis of hyperadrenocorticism in dogs. J Small Anim Pract 1997; 38:99-102. 22. Rijnberk A, van Wees A, Mol JA. Assessment of two tests for the diagnosis of canine hyper - adrenocorticism. Vet Rec 1988; 122:178-180. 23. Castillo V, Blatter C, Gomez NV, et al. Diurnal ACTH and plasma cortisol variations in healthy dogs and in those with pituitary-de - pendent Cushing's syndrome before and after treatment with retinoic acid. Res Vet Sci 2009; 86:223-229. 24. Hanson JM, Kooistra HS, Mol JA, et al. Plasma profles of adenocorticotropic hormone, cortisol, alpha-melanocyte- stimulating hormone, and growth hormone in dogs with pituitary-dependent hyperadrenocorticism before and after hypophysectomy. J Endocrinol 2006; 190:601- 609. 25. Kemppainen RJ, Clark TP, Peterson ME. Preservative effect of aprotinin on canine plasma immunoreactive adrenocorticotropin concentrations. Domest Anim Endocrinol 1993; 11:355-362. 26. Rodriguez Pineiro MI, Benchekroun G, de Fornel-Thibaud P, et al. Accuracy of an adrenocorticotropic hormone (ACTH) immunoluminometric assay for differentiating ACTH-dependent from ACTH-independent hyperadrenocorticism in dogs. J Vet Intern Med 2009; 23:850-855. 27. Scott-Moncrieff JCR, Koshko M, Brown JA, et al. Validation of chemiluminescent enzyme immunometric assay for plasma adrenocorticotropic hormone in the dog. Vet Clin Pathol 2003; 32:180-187. 28. Zeugswetter F, Pagitz M, Hittmair K, Schwendenwein I. Diagnostic effcacy of plasma ACTH-measurement by a chemiluminometric assay in canine hyperadrenocorticism. Schweiz Arch Tierheilkd 2011; 153:111-116. 29. Bosje JT, Rijnberk A, Mol JA, et al. Plasma concentrations of ACTH precursors correlate with pituitary size and resistance to dexamethasone in dogs with pituitary- dependent hyperadrenocorticism. Domest Anim Endocrinol 2002; 22:201-210. 30. Reusch CE, Feldman EC. Canine hyperadrenocorticism due to adrenocortical neoplasia. Pretreatment evaluation of 41 dogs. J Vet Int Med 1995; 5:3-10. 31. Galac S, Buijtels JJCWM, Kooistra HS. Urinary corticoid:creatinine ratios in dogs with pituitary-dependent hypercortisolism during trilostane treatment. J Vet Intern Med 2009; 23:1214-1219. 32. Berry CR, Hawkins EC, Hurley KJ, Monce K. Frequency of pulmonary mineralization and hypoxemia in 21 dogs with pituitary- dependent hyperadrenocorticism. J Vet Intern Med 2000; 14:151-156. 33. Schwarz T, Stork CK, Mellor D, Sullivan M. Osteopenia and other radiographic signs in canine hyperadrenocorticism. J Small Anim Pract 2000; 41:491-495. 34. Rodriguez Pineiro MI, de Fornel-Thibaud P, Benchekroun G, et al. Use of computed tomography adrenal gland measurement for differentiating ACTH dependence from ACTH independence in 64 dogs with hyperadenocorticism. J Vet Intern Med 2011; 25:1066-1074. 35. Benchekroun G. Ultrasonography crite - ria for differentiating ACTH dependency from ACTH independency in 47 dogs with hyperadrenocorticism and equivocal adrenal asymmetry. J Vet Intern Med 2010; 24:1077- 1085. 36. Schultz RM, Wisner ER, Johnson EG, MacLeod JS. Contrast-enhanced computed tomography as a preoperative indicator of vascular invasion from adrenal masses in dogs. Vet Radiol Ultrasound 2009; 50:625-629. 37. Auriemma E, Barthez PY, van der Vlugt-Meijer RH, et al. Computed tomography and low- magnetic resonance imaging of the pituitary gland in dogs with pituitary-dependent hyperadrenocorticism: 11 cases (2001-2003). JAVMA 2009; 235:409-414. 38. van der Vlugt-Meijer RH, Meij BP, van den Ingh TSGAM, et al. Dynamic computed tomography of the pituitary gland in dogs with pituitary-dependent hyperadrenocorticism. J Vet Intern Med 2003; 17:773-780. 