Skippy has passed; 12 y/o Yorkie with likely pituitary tumor (Trilostane)

[Carole Alexander]

Hello to all and thank you for this forum; I am exceedingly grateful for your knowledge and counsel on behalf of those of us who are struggling to understand this devastating disease. My dog Skippy, a nearly twelve year old Yorkie, has been diagnosed with Cushings. He is symptomatic, i.e., PU/PD, aggressive eating, significant lethargy, the classic pot belly and some weakness in his rear legs. Skippy's blood chemistry is "normal", and an ultra sound of his adrenals revealed one adrenal is enlarged with an adrenal tumor and the other is "slightly smaller". The ACTH failed to confirm whether the Cushings is pituitary or adrenal related. I believe his numbers were 4.6,5.4 at 4 hours and 3.6 at 8 hours. My vet has ruled out diabetes and renal failure. While I have read an exhausting number of articles, I am uncertain as to what I should do next and still don't know what I don't know. My options appear to be to start him on Vectoryl/Trilostane to see if the drug "works" or take him to Purdue University for a second workup and MRI? (The initial cost is estimated at approximately $1,500). (Purdue is a vet teaching hospital but they do not specialize in endocrinology as far as I can determine.) I don't know if he is a candidate for surgical removal of the adrenal gland and/or if I would subject him to surgery despite the cost.

I would appreciate any feedback that you all can offer. Should I ask the vet to perform the LDDST? I don't believe he has hypertension or proteinuria, but I will double check.

Thank you for any advice that you might offer.

[labblab]

Hello Carole, and welcome to you and Skippy. As you'll see, I'be moved your reply so as to create a thread that is your very own. This way, it will be easier for our members to reply to you directly.

First of all, it appears that Skippy's diagnostic blood test was actually the LDDS and not an ACTH. The LDDS involves a baseline blood draw and then subsequent draws at the 4 and 8-hour marks. The results you report for Skippy are consistent with both the LDDS protocol and also with a dog who suffers from an adrenal tumor as indicated by the ultrasound imaging. So it would seem to me as though you do have the diagnosis in place, unless your vet is somehow questioning the accuracy of the ultrasound.

It is rare, but possible, for a dog to suffer from both a pituitary and adrenal tumor. When you speak about the $1500 estimate for an MRI, is that referring to imaging of the head to establish whether or not there is also a pituitary tumor? Or are you seeking more detailed imaging of the adrenals? I would not think that additional abdominal imaging would be that expensive, and in honesty, I believe I'd choose to invest my money in additional adrenal diagnostics since a tumor is known to be there. Depending upon the clarity of the initial imaging, you may want to seek another view along with the advice of a board-certified surgeon. Adrenal surgery is always a very serious undertaking, but the exact size and location of the tumor can greatly affect the risks and time frame for intervention.

There's much more we can talk about, but I'll quit for now and await your reply. Once again, welcome!

Marianne

[Carole Alexander]

Marianne, thanks for your quick reply. My vet is scheduled to call me at noon today. I will seek answers to the issues you raised and clarify the testing issues. I presume that if he had the LDDST as you stated, there is no reason to perform the cortisol test. I will reply with additional info about the proposed MRI shortly. Also, Skippy, a Yorkie mix is 12 not 15.
Thank you again for your help.

Carole

[labblab]

Whoops, so sorry about prematurely aging Skippy!! I've now edited his age so it should be correct.

And yes, given a "positive" result on an LDDS in conjunction with an adrenal tumor viewed on ultrasound, I don't think I'd spring for an ACTH right now unless it was desired in order to provide a baseline cortisol reading prior to beginning Cushing's medication. In terms of diagnostics, the ACTH often provides a "false negative" result when adrenal tumors are involved. In other words, the ACTH will fall within normal range even though an adrenal tumor may be causing hormonal abnormalities. So the LDDS is actually the better diagnostic blood test when an adrenal tumor is suspected. However, regardless of tumor type (pituitary or adrenal), the ACTH is the blood test that is used for subsequent monitoring of medication's effect on lowering cortisol levels. So for that reason, some vets prefer to document a baseline ACTH level before treatment begins, in addition to the LDDS.

Marianne

[Carole Alexander]

Thanks again Marianne for your reply. I spoke with Skippy's vet yesterday and ultimately I decided to proceed with an MRI of Skippy's adrenals before trying medication. The vet thinks Skippy is in excellent health and that he is very "early" onset Cushings. His enlarged adrenal is.9.7 centimeters; the other plump adrenal is .7 (If I recorded her statement correctly.) She said the tumor has not invaded Skippy's vessels and the tumor itself may be hyperplastic. She believes that further imaging of the adrenals will clarify treatment options so off to Purdue he goes as soon as I can secure an appointment.

If they recommend surgery and pursue that course of action, would it mean that Skippy will be on cortisone for the remainder of his life?

Skippy does not appear to be in pain; he is more like a chubby lump, very lethargic and disinterested in life beyond drinking, eating and peeing. The change is shocking as previously he was hyperactive, constantly playing and wanted to be outside every hour of the day.

I will update this post when I learn more. Thank you.

[Carole Alexander]

Skippy is scheduled for a consultation next Monday. I will post again when I know something more.

[molly muffin]

Hoping that skippy is doing okay. Is he still eating? How is the water levels doing?

[Carole Alexander]

Skippy is eating, drinking, peeing, and no diarrhea at the moment. He is much less lethargic, but no ball of fire. He does want to get up on sofa, bed, etc. and puts his paws up but won't try to jump. He shows no signs of renal failure but I have no idea of how he is doing overall. He will be tested Tuesday early AM; I'll post after I know more. Thanks for your support!

[Budsters Mom]

Well this sounds encouraging. Skippy is blessed to have you in his corner.

Kathy

[molly muffin]

This is super positive! Great he is eating, no diarrhea, and sounds much more energetic than he was.

Molly completely quit jumping up eventually and would put her paws up and wait for her "lift" I'd say, you need a lift up molly and she'd just look and wag her tail. If you ignored her she would eventually bark at you and put her paws back up. Which I always found just hilarious, but then it was all part of Diva molly and how she ran our lives.

Skippy is letting you know in his own adorable way, exactly what he wants you to do.