New here - adrenal mass questions

[barnesandwinn]

Hi,

In visiting this site I am hoping to learn more about cushings and specifically, adrenal tumors. Barney, my beloved 12 year old cocker spaniel has a large tumor on his right adrenal gland (found on ultrasound).

Background
Back in 2011 he went through the battery of tests for Cushing's but as high-dose dex test came up negative testing stopped. At that time he was showing only slight symptoms - distended belly, weight gain, slight increase in thirst and hunger and panting. There was some weakness in his hind legs, but that was later chalked up to his IVDD (disk disease), the hunger and weight gain thought to be his hypothyroidism and the panting/increase in thirst due to it being a hot summer. Anyway, symptoms seemed to go away so I didn't really think anything about it until now, almost three years later.

Current Situation
About one month ago I noticed an increase in water consumption, hunger, restlessness, panting and the weakness in hind legs. His belly was distended and seemed tight. Lots of shivering. Tests he's had are as follows:

--blood work - things looked pretty normal except elevated liver enzyme.
--urinalysiss - gravity = 1.011, protein 1+ and trace blood in urine. no bacteria found but started a course of antibiotics just to be sure it wasn't an infection.
--urine cortisol/creatine ratio = 149
--ultrasound - found a large right adrenal mass measuring L - 5.61 cm x W-4.10. It's located immediately adjacent to the caudal vena cava. Ultrasound said not evident of invading the vessels, but that it cannot be ruled out. Other finding is a course liver.
--awaiting results of the ACTH endogenous, which should come back this week ending 5/23.
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Next steps:
Calling board certified specialists and setting up consult for treatment options. I live in the Boston area so hoping to get an appt. with Angell asap.

Though I am trying to keep emotion/worst case thinking out of the equation until I have every fact, I am extremely worried that this tumor is growing by the day and getting into the major artery. From what I am reading a large tumor in this location is very bad. It goes without saying that my little man means the world to me and I'm very afraid of what all of this means....

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---As I await the next appointment, I am concerned that Barney is shivering so much. My Vet assured me he is not in pain as didn't even flinch during exams and manipulation of body during the ultrasound, etc. etc. Does anyone know whether the shivering is from the cortisol or other things beings released from the tumor?

---I am compiling a long list of questions and wondering whether I can receive some guidance as to the questions I should be asking. Also, any experiences from others who have gone through this would be appreciated. And of course, any recommendations for doctors greatly appreciated. Thank you so much for your help. I am grateful.

[Harley PoMMom]

Hi and welcome to you and Barney! So glad yuou found us and we will help in any way we can. I have only a moment to post but did want to provide you with a list of questions that one of our dear members made for pet parents who are contemplating an adrenalectomy for their furbaby:
Part I - Questions to ask when considering if surgery is an option for your dog’s adrenal tumour:
1. What type of tumour do you suspect, ?functional, ?non-functional, pheochromocytoma, benign, metastatic
2. Expected life span for my dog in a normal situation. If your dog is close to, at or past his expected lifespan for his breed is surgery going to be of any benefit?
3. Prognosis for my dog if we treated medically i.e. with Cushings medications. AND if we do not proceed with surgery how long do you think it would be before the tumour started adversely affecting his quality of life?
4. If he is miserable now, does the benefit of potentially risky surgery outweigh his current quality of life?
5. Are there any other health problems that could impact on a positive surgical outcome, for example: if your dog is overweight or has heart, BP, liver, kidney or lung conditions
6. Is there any sign of tumour spread – imaging should be done, including ultrasound and on advice of specialists either CT or MRI to check whether there is local invasion around the tumour, into blood vessels including vena cava or spread further away in the body to lungs etc
7. Surgeon recommendations – would he/she do it for their own dog?
8. Psychological impact for the owner: It is important to understand this is risky surgery, sadly current guidelines indicate 1:5 dogs do not make it, and some recommendations are not even that high. Can you accept it if your dogs dies during or in the postoperative recovery period surgery? This is where it is important to weigh up whether the benefit of your dog being fully cured is worth the risk of possibly losing him.
9. Financially – can you afford it? Find out estimate of costs.
10. Hopefully this will not happen, but if your dog collapses, e.g his heart stops either during his surgery or afterwards what emergency measures should be undertaken, do you want your dog to have CPR, how far are you (the owner) willing to go for your dog to be saved in such circumstances

