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