Canine Cushing's Case Files: the Ins and Outs of Detection And

Canine Cushing’s Case Files: THE INS AND OUTS OF DETECTION AND TREATMENT 01CS-VET0001-0615 SPON SORED BY DECHRA VETERINARY PRODUCTS Canine Cushing’s Case Files: THE INS AND OUTS OF DETECTION AND TREATMENT CLINICAL ARTICLES PRACTICE-RELATED ARTICLES 6 Case file: DALI 26 Your veterinary team’s role in identifying by Audrey K. Cook, BVM&S, MRCVS, DACVIM, DECVIM dogs with hyperadrenocorticism 8 Case file: PRINCESS 28 Your veterinary team’s role in by Lori Thompson, DVM, DACVD treating and monitoring dogs with hyperadrenocorticism 10 Case file: MITCH by David Bruyette, DVM, DACVIM 30 The economics of managing hyperadrenocorticism in dogs 12 Case file: HOLLY by Fritz Wood, CPA, CFP by Christopher G. Byers, DVM, DACVECC, DACVIM 32 Avoiding practitioner pitfalls 14 Case file: LIBBY with canine Cushing’s cases by Todd M. Archer, DVM, MS, DACVIM by Andy Roark, DVM, MS 16 Case file: BOCA by Cynthia Nichols, DVM DECHRA VETERINARY PRODUCTS 18 Case file: HOWIE SUppLEMENTAL RESOURCES by Christopher G. Byers, DVM, DACVECC, DACVIM 34 Diagnosis, Treatment and Monitoring 20 Case file: CALLIE of Hyperadrenocorticism by Orla Mahony, MVB, DACVIM, DECVIM 37 Technical Brochure for VETORYL® 22 Dogs with recurring pyoderma Capsules (trilostane) by Thomas Lewis, DVM, DACVD 24 5 questions veterinarians ask the Dechra Veterinary Products Technical Services Team hen you know the ins and outs of something, it Dechra Veterinary Products, the manufacturer of VETORYL® Wmeans you know the intricate details, fine points, Capsules (trilostane), understands how challenging the diag- peculiarities, or technicalities of a certain subject. The nosis and management of canine hyperadrenocorticism, or phrase the ins and outs also has a second meaning — the Cushing’s syndrome, can be. The disease can manifest in many different ways and, of course, each patient is unique. To help windings of a road or path. When faced with a case of practitioners and staff recognize the disease and provide the hyperadrenocorticism in a dog, you may feel you are on a best treatment for these patients, Dechra Veterinary Products winding path. Often the diagnosis is not straightforward sponsored a 12-article series for your reference, Canine Cush- or obvious. The clinical signs can be subtle or have a ing’s Case Files: The Ins and Outs of Detection and Treatment, that was inserted in dvm360 magazine throughout 2013. That series gradual onset. And because hyperadrenocorticism is the core of this e-book, along with two bonus case reports, commonly affects older dogs, clients may attribute the available only here. changes they’re observing to “normal aging.” The veterinarians who managed the eight clinical cases in 2 | CANINE CUSHING’S CASE FILES Hyperadrenocorticism affects many adult dogs. Whether the disease is pituitary-dependent (80% to 85% of spontaneous cases) or adrenal- dependent (15% to 20% of cases), the clinical and laboratory abnormal- ities associated with it result from chronic hypercortisolemia. Clinical this e-book describe their diagnostic process and their treat- signs of hyperadrenocorticism at the time of diagnosis can vary widely, ment protocol and share their personal perspective on each and they develop so gradually that owners often mistake the signs for case. In addition, a veterinary dermatologist provides insight “normal” aging. Being aware of the more subtle signs of canine hyper- on why practitioners should consider hyperadrenocorticism in adrenocorticism can be key to early diagnosis and initiation of therapy. dogs that have recurring pyoderma. Whenever possible, pituitary-dependent hyperadrenocorticism As with any type of case, client communication, involvement and adrenal tumors should be differentiated to help guide therapy of the entire veterinary practice team, and understanding the and patient monitoring. Early diagnosis and management of canine financial impact on practice health are critical to skillfully manag- hyperadrenocorticism may not only improve the patient’s clinical ing patients with chronic diseases such as Cushing’s syndrome. To signs but may also keep the more severe consequences of Cushing’s address such issues, this e-book also includes articles on: syndrome from developing. • Answers to the top five questions that veterinarians ask the Dechra Veterinary Products Technical Services Team Common clinical signs of canine hyperadrenocorticism about canine hyperadrenocorticism and VETORYL® Capsules (trilostane). Polyuria (owners may complain Alopecia The veterinary practice team’s role in educating and com- • • • of housesoiling) • Recurrent skin disease municating with clients about identifying, treating, and • Polydipsia • Lethargy monitoring dogs with hyperadrenocorticism • Polyphagia (owners may • Pendulous abdomen • The