Part II - Surgery has been recommended as treatment for your dogs adrenal tumour, here are a few suggestions on what questions you should ask your surgeon:
1. Are you board certified? How many operations of this type have you done? What complications have you experienced? What were the outcomes?
2. Please explain to me how you will do the surgery, which part would likely give you the most trouble? Will you be doing the actual surgery or a resident in a teaching situation? If so, is their close supervision?
3. Will there be a specialist anaesthetist available for the surgery?
4. If it hasn’t been done, do we need a CT/MRI scan to look at the tumour more closely to check for vena cava involvement or any other tumour spread?
5. What are the risks associated with this surgery, including
• Bleeding (including trauma to blood vessels or other organs during surgery)
• clots
• Blood pressure or heart problems such as arrhythmias
• pancreatitis
• pneumonia
• kidney failure
• infection
• wound problems
• bowel problems
• anaesthetic risks
• adrenal insufficiency or electrolyte abnormalities
• death (sorry but you have to ask that risk too)
6. If we proceed with surgery does my dog need preoperative treatment with Cushing’s meds, antihypertensive if high blood pressure is a problem – phenoxybenzamine recommended preoperatively for dogs with pheochromocytoma, anticoagulants or anything else?
7. How will you treat to prevent clots postoperatively?
8. What would you do if you found anything else during the surgery i.e. nodules in other organs e.g. spleen, opposite adrenal, liver, kidney. Would you remove them and what are the risks associated when doing additional abdominal surgery together with adrenalectomy
9. How long will it take and when will you contact me so I know all is OK, when can I visit after surgery?
10. How will the postoperative period go, how long would you anticipate he would need to stay in hospital? How will we manage pain?
11. What monitoring would be needed, e.g. heart monitoring, oxygen levels in the postoperative period
12. If your dog has an adrenocortical tumour affecting cortisol production will he need to be on steroids following surgery and for how long?
13. If there are problems when I take him home, who do I contact? Hopefully the surgical team until all is stable.


Please know we are here for you and Barney, and do not hesitate to ask all the questions you want.

Hugs, Lori

[Squirt's Mom]

Hi and welcome from me, too!

I just wanted to let you know that I edited your initial post to remove the email address. The threads here are open to any to read and unfortunately there are unscrupulous people out there who may not have your best interest at heart but rest assured we do. ;)

Hugs,
Leslie and the gang

[barnesandwinn]

Thank you for these questions, which will be very helpful!

Also, I appreciate you removing my email address from my post.

[Trish]

Hi!

I am just peeking in before I head to work and spotted your post. Don't have much time now, but there is always time to spread a bit of hope!! My dog had a tumour on his right adrenal gland and it was invading his vena cava and had successful adrenalectomy to remove it. That was 18 months ago now and apart from a few hiccups along the way he is doing great!

Barney's tumour is on the large side so like you I would be very keen to speak to specialists, I would go and see both IMS and a surgeon as I think the input from both is important.

Re the shivering, has Barney had BP checked? One type of tumour in the adrenal can affect BP, which is the sort my dog had a pheochromocytoma. He has always been a trembly dog being a terrier but I did notice it was worse when BP was up.

Is he on any other meds? You mentioned thyroid problem?

Glad you found us, we have quite a bit of experience here with adrenal tumours and I will be happy to help in any way I can :)

Trish :)

[pansywags]

Welcome, and I'm sorry for what brought you here seeking help for Barney - I wish you both the best.

I noted shivering with Pansy (video here https://www.youtube.com/watch?v=YV7mc78B1UM) and others have seen this as well. It always happened while she was laying down, usually while sleeping and did not seem to cause her any distress. I also wondered whether it might indicate that she was in pain but was assured by several vets that her discomfort level was probably mild. I don't know what causes this shivering (Pansy had a pituitary macroadenoma) and the vets at UC Davis didn't give me a clear answer but I have hear others say it may be due to changes in cortisol levels - it has also been observed in dogs who are undergoing Rx treatment.

[barnesandwinn]

Thanks for the concern, and for the information. I read that Pansy has passed and I am sorry for your loss. It's generous of you to be helping others through the information and support you share.

