What is Adrenal Gland Cancer (Pheochromocytoma)?
Your dog’s adrenal gland has two unique areas, which are the inner medulla and the outer cortex. The cortex has several layers that create and distribute three chemicals, androgens, glucocorticoids, and mineralocorticoids (aldosterone). What makes this type of cancer even more dangerous is the rate of speed with which it spreads to other organs. This happens due to the fact that the adrenal gland has a direct route through lymph nodes for distributing hormones, and cancer cells are able to be distributed right along with them. The cause of pheochromocytoma is not known yet, although some veterinary medical professionals believe that exposure to toxins or other chemicals may be a contributing factor.
Adrenal gland cancer (pheochromocytoma), which are endocrine tumors that come from the chromaffin (neuroendocrine) cells in the adrenal gland, are not common in dogs. Pheochromocytoma can cause an increase of hormones, which include epinephrine, aldosterone, and cortisol. These hormones cause symptoms that are like those that happen when your dog is stressed, only these can happen at any time, no matter whether your dog is stressed or not. Just like many other cancers, pheochromocytoma is most common in older dogs, and the average age of those with pheochromocytoma is about 10 years old.
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Symptoms of Adrenal Gland Cancer (Pheochromocytoma) in Dogs
The symptoms of pheochromocytoma may not be noticeable in many dogs, because they are mild, intermittent, and can be mistaken for many other diseases and disorders. Some of the most common are diabetes, renal disease, hyperadrenocorticism, and hepatic disorders. Clinical symptoms that are most often noticed are:
- Abdominal distention
- Acute blindness
- Dry skin
- Excessive thirst and urination
- Loss of hair
- Lumps on neck and back from calcium deposits
- Nosebleeds (epistaxis)
- Weight loss
Causes of Adrenal Gland Cancer (Pheochromocytoma) in Dogs
As with many cancers, studies are underway to try and unravel the mystery of this disease, which can be so detrimental to the health of humans and animals alike. Presently, the cause of pheochromocytoma is not known, although some experts believe it has something to do with exposure to toxins or chemicals.
Diagnosis of Adrenal Gland Cancer (Pheochromocytoma) in Dogs
Your veterinarian will do a physical examination of your dog that includes body temperature, weight, height, heart rate, respirations, blood pressure, and reflexes. He will do some neurological tests to see if your dog’s sensory and motor skills are normal, as well as balance, coordination, and cognition. Laboratory tests, such as complete blood count, blood chemistry profile, glucose levels, urinalysis, and fecal examination.
Your dog’s medical history is usually needed to inform the veterinarian of any illnesses or injuries your dog has had, and if his immunizations are up to date. Be sure to let him know if there has been any strange behavior or change in appetite. A fine needle aspiration will be done if it is possible to remove cells from the tumor for analysis. This will let the veterinarian know if the tumor is cancerous. An MRI, ultrasound, CT scan, and x-rays will be done to determine the areas affected by the tumor and to see if it has spread.
Treatment of Adrenal Gland Cancer (Pheochromocytoma) in Dogs
Since pheochromocytomas usually occur with other medical disorders, the veterinarian will want to treat the one that is the most serious first. Some of these are pulmonary edema, heart attack, cerebral hemorrhage, extreme increase in blood pressure, and heart failure. Treatment for pheochromocytomas includes removal of the adrenal gland and nearby lymph nodes. If it cannot be removed with surgery because of other illness or age, medications such as Lysodren can be used. However, this drug may also have serious side effects, so the veterinarian may choose to keep your dog under observation for the first 24 hours. The surgery to remove the adrenal gland is complex and has many possible complications, such as severe spikes in blood pressure and pulmonary embolism. Some other critical side effects of surgery may include electrolyte imbalances, hemorrhage, and pancreatitis.
The best treatment for any kind of tumor is surgical removal, but sometimes that is not an option. Sometimes, it may be necessary to remove the gland as well as the tumor, in which case your dog will need medication indefinitely to regulate his hormones. In some cases, the tumor may be unable to be removed, such as when it has integrated itself into a vital organ or if it has already metastasized. In these cases, chemotherapy may be suggested if your dog is in relatively good health, but these tumors are hard to treat with chemotherapy alone.
