Relapse or new case of adrenal based Cushing's after adrenalectomy??

[KristinB]

Hello everyone-
My name is Kristin, I live in Atlanta, GA and I am mom to 15 year old Maggie, my lab/hound mix. A little over three years ago, Maggie was diagnosed with adrenal based Cushing's. She had a tumor on her adrenal gland. She underwent surgery to remove the gland and did well. She has not been on medication since right after the surgery when it was needed to balance her cortisol levels.

Fast forward until now and it's like a repeat of three years ago...drinking buckets of water, insatiable thirst and appretite, increased urination, hair change, panting, etc. She is exhibiting all the exact same signs as three years ago when she had the tumor.

We have an appointment tomorrow morning with her vet to discuss her symptoms. Is it possible she has a new tumor on the existing adrenal gland? Is it possible she could now have pituitary Cushing's? I of course need to start with testing and then a diagnosis, but I cannot imagine what else this could be.

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[Buffaloe]

Hi Kristin,

I'm sorry you have to deal with this now but thank goodness you have already had three great additional years with Maggie.

My Shiloh had a very successful adrenalectomy in 2006 at the age of 12. Three years later she exhibited all of the old symptoms, although not quite as badly. We did an ultrasound and found her to have a 3 cm. tumor in her right adrenal gland. I thought, no sweat, we'll have it removed like the one in her left gland. Trouble was, she was now 15. My surgeon is the best and he just said, cut and dry, he would not operate on her at this point. So, we had the choice of treating her with Lysodren or Trilostane. We chose Lysodren and she did pretty well for 6 months or so.

The wonderful ultrasonographer who did all of her ultrasounds told me that if any of the bad cells escape, they seem to like to find the same kind of tissue (adrenal glands). I definitely think you need to get Maggie a good ultrasound and then you will know. Whatever happens, I hope Maggie lives with a good quality of life for a nice amount of time.

Ken

[KristinB]

Hi Ken-
Thank you for your prompt reply. Just reading it and knowing someone was in my shoes is comforting. I'm sorry you lost Shiloh, but glad you had some additional time with her, too.

I do plan on another ultrasound for a definite diagnosis, yes. We went to an internal medicine specialist for that last time.

I wanted to ask you what your experience with the Lysodren was like? I've read of some pretty bad side effects. Do you feel it was why Shiloh gained six months? Was Cushing's the cause of Shiloh's passing eventually?

I want to be able to ask all the right questions of my vet, so this is very helpful.

Thank you,
Kristin

[KristinB]

Hello-
I am new here and posted about my 15 year old Maggie who seems to have another adrenal tumor after an adrenalectomy three years ago. All the Cushing's symptoms are back. We go for blood tests and ultrasound tomorrow.

I've been reading about Lysodren as a possible drug my vet may recommend, since any surgery on a 15 year old dog is unlikely to be recommended. Yes, I do a lot of research before I have to, but it helps me to feel informed! What are others' experiences with Lysodren? I am wondering how much time it can buy a 15 year old dog, and what the quality of life may be for her on such a drug during that time. At this point, I would choose for her to be happy and comfortable over having more time.

Thank you in advance.

Kristin

Moderator's Note: Kristin, I have merged you new post about lysodren into the original thread for your pup. We, usually, like to keep all posts on a pup in a single thread as it makes it easier for other members to refer back to the pup's history, if needed.

[Jenny & Judi in MN]

Hi Kristin, I'm sorry you are starting over with your dog. I'm one of the newest people around here but we have been trying to get Jenny's dose right on Lysodren since July. We had about a month where she was perfect but her maintenance dose wasn't high enough so we are reloading right now.

For that month I had my old Jenny back. Happy, peppy, playful. It is a serious drug and getting the dose right takes a bit but then I think it is fine.

A receptionist at the vet's office told me her dog has been taking Lysodren since he was 11 and he is 17 now. She said she remembers the first year or so took a lot of adjusting but after that he has been on his maintenance dose.

so, I'd think it would be how much to get your dog's levels under control. My vet is not a specialist but we will either be doing Jenny's 4th or 5th ACTH this week. Once to diagnose, once after loading, once to check maintenance, once to see if increase worked, and now again after the reload.

best of luck to you.

Judi

[StarDeb55]

Kristin, welcome to you & Maggie! It is always great to hear about a successful outcome after an adrenalectomy. I do recall that we have another member whose pup developed a second adrenal mass several years after successful surgery to remove the first affected adrenal gland. Unfortunately, my memory fails me right now, but let me ask some of the forum staff to see if they recall.

Now, your questions concerning lysodren, I can offer some help with but just not in relation to the treatment of ADH. I have, now, treated 2 pups with PDH quite successfully with lyso. My first boy was treated for nearly 8 years, crossing the bridge at 15. Harley, my 2nd boy, was diagnosed at 13 1/2, & was treated with lysodren. He did pretty well for 2 years, crossing the bridge at 15 1/2 from an unrelated malignancy. Lysodren causes the adrenal cortex tissue to necrose (die) which is how the level of cortisol is controlled. You do not want to knock out all of the adrenal cortex, but just enough to bring the cortisol down to a more healthy level. My understanding is that lyso should shrink the size of any adrenal tumor that is present, but from everything I've read in this group, you need to be aware that adrenal tumors can be somewhat resistant to lysodren, & your pup may need a higher dose to gain symptom control.

