Page 990 - Cote clinical veterinary advisor dogs and cats 4th

Hyperadrenocorticism 486.e1

Gastrointestinal signs
(i.e., decreased appetite, anorexia,
VetBooks.ir Diseases and Disorders
vomiting and/or diarrhea)

Consider:
1. Hypocortisolism
2. Direct side effects
3. Unrelated to mitotane

Discontinue mitotane
until evaluation ASAP

History, PE
CBC/Profile/UA
Imaging (if needed)

Problem identified Problem not identified

Address problem; ACTH stimulation
continue to treat HAC test

PDH

ATH
Cortisol Cortisol
nondetectable detectable

Induction Maintenance
Stop drug administration
and refer to algorithm
Hyperadrenocorticism: Relative cortisol deficiency? Reassess history, PE
Mitotane Induction for Try increasing prednisone CBC/Profile/UA
Pituitary Disease (p. 1426) (0.4 mg/kg/day) Imaging
Induction Maintenance
Signs do not Problem not
resolve identified

Relative cortisol deficiency? Reassess history, PE Drug intolerance; Drug intolerance;
Try prednisone 0.2 mg/kg/day CBC/Profile/UA give lower doses give lower doses
and wean off slowly Imaging more more
frequently frequently

Signs do not resolve Problem not identified Signs do not Signs do not
resolve resolve

Drug intolerance; Drug intolerance; Decrease dose in Decrease dose in
give lower doses more give lower doses more 10%-25% increments 10%-25% increments
frequently frequently until find max tolerable dose until find max tolerable dose
HYPERADRENOCORTICISM Gastrointestinal signs in dogs receiving mitotane as treatment for HAC. (From Rand
J, et al, editors: Clinical endocrinology of companion animals, New York, 2013, Wiley-Blackwell.)

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