If the tumor is small and has not spread, the veterinarian may decide to use radiofrequency ablation (RFA) to kill the cancer cells. This procedure is done by sending a current of high temperature through a tiny needle into the tumor, which has been very successful in the past, and is less invasive than surgery.
Recovery of Adrenal Gland Cancer (Pheochromocytoma) in Dogs
If your veterinarian is able to remove the entire tumor without damaging the endocrine glands, the chances of your dog’s survival is excellent although there is a chance that the tumors may recur. If you and the veterinarian are able to catch it early enough, another treatment can virtually eliminate the chances of a recurrence. Be sure to follow up with your veterinarian regularly and contact him if there are signs of the tumor returning.
Adrenal Gland Cancer (Pheochromocytoma) Questions and Advice from Veterinary Professionals
My dog has just been diagnosed with an adrenal tumor that has gone into a vein and also looks to have spread to his liver. Vet has said surgery is to risky and no point as it has spread. We are devastated. Has anyone had any success with alternative therapies?
My 12 yr old mixed breed (cocker spaniel/bulldog/dauschund) was in collapse, and after a scan, we found out he had an inoperable adrenal tumor invading his vena cava. Our vet prescribed phenoxybenzamine, benazepril, and prednisone. The prednisone5mg was making him agitated, so we only give it to him every other day. He was given days or weeks to live, but he's by my side 2 yrs later. Doing well for 14yrs old. We just recently upped his benazepril for blood pressure. I give half dose of phenoxybenzamine because it's expensive from a compound pharmacy, but I think we'll be increasing it to prescribed dose soon. Hoping he makes it to 15, but we've been blessed to have him this long. Good luck w your dog! Hope this info helps someone dealing w this rare kind of tumor.
Sorry to hear about your dog. Yes my dog was diagnosed also with a tumor and given three weeks to live 6 months ago. Blood work off the charts and I was told she had cancer and prepare her for the next life. After crying my eyes out, I took charge, did some research and changed a few things; 1. I did not give my dog the prescribed meds. 2. Threw away the dog food 3. I bought Spinach, Calf liver, Whole grain Brown rice and Carrots. Had to to grind the food and feed her with a syringe from the side of her mouth until one day (7)she ate on her own a little. I also gave my dog Unrefined Coconut oil. 10 days later I re-ran her blood work and the Doctor was shocked to see that ALL of the results had reversed and now in normal ranges. WASH the rice several times before cooking. This allows it to sprout. wash the vegetables and do not cook them, just chop them very small or grind them Coconut oil is used to cook the liver, mix in the food and/or give straight as a treat. The coconut oil has cancer fighting properties. Finally, if reheating a batch of this food, DO NOT MICROWAVE IT. The microwave destroys the nutrients. Hugs and best wishes for your dog and prayers for you both.
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Our beautiful Bichon Poodle mix Riley was the love of our life. He was just about 11. he had started limping on and off on his right rear leg, but usually only for a few steps right after rising. We had a vet appt scheduled as we feared all his jumping up and down off couches and our bed might have resulted in a cruciate tear, or that we needed some meds for arthritis. It was strange because if he went out to do his business, he could lift either leg to a 90 degree angle with no problem, run with no limp, and even jump up on his hind legs. But at other times, the leg would seem almost to "dangle" and he would tap the foot up and down off the floor. We also noticed that his right front leg had begun to bow out like a bulldog for some reason. It had become more and more pronounced. Neither of his legs or any of the joints seemed painful in any way.
Flash forward. 2 days ago, I got up and dressed for work. Riley was right at my heels as always, tail wagging ears up, prancing along as normal as can be.Went out, did his usual, sat for a cookie...normal, normal, normal. he went back in the bedroom to get back in the bed with my husband and I snuggled him and kissed him and told him I'd be back later. He did everything exactly as he did every day for years...went up and started nudging my husband, tail wagging furiously, and snuggled up with him.
