BACKGROUND:Treatment of naturally occurring Cushing's syndrome includes surgery or medical management but there is little information on how primary care veterinarians (PCVs) select and monitor such treatment. HYPOTHESIS/OBJECTIVES:Determine how PCVs from selected European countries treat and monitor Cushing's syndrome in dogs. METHODS:Cross-sectional survey study assessing treatment and monitoring protocols used by PCVs when managing dogs with Cushing's syndrome. RESULTS:A total of 2178 responses from 9 European countries were included. Overall, 1694 (77.8%) respondents attempted to differentiate functional adrenal tumor (FAT) from pituitary-dependent hypercortisolism (PDH). Adrenalectomy and hypophysectomy were recommended in 67.8% and 30.5% dogs with FAT and PDH, respectively. When surgery was not considered, 23.9% of respondents did not always suggest medical management. Of those recommending medical treatment, 1895/2163 (87.6%) respondents used trilostane either once (60.7%) or twice (39.3%) daily. Time to first follow-up was < 10, 10-14, and 15-30 days for 6.1%, 59.8%, and 31.1% of respondents, respectively. Long-term follow-up was every 3-4 (41.7%) or 5-6 months (37.9%). Monitoring is performed using ACTH stimulation test (54.6%), pre-pill plasma cortisol concentration (18.4%), and both pre- and post-pill plasma cortisol concentration (13.3%). CONCLUSIONS AND CLINICAL IMPORTANCE:Approximately one-third of PCVs do not recommend adrenalectomy for FAT and two-thirds do not recommend hypophysectomy in PDH. Despite demonstrated benefits of medical treatment, one-quarter of respondents do not always recommend it, which may adversely affect life expectancy and quality of life. Treatment and monitoring protocols vary among PCVs. These results suggest that further education of PCVs about management of Cushing's syndrome in dogs may be warranted.

BACKGROUND:The survival of dogs with pheochromocytoma (PCC) treated with adrenoreceptor antagonists has not been described or compared to surgically managed cases. HYPOTHESIS/OBJECTIVES:The objective of this study is to evaluate the survival of medically and surgically managed dogs with PCC and investigate factors associated with survival. ANIMALS:Two hundred fifty-five dogs with PCC, treated with alpha-adrenoreceptor antagonists (AA) without adrenalectomy (Group 1, n = 75), adrenalectomy +/- AA (Group 2, n = 128), or neither treatment (Group 3, n = 52). METHODS:Retrospective, multicenter review of medical records. Median overall survival time (OST) for Groups 1 and 2 combined was calculated using Kaplan-Meier estimates, and then compared between Group 1 and Group 2 using Log-Rank testing. Cox proportional hazard analysis identified factors associated with survival in Groups 1 and 2 individually and combined. RESULTS:Median OST for all cases was 854 (95% CI: 572-1136) days. Median OST was lower in Group 1 (247 days, 95% CI: 76-418 days) than in Group 2 (927 days, 95% CI: 587-1267 days; p < 0.001). In Group 2, 88/92 dogs (97.8%) that received presurgical AA treatment survived to discharge compared to 23/27 (85.2%) that did not receive AA pretreatment (p = 0.03). Lack of clinical signs at presentation was associated with increased survival in both groups combined (HR 0.5; 95% CI 0.3-0.9; p = 0.02) and in Group 2 alone (HR 0.3; 95% CI 0.1-0.7; p = 0.01). CONCLUSIONS AND CLINICAL IMPORTANCE:Dogs with PCC treated with adrenalectomy have longer survival compared to those managed with AA without adrenalectomy.

Allopurinol, one of the drugs routinely used to treat canine leishmaniosis (CanL), is an inhibitor of the enzyme xanthine oxidase, which plays a fundamental role in purine metabolism. Its inhibitory action on this enzyme leads to a state of hyperxanthinuria, favouring the development of xanthine crystals and/or uroliths. However, not all dogs with CanL treated with allopurinol develop xanthinuria and/or xanthine uroliths, and there is not much information on the possible risk factors that contribute to this event. This study aims to evaluate potential predisposing factors associated with the development of xanthinuria in dogs with a previous diagnosis of CanL that were treated with allopurinol. A multicentric, retrospective, observational study was conducted and included dogs with CanL undergoing allopurinol therapy. Dogs that developed xanthinuria (Xgroup) and those without xanthinuria (NXgroup) were selected from cases admitted to three referral hospitals between 2011 and 2022. Medical records were reviewed, and clinical and laboratorial variables were compared between groups. Descriptive statistics, contingency tables and non-parametric tests were used (P < 0.05). In total, 90 dogs were selected, 45 for each group. Only age and serum alpha-1 globulin concentration were significantly different between groups at day 0. Dogs from Xgroup were younger (median 4 years; interquartile range (IQR) 2–7) than those from NXgroup (median 6 years; IQR 4–9; P = 0.002). At the time of CanL diagnosis, a higher percentage of dogs from NXgroup had decreased serum alpha-1 globulin concentrations (38.9

