Boszko et al VRU 2025-
Comparing cervical CT to surgical findings in dogs with primary hyperparathyroidism:
Agreement in laterality?
Agreement in position?
Agreement in gland size?
False negative rate?
- Near perfect agreement for laterality
- Near perfect agreement for position
- Fair agreement for gland size
- 5/20 (25%) - pathological parathyroid or thyroid tissue that was removed during surgery that was not identified on CT
*** These findings suggest that while CT provides better agreement than ultrasound for certain aspects of parathyroid pathology, continued bilateral cervical exploration remains essential for accurate diagnosis and treatment
Chiti et al Vet Surg 2020-
When performing adrenalectomy with thrombus removal (renal venotomy for thrombectomy) was preservation of the kidney:
Success rate?
Major intra-op complication rate?
Minor intra-op complication rate?
What side was the procedures performed?
- 5/5 (5 renal venotomies and 1 caval venotomy)- Kidney preservation was achieved in all dogs
- 0%
- 3/5 (60%)- Minor hemorrhage from the venotomy site occurred that was managed with hemoclips, suturing and placement of a topical hemostatic agent
- Left
** All dogs were discharged from the hospital within 3-4 days
** 4/5 dogs (80%) had not recurrence. 1/5 dogs (20%) died from suspected PTE.
Del Mango et al JFMS 2023-
Did unilateral adrenalectomy resolve the primary hyperaldosteronism in cats?
Survival rate?
What was the cause of death in those that did not survive?
Most common tumor type?
- Yes in all cats
- 97% of cats survived to discharge
- One fatal complications (3%) was reported and was likely due to DIC post-op
- Cortical carcinoma (69%)
** The most frequent clinical signs were lethargy (69%) and neck ventroflexion (59%)
** Hypokalemia was present in all cats (100%), creatinine kinase was evaluated in 15 (52%) and hyperaldosteronism was documented in 24 (83%)
** Hypertension was frequently encountered (89%)
** The median adrenal mass size was 2 x 1.5 cm; vascular invasion was present in 5 cats (17%), involving the caudal vena cava in 4 cats and the renal vein in one
** One major intraoperative complication (3%) was reported and consisted of hemorrhage during the removal of a neoplastic thrombus from the caudal vena cava
** In 14%, minor postoperative complications occurred and were treated medically
** Hypotension was the most frequent anesthetic complication (26%)
** The adrenal masses were classified as cortical adenoma (32%) and carcinoma (68%)
** The potassium level normalized in 24 cats (83%) within 3 months of surgery; hypertension resolved in 21/23 cats (91%)
** Follow up was available for 25 cats with a median survival of 1082 days
Farrell et al JAVMA 2023-
In dogs undergoing bilateral, single-session, laparoscopic adrenalectomy:
Median maximal tumor diameter?
Median surgery and anesthetic times?
Conversion rate?
Cardiac arrest rate?
Survival to discharge?
- 2.6 for the right and 2.3 cm for the left sided tumors
- 158 min for surgery and 240 minutes for anesthesia
- 1/6 (17%)- Due to renal vein laceration during initial adrenalectomy
-1/6 (17%)- However the dog was resuscitated successfully and contralateral laparoscopic adrenalectomy was performed without complications
-100% survived to hospital discharge
Fontes et al JAVMA 2024-
In dogs with invasive adrenal tumors that did not undergo adrenalectomy:
MST?
Which structure was most common invaded?
What was the most common cause of death?
- 50 days
- Caudal vena cava
(18/30; 93% of dogs had vascular invasion primarily into the caudal vena cava) - The most common cause of death or euthanasia was hemoabdomen (25%)
Mayhew et al JAVMA 2023-
Laparoscopic adrenalectomy for non-invasive unilateral masses:
Surgical survival rate?
Survival to discharge?
Major hemorrhage rate?
Capsular penetration rate?
Effect of capsular penetration on recurrence?
Factors associated with conversion?
- 99%
- 95%
- 5.5%; From ipsilateral renal vein
- 19%
- 6.5 times more likely to see recurrence
- Increasing BCS, loss of visualization, lesion size, and surgeon experience
Mitsui et al JAVMA 2024-
In dogs undergoing adrenalectomy, pre-op TEG:
What % were hypercoagulable?
What % was hypo coagulable?
Did having hyperadrenocorticism affect coagulation status?