[barnesandwinn]

Hope is needed and well-received!! :)
Thank you! Did your dog also have trouble breathing? I'm noticing more labored breathing, which I will speak to the specialist about. Is this common?
I am meeting with an IMS tomorrow morning and hope to get some additional facts about what he and I are dealing with.

[molly muffin]

Welcome to the forum.

I think Lori and Trish have already given you what you need to take with you to the surgeon, asking questions and getting an idea of the risks vs advantages of surgery is your best option. The more you know the better equipped you'll be to make a decision.

Whatever you decide we will support you and Barney on this journey.

Sharlene and molly muffin

[barnesandwinn]

Thank you!!

[Trish]

Flynn was not particularly breathless that I remember, make sure you have that on your list of questions for the IMS today. Good luck with the appointment and do come back and let us know what happened when you get the chance :)

[goldengirl88]

Welcome to you and your baby. So sorry for the troubles with your Barney. I will say a prayer that all goes well and that you can formulate some plan of action after talking with the specialists. Good Luck. Blessings
Patti

[barnesandwinn]

Thank you. I received valuable information from the specialist and have a much better understanding of his condition, and the next steps/tests needed before any responsible recommendation could be made. His blood pressure was very very high when they tested today so that needs to be retested when he is calmer, also more tests need to come back re: his low thyroid issue......They did an x-ray of his chest today, those results come back shortly.......

Anyway, fast forward a few hours after that appointment and my regular vet called to say that the endogeneous ACTH test she ran last week came back highly suggestive of a pituitary tumor in addition to the adrenal tumor found on the ultrasound. Not good news.

So, it's now waiting until the specialist digests this latest bit of information and gets the other tests back. I won't even try to make sense of anything until she and I speak next. The specialist is excellent as is the hospital in Boston she is with. My regular vet is also wonderful. Very confident with the team he and I have on our side.

Has anyone had an experience with both the pituitary and adrenal tumors? Thx.

[molly muffin]

When it comes to checking the BP, what most vets do is like a curve. They take a few at different times (usually after being in a quiet area, calming, sometimes with the owners there to help them be calmer) then they throw out the highest and lowest and come up with the average.

It isn't unheard of for dogs to sometimes have both. It's not super commone though.

It does mean that if that is the case, then even removing the adrenal tumor, then there might still be some cushings symptoms come back for which medication would be needed. This is in the long run, with the adrenal tumor likely being the one they will concentrate on since they don't want any invasion of the vena cava to occur. That is just my thoughts and you'll know more after the results of these tests come back and you have a chance to have a talk with your team.

Sharlene and molly muffin

[goldengirl88]

My Tipper has both an adrenal tumor and a pituitary tumor. It has been challenging to say the least, but I keep on top of everything. Tipper has to have an ultra sound every three months. She went almost a year without any growth of her adrenal tumor, and this last visit it grew a very miniscule amount. If it gets much larger on the next ultra sound I may need to think of what I am going to do as far as removal, or keep watching. I have had some periods where I have had a hard time with balancing her pre and post numbers on her ACTH test, probably due to having both tumors. She will have been treated two years in August, and God willing she will be here much longer. I know it is a shock for most of us to just deal with one tumor, but two can be overwhelming when it hits you. Let's see what your testing shows, and then you can make a plan after you know all the variables. Blessings
Patti

[Trish]

Hi
Glad you got some answers from your visit yesterday. Flynn did not have a pituitary tumour but he has had liver tumours he has surgery on twice. It will be good to get the IMS interpretation on the ACTH when they look at all the results together when they come in.

Did the IMS mention pheo associated with the high BP? Yes it is hard to get readings when they are not stressful. The last IMS I spoke to about BP a few weeks back said he takes "white coat syndrome" into account up to about 200, but then it should settle as the dog calms down. My vet tests his BP regularly as he remains on BP meds and he uses the protocol Sharlene has described. High BP was one of the main indicators for my dogs pheochromocytoma (pheo).

Flynn's tumour was 1.1cm x 1.5cm with another 1cm protruding through the blood vessels out the adrenal gland and into the vena cava. But they got it out easily enough, he only needed a small venotomy (incision into vena cava). I guess a recommendation to surgeon will be made based on the results of this current testing, so I hope you get news soon. :)