Lucygoo - Pit. macroadenoma, endoscopic transsphenoidal surgery, trans-oral approach

Hello All!
My dog Lucy, 11 1/2 year old shephard/lab mix, has had cushing's for about 2 years now, and been treated with trilostane. She's been pretty stable at 120 mg/day, 60 mg in the morning and 60 mg at night. However, over the past couple months her appetite started decreasing, so we had yet another stim test in February. Vet said her numbers were good, so to keep her at 60 and 60. Now she's hardly eating at all, has lost 20 lbs., (she's about 50 lbs now) is very lethargic, and seems to be in a drugged out state...i.e., standing and staring at a wall for long periods, no energy, depressed, very weak in her hind legs, almost like she's on a sedative.
I decided to stop the trilostane, her last dose was 60 mg. sunday morning....I have two vets now working on this. I'm afraid I'm losing her, and I can't stop crying. The vets told me to keep her off the trilo for a couple days, see if she bounces back. Has anyone else had this happen before? Good ACTH numbers, but clinically symptoms seem to be Addisonian? I'm hoping that's all it is, and she bounces back.
They're also telling me if she doesn't start eating we have to do another sonogram and more blood tests to rule out whatever. I hate to put her through the trauma of that right now. I've taken off from work now because I don't want to leave her....this is exhausting. Please someone tell me there's hope for her....thanks, Gina

Hi
Sorry your dog is having a rough time right now. From what you wrote it sounds like your dog has had to much trilo. Sometimes some dogs will begin to require less trilo, out of the blue. Please get the actual numbers and post them. Terms like right in the ball park and right where they need to be is very relatiive so the numbers mean more then the terms do. Did they offer any pred? sometimes pred will help with those issues and very quickly within a couple hrs. Maybe talk to your vet about it, it is what we give when our dogs get to low.
Please do get the actual numbers sometimes vets with only a bit of experience with cushings or trilo will make errors in interpreting the results.

Sharon

Hi Gina!

As Sharon mentioned, have you tried giving some prednisone? Prednisone should help "perk" up Lucy if it is low cortisol. And really if it is that, she needs some...and maybe to have her electrolytes checked too.We like numbers only bc we have been told they have been "fine" only to find out they really aren't...so if you have them, it would help to post them.

The only other thing I can think of is the possibility of seizures. Does Lucy respond when she is staring at the wall? Does she respond to your voice?

If you can post her last bloodwork numbers, anything out of the ordinary, if you have them, that would help too!

You'll have lots of help here so please try to get back with some more information and we will be saying prayers for you both in the meantime!!!
Beth, Bailey and always Scoobie

I agree with the others - probably the dog now requires less trilo, maybe none. I would try giving her prednisone to give her some immediate relief. It mimics the cortisol she is probably lacking. Check with your vet first but it should help short term. Hang in there! Kim

Thanks everyone:)

I don't have the actual numbers, but I'll get them tomorrow. As far as seizures, she responds to me, but much slower than usual..sometimes I'll have to snap my fingers iin front of her or touch her and say, "Lucy!", and then she looks at me.
We actually went through something similar to this about a year ago, and she bounced back....I posted in the canine cushings forum but I can't remember what name, but this seems much different. She just seems so old and tired all of a sudden. And she's skin and bones. God, how I miss when she was a voracious pig...and I was complaining about that then!!!
One of my vets mentioned today that sometimes cushing's is a tumour, but Lucy's is pituitary, but she still said it's a progressive disease, and sometimes cushing's dogs just stop eating.
I did mention the prednisone...I actually have an old bottle of hers that they prescribed for her long ago, but it expired in '06....I was tempted to give her one last night, but I didn't. The one vet said they do give prednisone for cushing's dogs, but usually only if, A, there's something else going on, or B, they're in Addisonian.
The other disturbing thing is, I noticed that her water consumption is slowly increasing.....faster than her appetite...which to me means the cushing's is full on...she just doesn't want to eat.
Anyway...as soon as I get the numbers I will post them, and thank you all for responding and your kind thoughts. :)

(I hope this isn't too incoherent...I've been drinking too much wine lately....sorry if I sound like an idiot)

Thanks, Gina

Definitely sounds like a lack of cortisol/too low cortisol....prednisone would/should help.....I do question what the "right" level of cortisol is based on the ACTH stim tests.....some folks have dogs w/somewhat/slightly elevated levels that are doing quite well....cortisol actually helps certain conditions

