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I have a cat, male, 15 years, previously otherwise healthy (until yesterday he's always been active, healthy weight, energy level about the same as a 7-8 year old) except for a heart murmur since birth, until an ER visit last night diagnosed critically low potassium and moderately high blood sugar. Working theory based on x-rays and bloodwork so far is hyperaldosteronism due to a possible tumor on adrenal gland, non-metasticizing, unknown if malignant. He's getting ultrasound today to confirm.

I have been researching treatment options if it comes back positive as a tumor, which I have a feeling it will.

All the options so far seem very high risk. There's an adrenalectomy, which apparently can go either very great or very poorly, and from my research this won't be an option if the tumor is bilateral or there's not much functioning gland that can be saved.

There's Lysodren, which appears to have risky and awful side effects. There's also ketoconazole, which can cause liver damage, which worries me because of his age although I believe him to be otherwise healthy.

I'll also be talking to the doctor at the hospital for more options today, but my question for you guys is are there any other treatment options I can add to my list? I'm trying to build as comprehensive a list as possible from internet research, talking to the doctor, and other people's experiences.

I'm looking both for personal experiences from pet owners as well as cited treatments and opinions from any professionals here. I am open to natural treatment suggestions as well.

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    I've never seen this before but I'll ask a few cat vets I know for you, good learning opportunity. – Rebecca RVT Jan 2 '17 at 18:21
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    Well got a quick response for one of them, she said it's really rare and often associated with chronic kidney disease. She sent me a few links which I will post here for you. Recognition and diagnosis - veterinarymedicine.dvm360.com/… //// Treatment and Prognosis - veterinarymedicine.dvm360.com/… /// A case report - veterinarymedicine.dvm360.com/… – Rebecca RVT Jan 2 '17 at 19:02
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    I would post this as an answer but they don't like links in case the site goes down, it's REALLY LONG AND WORDY so if you need clarification just let me know. I hope it helps - they say prognosis is good. – Rebecca RVT Jan 2 '17 at 19:04
  • @Rebecca Amazing thank you. Ultrasound confirmed a tumor, one side, haven't talked to doc yet so not sure if it's his aldosterone that's high, or cortisol (Cushing's disease), in the waiting room now and this will be a perfect read. – Jason C Jan 2 '17 at 20:28
  • @Rebecca Firstly, great reads, thanks. So, we aren't actually sure what hormones the tumor is producing yet. I didn't realize that those results were a separate panel. All the labs here are backlogged from the holiday so we've got a long 5 day wait to confirm. In the mean time we're focused on getting his potassium up to the point where we can take him off IV and give it orally. He doesn't seem to be presenting other issues. The tumor is large but no sign of it in the vein there, it seems ideal for surgery except his heart murmur and age concern me. – Jason C Jan 3 '17 at 15:09
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So, basically, there are no "alternative treatments" for this, at least not in my case where the hyperaldosteronism was caused by an adrenal tumor.

All non-surgical treatment options revolve around countering the symptoms, such as potassium supplements to raise potassium levels. None seem to lead to particularly good quality of life except in very mild cases.

However, for large tumors, you simply can't keep up. In my cat's case, his potassium was so low and being depleted (through urine) so quickly that the combination of IVs, oral supplements, and a paste applied to the skin, still barely countered it.

In addition, any solutions that treat the symptoms are temporary at best, as the tumor grows it will eventually overwhelm any efforts.

So the only true solution seems to be to surgically remove the tumor via an adrenalectomy, or to put the animal down.

Note that surgery is only a viable solution if the tumor is not caused by a metastatic cancer (in which case, expect more). If the tumor has invaded the nearby vena cava, (there is a picture of the anatomy, as well as some decent info, on this page), removal becomes significantly more difficult and risky, and sometimes impossible. However, it is my understanding that assessing both of the previous conditions generally requires access to the tumor anyways, so it doesn't seem to me like they can be readily used to make judgments ahead of time. According to the previous link, in dogs at least (the condition is rare in cats), the general survival rate of an adrenalectomy is roughly 78%.

I opted for the surgery, of course. In my cat's case the tumor was benign, isolated, and in a relatively ideal form for removal. The operation was performed the moment his potassium was back up to safe levels (it took 4-5 days for his levels to respond to the supplements). The surgery was a success, and the cat has recovered 100%. In fact, it's like it subtracted 5 years from his age.

Other cases may be different, I don't know, but in my case there were no other options.

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