39. Taoda T, Hara Y, Masuda H, et al. Magnetic resonance imaging assessment of pituitary posterior lobe displacement in dogs with pituitary-dependent hyperadrenocorticism. J Vet Med Sci 2011; 73:725-731. VETORYL ® Capsules (trilostane) 10 mg, 30 mg, 60 mg and 120 mg strengths Adrenocortical suppressant for oral use in dogs only BRiEf SummaRY (For Full Prescribing Information, see package insert.) CauTiOn: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. DESCRipTiOn: VETORYL is an orally active synthetic steroid analogue that blocks production of hormones produced in the adrenal cortex of dogs. inDiCaTiOnS: VETORYL CAPSULES are indicated for the treatment of pituitary-dependent hyperadrenocorticism in dogs. VETORYL CAPSULES are indicated for the treatment of hyperadrenocorticism due to adrenocortical tumor in dogs. C O nTRainDiCaT i OnS: The use of VETORYL CAPSULES is contraindicated in dogs that have demonstrated hypersensitivity to trilostane. Do not use VETORYL CAPSULES in animals with primary hepatic disease or renal insuffciency. Do not use in pregnant dogs. Studies conducted with trilostane in laboratory animals have shown teratogenic effects and early pregnancy loss. WaRningS: In case of overdosage, symptomatic treatment of hypoadrenocorticism with corticosteroids, mineralocorticoids and intravenous fuids may be required. Angiotensin converting enzyme (ACE) inhibitors should be used with caution with VETORYL CAPSULES, as both drugs have aldosterone-lowering effects which may be additive, impairing the patient's ability to maintain normal electrolytes, blood volume and renal perfusion. Potassium sparing diuretics (e.g. spironolactone) should not be used with VETORYL CAPSULES as both drugs have the potential to inhibit aldosterone, increasing the likelihood of hyperkalemia. Human WaRningS: Keep out of reach of children. Not for human use. Wash hands after use. Do not empty capsule contents and do not attempt to divide the capsules. Do not handle the capsules if pregnant or if trying to conceive. Trilostane is associated with teratogenic effects and early pregnancy loss in laboratory animals. In the event of accidental ingestion/overdose, seek medical advice immediately and take the labeled container with you. pRECauTiOnS: Hypoadrenocorticism can develop at any dose of VETORYL CAPSULES. In some cases, it may take months for adrenal function to return and some dogs never regain adequate adrenal function. A small percentage of dogs may develop corticosteroid withdrawal syndrome within 10 days of starting treatment. This phenomenon results from acute withdrawal of circulating glucocorticoids; clinical signs include weakness, lethargy, anorexia, and weight loss 1 . These clinical signs should be differentiated from an early hypoadrenocortical crisis by measurement of serum electrolyte concentrations and performance of an ACTH stimulation test. Corticosteroid withdrawal syndrome should respond to cessation of VETORYL CAPSULES (duration of discontinuation based on the severity of the clinical signs) and restarting at a lower dose. Mitotane (o,p'-DDD) treatment will reduce adrenal function. Experience in foreign markets suggests that when mitotane therapy is stopped, an interval of at least one month should elapse before the introduction of VETORYL CAPSULES. It is important to wait for both the recurrence of clinical signs consistent with hyperadrenocorticism, and a post-ACTH cortisol level of > 9.1 μg/dL (> 250 nmol/L) before treatment with VETORYL CAPSULES is initiated. Close monitoring of adrenal function is advised, as dogs previously treated with mitotane may be more responsive to the effects of VETORYL CAPSULES. The use of VETORYL CAPSULES will not affect the adrenal tumor itself. Adrenalectomy should be considered as an option for cases that are good surgical candidates. The safe use of this drug has not been evaluated in lactating dogs and males intended for breeding. aDVERSE REaCTiOnS: The most common adverse reactions reported are poor/reduced appetite, vomiting, lethargy/dullness, diarrhea, and weakness. Occasionally, more serious reactions, including severe depression, hemorrhagic diarrhea, collapse, hypoadrenocortical crisis or adrenal necrosis/rupture may occur, and may result in death. Distributed by: Dechra Veterinary p roducts 7015 College Boulevard, Suite 525 Overland Park, KS 66211 VETORYL is a trademark of Dechra Ltd. © 2011, Dechra Ltd. NADA 141-291, Approved by FDA 1 Greco DS, Behrend EN (1995) Corticosteroid withdrawal syndrome. In: Kirk's Current Veterinary Therapy XII; Bonagura, J. (ed); WB Saunders, Philadelphia PA: pp 413-5. TODAY'S VETERINARY PRACTICE | January/February 2016 CANINE PITUITARY DEPENDENT HYPERADRENOCORTICISM SERIES 44