My Pug Scoop (Precious Scoop has passed... )

Quote:

---

Originally Posted by scoora

Don't know too much about the Acth test and the results.

---

The ACTH stimulation test is a simple and safe screening test in the diagnostic evaluation of dogs with hyperadrenocorticism (Cushing's syndrome). It's also used to monitor dogs on medical therapy (e.g., Lysodren, Trilostane, etc.). Simply put, it's a test of adrenal gland reserve; it checks how the adrenal glands respond to a certain hormone. This hormone is called adrenocorticotrophic hormone, also known as ACTH. ACTH is made in the pituitary gland (pea-sized structure located at the base of the brain) and travels through the bloodstream to the adrenal glands (small paired glands buried in fat in the front of each kidney).


An ACTH stim test contains synthetic forms of ACTH (Adrenocorticotrophic Hormone) such as Cortrosyn, ACTHAR gel, or another agent called Synacthen. ACTH and the synthetic forms of ACTH stimulate the adrenal glands to release Cortisone.

In an ACTH stim test a sample of blood is taken from an animal (the "pre-level"); then the animal is injected with a small amount of the synthetic form of ACTH to stimulate the adrenal glands to produce Cortisol.


A second blood test is taken a hour later (the "post-level") to measure the change in circulating cortisol. The results of the two blood tests are then compared.

With Lysodren, ideally, one wants the pre and post number between 1-5 ug/dl. With Trilostane, goal of therapy is having pre and post between 1.45-5.4 ug/dl and a post as high as 9.1 ug/dl as long as clinical symptoms are controlled.

Hope that helps :)

Love and hugs,
Lori

Someone here once described the ACTH like this - imagine a sponge full of water being squeezed to see how much water was in there. This is what the ACTH is doing with the adrenals - not squeezing them literally but causing them to empty as much cortisol as they can. The cortisol flowing in the bloodstream is measured before the stim agent it given (the first or pre number) then measured again after the stim agent has made the adrenals empty (the last or post number). The post number is the most important and the one we want to see within those ranges Lori gave.

You're doing good! Keep asking questions! :)

Hugs,
Leslie and the gang

How long was your dog on the meds before the trembling started? I am wondering when I will start seeing that or if. :(

I know that has to be hard to see. I hope it is a symptom that will go away for your sweet pup.

I just wanted to stop by to add a couple of thoughts since my own Cushpup was one who also suffered from weird tremoring episodes. Although I do not believe he was cold or in pain, it looked as though he was shivering across his shoulders. It happened most often when he was resting or even asleep.

In our case, I first noticed the tremors a couple of weeks prior to his Cushing's diagnosis. He was treated several years ago when the protocol called for higher doses of trilostane, and he was indeed started off on a very hefty dose. The tremoring became much more frequent and obvious shortly after starting on the trilo. It remained for a couple of months, but then stopped altogether.

We were never sure as to the cause. As the Dechra rep stated, tremoring is now listed as a possible side effect to treatment. However, I think her answer is correct in that nobody knows whether it is actually caused by the drug itself or whether it is related to some as-yet-unknown mechanism associated with the Cushing's syndrome.

Since my own dog started the tremoring prior to the trilo, I can't solely blame the drug. However, the tremors did worsen right after he started on it. FWIW, his cortisol level was sky-high per his diagnostic ACTH test, and I have always speculated that the tremoring was related to the cortisol level itself -- maybe rapid changes in either direction. I've especially thought this might be true because we have had Lysodren parents report the same thing.

Anyway, I don't think the mechanism is yet understood either by Dechra or anybody else. But I just wanted you to know that other members have reported the same types of experiences.

Marianne

Lori and Leslie-Wow.Thank you for all that great info. It sure helps me to understand what the ACTH test is about.

Amy-Thank you. I too hope it is a symptom that will go away. Scoop had a little bit of trembling in his back legs before he started the Vetoryl. I thought it might have something to do with his muscle loss. Scoop lost quite a bit of muscle but what do I know. After starting Vetoryl he has a lot more trembling and it is now in the front and the back.

Marianne-That sounds so much like Scoop but his started in his back legs but now has trembling in front and back legs. I have only seen it once while he was standing. All the rest of the time he is either sleeping or resting. Scoop's happens during the day. I don't see it at night. Vetoryl only stays in the body, what, 8 or 12 hours? So like you said, Marianne, maybe at night the cortisol has leveled off and during the day it is going down or rising back up. That's very interesting.

