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Thread: Is it cushings or not with our blue

  1. #1
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    Default Is it cushings or not with our blue

    New to forum...so here's our story...our 5 year old Australian Shepard lab mix (100 lbs)went from energetic puppy to old man seeming overnight. Last January we noticed his symptoms...lethargic, mopey, sad, tired, not wanting to run and play or engage, no longer jumping on bed, hungry constantly to the point of stealing off counter, garbage (which he never did) drooling, thirsty drinking constantly , peeing alot, snoring, pot belly...we went to the vet as nervous parents with the complaint of "he just ain't right". Everything checked out fine with regard to bones hips knees etc. Xrays showed nothing amiss. Urine tests (first catch in am) showed diluted urine. Bloodwork (they had him for the whole day) showed positive for cushings but they said the adrenal type. We had never heard of that before. We had ultrasound in June from prominent vet specialist who found nothing. We chalked it up as false positive results. His hair has never grown back on his belly and now I see what I suspect as that cutaneous calcinosis -scaly bumps on top of his back almost like dandruff. My question is this...if we go back to vet what next steps should I expect? If I do nothing what should I expect? We are torn not knowing and realize each situation is different. I wish there was a clear cut answer. Will meds help or hurt? Will doing nothing help or hurt? Any advice would help thanks .

  2. #2
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    Default Re: Is it cushings or not with our blue

    Hello, and welcome to you and Blue — we’re so glad you’ve joined us! First of all, it’s unusual for severe Cushing’s symptoms to come on overnight; usually it’s a process of symptoms steadily worsening over time. However, having said that, Blue certainly does exhibit a number of the most common outward symptoms. So, combined with a “positive” blood test, Cushing’s has to be suspected. I am guessing the diagnostic blood test was the 8-hour LDDS test? If so, however, this is one clarification. Depending upon the results of that test, Cushing’s in general can be diagnosed. Also, if the results turn out in a certain pattern, they point to a pituitary tumor as the cause. However, they can also turn out in such a way that either a pituitary or adrenal tumor could be the cause. I suspect that’s what happened for Blue, and the goal of the ultrasound was to see if an adrenal tumor was indeed present. Based on the ultrasound report, it sounds as though no tumor was seen. Therefore, if Blue has Cushing’s, it must instead be caused by a pituitary tumor. In that event, you’d expect to see both adrenal glands to be enlarged to some extent (because they’re being “overworked” by churning out excess cortisol, as it were). However, a minority of cases do not show adrenal enlargement, especially early on in the disease process.

    So here are some questions for you. Can you find out the exact results of Blue’s diagnostic blood test, as well as any other blood panel abnormalities? Cushpups typically display elevated liver numbers, especially the ALKP (or sometimes listed ALP). Often they also have high cholesterol and also some abnormalities in white blood cell counts. Finally, did the ultrasound note anything abnormal at all about any internal organs? In addition to adrenal enlargement, Cushpups often exhibit liver abnormalities as well.

    Once we see this additional info, that will help us chart the path forward. As I say, Blue certainly does sound as though he is suffering from Cushing’s symptoms that are affecting the quality of his life. And if cutaneous calcinosis is emerging, you really do want to nip that in the bud because it can make a dog’s life miserable. In fact, if a biopsy confirmed CC, that would pretty much confirm the overall Cushing’s diagnosis in and of itself. And if Blue were mine that would definitely prompt treatment. But we can talk more about that in another reply.

    Once again, welcome to you both!
    Marianne

  3. #3
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    Default Re: Is it cushings or not with our blue

    Thanks for replying...yes from January to June it was clear something was wrong. In fact we kept looking back to try to figure out when it might have started. I'll see if I can get the blood test results but you are right thats just what happened. When they saw nothing in ultrasound they said could be false test results or early onset? We went home with no treatment happy that they were "wrong" . Well now it's February and well...I will call vet today then to have his skin tested but I bet you're right if its that cc then I bet we pretty much know for sure. Will the vet order more tests again then like bloodwork again ? Or another ultrasound? I've heard it said if they don't have it and you give them meds it could hurt them but if we can't confirm diagnosis then how do we know what to do? It's scary because I worry about meds and dosage and side effects ...ugh... thanks for your advice...

