1. Chasee Parker

2. Signalment Canine, Schipperke mix Canine, Schipperke mix Female, Spayed Female, Spayed 12 years old 12 years old

3. History Significantly increased appetite over past year Significantly increased appetite over past year PU/PD PU/PD

4. Physical Exam Abdomen: Hepatomegaly palpated Abdomen: Hepatomegaly palpated PLN: Prominent axillary lymph nodes PLN: Prominent axillary lymph nodes Integument: Scaling noted Integument: Scaling noted All other parameters within normal limits All other parameters within normal limits

5. Diagnostic Tests CBC: plasma protein lipemic, no other abnormalities noted CBC: plasma protein lipemic, no other abnormalities noted Biochemistry: hypercholesterolemia (397 MG/DL, rr=138-317), elevated alkaline phosphatase (637 IU/L, rr=14-120), ALT (204 IU/L, rr=16- 73), elevated creatine kinase (1314 IU/L, rr=48-380) Biochemistry: hypercholesterolemia (397 MG/DL, rr=138-317), elevated alkaline phosphatase (637 IU/L, rr=14-120), ALT (204 IU/L, rr=16- 73), elevated creatine kinase (1314 IU/L, rr=48-380) Urinalysis: 3+ protein, specific gravity 1.022 (rr=1.015-1.045) Urinalysis: 3+ protein, specific gravity 1.022 (rr=1.015-1.045)

6. Diagnostics continued Elevated urine cortisol/creatinine ratio Elevated urine cortisol/creatinine ratio Urine culture Urine culture Triglyceride level: mildly elevated (218 MG/DL, rr=19-133) Triglyceride level: mildly elevated (218 MG/DL, rr=19-133) ACTH Stimulation Test: ACTH Stimulation Test: -base line=7.5 UG/DL, post=27.3 UG/DL -base line=7.5 UG/DL, post=27.3 UG/DL FNA of right axillary lymph node FNA of right axillary lymph node

7. Radiographs Spine-Lumbosacral: Spine-Lumbosacral: bilateral hip dysplasia with secondary degenerative joint diseasebilateral hip dysplasia with secondary degenerative joint disease L6-7 and L7-S1 spondylosis deformansL6-7 and L7-S1 spondylosis deformans

8. Hip Dysplasia

9. Spondylosis Deformans

10. Radiographs Thoracic: Thoracic: spondylosis deformansspondylosis deformans shoulder degenerative joint diseaseshoulder degenerative joint disease no evidence of pulmonary metastatic diseaseno evidence of pulmonary metastatic disease

11. Lateral Thorax

12. Ventral-Dorsal Thorax

13. Abdominal Ultrasound Hepatic hyperechogenicity, as with pronounced vacuolar changes Hepatic hyperechogenicity, as with pronounced vacuolar changes Hyperechoic nodule in midregion of spleen Hyperechoic nodule in midregion of spleen Bilateral adrenomegaly Bilateral adrenomegaly Small splenic nodules, likely benign Small splenic nodules, likely benign Gallbladder sediment Gallbladder sediment

14. Left Adrenal Gland

17. Spleen

18. Liver

19. Right Liver

20. Gallbladder

21. Gallbladder

22. Right Adrenal Gland

24. Measurements

25. Diagnoses Polyphasia Polyphasia Possible hyperadrenocorticism - elevated ALT, ALKP and hypercholesteraolemia Possible hyperadrenocorticism - elevated ALT, ALKP and hypercholesteraolemia Lipemia despite fasting –elevated triglycerides and cholesterol Lipemia despite fasting –elevated triglycerides and cholesterol Proteinuria Proteinuria Abdominal/thoracic masses/prominent lymph nodes Abdominal/thoracic masses/prominent lymph nodes

26. Assessment Clinical signs of polyphagia and polyuria in conjunction with elevated liver enzymes (ALT and ALKP), hypercholesterolemia, ACTH stim. test and the ultrasound findings are suggestive of hyperadrenaocorticism Clinical signs of polyphagia and polyuria in conjunction with elevated liver enzymes (ALT and ALKP), hypercholesterolemia, ACTH stim. test and the ultrasound findings are suggestive of hyperadrenaocorticism Leads to hyperactivity of adrenal glandLeads to hyperactivity of adrenal gland Benign tumor of pituitary or tumor of adrenal glandBenign tumor of pituitary or tumor of adrenal gland

27. Assessment continued Persistant proteinuria and lipemic plasma protein causing an elevated triglyceride level is also consistant with hyperadrenocorticism Persistant proteinuria and lipemic plasma protein causing an elevated triglyceride level is also consistant with hyperadrenocorticism Elevated urine cortisol/creatinine ratio also supportive of hyperadrenocorticism, but also consistant with neoplasia, hyperthyroidism and stress Elevated urine cortisol/creatinine ratio also supportive of hyperadrenocorticism, but also consistant with neoplasia, hyperthyroidism and stress

28. Assessment continued Abdominal ultrasound is supportive of hyperadrenocorticism as the primary ruleout Abdominal ultrasound is supportive of hyperadrenocorticism as the primary ruleout No evidence of neoplasia or metastatic disease on either the ultrasound or radiographs No evidence of neoplasia or metastatic disease on either the ultrasound or radiographs Thoracic and abdominal radiographs revealed orthopedic disease including spondylosis and DJD of shoulders and hip dysplasia with secondary DJD Thoracic and abdominal radiographs revealed orthopedic disease including spondylosis and DJD of shoulders and hip dysplasia with secondary DJD