Abstract Background Several tests are available to diagnose naturally‐occurring Cushing's syndrome in dogs but there is a paucity of information on how primary care veterinarians (PCVs) use or interpret them. Objectives Determine how PCVs from selected European countries diagnose Cushing's syndrome in dogs. Methods Cross‐sectional survey study assessing testing protocols used by PCVs for screening and differentiation of Cushing's syndrome. Results Two thousand one hundred and seventy‐eight responses from 9 European countries were included. When Cushing's syndrome was suspected, 98.7% of respondents perform endocrine testing, whereas 1.2% rely on a treatment trial. Among the former, 59.9% reported performing screening tests in the absence of supportive clinical signs but with consistent clinicopathological abnormalities. Of 2150 respondents who performed endocrine testing, 66.6% report always using the same initial screening tests regardless of their pretest suspicion of disease. The tests most reported are the ACTH stimulation test (34.8%), low‐dose dexamethasone suppression test (LDDST; 30.4%) or a combination of different tests (25.2%). In the absence of financial constraint, 1419 (66.0%) respondents always attempted differentiation, using abdominal ultrasonography (81.0%) and LDDST (46.1%). Overall, 69.8% of respondents reported offering referral to a specialist in ≤20% of cases suspected or diagnosed with Cushing's syndrome over the previous 5 years. Conclusions and Clinical Importance Testing protocols vary among PCVs. Almost 60% of respondents potentially screen dogs without consistent clinical signs, raising concerns for overdiagnosis. A proportion never attempt differentiation, which likely affects prognosis. Cases are rarely referred to a specialist, reflecting that Cushing's syndrome is mainly managed in primary care practices. These results suggest that there is room for further education of PCVs.

AbstractBackgroundHypoadrenocorticism in cats is uncommonly reported. Most reports consist of cats with hyponatremia, hyperkalemia, or both.Hypothesis/ObjectivesTo describe clinical findings, treatment response, and outcome in cats diagnosed with hypoadrenocorticism, including cats with abnormal and normal serum sodium and potassium concentrations.AnimalsForty‐one cats with hypoadrenocorticism; 36 with and 5 without abnormal serum sodium and potassium concentrations.MethodsMulticenter retrospective observational study. Data for the entire cohort were assessed using descriptive statistics and differences between cats with and without abnormal serum sodium and potassium concentrations were evaluated.ResultsMedian age was 5.7 years (range, 0.2‐13.8). Twenty‐three (56%) cats were male and 18 (44%) were female. Cats with hyponatremia, hyperkalemia, or both were less likely to have a history of vomiting (P = .01) but more likely to be hypothermic (P = .03), dehydrated (P = .04) or weak (P = .04) on examination, compared with nonhyponatremic and nonhyperkalemic cats. Frequency of hypercalcemia was 31.7%. Exocrine pancreatic insufficiency (EPI) was diagnosed in 4/7 cats tested; all 4 had concurrent cobalamin deficiency. Thirty‐five (85.4%) cats survived to discharge. In 2 cats, hypoadrenocorticism occurred secondary to lymphoma. Median survival time (MST) for all‐cause mortality was 2035 days (95% confidence interval [CI], 294‐4380 days); MST for disease‐specific mortality was not reached.Conclusions and Clinical ImportanceApproximately one‐third of cats with hypoadrenocorticism had hypercalcemia. In some cases, hyponatremia and hyperkalemia were not observed. Cats with nonneoplastic associated hypoadrenocorticism that survive initial hospitalization can have a favorable long‐term prognosis. Testing for EPI may be warranted in cats with hypoadrenocorticism.

