2011 junecb managementtreeendocrinology

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Trilostane Treatment for Canine Pituitary-Dependent Hyperadrenocorticism Ellen Behrend, VMD, PhD, Diplomate ACVIM Auburn University M a n a g e m e n t T r e e / ENDOCRINOLOGY Peer Reviewed Investigation Diagnosis Treatment Result ACTH = adrenocorticotropic hormone, stim = stimulation This algorithm can be downloaded from cliniciansbrief.com and printed for use in your clinic. 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 • Restart medication at 25% lower dose • Recheck ACTH stim test in 7 days OR • Recheck ACTH stim test in 3 days • Restart medication at 25% lower dose when cortisol level is ideal or higher • Continue therapy • Recheck ACTH stim test at 30 days and, if doing well, at 90 days; then every 90–120 days, if signs recur, or if signs of cortisol insuf- ficiency are present Clinical signs controlled Clinical signs present • On day 30 or beyond? If giv- ing Q 24 H, then halve the dose and give Q 12 H • Recheck ACTH stim test after 10 days • If on recheck ACTH stim test at day 10–14, cortisol concentra- tions are lower or clinical signs improved, then maintain dose and recheck ACTH stim test again at day 30 • If recheck ACTH stim test results still above ideal after > 30 days on therapy or at day 10–14 no improvement was noted, increase dose 25%; recheck ACTH stim test in 7 days See Aids & Resources, back page, for references & suggested reading. Clinical signs present 32 ........................................................................................................................................................................NAVC Clinician’s Brief / June 2011 / Management Tree

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Transcript of 2011 junecb managementtreeendocrinology

Page 1: 2011 junecb managementtreeendocrinology

Trilostane Treatment for CaninePituitary-Dependent Hyperadrenocorticism

Ellen Behrend, VMD, PhD, Diplomate ACVIMAuburn University

Managemen t Tre e / ENDOCRINOLOGY Peer Reviewed

Investigation

Diagnosis

Treatment

ResultACTH = adrenocorticotropic hormone, stim = stimulation

This algorithm can be downloaded from cliniciansbrief.com and printed for use in your clinic.

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 HOR• After 10–14 days of treatment

• Run ACTH stim test beginning 4–6 H aftertrilostane administration• Check with your reference laboratory for “idealrange”; it is approximately 30–150 nmol/L or1–5 mcg/dL pre- and post-ACTH stim testing

Response below ideal Response ideal Response above ideal

• Discontinue for 2–3 days• Restart medication at 25%lower dose• Recheck ACTH stim test in 7days

OR• Recheck ACTH stim test in 3days• Restart medication at 25%lower dose when cortisol levelis ideal or higher

• Continuetherapy• Recheck ACTHstim test at 30days and, ifdoing well, at90 days; thenevery 90–120days, if signsrecur, or if signsof cortisol insuf-ficiency arepresent

Clinical signscontrolled

Clinical signspresent

• On day 30 orbeyond? If giv-ing Q 24 H,then halve thedose and giveQ 12 H• Recheck ACTHstim test after10 days

• If on recheck ACTH stim test atday 10–14, cortisol concentra-tions are lower or clinical signsimproved, then maintain doseand recheck ACTH stim testagain at day 30

• If recheck ACTH stim test resultsstill above ideal after > 30 dayson therapy or at day 10–14 noimprovement was noted,increase dose 25%; recheckACTH stim test in 7 days

See Aids & Resources,back page, for references& suggested reading.

Clinical signspresent

32 ........................................................................................................................................................................NAVC Clinician’s Brief / June 2011 / Management Tree