"Atypical Cushing's"/Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism
We have had several members whose dogs have been diagnosed as having congenital adrenal hyperplasia-like syndrome, and we have many other people asking about "Atypical Cushing's", so this is for anyone who might be looking for information on those conditions.
If a dog continues to exhibit Cushing's symptoms, yet tests negative or borderline for Cushing's on the usual tests (ACTH stimulation test and Low Dose dexamethasone suppression test) your Vet or Internal Medicine Specialist Vet may feel that it is a good idea to test for "Atypical Cushing's", congenital adrenal hyperplasia-like syndrome or hyperestrinism. An "adrenal panel" blood test can be sent to the University of Tennessee for analysis.
Although not actually Cushing's, dogs with these conditions often have many of the same clinical symptoms as Cushing's dogs do, and the treatment may also be similar.
Here is the Research Abstract of a presentation that was given by Dr. Jack Oliver at a meeting of the Society for Comparative Endocrinology in May/June 2005:
Steroid Profiles in the Diagnosis of Canine Adrenal Disorders.HYPERESTRINISM IN DOGS
Jack W. Oliver, D.V.M., Ph.D.
Director, Clinical Endocrinology Service
The University of Tennessee
The Clinical Endocrinology Service at the University of Tennessee utilizes steroid hormone profiling in the diagnosis of adrenal disease. Many of the cases received have had preliminary diagnostic workups with either ACTH stimulation or low dose dexamethasone suppression testing that has been negative, but signs of Cushing's disease persist. Many of these atypical Cushing's-like cases will have abnormal levels of adrenal intermediate steroids and sex hormones. Included in the atypical cases are a considerable number of dogs that have hyperestrinism (elevated estradiol levels), with and without increased levels of other steroids. The dogs with hyperestrinism typically present with some or all of the following clinical signs: “Cushingoid” appearance, presence of chronically elevated levels (usually extremely elevated) of serum alkaline phosphatase, hepatomegaly, steroid hepatopathy on biopsy, PU/PD, dilute urine, panting, haircoat problems and skin biopsies that indicate presence of an endocrinopathy. The talk will focus on case presentations that associate clinical signs presented by dogs with primary hyperestrinism (elevated serum estradiol levels), including the association of high estradiol with increased alkaline phosphatase, and the fact that sex steroids can cause elevated cortisol/creatinine ratios. Treatment concerns will be addressed, such as mitotane and trilostane resistance. Other potential treatments for hyperestrinism will be discussed.
Jack W. Oliver, Proceedings 25th ACVIM Forum, Pp. 471-473, Seattle, WA. 2007.
https://vetmed.tennessee.edu/wp-cont..._Diagnosis.pdf
Diagnostic Laboratory Insight with Regard to Adrenal Disease.
Jack W. Oliver, Proceedings 20th ACVIM Forum, Pp. 541-543, Dallas, TX. 2002.
See attached image
Client Information Adrenal Steroid Profiles in the Diagnosis of Adrenal Disease.
https://vetmed.tennessee.edu/wp-cont...lient_Info.pdf
A document from UTenn Endocrinology Lab which explains how the tests that they do should be performed:
https://vetmed.tennessee.edu/wp-cont...otocols-V3.pdf
(Under “Adrenal Function,” see section F for an explanation of the ACTH stimulation test plus a full adrenal "panel", which includes cortisol and other adrenal hormones)
Treatment Option Considerations (revised 1-27-16):
https://vetmed.tennessee.edu/wp-cont...iderations.pdf
Lignans (phytonutrients) Information:
https://vetmed.tennessee.edu/wp-cont...NFORMATION.pdf