Hypercortisolism in dogs is frequently associated with systemic hypertension (SH). However, there are no studies evaluating the changes in systolic blood pressure (SBP) in dogs with adrenal-dependent hypercortisolism (ADH) during trilostane treatment or after adrenalectomy and their response to antihypertensive treatments. For this reason, the objectives of this study were to evaluate the changes in SBP in dogs with ADH during the first year of trilostane treatment or after adrenalectomy, the relation with clinical control of hypercortisolism and certain laboratory parameters, and the response to antihypertensive drugs. Fourteen dogs newly diagnosed with ADH were prospectively included and evaluated at diagnosis (T0) and 1, 3, 6, and 12 months after (T1, T3, T6, and T12, respectively). Dogs were classified as hypertensive (HT; SBP ≥ 160 mmHg) and non-hypertensive. In HT dogs, benazepril was considered as the first-line drug, and, if necessary, amlodipine was prescribed. The prevalence of SH at T0 was 79%, and it was reduced to 25% at T12. Blood pressure (BP) was not associated with disease control or selected laboratory parameters at any endpoint. Only 22% of dogs with SH needed more than one drug to normalize their SBP. In all dogs surgically treated that were HT at T0, BP normalized at T3.

BackgroundMeglumine antimoniate is used to treat canine leishmaniosis. In humans, it has been associated with pancreatitis. Although a few case reports have described acute pancreatitis secondary to antimonial treatment in dogs, some studies have concluded that pancreatitis is not an adverse effect of this medication. The objective was to evaluate whether treatment with meglumine antimoniate could induce pancreatitis in dogs with leishmaniosis, on the basis of clinical signs, canine serum specific quantitative pancreatic lipase immunoreactivity (cPLI) concentration, and ultrasonographic abnormalities.MethodsA prospective, observational, longitudinal, and multicentric study was conducted from April 2021 through February 2023.ResultsA total of 33 dogs with leishmaniosis were included and classified into LeishVet clinical stages; 13 (39.4%) were included in stage II, 11 (33.3%) in stage III, and 9 in stage IV (27.3%). and 14 (42.4%) developed pancreatitis, 10 during treatment with meglumine antimoniate, and 4 at the end of the treatment. Advanced LeishVet clinical stage was statistically associated with development of pancreatitis. In addition, nine dogs received prednisone at the beginning of treatment, but it was not statistically associated with the prevention of pancreatitis.ConclusionsMeglumine antimoniate remains the first line leishmanicidal treatment option for canine leishmaniosis, but it appears to induce pancreatitis in a significant percentage of dogs. Monitoring serum cPLI levels and performing an abdominal ultrasound should be considered when pancreatitis-associated clinical signs are observed, or when there is a high suspicion of circulating immune complexes in dogs with advanced LeishVet clinical stage.

Acute diarrhoea is a common presentation in dogs, and a common reason for antimicrobial prescription and nutraceutical use. This evidence-based guideline provides recommendations for antimicrobial and probiotic treatment of canine acute diarrhoea (CAD). A multidisciplinary panel developed the recommendations by adhering to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The opinions of stakeholders (general veterinary practitioners and dog owners) were collected and incorporated to ensure the applicability of this guideline. Four strong recommendations informed by high certainty evidence, and three conditional recommendations informed by very low or low certainty evidence, were drafted by the panel, along with an ungraded section on diagnostic work-up of dogs with acute diarrhoea. The ENOVAT guidelines initiative encourages national or regional guideline makers to use the evidence presented in this document, and the supporting systematic review, to draft national or local guidance documents.