My hsbad was in and around the house with him most of the day. He ran to the store for about 1/2 and hour, and then was back...Riley was still fine. He went out to do some yardwork and came in around 3pm to talk him out. Riley wagged and pranced outside, did his normal 3 pees and had a normal bowel movement, and went back in to sit for his cookie. My husband came back in at 5 and he was sitting on his bed...but wouldn't get up. My husband went to him and sat with him for a few, and he seemed to be pushing himself up on his front legs rather than actually sitting up. So he feared his leg was hurting. He tried to help him stand, and he stood up and started walking slowly...but after about 10 ft, just stopped and stood there looking at him. My husband said he looked scared. So he picked him up and brought him to the couch, where Riley laid down next to him but looked like he didnt feel well. I got home about 6:15....and I knew there was something very wrong. Riley and I were extremely bonded, and when I came in he didn't even get up. Ears stayed down, tail didn't move....he looked terrified. I went to him and all he could do was nudge my face. I petted him and as my hands reached his flank I felt what was like an electrical buzz. A quiver. I knew it was pain and so we immediately left for the emergency vet. My fear was that the rear leg had been a back injury all along.
The first vet said she found nothing significant. We noted that his belly seemed so hard and bloated, and that we feared a stomach issue. She sad it was tense from the pain but non-reactive..it was not his belly, he did not have pain there. She said his patella was subluxating a bit (common in his breed and he had had that for years) but that she didn't want to do a full cruciate tear exam because it would hurt him more, and we had an appt with the specialist 2 days later. We felt this vet blew us off and even rolled her eyes when we insisted we knew our dog and something was really wrong. She said he was "walking around in the back" and seemed fine...we said we could not see how given he could not walk when we brought him in. But she insisted and wanted to give him buprenorphine for pain with Tramadol to take home until our appt. He was given the buprenorphine, and we sat and waited 1/2 an hour for them to bring him to us. When they did, we were devastated. He was panting furiously and seemed incoherent. His head was lolling, his tongue hanging out...he couldn't even pull it in and close his mouth. It would just sit on the table. We asked repeatedly what had happened..why was he like this. They just kept telling us it was "normal" side effects of the meds. We didn't want to leave the ER. He would have like a moment of looking up at my husband, then me...then he'd be gone again. We sat in the parking lot for a a half hour. I was in tears and kept saying "this isn't right. I don't like his breathing" We even called back in from the parking lot to ask again about the panting and being so out of it and were told the dr said it was all normal and to go home and get some sleep.
We sat in tears and watched our poor little man panting like this for an hour and a half. I called 3 other emergency vets to ask if this was truly normal. All said he could be really out of it and that panting was a common side effect of opioids, which is what the buprenorphine was. He just didn't seem like it was just the meds to us. He was SO out of it he couldn't hold his head up..or drink..or even know we were there. Once in a while he would pick his head up and look at each of us...and then just seem to fade out. I don't know what made me do it...the nurse in me maybe...but I looked at his gums. They were white. his whole mouth was pure white. At that moment I knew he was going into or already in shock. We raced back to the vet and they whisked him away. We barely had time to say I love you.
THANK GOD it was a different vet as the shifts had changed.This vet stabilized him and initiated fluid therapy and pain management. They had to put him on Fentanyl. Please note that during this visit, bloodwork showed a blood sugar of 584 and elevated pancreatic enzymes and the vet told us he very obviously had a tremendous amount of pain in his abdomen. We were livid as e begged the 1st vet to do diagnostics and said over and over he was in pain and we thought it was his belly. This new vet first felt it was pancreatitis and diabetes. She told us the pancreatitis can be excruciating, but it usually easily remedied with antibiotics. They were going to give him insulin but then his urine came back completely normal. No glucose, no ketones. His xrays didnt seem to indicate pancreatic inflammation so they were now going on a hunt. His xrays did have an area behind his stomach that wasn't especially clear so they wanted to do an ultrasound, but wanted to get his pain alleviated first as did we. Riley was admitted to ICU and we went home about 2 a.m. I called every 1 1/2-2 hrs and was told he was resting on his pain meds and fluids. At 6am his blood sugar and labs were rechecked and everything was back to normal. Blood sugar was 96 and pancreatic enzymes dropping. They had also gotten his BP and heart rate, which had gone very high, down to normal. I now spoke to an internal medicine specialist who told me it was NOT diabetes, and probably not pancreatitis.The blood sugar was She wanted to go ahead with the ultrasound because she needed to know what had caused this. Within 10 minutes she called back and said the news was not good. Riley had a large, invasive, agressive adrenal tumor. It was compressing the vena cava and aorta, and to her appeared to have invaded them. She said she truly believed that the panting and white gums and shockiness were due to cardiovascular collapse, and said she had no idea how he even made it that time at home and them back to the ER. She also said it was touching the pancreas and the pancreas seemed inflamed there, so that was probably why the enzymes were off. She explained the options, and said surgery was the usual choice, but that she felt if it were her dog she would not attempt it.She said it was entirely up to us, but given his age, cardiovascular state, bloodwork, and the size of the tumor...his chances, if any, would be very very slim. She then said the recovery is tough, and that dogs with high risk factors often did not fare well due to hemmorhage, infection, etc, and said that if the tumor had invaded the vessels as she believed, he could develop a thrombus at any point, or hemmorhage. The nurse in me understood all this too well unfortunately. I asked if there were any way to bring him home. SHe said it was possible but she would need to send him on extremely heavy pain meds, and the same risks would apply. SHe did say that if we wanted to attempt surgery, she would be in it to win it with us, and if they got in and could do nothing, we could opt to euthanize on the table, or close him up and wake him up to say our goodbyes.