  4. #4
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    Default Re: Is it cushings or not with our blue

    Hi Larinda and welcome to you and Blue!

    CC can be caused by other things but 99% of the time it is caused by Cushing's. If Blue has not been exposed to any steroids and does have CC then the odds are really good he has Cushing's. Just for my peace of mind, tho, I would want an ACTH performed and probably another ultrasound just to be sure there is no sign of a tumor on one or both of the adrenal glands. You want to be sure the US is performed on a high resolution machine so they can see the most possible.

    Giving Vetoryl (Trilostane) to a pup who does not have Cushing's is dangerous but Lysodren (Mitotane) works differently and does not seem to have any effect on dogs who don't have the disease. HOWEVER, we want to be as sure as can be that the pup actually does have the disease before starting treatment with either drug. So pursue the CC diagnosis then follow up testing as recommended by the vet(s) and let us know what you learn.

    The most important thing I can tell you today is that you and Blue are now part of our family here at K9C. You will never be alone again. We are here to listen, to guide, to support anytime you need us.

    Hugs,
    Leslie
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  5. #5
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    Default Re: Is it cushings or not with our blue

    so I got some numbers for you if you know what they mean...in july 2017 the dexamethasone suppression test : cortisol - 4 hour post dex 4.6 ug/dL and cortisol 8 hour post dex 4.4 ug/dL .
    does that make any sense?
    now hematology from july shows ALP 259 5-160 u/l
    cholesterol 433 131-345 mg/dL
    the ultrasound showed everything normal. our vet called in a specialist to perform the test for accuracy so we trusted his judgement.
    seemed a mystery but fast forward to today...February...he's the same or slightly worse, and now the skin disorder. looking back we had him tested for allergies in 2016. nothing major there. he had skin disorder then and we changed his diet and it settled down. so I guess I should have them test for this CC. see what they want to do next?
    thanks .

  6. #6
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    Default Re: Is it cushings or not with our blue

    Hi again, and thanks for this additional information. Everything you’ve shared thus far is consistent with Cushing’s except for the normally-appearing adrenal glands. And as I wrote earlier, not every dog with a pituitary tumor exhibits adrenal enlargement especially in the early stages of the disease.

    As far as the LDDS, there should actually be three numbers: the resting (baseline) cortisol level, and then two more readings taken at the 4-hour and 8-hour mark. You’ve given us the last two readings; it would be interesting to know the first baseline reading, too. However, unless the baseline was over 8, I understand why an adrenal tumor needed to be ruled out. The quick explanation for this is that dogs with pituitary tumors generally show significant suppression of their cortisol levels after the low-dose dexamethasone injections have been given. Dogs with adrenal tumors do not. But a percentage of dogs with pituitary tumors don’t, either. Hence, the ultrasound to check.

    At this stage, if your vet thinks the skin issue could be calcinosis cutis and proceeds with a biopsy, I’m banking on Cushing’s as the correct diagnosis. Without a CC diagnosis, I suppose you could repeat the ultrasound. But even without the definitive CC biopsy, I still think Cushing’s is likely given all the symptoms and lab abnormalities. Let’s first see what your vet thinks about the skin condition, though.

    Marianne

  7. #7
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    Default Re: Is it cushings or not with our blue

    Vet wants to examine and possibly repeat the day long blood tests on Wednesday. Would that sound right? I guess we shall see.thanks so much. I have a copy of the original tests i wish I could send it to you somehow as it's hard for me to understand. I'll keep you posted thanks

  8. #8
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    Default Re: Is it cushings or not with our blue