economics and financial impact of managing Cush- complain of food stealing or • Excessive panting ing’s patients on your practice’s bottom line excessive begging) • Thin skin • Ways to avoid common practitioner pitfalls when providing long-term healthcare for a patient with a chronic disease Other clinical signs may include hypertension, comedones, sebor- rhea, heat intolerance, hyperpigmentation, calcinosis cutis, bruising, At the back of this e-book, we have included additional algo- facial paralysis, failure to cycle, clitoral hypertrophy, testicular atrophy, rithms and other supporting documents we hope you will find poor hair regrowth after surgery, recurrent urinary tract infections, demodicosis in a middle-aged or older dog, and a first incidence of helpful — Diagnosis, Treatment, and Monitoring of Hyperadreno- pyoderma in an older dog. corticism (p. 34-36), and the full Technical Brochure for VETORYL® Capsules (trilostane) (p. 37-52). Beyond this e-book, we provide a number of Cushing’s-related online resources in our CE Learning Center at www.dechrace.com. There you will find a CE module entitled Diagnosing and treating canine hyperadrenocorticism and another called Cushing’s disease: VETORYL® Capsules (trilostane) are the only FDA-approved drug Inside and out. Plus, to get your whole practice team on the same indicated for the treatment of pituitary-dependent and adrenal- page, we invite you to download and use the free comprehensive dependent hyperadrenocorticism (PDH and ADH) in dogs. Trilostane, resources from the Coping with Cushing’s syndrome Team Meeting the active ingredient, blocks hormone production in the adrenal cortex In a Box (available at www.dechrace.com). We also offer printed by competitive enzyme inhibition and is clinically effective in treating dogs with PDH and ADH; however, it does not affect tumor growth. clinic aids, such as client brochures and patient drop-off sheets for monitoring appointments, which are yours for the asking. Call • The use of VETORYL Capsules is contraindicated in dogs that have Dechra at (866) 933-2472 to request them. demonstrated hypersensitivity to trilostane. • Do not use VETORYL Capsules in animals with primary hepatic The main purpose of this e-book and all of our other disease or renal insufficiency. resources is to let you know that we are here to help you be • Do not use in pregnant dogs. Studies conducted with trilostane successful when you are faced with canine Cushing’s patients. in laboratory animals have shown teratogenic effects and early We want to help guide you along the sometimes winding path pregnancy loss. of diagnosing and managing dogs with hyperadrenocorticism • The most common adverse reactions reported are poor/reduced and provide you with the information and tools you need to appetite, vomiting, lethargy/dullness, and weakness. master the details, the fine points — the ins and outs — of • Occasionally, more serious reactions, including severe depression, canine Cushing’s syndrome. hemorrhagic diarrhea, collapse, hypoadrenocortical crisis or adrenal necrosis/rupture may occur, and may result in death. —Dechra Veterinary Products SpONSORED BY DECHRA VETERINARY PRODUCTS ©2015 | 3 Treat their Hyperadrenocorticism. Help restore their vitality. VETORYL® Capsules (trilostane) are the only FDA veterinary- approved treatment for pituitary-dependent and adrenal-dependent hyperadrenocorticism in dogs (Cushing’s syndrome). They contain the active ingredient trilostane, which blocks the excessive production of cortisol. Daily administration of VETORYL Capsules can greatly reduce the clinical signs associated with Cushing’s syndrome, helping to restore the dog’s vitality. Clinical studies demonstrated that treatment with VETORYL Capsules resulted in decreased thirst, decreased frequency of urination, decreased panting, and improvement of appetite and activity.1 Activity levels began to show improvement within 14 days of treatment. As with all drugs, side effects may occur. In field studies and post-approval experience, the most common side effects reported were: anorexia, lethargy/depression, vomiting, diarrhea, elevated liver enzymes, elevated potassium with or without elevated sodium, elevated BUN, decreased Na/K ratio, hypoadrenocorticism, weakness, elevated creatinine, shaking, and renal insufficiency. In some cases, death has been reported as an outcome of these adverse events. VETORYL Capsules are not for use in dogs with primary hepatic or renal disease, or in pregnant dogs. Refer to the prescribing information for complete details or visit www.Dechra-US.com. 24 Hour Technical Support: 866-933-2472 | www.dechra-us.com | [email protected] VETORYL is a trademark of Dechra LTD. ©2015, Dechra Ltd. NADA 141-291, Approved by FDA Dechra Veterinary

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