We talked with our son, who had grown up with him and made the group decision that all the options seemed to be more for us than the dog, and would only prolong suffering. We made the decision to say goodbye and headed to the vet with his favorite toy and blanket to spend time with him.
Unfortunately,that didn't happen. We arrived and went to the room, but as they were preparing the gurney to bring him to us, Riley simply stopped breathing. The initiated CPR, but since we had told the vet we had opted to let him go peacefully, she stopped them. 18 hours from seemingly fine to gone. It was horrific and devastating. We can only try to console ourselves with the knowledge that we spent that precious time with him before he went to ICU telling him we loved him and kissing and hugging him when he would look around at us before fading again...because we never got to say goodbye.
The vet tells us these tumors are "just horrible luck". That they are not genetic, hereditary, or caused by anything known. Of course, none of that helps us feel better. He had no symptoms we would have identified as anything other than getting older...occasional panting after play or running, limping a bit for a few steps after he got up, sleeping a little harder and longer than a year or two ago. She also told up as large as it was (baseball sized) it was not palpable. She could not feel it on exam. She did say that the lame right back leg could well have been from nerve compression in his spine. as for the front right leg,the vet said it was probably bowing from him putting more weight on it to stay off the right rear. And then she also said that all those symptoms could also still have been from normal aging because many times these tumors cause no significant symptoms. This is just a horrible, horrible cancer...not that any are good....and our experience has left us heartbroken and devastated.
We were encouraged by the internal medicine vet....who was wonderful...to file a formal complaint against that first vet who blew us off and sent us home, and we have. We firmly believe she caused or baby to suffer unnecessarily, and may even have caused his complete cardiovascular collapse, hastening his death and prohibiting us from saying goodbye. We have yet to hear back.
Hi, I just wanted to tell you how similar your experience is to ours. We had a beautiful little Jack Russell / terrier mix named Halo who was 9 years old. She too was the light of our lives. My fiancé and I loved her and doted on her.
We cooked for her, brushed her teeth, bathed her - she was our little baby.
She was absolutely fine up until about 5 weeks ago on Sunday the 10th of February. I gave her her breakfast and a couple of hours later, she started vomiting. She vomited about 7 times and was very weak. My fiancé and I decided to rush her to the vet. When we got there ( at 11:30 am ) he examined her and told us he could see she was in a lot of abdominal pain. She was doing this “prayer” pose with the back half of her body up in the air. This apparently indicates severe abdominal pain.
The vet said she’s not in a good way and that he needed to put her on a drip, give her antibiotics in case of infection and give her painkillers and take an X-ray.
He said he would call us back in half an hour. When he called us back he said that she had a very high glucose level and that her liver was palpable. ( inflamed ) but he couldn’t really see anything else of significane on the X-ray.
He said that Halo would need to stay the night and that he would run further tests in the morning if she hadn’t improved.
This was at 12:30.
By 4 pm that afternoon we got another call. It was the vet to tell us Halo had passed away.
Our entire world came crumbling down. We were in complete shock.
How did she go from being fine to DEAD in less than 6 hours.
We couldn’t believe it. We were and still are devastated.
We needed answers as to how and why she died. So we decided to send her body to a lab to have a post mortem done.
The lab results came back a week and a half later.
The post mortem revealed that our poor little Halo had an adrenal tumour on her right adrenal gland. Her right adrenal was 10 x the size of her left.
It was a functioning tumour that released hormones / adrenalin. Which damaged her heart. She ultimately died of a heart attack.