- 53%
- 0%
- Of the 14 dogs tested preoperatively for HAC, 4 of 8 (50%) HAC dogs were hypercoagulable and 2 of 6 (33%) non-HAC dogs were hypercoagulable
** Based on histopathology, 6 of 9 dogs (66%) with adenocarcinoma were hypercoagulable, 4 of 8 (50%) with pheochromocytoma were hypercoagulable and 6 of 10 (60%) adenoma were hypercoagulable
** None of the 3 dogs with other histopathologic diagnoses or combinations of diagnoses (adrenocortical hyperplasia, poorly differentiated sarcoma and both adrenocortical adenocarcinoma and pheochromocytoma) were hypercoagulable
Nappo et al VRU 2024-
How many anatomic variations of phrenicoabdominal veins in cats were identified?
Which variation was the most common?
- Three different vascular anatomical variations were found in the distal pericaval segment of the left phrenicoabdominal vein
- In 65 cases (50.8%) the left phrenicoabdominal vein drained directly into the caudal vena cava- MOST COMMON
Other variations:
- In 25 cases (19.5%), the left phrenicoabdominal vein drained into the distal third of the left renal vein, less than 5 mm from its opening into the caudal vena cava
- In 38 cases (29.7%) the left phrenicoabdominal vein drained into the distal third of the left renal vein, more than 5 mm from its opening into the caudal vena cava
*** The right phrenicoabdominal vein had a consistent path and drained into the caudal vena cava in all cases
Piegols et al JVIM 2025-
Cytological evaluation for adrenal tumors:
% of diagnostic quality?
% correlated with histopath?
Accuracy (adrenocortical vs. pheo)?
Complication rate?
- 88% had a predominant cell type identified and therefore were considered of diagnostic quality
- 86% correlated with the final histopathological diagnosis
- 77% vs. 84%
- 16% (all self limiting)
** The following complications were identified: grade 1 bradycardia, grade 2 intermittent second degree AV block, grade 2 hypercapnia, grade 2 hypothermia and grade 3 apnea
** Of the 6 dogs that had complications, 4 (67%) had pheochromocytomas and two (33%) had adrenocortical adenomas
Taylor and Monnet Vet Surg 2021 -
Comparing open versus laparoscopic adrenalectomies in dogs:
Most common intra-op complication?
Which had the shortest surgery time?
What % of dogs had GI signs PO?
Was a difference in survival time or long term outcomes identified?
- Hypotension (Lap14% vs Open 62%)
- Laparoscopic (~70 min); Open was ~109 minutes
- 27% in the open group vs 0% with laparoscopy had GI signs post-op
- No
** Laparoscopic adrenalectomy was associated with a shorter surgical time and a reduced incidence of hypotension compared with open adrenalectomy in this case-matched study.
** Short- and long-term outcomes were not affected by the surgical technique used to complete the adrenalectomy
Travail et al JVIM 2025-
In dogs with primary hyperparathyroidism and treated with parathyroidectomy:
What relationship with plasma PTH concentration pre-op have with chances of PO hypocalcemia?
Sensitivity?
Specificity?
Other risk factors for developing hypocalcemia?
- Higher pre-op PTH was associated with development of PO hypocalcemia
- 97%
- 42%
- Older age and lower body weight
*** Using a cutoff of >/= 75 pg/mL, pre-surgery plasma PTH concentration had a sensitivity of 96.6% and a specificity of 42.3% for the development of post-surgery hypocalcemia
Traverson et al JAVMA 2023-
Hemoabdomens secondary to spontaneous adrenal rupture:
Is it better to take them to surgery emergently or delay?
Most common tumor type?
Mortality rate?
What was associated with lower short-term survival?
Recurrence rate?
Met rate?
- Delayed tx (up to a week) was superior (want CV stability, better visibility, and hemodynamic control)
- 60% were adrenocortical (36% medullary tumors)
- 21%
- Additional surgical procedures decreased survival rate to 75%
- Low (1.6%)
- Low (5%)
** Need for intraoperative blood transfusion was significantly associated with emergent surgery and presence of active intraoperative hemorrhage
** The short term (</= 14 days) complication rate was 42%
*** Negative prognostic factors for short term survival included:
1. Emergent surgery
2. Intraoperative hypotension
3. Performing additional surgical procedures
Waldron et al JAVMA 2025-
Using spot urine normetanephrine to creatinine ratio to diagnose canine pheochromocytoma:
Sensitivity?