Hi;
The way your vet gives pred is only vet specific, most vets have no problems giving a dog that is not feeling well a tiny bit of pred to help them. It is not only given when something else is going on? or in addisions. sometimes when the levels are well controlled and the dog gets stressed the reserve cortisol gets used up and the dog kind of goes addisons, temp as they dont have enough cortisol to keep them feeling good. Sometimes when Nikes legs look weaker or she looks like she is having a bit more trouble standing, I will give her 2.5 or 5 mg of pred, she is 85 lbs so it is just a wiff but it works great she is back to herself in a couple hrs.
As well your vet is correct Cushings both Adrenal and Pituitary is caused by a tiny tumor on the gland. It caused the gland to malfunction but it is a tumor and for the most part they stay tiny. the tumor itself does not cause problems. sometimes they can grow into what is called a macrotumor but it does not happen often. The tumor does not cause cushings, the effect the tumor has on the glands causes Cushings. Cushings is excessive cortisol production. Normally the pit gland regulates the amount of cortisol in the blood if it sees not enough it sends the message to the adrenals to produce more if sees to much it tells the adrenals to slow down. with the tumor on the pit gland it knocks out that regulation so the adrenals dont get any message to stop so they keep producing and they do. The only way we can decrease the amount is to give the meds used to treat so they only secrete a level or cortisol we want which is between 1 and 5 ug/dl. As far as being progressive I have to disagree again by keeping the cortisol in a theraputic level the cushings should not advance as it is the increased cortisol that is "Cushings" not the tumor so it should not progress if the cortisol levels stay controlled. My dog has been treated for over 3 years and still doing as well or better then she was 3 years ago and she is an old dog. For the most part if your dog is not eating, it is probably not due to cushings, but due to something else or to much medication. Sometimes when Nike would sniff her food and walk away, was when her cortisol levels were to low, I held her meds, and gave pred and she would get back to normal. Holding the trilo should help, I really wish your vet would consider pred. IMO it is irrisponsible of your vet not to give you something that may get your dog feeling better now and not let you try it, it should not do any harm, instead of letting the trilo work its way out of your dogs system then feel better in a day or 2 or more. Sorry Now I will get off my high horse..;)
I hope this helps understand things a bit better. Good luck
Sharon

Gosh, I am so sorry to hear about Lucy's worrisome behavior! Along with everyone else, I will be very interested to hear the results of her ACTH test. And if her electrolytes (simple blood test) have not been checked recently, that would be my next course of action. This is due to the fact that trilostane can cause imbalances in blood chemistries that can create serious problems if undetected and uncorrected.

One other thought comes to my mind, and that is the possibility that Lucy's pituitary tumor may be enlarging and placing pressure on other parts of her brain. This may be what your vets are referring to when they speak about the potential for a progressive decline. Enlargement sufficient to cause neurological problems occurs in only a small percentage of Cushpups, but those problems can consist of the types of things that you are describing: loss of appetite, lethargy, confusion.

Unfortunately, a pituitary tumor can only be visualized by a CT scan or MRI of the head, and both these tests are fairly expensive. If Lucy were to have an enlarging tumor, radiation treatment can offer significant relief for many dogs. But undertaking radiation would be a major decision. So I am hopeful that an expanding tumor is not the cause of Lucy's problems. But I did just want to mention this possibility so that you'll be better prepared if your vets also mention it to you.

Please do get back with us as soon as you find out her test results.

Marianne

Hi Gina,

I am so sorry that Lucy is not feeling well. :(

Along with giving some pred, having her levels checked and her electrolytes checked, I would also have her checked for diabetes. Diabetes can come on rapidly, so even if she has been checked in the last few months, I would have that done again. A cognitive disorder is also a possibility I would want looked into.

I would insist that Lucy be given some pred, even if just one dose administered by the vet! If she perks up, then that is a pretty good indication that the Trilo dosage is too high. If her cortisol is too low, she will bounce back in an hour or so.

Let us know what the vet has to say and please let us know how Lucy is doing.

Hugs,
Leslie and the girls

Hey Gina...

Been thinking of you all day....how is Lucy? And how are you?

Hugs, Beth, Bailey and always Scooter