Very difficult to come to terms with this, we did not notice any signs or symptoms. The only symptom we recall was that she panted a lot. But we just thought she was hot. We live in South Africa so the weather here can get extremely hot in summer.
Other than that she was a happy dog, full of energy. She loved her walks and we had even taken her for a walk the day before she died. She ran, barked and seemed her normal self. She even ate her breakfast the morning she died. She was never lethargic and she never lost her appetite.
Like you, we never got to say goodbye to Halo.
It was all so sudden and so quick.
The vets said that adrenal gland tumours are very rare. And the symptoms come and go and are difficult to pick up.
We wish we could have saved her. We wish we could have done more.
In October 2017 we had taken Halo to have an abdominal scan after it was discovered that her liver enzymes were high. The abdominal scan showed NORMAL adrenal glands. This means that the tumour developed recently and could have developed over a period of months.
I’m just not sure what more we could have done.
But thank you for sharing your experience, it helps to know that we are not alone.
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Snickers, our 15 year old English Cocker Spaniel last week has been diagnosed with adreanal mastastic cancer.
This causes him to have difficult in swallowing , so eating for him is rare. Feeding has gotten so that he is fed with a syringe twice a day. He is taken a probiotic when he is fed. He has been reduced to skin and bones over the last week.
Is there any hope?
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11 year old dog diagnosed with pheochromocyoma. Has very high bp which we are trying to control with Amlodine. We started him on phenoxybenzamine, however had to stop due to recent diagnosis of glaucoma. He is on eye drop medications to lower glaucoma. Surgery does not seem to be an option. What other medications besides the phenoxy can be used? Is chemo or radiation an option?
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hello, I'm looking for an oncologist that provides Radio frequency ablation for bone cancer, please call me if you have any question 213 948 3188, I'm willing to pay extra since its a sunday.... my dog needs help....
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I was told by a veterinary internist that a pheochromocytoma may be benign. According to this website, you are telling me that it is cancer and will metastasize. Any other current treatments other than surgery? How do you know for sure there was metastasis?
Pheochromocytoma are usually benign, but may be locally invasive and in some cases may metastasise to the liver, lungs and lymph nodes. The treatment of choice is surgical removal, but the overall prognosis is guarded; other treatment options are usually centered around stabilisation prior to surgery. Regards Dr Callum Turner DVM
Hello Jean J. I would love to hear how your dog has fared and whether or not he had the surgery. Your situation 10 months ago is eerily similar to mine now.
Hey everyone! I just found out today through biopsy that my 12.5 year old shih tzu was diagnosed with pheochromocytoma.
About 3 weeks ago, he had his Right adrenal gland removed. The perioperative period was a little daunting but they said he did ok. THe only issue was low blood sugar and appetite but he bounced back the 2nd day post op.
Prior to this, my dog has been having MILDLY ELEVATED LIVER ENZYMES for about a year and a half. The vets wanted to recheck it in a month after starting him on Denamarin. Still high. This went on for months. THey kept telling me its nonspecific and nothing to worry about. We also ran a bile acid test to see if the liver was functioning. This was normal.
WHile I agree that liver enzymes being slightly elevated (especially for months to years) may seem non-specific and not something to be concerned about, they are still elevated and out of normal range. WHen ALT/AST enzymes are elevated for periods of time for no good reason, I do not believe that it is just a fluke. I am a critical care nurse and from taking advanced physiology and pathophysiology courses in graduate school, I learned that elevated enzymes means some type of damage. Yes it could be the food or other random etiology but I changed my dog's diet from kibble to FROZEN RAW or freeze-dried RAW and I was certain that this would help his liver values. Kibble is horrible and I've watched so many documentaries.
Nonetheless, I chose to chase it. Yes, it's mildly elevated. No, the Denamarin wasn't helping. Yes, the liver bile acid test was normal but I am not waiting until values become extremely abnormal before intervening. In medicine, there is a fine line between waiting and acting. I am GRATEFUL I ACTED. WHAT IS DAMAGING my dog's liver????
I took him for an ultrasound of the abdomen on my own free will. The vets said this was an option but were not pushing me to do it. He was diagnosed with Hepatic vacuolar hepatopathy which is another non-specific diagnosis. However, it is known that over secretion of hormones from the adrenal gland can cause this and subsequently cause damage to liver cells by storing glycogen on the surface of the liver.