Specificity?
PPV?
NPV?
Was it related to mean tumor volume?
What % of pheos were biochemically silent?
- Sn 79%
- Sp 77%
- PPV 83%
- NPV 71%
- No [Median tumor volume did not correlate with normetanephrine values, nor did those values correlate to patients that experienced intraoperative complications]
- 21%
*** Urine normetanephrine to creatinine levels but not metanephrine to creatinine levels can potentially differentiate a pheochromocytoma from a nonpheochromocytoma
Young and Degner Vet Surg 2023-
Using US guided minimally invasive parathyroidectomy:
Resolution of hypercalcemia?
PO hypocalcemia?
Permanent hypocalcemia?
- 98%
- 16% - 9% clinical and 7% subclinical for hypocalcemia
- 4%
Technique Description:
- An ultrasound guided mini lateral approach was made via a plane established between the sternocephalicus muscle and sternohyoideus muscles to expose the thyroid gland and enlarged parathyroid gland
- Abnormal parathyroid glands were removed en bloc via partial thyroidectomy
*** The technique for bilateral disease was similar, the skin incision was made along midline and moved laterally to develop the above mentioned plane of dissection
Burkhardt et al Vet Surg 2021-
Parathyroid tumors:
What was the agreement between US and surgery in number? side?
What US size was used as the cut off for distinguishing malignant from benign?
What pre-op iCa had the greatest odds of PO hypocalcemia?
- 66% number and 72% for side of affected gland
- Ultrasound cut off of > 8 mm best distinguished malignancy
-Pre-op iCa >1.75 mEq/L had a 7.5 times greater odds of hypocalcemia post-op
Griffin et al Vet Surg 2025-
Sentinel LN in thyroid carcinoma:
How many SLN were identified per case?
How many cases had variability between pre and intra-op SLN?
What % of extirpated LN’s had mets?
- At least 1 SLN in all dogs
- 50%
- 3/12 LN (25%)
Enright et al Vet Surg 2022-
Alpha blocker treatment prior to adrenalectomy in dogs with pheochromocytomas:
In what group did the intraoperative systolic blood pressures reach a higher level by a magnitude of nearly 20%?
Was a preoperative alpha-blocker associated with increased survival?
Survival for surgery?
Survival to discharge?
- Intraoperative systolic blood pressures reached higher levels by a magnitude of nearly 20% in dogs that were treated preoperatively with an alpha-blocker
- No it was not associated with increased survival
- 100%
- 80% (44/53 dogs)
Naito et al JAVMA 2024-
Compared the survival time of cats with hyperparathyroidism treated with thyroidectomy or methimazole.
Based on univariate analysis, what was associated with a longer survival time?
Based on multivariate analysis, what was the prognostic factor for good outcome? What was not a predictor of good outcome?
- Univariate analysis revealed that survival time was significantly longer with thyroidectomy and high body weight than with methimazole
- Multivariate analysis revealed thyroidectomy as an independent prognostic factor for good outcomes. Body weight and age of the cat were not independent predictors of good outcome.
*** Compared with methimazole alone, thyroidectomy was associated with a longer survival time in feline hyperthyroidism and can be considered an irreversible treatment modality in settings where radioisotopes are not available
Enache et al JVIM 2023-
Dogs with thyroid neoplasia that underwent thyroidectomy:
- Overall MST?
- Met rate?
- What was associated with increased risk of death due to another cause?
- What was associated with higher risk of thyroid cancer related death?
- 802 days
- Metastasis were identified at admission in 12 (8%) dogs and were associated with higher thyroid cancer-related fatality
- Thrombosis (occurred in 28%)
- Nonfollicular carcinoma and administration of chemotherapy
Sumner Vet Surg 2022-
What technique was described to assist in parathyroidectomy surgeries in dogs?
Minimally invasive video-assisted parathyroidectomy
*** Noted to be successful at removing all parathyroid masses in all dogs without complication
Vose JVIM 2024-
What % of dogs had increased pre-treatment serum gastrin concentrations?
Was gastrin concentrations correlated with iCa or PTH?
Did treatment with parathyroidectomy resolve the elevated gastrin levels?
- 18%
- No
- No [Treatment of PHPT decreased PTH and iCa concentrations, but not gastrin concentrations]
