To Carie Guppy:
 
>   Now, a year later, she's losing weight again and her vulva is swollen.  I
>knew immediately that her second one was acting up, and my vet agrees.  A
>classmate suggested using Lysodren to specifically kill the adrenal cortex,
>and to use it as a titration to effect.  My vet is curious whether we can
>remove the second one and supplement her on Prednisolone for the rest of her
>life.  I prefer not to put her throught this risky surgery if I can target the
>adrenal with Lysodren.  What is your experience with both of these options?
 
    Yes, it does sound like the other adrenal is acting up.  Unfortunately,
Lysodren is not the answer - it has little effect on the cells that secrete
the estrogens, - concentrating more on the zona glomerulosa and fasciulata
- which secrete cortisol.  Most ofthe people who have tried it have not
been happy with the results.  Ketoconazole has likewise been disappointing.
 
    Surgery is probably the answer - a subtotal adrenalectomy is probably
the answer.  While I have heard of one case in which bilateral adrenalectomy
has been performed, and the animal maintained on flucortisone, I think it's
pretty risky and there is not a well-establish protocol to follow.
 
    My suggestion - remove half of the remaining adrenal - it is done a
lot more with good results....
 
Bruce Williams, DVM
[Posted in FML issue 1194]