Adrenalectomies in ADH Cushings

RE: Adrenalectomies in ADH Cushings

grumpyoldman — Mon, 05 Feb 2018 23:55:34 GMT

I always offer thyroidectomy if you have fine instruments and a loupe or an operating microscope and some beaver blades the parathyroid shows up like a golf ball .its a very quick easy surgery. The clients with forumitis are the ones that elect for meds only after tales of hypocalcaemic horror stories.

RE: Adrenalectomies in ADH Cushings

Thomas Johnson — Sat, 03 Feb 2018 09:23:40 GMT

[quote user="Beats"]

[quote user="Thomas Johnson"]It continues to surprise me the number of clients who decide to continue medicating their cats rather than book them in for a thyroidectomy.[/quote]

Could it be clinic pricing structure?

Generally clients pick the cheapest reasonable option in my experience. Here that would be a thyroidectomy and that is what most choose.

If they're concerned about the anesthetic/surgical risks, I would let them read the warnings on the medicine bottle and advice on all the monitoring that is apparently required.

[/quote]

Thyroidectomy does work out cheaper than long-term medication and monitoring with our pricing structure, and I enjoy doing thyroidectomies and try to encourage clients to take that route (obviously discuss radioactive iodine as well).

RE: Adrenalectomies in ADH Cushings

Beats — Fri, 02 Feb 2018 20:18:19 GMT

[quote user="Thomas Johnson"]It continues to surprise me the number of clients who decide to continue medicating their cats rather than book them in for a thyroidectomy.[/quote]

Could it be clinic pricing structure?

Generally clients pick the cheapest reasonable option in my experience. Here that would be a thyroidectomy and that is what most choose.

If they're concerned about the anesthetic/surgical risks, I would let them read the warnings on the medicine bottle and advice on all the monitoring that is apparently required.

RE: Adrenalectomies in ADH Cushings

Beats — Fri, 02 Feb 2018 20:14:24 GMT

[quote user="David Mills"]Like hyperthyroidism, I'm surprised it's not been made more of a surgical disease.[/quote]

I think it's trendy to take out the pituitary these days, e.g.:

https://www.ncbi.nlm.nih.gov/pubmed/12431801

http://onlinelibrary.wiley.com/doi/10.1111/jvim.14367/pdf

[not that I'm recommending trying!]

Personally, I'm surprised that so many cases need treated. Though perhaps I've just had a poor track record with the ones I have seen and that has clouded my judgement. A drug rep once chastised me for not picking up subtle cases of HAC and treating them - if they're subtle, I'm not going to treat them, even if I did pick them up. If they're glaringly obvious to the man in the chip shop I don't always treat them either.

Carmel Mooney gives a balanced argument on the decision to treat or not [not found in Dechra-sponsored literature that I've seen]:

http://onlinelibrary.wiley.com/doi/10.1111/j.2044-3862.2009.tb00396.x/abstract

RE: Adrenalectomies in ADH Cushings

Thomas Johnson — Fri, 02 Feb 2018 17:54:40 GMT

[quote user="David Mills"]Like hyperthyroidism, I'm surprised it's not been made more of a surgical disease.[/quote]

It continues to surprise me the number of clients who decide to continue medicating their cats rather than book them in for a thyroidectomy.

RE: Adrenalectomies in ADH Cushings

David Mills — Fri, 02 Feb 2018 17:49:31 GMT

Great, thanks. Suspect we will give it a go, and save ourselves about 12k a year. Can see a case series in the making.

The literature talks about clots being an issue intra/periop but will see. Like hyperthyroidism, I'm surprised it's not been made more of a surgical disease.

RE: Adrenalectomies in ADH Cushings

grumpyoldman — Thu, 01 Feb 2018 20:31:20 GMT

Yes, sorry they were PDH . I always preferred lysodren until the Bristol Myers fiasco. Pred does have some mineralocorticoid activity, we have had Addisons on the cheap do well on just pred.

RE: Adrenalectomies in ADH Cushings

David Mills — Thu, 01 Feb 2018 20:23:42 GMT

Have you done them for PDH too? Can't see why it wouldn't work. Obviously would need some supplementation after bilateral adrenalectomy, good to know preds worked (I've always been very sceptical dogs need specific mineralocorticoid).

RE: Adrenalectomies in ADH Cushings

grumpyoldman — Thu, 01 Feb 2018 18:50:21 GMT

I did it several times when Lysodren disappeared pre vetoryl. One Yorkie I remember George Waite went on to survive just on pred 2.5mg daily for about 6 years. We started that one on Fflorineff as well but the owners stopped it soon afterwards on cost grounds. Don't recall any problems but I can imagine the Internal medicine PC police would be waiting around a corner for you to stub your toe these days, "kings new clothes" etc It was no more difficult than a ferret adrenalectomy. My last one in a dog was a phacochromocytoma in an SBT popped out quite well and the dog did fine until the mets started to recreate the hypertension about 9 months later. Never tried it in a cat with Cons syndrome ,keep looking but they are usually so old and knackered by the time you get them the owners are already digging a hole.