Objectives The aim of this study was to collect clinical information from owners of cats with hypersomatotropism (HS) distributed worldwide, assessing the impact of HS and its treatments on cats’ quality of life (QoL) and survival time. Methods A survey focused on clinical presentation, diagnostic procedures, treatments, cats’ QoL and disease progression was distributed worldwide to owners of cats with HS. The owner’s perception of the cats’ QoL before and after or during treatment was defined using a score ranging from 1 (poor) to 5 (excellent). Improvement following treatment (IFT) was quantified using a score ranging from 1 (absent) to 5 (obvious). Different treatment groups, including at least five cases, were compared. Results A total of 127 cats were included from at least 11 different countries. Among these, 120 (95%) were diabetic and 7 (5%) were not. Out of 120 diabetic cats, 55 (46%) were treated with insulin as a single treatment (INS). Other treatments were not mentioned to owners in 35/120 (29%) cases. The median QoL score at diagnosis was 2 (range 1–5) and improved after treatment in all groups. Cabergoline (4; range 1–5), radiotherapy (4; range 2–5) and hypophysectomy (5; range 4–5) showed better median IFT scores compared with INS (3; range 1–5) ( P = 0.046, P <0.002 and P <0.0001, respectively). Hypophysectomy IFT proved superior to cabergoline ( P = 0.047) and was equal to radiotherapy IFT ( P = 0.32). No difference was found between cabergoline and radiotherapy IFT ( P = 0.99). The median survival time (MST) was 24 months (range 0–75 months). Cats treated with INS showed shorter MST (22 months; range 0–69 months) compared with cats treated with causal treatments combined (36 months; range 3–75 months) ( P = 0.04). Conclusions and relevance Not all cats with HS will have diabetes mellitus. Causal treatments seem associated with the greatest improvements in perceived cats’ QoL and survival; such treatments should therefore be discussed with owners. Cabergoline could be an effective alternative management option.

Background: Twice daily low trilostane doses have proven to be effective to manage canine Cushing's syndrome. However, survival and prognostic factors in dogs treated with this protocol have not been evaluated. The aim of the study was to evaluate survival and prognostic factors, including systolic blood pressure (SBP) at diagnosis, in dogs with pituitary-dependent hyper-cortisolism (PDH) treated with low trilostane doses. Methods: Medical records of 91 dogs newly diagnosed with PDH initially treated with 0.2-1.1 mg/kg of trilostane twice daily were retrospectively included. Survival times were calculated using the Kaplan-Meier estimator. Univariable and multivariable analysis were performed using the Cox proportional hazard regression analysis. Results: Overall, median survival was 998 days (range 26-1832 days, 95% confidence interval = 755-1241 days). In the multivariable analysis, age (hazard ratio [HR] = 1.337, p < 0.001), presence of calcinosis cutis (HR = 5.271, p < 0.001), body condition score (BCS) <= 3/9 (HR = 8.100, p < 0.001) and higher platelet count (HR = 1.002, p= 0.022) were negatively correlated with survival. SBP was not associated with survival. Conclusions: Low-dose trilostane treatment twice daily provides slightly longer survival than previously reported for dogs with PDH treated once or twice daily at higher doses. Older age, presence of calcinosis cutis, low BCS and higher platelet count, but not systemic hypertension, are predictive of poorer prognosis in dogs with PDH.

Xanthinuria is a significant adverse effect in dogs on long-term allopurinol for treatment of leishmaniosis. The study aims to investigate how the Iberian veterinary community (IVC) identifies, manages, and proactively prevents xanthinuria secondary to allopurinol treatment. A cross-sectional study was conducted using an online survey, translated into two languages, and disseminated to the IVC via social networking forums. Respondents were asked to share their treatment regimens, adverse effects attributed to treatment, as well as preventive and reactive measures against xanthuria. Of two-hundred and thirty respondents, 99.6% prescribe allopurinol for canine leishmaniosis. Xanthinuria was estimated to happen in less than one out of every four dogs by 91.7% of the clinicians. Xanthinuria has been detected by 71.6% of respondents at least once. Three out of every four respondents inform owners about deleterious effects of allopurinol, and 28.4% consider implementing a change in diet in advance of treatment as a proactive measure. To monitor xanthinuria, urinalysis and diagnostic imaging are used by 71.2% and 31% of clinicians respectively. When xanthinuria is detected, 43.2% of the respondents discontinue allopurinol, 24% replace it by nucleotide-analogs, 14.9% reduce its dosage, and 3.1% split its dosage but increase administration frequency. Additional measures are taken by 72.1% of the respondents, 59.4% of whom prescribe a low-purine diet. The IVC recognizes xanthinuria as a fairly common secondary effect of long-term allopurinol treatment in dogs with leishmaniosis and recommends periodically monitoring and preventive measures.