    7/27/17 7:35 AM (Last Updated)
    TEST RESULT REFERENCE VALUE
    Cortisol - 4 hr
    Post Dex
    4.6 ug/dL
    Cortisol - 8 hr
    Post Dex
    b 4.4 ug/dL
    b Low-Dose Dexamethasone Diagnostic Intervals (Canine)
    4 hours 8 hours Interpretation
    ----------------------------------------------------------------------
    <1 <1 Normal
    1.0-1.5 1.0-1.5 Inconclusive
    >1.5 and >50% >1.5 and >50% Consistent with hyperadrenocorticism
    of baseline of baseline Further testing required to
    differentiate adrenal tumor from
    pituitary-dependent
    hyperadrenocorticism (PDH)
    <1.5 or <50% >1.5 and >50% Consistent with pituitary-dependent
    of baseline of baseline hyperadrenocorticism (PDH)
    <1.5 or <50% >1.5 and <50% Consistent with pituitary-dependent
    of baseline of baseline hyperadrenocorticism (PDH)
    >1.5 or >50% >1.5 and <50% Consistent with pituitary-dependent
    of baseline of baseline hyperadrenocorticism (PDH)
    High-Dose Dexamethasone Diagnostic Intervals (Canine)
    4 hour 8 hour Interpretation
    ----------------------------------------------------------------------
    <1.5 or <50% >1.5 and >50% Consistent with pituitary-dependent
    of baseline of baseline hyperadrenocorticism (PDH)
    >1.5 and >50% <1.5 or <50% Consistent with pituitary-dependent
    of baseline of baseline hyperadrenocorticism (PDH)
    <1.5 or <50% <1.5 or <50% Consistent with pituitary-dependent
    of baseline of baseline hyperadrenocorticism (PDH)
    >1.5 and >50% >1.5 and >50% Further testing required to
    of baseline of baseline differentiate PDH from adrenal
    tumor.
    Hyperadrenocorticism is a clinical disorder with clinical signs. If
    the animal has no clinical signs, we do not recommend treatment.
    Approximately 5% of dogs with hyperadrenocorticism will have normal
    low dose dexamethasone suppression results. Conversely, some animals
    with significant nonadrenal disease may fail to adequately suppress on
    this test.


    does this help at all? I copied it from his test results page.
    thanks
    larinda

  9. #9
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    Default Re: Is it cushings or not with our blue

    Gosh, how good of you to lay out the entire test interpretation guidelines. However, the one value that remains missing is the first of the three blood draws: the baseline (or resting) cortisol reading. It’s so odd that it’s not listed on the lab sheet. Maybe it’s printed somewhere else on the lab results along with some other testing.

    The reason why it’s an important value to know is because all the “<50% or >50%” interpretations refer to comparing the 4 and 8-hour values to the original baseline cortisol reading. In Blue’s case, we know the LDDS was consistent with a Cushing’s diagnosis in general, because the 8-hour reading was greater than 1.5. However, in order to know whether either the 4-hour or 8-hour reading is greater or less than 50% of the baseline reading — we need to know what the baseline reading actually was.

    I am making the assumption that Blue’s baseline reading was not greater than 8. If that was true, this is the interpretive line that fits his results (with my clarification in brackets):

    [4-hour reading] >1.5 and >50% [of baseline]; [8-reading] >1.5 and >50% [of baseline]: Further testing required to differentiate PDH from adrenal tumor.
    When you return to the vet, I’d ask him/her to point out where the result is for Blue’s baseline cortisol on the LDDS. That way, we’ll know for certain how to interpret his test. As far as repeating the LDDS, I suppose you could do so. But since it’s already turned out positive once, perhaps the money would be better put towards some alternative diagnostics, such as a skin biopsy, or an ACTH stimulation test as Leslie suggested earlier. This is a second diagnostic blood test for Cushing’s, and is also used for monitoring treatment progress after medication has been started. It can be helpful to know how high cortisol levels are on this test prior to beginning treatment. One drawback to this test is that it has a higher percentage of “false negatives” than does the LDDS. Also, it cannot distinguish between the pituitary or adrenal form of the disease (the Endogenous ACTH, a different test, does that). Still, in Blue’s situation, an ACTH stimulation test might be useful corroborative info to consider.

    Marianne

  10. #10
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    Default Re: Is it cushings or not with our blue

    Hello and welcome from me too. You could also have the ACTH done to find out what his cortisol results are for within the adrenal gland, how much is it making. That is only 2 draws, a pre and a post.

    It does appear that your vet said the LDDS was positive for cushings, so I am thinking that yes the stuff on the back is probably cc and to get rid of that you need to get the cortisol levels down.

    Since he was positive, it doesn't matter which type you of medication you would use, vetroyl or lysodren and most vets opt to go with the medication they are most familiar with using. So that would be a discussion to have with your vet about treatment.
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

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