Stella - 10 year old Corgi/American Eskimo mix (Stella has passed)

Hello everyone. So happy we found this forum.

Our 22 pound 10 year old Corgi/American Eskimo mix, Stella, was diagnosed with Cushings at the end of 2019. We went the holistic route for a while, guided by a wonderful vet. It finally reached a point where he thought Trilostane would be helpful, along with the supplements we’d already been giving her, which included Lignans and Melatonin. So we started off about 3 months ago at .005ml/5mg (Liquid Trilostane) twice a day. Since then we bumped up to .0075ml/7.5mg twice a day.

The good news is that her water consumption dropped way back down, her hair is growing back like wildfire, and all her labs look great.

Our only concerns are:

1 - She’s become a very picky eater. She’s also not finishing all of her food. She used to scarf down her entire meal in about a minute. I understand was a result of the Cushings but she had a pretty healthy appetite before the Cushings kicked in.

2 - Her energy level has dropped off. Getting her to go for walks is a bit of a chore and she just doesn't the seem like her self. The feedback we’ve been getting is that her body has been through a lot and now that the high levels of cortisol aren’t pumping through her system, she’s finding her new homeostasis.

She’s not due for another ACTH for about another month but my wife and I feel a bit uneasy with some of this behavior. Maybe the sluggishness is due to the continued use of Melatonin?

Love to get some feedback on this.

Thank you all so much.

Chris and Adele

Hi and welcome to the forum. When was Stella's last ACTH test? And what were those results? Please post the results of any Cushing's tests that she has had along with blood work, highs and lows only, with ref. ranges, please. That would be very helpful.

Thank you so much for the quick reply Joan.

Here you go. Please let me know if you need anything else.


Last ACTH was April 6.

Pre Trilostane ACTH in Feb. 2020:

CORTISOL SAMPLE 1 Result: 3:3 Range: 1.0-5.0
CORTISOL SAMPLE 2 Result: 35.9 Range: 8.0-17.0

First ACTH with Trilostane (March 12):

CORTISOL SAMPLE 1 Result: 4.4 Range: 1.5-6
CORTISOL SAMPLE 2 Result: 12.3 Range: 1.5-6

2nd ACTH with Trilostane (April 7):

CORTISOL SAMPLE 1 Result: 3:3 Range: 1.5-6
CORTISOL SAMPLE 2 Result: 8.6 Range: 1.5-6

3rd ACTH with Trilostane (April 24):

CORTISOL SAMPLE 1 Result: 1.7 Range: 1.5-6
CORTISOL SAMPLE 2 Result: 8.2 Range: 1.5-6

As far as her April 25 bloodwork goes, there were a few things that were a bit off:

Amylase - A bit low at 322. Range: 337-1.469
Urinalysis - Gravity: 1.014
Crystals: 1+ CALCIUM OXALATE DIHYDRATE (1-5)/HPF

I am sorry you had to find us, but glad you did. There can be several reasons for this. I can not read the numbers like some of the folks can, and I am not as well versed in dosing. I can say the activity can very well be due to the drop in cortisol. If you are really concerned you may need to run an ACTH even though it isn't scheduled. Welcome to the forums.
Angela

Hello and welcome from me, too! Under these circumstances, I agree with Angela that I would want to proceed with another ACTH monitoring test now. I’m not sure how recently you increased her trilostane dose, but cortisol levels can shift over time, even when a dose is left unchanged. Since it’s now been two months since her last test and her behavior has become somewhat worrisome, I wouldn’t wait to recheck her cortisol. I’d go ahead now.

Her diagnostic ACTH was indeed consistent with Cushing’s, and the monitoring tests thus far have not been too low. But again, since her trilostane dose was increased at some point, her level may have drifted further downward since April.

If cortisol is not the issue, you could certainly try discontinuing the melatonin. I’m actually not sure what value there is in continuing with the melatonin and lignans for any reason, now that you’re treating with the trilostane. If your girl was doing well right now, I’d understand not rocking the boat at all. But since something seems to be amiss, you may well want to at least drop the melatonin to see if that helps.

Do let us know how things develop, OK?
Marianne

Thank you both so much.

So we've cut back the Melatonin considerably and are set for another ACTH on Friday.

I will keep you all posted.

Thanks Again!

I wish I had better news to report this morning.

We were unable to perform the ACTH on Friday because Stella didn't eat Thursday night or Friday morning. We stopped the Trilostane because of this. Stella has barely eaten since.

My wife and I are struggling and trying to remain present for our baby girl.

The one bright spot: Her labs and x-rays were all good. Her baseline morning cortisol was OK considering she hadn't had any Trilostane beforehand.

We are trying to get her into a specialist at the local VCA to possibly get an MRI as our vet mentioned that sometimes, although rare, the pituitary tumor can enlarge and cause neurological issues.

At a loss right now but we are putting one foot in front to the other.

Hope to have further answers soon.

🙏🏻

I’m so sorry to hear that Stella is doing poorly. Sadly, if her Cushing’s is caused by a pituitary tumor and there’s no other obvious cause for her inappetence and lethargy, an expansion of the tumor may indeed be the culprit. I know this from personal experience with my own Cushpup, a Labrador retriever. He was initially treated successfully with trilostane, but developed several neurological abnormalities a few months later, culminating in his refusal to eat and drink entirely. If all of Stella’s labwork was normal — especially her potassium/sodium balance and her cortisol level — then I’m afraid your vet is correct in terms of possible neurological involvement from the tumor. My own dog was was ill clear back in 2004 and the only available treatment for a macrotumor at that time was a prolonged series of conventional radiation treatments that would have spanned a month. For several reasons, we chose not to pursue that on his behalf and we did end up losing him to what we assume were the effects of the expanding tumor. Since that time, however, drastically shorter laser treatments have been introduced in certain vet schools and specialty centers. So if the tumor is the problem, treatment may be something you would want to consider for Stella.

I will warn you that imaging of the head, either via CT or MRI, is typically quite expensive. In our case, we had already decided that we wouldn’t put our boy through the radiation treatment even if a macrotumor was present, so we did not pursue the imaging, either. For that reason, we’ll never know for certain whether that was the cause of his problems. But as our specialist told us, any time a Cushing’s dog with a pituitary tumor but normal labwork stops eating, an enlarging tumor has to be suspected.

So I do think your vet’s advice is accurate, as sorry as I am to say so. My heart goes out to you in the face of Stella’s inappetence. I think there are very few issues that are as stressful for parents than the struggle to try to tempt a sick dog to eat. I’ll surely be keeping my fingers crossed that she’ll suddenly perk up on her own. But in the meantime, we’ll be right here if you have more questions or just want to vent. Please do keep us updated.

Marianne

Prayers rising for Stella as well as the both of you. Please keep us updated and know we are beside you all the way.

Hugs,
Leslie

Thank you all so much. This site has made this process for my wife and I much more manageable. So we thank you for the words of support and encouragement.

2020 is the gift that keeps on giving. :(

Stella is our world. Lots of tears right now.

She is in good hands. I took her to ACCESS Emergency last night in the San Fernando Valley. She's going to be looked over by an internal medicine specialist and hopefully a neurologist.

Even though all signs point to an enlarging tumor, I am holding out hope for a miracle.

And if it is the tumor I know we still have options.

She's a STRONG girl. AND I will trust that the universe knows what's best for her.

Thanks you all!