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

That is always the hope that the radiation will completely get rid of the cushings, but I think that most dogs end up back on vetroyl. I wonder if it is because the pituitary is damaged from the tumor and doesn't actually recover normal functioning in cortisol production.

Good speculation Sharlene; I guess there is no way to know if the pituitary is damaged. Just keep on treating the symptoms...Skippy is all over the place, moments of normalcy with a fair amount of lethargy. He's becoming a gourmet people food eater, declining canned or kibble at every opportunity. Also, doesn't want to eat at all early in the morning. I'm eager for cortisol testing.

GOOD NEWS: The perianal adenoma is shrinking and drying. No bleeding in a week or more. It's far from gone but I am astonished that Vetoryl would help control sex hormones. In September when we restarted Vetoryl, his IMS, Scott-Moncrieff wanted to wait and see if Vetoryl would reduce the tumor. I was highly skeptical. We shall see if it will reduce further.

Well that would be excellent if it actually helped to get rid of the adenoma without surgery.
I think both vetroyl and lysodren help to control sex hormones if memory serves me.

I am actually surprised the Vetoryl is lowering and not raising the intermediates. ;) Per the treatment sheet by Dr. Jack Oliver et al from UTK for Atypical Cushing's:

Quote:

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Trilostane always increases 17-hydroxyprogesterone (some cross-reactivity with pregnenolones in assays??), and frequently increases estradiol and androstenedione as well

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Of course, new things may have been discovered since then and Skippy may be among those in the forefront who disprove this current theory on Trilostane and intermediates. ;) Regardless I am VERY glad his butt is getting better and I know the two of you are! :D

I guess it could be a case of false observation, like false memory.:) He goes to Purdue tomorrow so I'll see what they think. It has definitely shriveled and is much scabier. (This problem is disgusting especially since Skip is having another bout of diarrhea and no eating that started two days ago.) I have stopped the Vetoryl, emailed the IMS and restarted diarrhea treatment and he ate eagerly this morning. The timing is terrible in respect to accurately testing his cortisol. But, if he won't eat I can't treat. He walked this morning but no attempt to poop. What I know for sure is I have one high maintenance pup. If I were working, caring for him would be impossible between his dietary proclivities, his bathroom needs, and medicating him with five different meds twice daily. (I am losing the Denamarin battle; he spits out even the tiniest pieces of the so called chewables.) I don't think his cortisol is too low, but symptomatically...I know nothing.

Molly got tired of her denamarin treats too and would just turn her nose up at them. I think, remembering back, that I switch to a different brand with the same main ingredients but a different size/flavor.

Well, yes, that does make it more difficult to get an accurate reading of where cortisol is if he isn't on vetroyl due to the diarrhea, but not to be done about that.

Ugh, I'm sure that isn't any fun taking care of and keeping clean his bum with the diarrhea. Good times eh. :) :)

Hey Sharlene, Yep high maintenance for this little boy. Purdue visit today was inconsequential as of now. They did a full blood panel, urine, blood pressure, but no cortisol check. BP was 110 but no other results yet. They will test basil cortisol but only to assess if it's too low. My sense is that she, Dr. Scott-Moncrieff has no real idea as to why Skippy is cycling thru diahhrea, won't eat and severe lethargy. I'm convinced it's the Vetoryl, i.e., too much. But he still has many clinical symptoms of Cushings. There was some speculation that his symptoms may relate to his continued response to radiation. They ask me to try a Royal Canin canned food to try to regulate his food. I did tonight after warming it and with beef broth. He wouldn't even sniff it although he is hungry. I fed him chicken and rice!

My plan next is to wait for the basil cortisol number and then reduce Vetoryl back to 10mg twice a day. I plan to have a stim in 10 to 14 days either at Purdue or local vet and then see where we go. Incredibly frustrating and making me crazy. My mistake was to not stim him immediately after the last episode of diahhrea, no eating and lethargy!

Sorry, no comparison between ACTH and McFarland yet...

Oh, IMS thinks the ademoa may have grown, or at least, changed! They shoot horses...

I received this email last night from IMS: "Skippy’s cortisol this morning was 5 . Hard to interpret since he did mot have consistent treatment for the last few days. He is also azotemic again (increased BUN and Creatinine). I am checking his urine for protein. Should have that back by later tomorrow morning. I think we should go back to 10 mg twice a day of Vetoryl and recheck his blood work in a week or so. Have to figure out if vetoryl is making his kidney function worse." I think this means he is in kidney failure possibly caused by proteinuria? I know that one of the possible side effects of Vetoryl is renal disease. But will reducing the dose help or should I ask her about stopping Vetoryl altogether? Is this condition otherwise treatable? I have no numbers so I don't know how bad this is.

I dosed Skippy last night with 15mg (before seeing her email). Don't know about diarrhea as he went out in dark of early morning and I half asleep. Hasn't moved since 7am, no interest in food, let alone Royal Canin selective. Skippy's lost 5lbs since August. Thanks for any insight.

No insight here, but wanted to comment to let you know I'm still following along and keeping you both in my thoughts.

Thanks for your kind words. My pen pal, Dr. Scott-Moncrieff checked Skippy's urine and proteinuria is now secondary to chronic Cushing's. She said to stop the Vetoryl as she is concerned about dehydration. Also, we are stopping the Amlodipine as his blood pressure continues to be low. Next Tuesday they will perform an ACTH, or maybe just measure basil cortisol and another blood panel to help develop a treatment plan. I believe that if his kidney values were life threatening, she would tell me, not that I could do a thing about it.