Thank you everyone for all the great information and for all the help.

Vicki-Scoop and Raleigh's mom

Vicki: are you testing Scoop's blood sugar? Jenny had some serious low blood sugar incidents before I started testing and the only symptom was back leg trembling. I thought it was the Cushings, took her in and her blood sugar was 40 :eek:.

As his cortisol goes down you'll need less insulin. Just a thought. hang in there. Judi

Judi-WOW! 40 That's scary. Scoop has had some spot BG checks since he started on Vetoryl. His have been pretty high. My husband and I tried to test Scoop at home after he was first diagnosed 2 years ago with diabetes. We were not successful. We tried and tried. I sure wish we could do it at home. Then I could check it more often but I have to take him to the vet's to get it checked. Sometimes they use our meter and then it doesn't cost so much. He had a spot check when he had his ACTH done and it was high. Scoop's vet went to a conference in Atlantic City this past week. She spoke to an endocrinologist from California and talked to him about Scoop. He suggested that Scoop's insulin be cut in half. He's been getting 10 units and he said to cut it to 5 units. She told him he has been testing high but he said he would recommend to cut it. I don't understand why you would cut the insulin if his sugar isn't low. It really makes me nervous but we are going to try it starting Monday morning and do a spot check on Wednesday.
Thanks for the suggestion Judi.

Vicki-Scoop and Raleigh's mom

I have never understood it very well but over on the diabetes forum they talk about Somagyi rebound

http://diabetes.about.com/od/glossar.../g/somogyi.htm

basically, I think if a dog is getting too much insulin, their body overreacts causing huge highs and huge lows. Since Scoop has been a stinker about testing you could be missing the lows.

Just a guess but this may be what your vet is looking for.

Have they done some curves? did you post them on the diabetes forum?

I really struggled getting Jenny to cooperate for home blood testing. It was a 3 week long bloody battle. Now? She is much better for her testing than she is for her shot. So, if you ever get your courage up and want to try again, I recommend it.

Please keep us posted! hugs, Judi

Hi Vicki,

Did you register at the diabetes site? They will be able to help you most with this situation so I would sure be talking to them before starting the half-dose. We have a saying around here - Listen to your gut because no one knows YOUR baby like YOU. ;)

Hugs,
Leslie and the gang

Judi and Leslie-Thanks so much. It is so great to be able to talk to others who have experience and knowledge about all this. There is so much going on with Scoop, it is so scary. I trust Scoop's vet and the specialist she talked to seemed to impress her. When we started this I told her if she's not comfortable with this, then she should refer Scoop to a specialist. She said she would if she feels uncomfortable with things.

Judi-I have never heard of Somagyi rebound. I will be checking it out when I am done here. What you said makes sense to me. A curve was done Aug. 30. The vet wanted to make sure his diabetes wasn't causing his problems before he got tested for Cushing's. She was happy with the curve. What you said has me thinking. Up till now there wasn't much reason to worry about testing at home. He was doing so good with his diabetes. He is such a good boy about getting his shot but I don't think he will put up with the testing. Where do you prick Jenny at to get the sample? We were shown to do it in the ear but at home we couldn't get any blood from there so I had watched videos about doing it on the inside lip. Scoop did not like that at all. He even snapped but did not bite at my husband. I took him to the vet's and she had a hard time with it too. Since Scoop has been sick he doesn't like when I go in his mouth. So it would be very difficult to get blood. It would probably be a good idea to do another curve. I feel so bad to have to leave Scoop at the vet's all day. He gets so nervous when we are on the way to the vet's. I had to take him on Saturday. He has a nasty sore under his front "underarm". He shook so much in the car.

Leslie-Yes, I did register at the diabetes site. I just seem to spend my time here. I feel like I have so much to learn about Cushing's but looks like there are things to learn over there too.

The vet told me when we started with the Cushing's meds that this will not be easy with dealing with both plus Scoop has a head tilt yet from Vestibular Disease. The vet's been trying to find out if he has a ruptured eardrum. She talked to a neurologist about the possibility the pit tumor could be causing the head tilt. His cataracts from the diabetes are bad. We have to watch when we take him out, he has trouble with steps and the uneven yard. He's good in the house but he walks with his head tilted. Sorry to go on and on but it is so hard to see Scoop now compared to the beginning of July before all his problems started. I love him so much and it hurts so much to see what has happened to him.

Thanks so much for listening and all your help and suggestions.
Vicki-Scoop and Raleigh's mom