Lucy is a 12 year old spayed female mixed breed dog that presented to Dr. Maxwell Bush of the PVESC Surgery Department for treatment of a left-sided adrenal mass. She was previously evaluated by Dr. Adam Shoelson of the PVESC Internal Medicine Department. Dr. Shoelson diagnosed with Lucy with hyperadrenocorticism, likely secondary to her adrenal tumor. Thus, our suspicion of index for a functional adrenocortical tumor increased. Additional information on the pre-operative management of Lucy’s hyperadrenocorticism can be found in the this Internal Medicine article.

With medical management resulting in ideal hyperadrenocorticism and improved blood pressure control, Lucy was deemed a good candidate for anesthesia and surgery. Furthermore, her medium to large size, the left-sided nature of her adrenal mass (the left adrenal gland is surgically more accessible), and the lack of obvious metastasis or vascular invasion, allowed us to recommend a laparoscopic approach for her adrenalectomy. Laparoscopic surgery, both in people and animals, has been shown to reduce peri-operative morbidity and mortality significantly. A video from Lucy’s laparoscopic procedure is provided below.

Lucy’s left adrenal tumor was successfully excised laparoscopically. She had a very stable anesthesia and recovery. She was discharged just one day after surgery. Trilostane (Vetoryl) and enalapril therapy were discontinued. A physiologic daily prednisone dose was administered until her first Internal Medicine recheck appointment. Lucy’s adrenal mass was submitted for histopathology, which was consistent with a narrowly excised adrenocortical carcinoma without evidence of vascular invasion.

Through Lucy’s post-operative rechecks with Dr. Shoelson, her liver enzymes improved and then normalized. She is now non-hypertensive. Lucy is clinically normal at home.

Three weeks post-operative, Lucy’s owners sent us a fantastic update: “She is like a puppy.  She runs all over, eats her meals and treats and drinks her water normally, not in excess. Her coat is finally shedding after almost two years and it looks so full and healthy.  It had been so dry, dark, and oily-looking, with no shedding!  This was unheard of for a dog with Pyrenees in her but no one seemed to think it strange except us. Thank you so much.  It was amazing that the surgery could be done laparoscopically by Dr. Bush and thankfully  was recommended by Dr. Shoelson. We are so happy that Lucy had such a wonderful place to go to for medical services.  You are all so kind, caring and very knowledgeable.”

For the future, we would like to continue to pursue minimally invasive laparoscopic surgeries for a variety of procedures, including adrenalectomies and cholecystectomies. However, ideal patient selection can be challenging and is of paramount importance to ensure success.

Authored by: Maxwell Bush, VMD, DACVS-SA, Surgery