Centrális Cushing-kór műtéti megoldása: hipofízis-mikroadenoma sikeres endoszkópos eltávolítása egy Boxer kutyában - Esetismertetés

Abstract

SUMMARY Background: Hypercortisolism is one of the most common endocrine disease in dogs. It could have peripheral or central aetiology. The central hypercortisolism is caused by adrenocorticotropic hormone dependent pituitary gland adenoma in most cases. According to another grading system, P/B ratio is a good method to distinguish microtumours from macrotumours. Treatment includes conserva-tive and/or radiotherapy and surgery.Materials and Methods, Results and Discussion: An 8-year-old female boxer was presented for evaluation with the signs of PU/PD and weight loosing. Preoperative examination included minimal data-based and special test (ACTH, LDDS, HDDS, MRI, CT), which confirmed the diagnosis of the central Cushing disease. Preoperative 3D-planning was performed based on the DICOM images from CT and MRI. During the first surgery, intensive bleeding was observed, thus we postponed the intervention. During the second surgery the tumorous pituitary gland was removed without complication. Histopathology showed micro-adenoma. During 3 days hospitalization strict blood and urine control was performed in every hour. Supplementation therapy was started with prednisolone, desmopressin and thyroxine. 11 days later the dog was dull, depressed and had a stiff gait. Control MRI showed myelitis of spinal cord between C1-C5. The CSF showed signs of septic meningoencephalitis but the CSF bacteriological test did not confirmed any microorganism. Antibiotic was given for 7 days intravenously and at the end of the treatment the symptoms were resolved. 100 days after the surgery, control MRI showed the intact and empty sella turcica. After the MRI prednisolone and desmopressin was tapered and stopped. After almost 1 year follow-up the dog is fine, has gained her weight back and again vivacious. The authors highlight the importance of the detailed perioperative monitoring and the preoperative 3D-planning, which could help in the presurgical visualization and intraoperative navigation.