This study aims to gather knowledge about the use of deoxycorticosterone pivalate (DOCP) by Western European Veterinarians (WEV) in dogs with typical hypoadrenocorticism. An observational cross-sectional study was conducted using an online survey, translated into four languages and disseminated to veterinary affiliates and mailing lists in six countries of Western Continental Europe. Respondents were tasked to share their therapeutic approach to hypoadrenocorticism, whether they preferred DOCP or fludrocortisone and the specific practical use of DOCP. One-hundred and eighty-four responses were included. Of these, 79.9% indicated that they preferred prescribing DOCP over fludrocortisone as a first-line treatment for mineralocorticoid supplementation. A total of 154 respondents had used DOCP at least once. Eighty percent of those who reported their initial dosage prescribed 2.2 mg/kg. After starting DOCP, 68.2% of the respondents assess electrolytes 10 and 25 days after administration following manufacturer instructions. In stable dogs, electrolytes are monitored quarterly, monthly, semi-annually, and annually by 44.2%, 34.4%, 16.9%, and 4.6% of respondents respectively. When treatment adjustment is required, 53% prefer to reduce dosage while 47% increase the interval between doses. Overall, DOCP is the preferred mineralocorticoid supplementation among WEV. Reported variability underlies the need to investigate the best strategies for DOCP use and therapeutic adjustments.

Abstract Background Results of ACTH stimulation test (ACTHst), pre‐ and post‐trilostane serum cortisol concentrations (SCCs), urine concentration (urine‐specific gravity [USG]), and urine cortisol : creatinine ratios (UCCRs) are common variables used to monitor trilostane treatment of dogs with pituitary‐dependent hyperadrenocorticism (PDH). However, none has consistently discriminated dogs receiving an adequate dose (A) from those overdosed (O) or underdosed (U). Objectives To assess and compare recommended monitoring variables, including serial SCCs in a cohort of dogs with PDH treated with trilostane. Animals Privately owned dogs with PDH (n = 22) and 3 healthy dogs (controls). Methods Prospective, multicenter, 2‐day study. On day “a” (randomized): ACTHst was completed. Day “b” (>2 to <7 days later): SCCs were assessed −0.5 hours, immediately before, and 1, 2, 2.5, 3, 3.5, 4, 6, 8, and 12 hours after trilostane administration. On the first study day, urine collected at home was assessed for USG, UCCR and owner opinions regarding PDH were categorized as: A (clinical signs resolved), U (remains symptomatic), or ill (possible O). Results At 27 pairs of evaluations, 7 dogs were categorized as A, 19 U, and 1 possible O (excluded from the study). There was overlap in SCC results from the A and U dogs at every time point. Results of USG, UCCR, and ACTHst did not discriminate A from U dogs. Trilostane suppresses SCC within 1 hour of administration and its duration of action in most PDH dogs is <8 hours. Conclusions and Clinical Importance No single variable or group of variables reliably discriminated A dogs from U dogs during trilostane treatment for PDH.

Abstract Background Systemic hypertension (SH) is common in dogs with hyperadrenocorticism (HAC) however there are not many studies assessing its prevalence and risk factors. Objectives To determine the prevalence and severity of SH in dogs with HAC and its association with clinical and laboratory findings to identify potential risk factors. Animals Sixty‐six client owned dogs with spontaneous HAC. Methods Retrospective cross‐sectional study. Medical records of dogs with HAC were reviewed. Systolic blood pressure (SBP) was measured using Doppler ultrasonography. Clinical signs, physical examination findings and clinicopathologic data (CBC, serum biochemistry and electrolytes, urinalysis and urinary culture, and adrenal function tests) were reviewed for analysis. Results Prevalence of SH (≥150 mm Hg) was 82% (54/66) and prevalence of severe SH (≥180 mm Hg) was 46% (30/66). All dogs with thrombocytosis had SH (P = .002), and a platelet count ≥438 × 103/μL was 100% specific and 61.1% sensitive to predict SH (AUC = .802, P = .001). Median potassium levels were lower in hypertensive dogs (4.1 mEq/L, range 3.1‐5.4 mEq/L) than in normotensive ones (4.5 mEq/L, range 4.0‐5.0 mEq/L) (P = .007). Dogs with UPC ≥ 0.5 had higher median SBP than those without proteinuria (P = .03). Dogs with concurrent diabetes mellitus seemed to have a reduced risk of SH (OR = .118, 95%CI = .022‐.626, P = .02). Conclusions and Clinical Importance Systemic hypertension is common in dogs with HAC and is frequently severe. Blood pressure should be routinely assessed in these dogs, especially if thrombocytosis, proteinuria or low potassium concentrations are present.