My dog was exhibiting atypical cushings symptoms as well; this also supported the premise that there was something wrong with his adrenal gland.
Well, they found a nodule on his R adrenal gland.
The gold standard was to surgically remove it. As you all were, I was nervous to have my dog undergo surgery.
Anesthesia is scary and the perioperative phase even scarier. I was scared he would form blood clots, be in severe pain, or have deadly arrhythmias (heart rhythm disorders) and even electrolyte imbalances. NO prophylactic anti-coagulants for dogs apparently; in humans we administer heparin a couple days after surgeries.
However, my dog is resting and is his happy joyful self three weeks later. I followed my surgeons instructions for home care to the T.
If you can help it do the surgery. I made sure to optimize my dog's health prior. I walked him 3x's a day, fed him NO kibble only RAW frozen (Primal pet from pet supplies plus) and gave him supplements/vitamins. I also give him probiotics in his water because he was sent home with 4 weeks worth of antibiotics. I had to taper Prednisone (a steroid) until his left adrenal gland would function and compensate.
It was a small tumor and it did not invade the vena cava (my biggest worry). Since it was on the R side, it was a little more risky because it is further back than the left one which means more manipulation. It was done open abdomen instead of laparoscopically given the location and depth of the tumor.
I will follow up and see how I can monitor for any metastasis. He said it is HIGHLY unlikely but is estimated at 15% per literature. However, he has never seen this in his practice.
He also mentioned recurrence? But, I am not sure what he meant by that because he took out the entire R adrenal gland.
Nonetheless, point is: CHASE YOUR DOUBTS!!!! Shih tzu's also typically have a longer life span (~16-18 years) which is why I decided even more that this was the right decision. AT the time of agreeing to do the adrenalectomy, I did not know yet if it was malignant or benign and my internal med vet said there is no way of knowing unless the gland is removed and sent for biopsy. SO... I went for it, said a lot of prayers and prepped my dog in the best way I knew how.
You are your pet's ADVOCATE. If something doesn't feel right, it probably isn't. I am lucky that I have medical/nursing background to support my actions.
I hope I helped you guys with any questions. Sorry if there are typos, I just came from working a 13 hour shift. I will try to check back on this website to answer questions.
- Xtine RN, BSN, CCRN
My dog passed away this last July 2017 . He was diagnosed with Pheochromacytoma and early stage kidney disease in May of 2016. Fearing the complications of surgery, we opted to try Radiation Sterotatic treatment. Which is treating the tumor with high radiation . This treatment has no proven track record with this type of cancer. We got mixed results. After a year his tumor only increased 1 cm . However, the tumor was functional meaning, my dog had to stay on the same high dosage of blood pressure meds to counter act the hormonal release. We thought the tumor would shrink and his blood pressure would decline over the months but didnt. The last two months his blood pressure remain stable and normal with his meds. But his heart rate increased from average of 100bpm to 130 bpm. In combination with his kidney disease which we had stabilized his appetite decreased. The last week of his life he stopped eating all together. His blood pressure could no longer be controlled with medication. If I had to do it over again, I would have opted for the surgery. Although the tumor may be considered benign, the functional nature of the hormone release is what causes damage from the increased blood pressure.
Just got the news that our 9 yo dog may have this. I am praying surgery is an option although ultrasound showed a decent sized mass. Never did I expect to hear this when I took him in due to increasing lethargy from last week. Last week he went in for an ear infection! Today ... this ! Shocked. Feeling bad that I must have missed signs but vet explained there are episodic & easily missed. All I know is my doggy is totally different from last Saturday to today! All I am reading is exactly my dog. So sad but hopeful. Your post was very helpful. I will opt for surgery if an option based on your comments.
Hello Jaz. I am so sorry for your loss. You must be heartbroken. It is always so difficult to know what to do for the best. Our vet thinks our 12 year old greyhound has it. She has recommended a CT scan but we are worried due to the anaesthesia his very high blood pressure. Do you mind me asking how old your dog was? Take care. X
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My dog is 12 1/2 years old. He was diagnosed with the pheochromocytoma tumor. No mention of metastasis. Dr. wants to know if I want chemotherapy done. I can't find any information on this. How do I know if he needs it or it works? He had an adrenalectomy.
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