Interactive case 14: The case of the nighttime food thief
Correct. It would seem to make sense to increase Ivy's trilostane dose at this time because her post-ACTH cortisol concentration is above the goal range of 5.4 to 9.1 µg/dl. However, cortisol concentrations in patients receiving trilostane and showing improvement in clinical signs may continue to decrease during this initial phase of treatment.3 So if clinical signs improve and the ACTH stimulation test does not indicate hypoadrenocorticism (monitoring for insufficient cortisol response is the primary reason for this first test), then it would be best to not alter the dose now.
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