Conn’s Syndrome/Right Adrenal Gland Mass In An 11-Year-Old FS DSH : Our Case Of the Month June 2020

June 3, 2020
The Focal Zone

Conn’s syndrome in cats is not a pathology we see every day, but an SDEP-trained sonographer is always prepared, having been drilled in the 17-point abdominal protocol including every adrenal every time, for both dogs and cats.  Melding the clinical signs, labwork, and thorough ultrasound imaging allowed for a prompt diagnosis and internist referral visit within 24 hours.

Dr. Cathy Jarrett, SDEP® Certified clinical sonographer and owner of Potomac Mobile Veterinary Ultrasound (Ashburn, VA) imaged this patient, and Dr. Gouri Krishna, DVM from Silver Spring Animal Hospital managed the case. Thank you to Amy Roth Jones, DVM, DACVR for her detailed interpretation of these diagnostic images.



An 11-year-old FS DSH cat was presented for poor appetite, hyperthyroidism, and previous episode of hypertension. The patient perked up a bit after receiving SQ fluids, Cerenia, and mirtazapine. CBC was WNL, blood chemistry found phosphorous 2.7, Na 156, K 2.6, bicarb 27, CK 441, Total T-4 7.3, USG 1.021.

Image Interpretation

The right adrenal gland presents as an enlarged somewhat bilobed homogeneously hypoattenuating soft tissue mass measuring 3.7 cm by 2.3 cm. The mass appears well encapsulated with a mildly hyperechoic surrounding retroperitoneal fat. The mass is vascular; however, no definitive vascular invasion of the cauda vena cava is seen. The mass does deviate the cauda vena cava dorsal medial. Pancreas: The right limb of the pancreas near the pylorus is slightly hypoechoic and effaces the right adrenal mass.


Right adrenal mass with reactive retroperitoneal fat – Suspect pancreatitis of the right pancreatic limb secondary to regional inflammation.


This study confirmed the presence of a right adrenal mass consistent with suspected Conn’s syndrome and hyperaldosteronism. The mass appeared fairly well encapsulated and surgically resectable. Given the size, it does efface the pancreatic limb in the region and is likely causing pancreatitis. A metastatic lesion or adhesion of the mass to the pancreas is thought less likely given the separation from the retroperitoneal cavity; however, this case may benefit from a CT for a more definitive and anatomic evaluation, and assessment of the regional vasculature as well as any possible involvement of the pancreas or other surrounding soft tissues. Alternatively, exploratory laparotomy for adrenalectomy with concurrent evaluation of the pancreas is and option. For any possible involvement, a partial pancreatectomy could also be considered. Consultation with an internal medicine specialist and surgeon was recommended. After discovery of the right adrenal mass the patient was immediately referred to an internist and was seen less than 24 hours later for further discussion of the right adrenal tumor and hypokalemia. Radiographs showed no evidence of metastatic disease. Surgical excision with hospitalization was discussed with fluid therapy and potassium supplementation (optional CT per our surgeon). Supportive care and medical management with oral potassium supplementation (consider spironolactone) was also discussed. Ultimately, the owner elected humane euthanasia in this case as the patient’s quality of life had declined significantly.
Left Adrenal
Right adrenal gland mass
Right adrenal gland mass and kidney
Pylorus, pancreas, and right adrenal gland mass.
View of right adrenal gland mass from the left side.