Study links canine hypercortisolism to stiffer adrenal glands: full analysis

A new canine imaging study suggests adrenal elastography may add clinically useful information in dogs with hypercortisolism, with affected dogs showing significantly stiffer adrenal glands than healthy controls. The research comes from Fernanda de Paula Sesti and colleagues and appears in Veterinary Radiology & Ultrasound, with fuller methodological detail available through the group’s 2025 master’s dissertation from the Federal Rural University of Rio de Janeiro. (rima.ufrrj.br)

The idea fits into a long-running challenge in canine hypercortisolism: diagnosis rarely rests on a single test. Hormonal testing remains central, while imaging helps sort out whether adrenal changes are symmetric, asymmetric, nodular, or mass-like, and whether adrenal-dependent disease is more likely. Recent guidelines and related literature continue to frame abdominal ultrasound as an important adjunct, but not a standalone answer, especially because imaging findings can overlap and endocrine tests have known limitations. AAHA’s endocrinopathy guidance notes that ACTH stimulation lacks sensitivity in some adrenal tumor cases, and more recent ultrasound studies have shown that even dexamethasone-suppressible dogs can occasionally still have adrenal-dependent disease or mixed lesions. (aaha.org)

In the new study, investigators evaluated 30 dogs total: 15 healthy controls and 15 dogs with hypercortisolism. According to the dissertation abstract, 11 affected dogs were confirmed by low-dose dexamethasone suppression testing and four by ACTH stimulation testing. Standard ultrasonography found significantly increased adrenal dimensions in the diseased group, particularly in the left adrenal gland, with more frequent changes at the cranial pole and caudal pole. On qualitative elastography, affected dogs most often showed mixed stiffness patterns, while controls showed uniformly moderate stiffness. On semiquantitative analysis, adrenal glands in the hypercortisolism group were 33% to 80% stiffer than adjacent mesentery, and group differences in adrenal stiffness were statistically significant. (rima.ufrrj.br)

That finding is notable because prior veterinary adrenal imaging work has focused more on morphology and perfusion than on tissue stiffness. Earlier studies have examined contrast-enhanced ultrasonography in dogs with pituitary-dependent hyperadrenocorticism and adrenal lesions, while more recent reports have continued to refine how clinicians interpret adrenal asymmetry, nodularity, and width measurements. This newer elastography work pushes the field toward functional tissue characterization, which could be helpful if future studies show it improves confidence in borderline or complex cases. (pubmed.ncbi.nlm.nih.gov)

Direct outside commentary on this specific paper was limited in public sources, but the broader industry direction is clear: adrenal imaging is becoming more nuanced as ultrasound technology improves and as clinicians look for better ways to distinguish hyperplasia, nodules, and neoplasia. Educational materials from IVIS and ACVIM programming reflect that growing emphasis on adrenal ultrasound technique and interpretation, including recent specialist ultrasound training focused on adrenal glands. That doesn’t validate elastography on its own, but it does suggest the study lands in an area of active clinical interest. (ivis.org)

Why it matters: For general practitioners, internists, and radiologists, the practical takeaway is cautious optimism. Elastography could become a useful complement when conventional adrenal ultrasound raises suspicion but doesn’t fully clarify the picture, or when clinicians want another noninvasive way to document adrenal change. But the evidence is still early. This was a small case-control study, and it doesn’t yet establish diagnostic cutoffs, interobserver performance, or how elastography compares head-to-head with existing imaging pathways in real-world patients. For now, it’s best viewed as promising adjunctive imaging, not a replacement for endocrine testing, abdominal ultrasound, or cross-sectional imaging when indicated. (rima.ufrrj.br)

There’s also a workflow question for practices: even if elastography proves useful, adoption will depend on equipment access, operator training, and whether the technique adds enough incremental value to justify time and cost. In canine hypercortisolism, where pituitary-dependent disease remains more common but adrenal-dependent disease can carry very different treatment implications, any tool that improves adrenal characterization could matter, especially in referral settings. Published background literature estimates adrenal-dependent hypercortisolism accounts for roughly 15% to 20% of canine cases. (pubmed.ncbi.nlm.nih.gov)

What to watch: The key next milestones are larger prospective studies, clearer reference ranges or stiffness thresholds, and data on whether adrenal elastography can help distinguish pituitary-dependent from adrenal-dependent disease, identify neoplastic change earlier, or track response over time. If those data emerge, elastography could move from interesting research tool to a more routine part of adrenal imaging in dogs with suspected hypercortisolism. (rima.ufrrj.br)