2011 junecb managementtreeendocrinology

168 views
126 views

Published on

Published in: Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
168
On SlideShare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
1
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

2011 junecb managementtreeendocrinology

  1. 1. M a n a g e m e n t T r e e / ENDOCRINOLOGY Peer Reviewed Ellen Behrend, VMD, PhD, Diplomate ACVIM Auburn UniversityTrilostane Treatment for CaninePituitary-Dependent Hyperadrenocorticism Trilostane • 2 mg/kg Q 24 H OR • 1 mg/kg Q 12 H • Decreased appetite, vomiting, diarrhea, listless- ness or water intake < 60 mL/kg Q 24 H OR • After 10–14 days of treatment • Run ACTH stim test beginning 4–6 H after trilostane administration • Check with your reference laboratory for “ideal range”; it is approximately 30–150 nmol/L or 1–5 mcg/dL pre- and post-ACTH stim testing Response below ideal Response ideal Response above ideal • Discontinue for 2–3 days Clinical signs Clinical signs Clinical signs • Restart medication at 25% controlled present present lower dose • Recheck ACTH stim test in 7 days OR • Continue • On day 30 or • If on recheck ACTH stim test at • Recheck ACTH stim test in 3 therapy beyond? If giv- day 10–14, cortisol concentra- days • Recheck ACTH ing Q 24 H, tions are lower or clinical signs • Restart medication at 25% stim test at 30 then halve the improved, then maintain dose lower dose when cortisol level days and, if dose and give and recheck ACTH stim test is ideal or higher doing well, at Q 12 H again at day 30 90 days; then • Recheck ACTH every 90–120 stim test after days, if signs 10 days recur, or if signs of cortisol insuf- • If recheck ACTH stim test results ficiency are still above ideal after > 30 days present on therapy or at day 10–14 no improvement was noted, See Aids & Resources, increase dose 25%; recheck back page, for references ACTH stim test in 7 days & suggested reading. Investigation TreatmentACTH = adrenocorticotropic hormone, stim = stimulation Diagnosis ResultThis algorithm can be downloaded from cliniciansbrief.com and printed for use in your clinic.32 ........................................................................................................................................................................NAVC Clinician’s Brief / June 2011 / Management Tree

×