Hope this helps.

Debbie

[Buffaloe]

Hi Kristin,

First, there is a chance that Maggie has developed a pituitary tumor causing her symptoms. But, I believe it is more likely a second adrenal tumor. You should know after your ultrasound.

Your two choices to treat an adrenal tumor medically are Lysodren or Trilostane. I studied them ALOT as far as treating an adrenal tumor. There are several considerations in deciding which medicine to use for a particular tumor. Shiloh's first tumor was malignant so we figured the second one probably was, as well. There is a school of thought that Lysodren may be the better choice if the tumor is suspected to be malignant. However, many top Internists, especially the younger ones, feel Trilostane is the better medicine to treat adrenal tumors. I do not believe it is likely for Lysodren to shrink an adrenal tumor. The problem with using Lysodren is that one often needs to give their dog higher and higher doses to control the excess cortisol produced by the adrenal tumor. Trilostane works in an entirely different way and the doses don't have to be so large. For whatever it's worth, I believe Trilostane is usually the better choice to treat the effects of an adrenal tumor.

My surgeon owns two wonderful specialty facilities here in Phoenix and they treat many dogs medically for adrenal tumors. They're only going to perform an adrenalectomy if they feel good about it. They use both Lysodren and Trilostane but I get the impression they use Trilostane more often. If you find out Maggie does have another adrenal tumor, you can talk it over with your veterinary professionals and do lots of research. You will make the right decision.

Ken

[KristinB]

Maggie update...she does have Cushing's disease, once again caused by another adrenal tumor, this time on her existing adrenal gland. As I posted in my introductory post, Maggie had an adrenalectomy three years ago to remove an adrenal gland with a large tumor causing her Cushing's at that time. Our choices are slim this time around. We don't know if the tumor is malignant or benign, as it cannot be removed. She needs one adrenal gland, and cannot undergo any surgery this extensive at her age. I can't believe this has happened to us again, it's an exact repeat of what we went through three years ago. My vet and I have decided to put her on Trilostane/Veterol at a low dose to see how she does. She could do well on it and it could relieve her Cushing's symptoms. She could do poorly on it, as it does have possible side effects. We should know within a week how she is doing. As I told my vet (and he agrees), my priority now is that she is happy and comfortable. She is 15 1/2 and that is all I want for her.

Can anyone share experiences with the Trilostane? I started her on it tonight.

Moderator's Note: I have merged your update concerning Maggie's diagnosis into Maggie's existing thread. We usually prefer to keep all posts on a pup in a single thread so other members can refer back to the pup's history, if needed.

[Harley PoMMom]

Hi Kristin,

I was wondering if you could provide some additional information about Maggie, such as her weight and the dose of Trilostane her vet prescribed for her, also is this dose once or twice a day? Thanks!

Love and hugs,
Lori

[KristinB]

Hi Lori-
Maggie is 59 lbs. and my vet has her on 30mg Trilostane per day.

[KristinB]

I know this seems like a small dose, but my vet was worried about giving her a large dose at age 15 1/2 and considering some other problems she has had (pancreatitis). We are just looking for comfort, not a cure at this point.

I am very glad I found this group. I really have no one else to share this with who understands what I am talking about.

[frijole]

First off, hugs and positive vibes being sent your way.. you surely have had alot to deal with. You mentioned pancreatitus and I wanted to share something I have learned dealing with my dog who has an adrenal tumor (pheochromocytoma). Her tumor emits adrenaline which causes heartburn and ulcers and she quits eating. Anyway.. I started using Slippery Elm Bark powder and it is a god send.

It is cheap and easy! I googled it and found a ton of positive reviews/videos from VETS that use it for any sort of stomach issues. I take the powder and mix it with water, boil it for 10 mins and then let it cool, cover and refrigerate. I put 2 TBS of the liquid over her food and it seems to be helping her. They say to put 1/4 tsp in 1 cup of water when you boil it but I use more than 1/4 tsp. I just dump a couple TBS in . They say you can't OD on it and it is working real well.

I share in case it is helpful... I also take my dog to weekly acupuncture for pain relief, hunger issues etc. It has worked miracles. She has lived with this tumor for over 1 1/2 yrs now and still enjoys life. I wish you the very best. Kim

[Harley PoMMom]

I believe that the 30mg starting dose is a good dosage to begin with especially considering the pancreatitis issue. I think that starting low and going slow is an excellent motto when dealing with a dog that has pancreatitis issues and Cushing's, it gives their system a chance to adjust to the Trilostane/Vetoryl.

Wishing you and Maggie the best of luck and please keep us posted.

Love and hugs,
Lori