BACKGROUND:Systemic hypertension (SH) is common in dogs and humans with hypercortisolism and can persist after treatment.OBJECTIVES:To evaluate changes in prevalence of SH and systolic blood pressure (SBP) in dogs with pituitary-dependent hyperadrenocorticism (PDH) during the first year of trilostane treatment, its relationship with disease control and selected laboratory variables, and their response to antihypertensive treatment.ANIMALS:Fifty-one dogs with PDH treated with trilostane Q12h.METHODS:Prospective case series study. Dogs were evaluated at diagnosis (T0) and 1, 3, 6, and 12 months (T12). Dogs were classified as nonhypertensive (SBP < 160 mm Hg) or hypertensive (SBP≥160 mm Hg) and subclassified according to target organ damage (TOD) risk. Hypertensive dogs were treated with benazepril and, if control of SH was not achieved, amlodipine was added.RESULTS:Prevalence of SH decreased from T0 (36/51) to T12 (17/37; P = .01). Changes in SBP during the study were influenced by the risk of TOD at T0. In severely hypertensive (SBP ≥ 180 mm Hg) dogs, the decrease in SBP was more pronounced whereas in normotensive (SBP < 140 mm Hg) dogs SBP increased slightly (P = .00). Blood pressure was not associated with disease control. Antihypertensive treatment was needed in 31/51 dogs, and in 13/31 dogs additional SH control with amlodipine was required. One third of nonhypertensive dogs at T0 required treatment with benazepril because SH developed during follow-up.CONCLUSIONS AND CLINICAL IMPORTANCE:In dogs with PDH, SBP should be measured at every visit, regardless of disease control or SBP at diagnosis. More than 1 drug may be necessary to manage SH in affected dogs.

Cyclooxygenase-2 (Cox-2) enzyme participates in different steps of the carcinogenetic process and in canine mammary tumours (CMTs), a high expression of Cox-2 is associated with malignancy and tumour angiogenesis. The objectives of the study were to evaluate the disease-free survival (DFS) and overall survival (OS) of a Cox-2 inhibitor as adjuvant therapy in dogs with highly malignant (HM)-CMTs and compare it with that of dogs treated with chemotherapy and with control dogs. Twenty-eight dogs were prospectively included. After surgery, dogs were alternatively allocated into two treatment groups (chemotherapy with mitoxantrone n=8; Cox-2 inhibitor, firocoxib n=7). Control group (n=13) included dogs whose owners rejected adjuvant therapy. All dogs were followed up for two years or until death. The DFS was significantly higher in dogs that received adjuvant treatment (mitoxantrone or firocoxib) (P=0.030) than in control dogs. Dogs on firocoxib treatment had significantly higher DFS (P=0.015) and OS (P=0.048) than control dogs. The DFS and OS of dogs on mitoxantrone treatment were not statistically different from controls. In conclusion, this study supports the use of firocoxib for the treatment of HM-CMTs. Further studies are needed to compare the efficacy of chemotherapy drugs versus Cox-2 inhibitors as adjuvant treatment in these cases.

Background Treatment of adrenal‐dependent hyperadrenocorticism ( ADH ) involves either surgical resection of the adrenal tumor or medical therapy. For many years, mitotane has been considered the medical treatment of choice for dogs with ADH . Objectives The aim of this study was to determine survival and prognostic factors for dogs with ADH treated with mitotane and trilostane. Animals Twenty‐six dogs with ADH were included in the study. Methods Fourteen dogs were treated with mitotane and 12 dogs were treated with trilostane. Medical records were reviewed. Epidemiologic factors, signalment, clinicopathologic abnormalities, endocrine test results, and treatment protocols were evaluated to identify potential predictive factors of overall survival time. Results Survival times of dogs treated with mitotane (median, 15.6 months) or trilostane (median, 14.0 months) were not significantly different. Using univariate analysis, age and postadrenocorticotropic hormone cortisol concentrations were inversely correlated with survival time. The multivariate model also identified weakness at presentation as a negative prognostic indicator. Conclusion and Clinical Importance The type of medical treatment (mitotane versus trilostane) does not influence survival time in dogs with ADH ; therefore, trilostane, a drug with less frequent and milder adverse effects, might be used as the primary medical treatment when adrenalectomy cannot be performed.