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1426.e2 Hyperadrenocorticism: Mitotane Maintenance for Pituitary Disease

Hyperadrenocorticism: Mitotane Maintenance for Pituitary Disease
VetBooks.ir

Clinical signs of HAC recur
OR
Scheduled recheck

ACTH stimulation test

Response below ideal Response ideal Response above ideal

• No further mitotane Continue therapy as is Post-ACTH Post-ACTH substantially
• Repeat ACTH stim mildly elevated elevated
in 2-3 weeks (160–250 nmol/L) (>250 nmol/L)

Increase mitotane Reinitiate induction protocol
Response below ideal Response ideal dose 25% and repeat for 5–7 days,
ACTH stim in 4 weeks then repeat ACTH stim

If cortisol non- Reinitiate maintenance
detectable, therapy at 25% lower dose When control achieved
+
measure Na /K + as judged by ACTH stim,
reinstitute maintenance therapy
at 50% higher dose
Note: Ideal range is approximately 30–150 nmol/L pre- and post-ACTH; normal resting range is approximately 10–160 nmol/L.
HAC, Hyperadrenocorticism; ACTH stim, ACTH stimulation test.
(From Rand J, Behrend E, Gunn-Moore D, Campbell-Ward M, editors: Clinical endocrinology of companion animals. New York: Wiley-Blackwell, 2013.)
AUTHOR & EDITOR: Ellen N. Behrend, VMD, PhD, DACVIM

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