5 year old male entire working cocker spaniel with pu/pd since march and very polyphagic. Developed unilateral facial paralysis in the past week.

RE: 5 year old male entire working cocker spaniel with pu/pd since march and very polyphagic. Developed unilateral facial paralysis in the past week.

Stumpy — Thu, 16 Jul 2020 09:31:01 GMT

Thank you, yes I measured length!! but have saved the image on the scanner so can go back and measure properly.

Liver looked homogenous, nothing exciting to see but again I would not be able to pick up subtle changes.

Will look at running endogenous acth.

Thank you so much.

RE: 5 year old male entire working cocker spaniel with pu/pd since march and very polyphagic. Developed unilateral facial paralysis in the past week.

Andrew Kent — Thu, 16 Jul 2020 09:24:53 GMT

Hi Stumpy,

Thanks for the update.

[quote userid="14533" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29211/5-year-old-male-entire-working-cocker-spaniel-with-pu-pd-since-march-and-very-polyphagic-developed-unilateral-facial-paralysis-in-the-past-week/224275#224275"]as a follow on, the dog is very polydipsic , in excess of 3litres a day (weight 14.8kg) and further urine samples were dilute 1.012, 1.015.[/quote]

Sounds fairly convincing.

[quote userid="14533" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29211/5-year-old-male-entire-working-cocker-spaniel-with-pu-pd-since-march-and-very-polyphagic-developed-unilateral-facial-paralysis-in-the-past-week/224275#224275"] scanned the abdomen but I am very basic at scanning but am sure I found the left adrenal which was very enlarged measuring 18mm. I didn't find the right adrenal but that is probably more to do with me.[/quote]

We tend to measure height rather than length of adrenal glands (your image looks like you are measuring the length?) so not sure which your 18mm is. Can you measure the height of the caudal pole?

Any comment on the liver?

[quote userid="14533" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29211/5-year-old-male-entire-working-cocker-spaniel-with-pu-pd-since-march-and-very-polyphagic-developed-unilateral-facial-paralysis-in-the-past-week/224275#224275"]we ran an acth stim test which was positive . basal cortisol was 72.3 and post acth was 902 (125-520).[/quote]

Certainly consistent with HAC but obviously none of the tests have 100% specificity so we need to be confident we have excluded non-adrenal disease.

[quote userid="14533" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29211/5-year-old-male-entire-working-cocker-spaniel-with-pu-pd-since-march-and-very-polyphagic-developed-unilateral-facial-paralysis-in-the-past-week/224275#224275"]I assume at this stage despite lack of physical changes, we can assume hyperadrenocorticism ?[/quote]

Not all dogs have obvious physical changes so agree this may well be the most likely diagnosis.

[quote userid="14533" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29211/5-year-old-male-entire-working-cocker-spaniel-with-pu-pd-since-march-and-very-polyphagic-developed-unilateral-facial-paralysis-in-the-past-week/224275#224275"]If the facial paralysis is linked does that make pituitary based more likely and is MRI indicated?[/quote]

I'm not sure this is linked as a pituitary mass should not impact the facial nerve. This may be more likely idiopathic unless there are other neuro deficits.

But pituitary is more common - you could measure endogenous ACTH if its not possible to evaluate completely the adrenals with US.

Andy

RE: 5 year old male entire working cocker spaniel with pu/pd since march and very polyphagic. Developed unilateral facial paralysis in the past week.

Stumpy — Thu, 16 Jul 2020 08:52:26 GMT

Hi Andy

Just as a follow on, the dog is very polydipsic , in excess of 3litres a day (weight 14.8kg) and further urine samples were dilute 1.012, 1.015.

free t4 was also within normal

we ran an acth stim test which was positive . basal cortisol was 72.3 and post acth was 902 (125-520).

I scanned the abdomen but I am very basic at scanning but am sure I found the left adrenal which was very enlarged measuring 18mm. I didn't find the right adrenal but that is probably more to do with me.

I assume at this stage despite lack of physical changes, we can assume hyperadrenocorticism ?

If the facial paralysis is linked does that make pituitary based more likely and is MRI indicated?

Photo is not great as took picture of screen .

Thank you for your advice

RE: 5 year old male entire working cocker spaniel with pu/pd since march and very polyphagic. Developed unilateral facial paralysis in the past week.

Stumpy — Fri, 10 Jul 2020 20:00:46 GMT

Thank you.

RE: 5 year old male entire working cocker spaniel with pu/pd since march and very polyphagic. Developed unilateral facial paralysis in the past week.

Andrew Kent — Fri, 10 Jul 2020 18:20:46 GMT

Hi Stumpy,

Hyperadrenocorticism is certainly a differential for PUPD and polyphagia although your ALP is not that high. I like to try to get the owner to catch a number of urine samples to see what the USG does over a 24 hour period and, ideally, also get the water intake quantified if you can. Especially if there are no external signs strongly indicative of HAC.

I agree that the T4 may well be non-thyroidal as doesn't sound like there is a clinical suspicion of hypothyroidism and there is no anaemia, hypocholesterolemia etc.

I rarely get excited by bile acids at that level so probably not significant.

I would likely do the urine/water testing above and get an abdominal ultrasound if you can to look at adrenals etc.

Andy