Macroadenomas

[pansywags]

Here is Pansy's story in the form of a summary of events since early 2012 and symptoms exhibited. Her history is long so I'll say right here that I think the takeaway from our experience is that if your dog tests positive for Cushings but does not display the classic sign of a ravenous appetite, accelerate your diagnostics immediately. In hindsight I feel Pansy showed her first signs (hind leg weakness) 2 years before she died, and we had a lot of delays along the way (home vet stopped testing entirely after ACTH stim so LDDS wasn't done for three months after I got referred to local IMS, local IMS office communication problems resulting in another delay of a month, waited for vet of choice at Davis for another month). I'll never know for sure but perhaps Pansy and I could have had more time together if we'd gotten a definitive expert diagnosis six months earlier.

• Hind leg weakness noted Spring 2012, Physical therapy at rehab clinic for a year then home PT for the rest of her life
• Hypothyroid Nov 2012, started on meds
• Surgery to remove a dermal cyst Dec 2012, fur never regrew
• Appetite declines Spring 2013
• Series of 3 UTIs with e coli, July-Dec 2013, Very Thirsty Dog
• Retested thyroid Aug 2013, post-pill levels normal
• Seizurelike event Oct 2013, incontinence begins
• ACTH stim negative for Cushings Nov 2013
• Scabby skin lesions first noticed Mid Dec 2013
• Seizurelike event Jan 2014
• Referred to local IMS, LDDS test positive for Cushings Feb 2013
• Self-referred to UC Davis after local IMS stopped responding to my questions. Cushings confirmed at UCD after urine, blood, endogenous ACTH and abdominal ultrasound. Indication pituitary, likely macro early March 2014
• Cardio consult with ECG showed mass on heart but did not necessarily contraindicate anesthesia late March 2014, UC Davis
• CT scan showed mass on heart, probably chemodectoma. Pituitary macroadenoma confirmed, additional mass found behind eye, late March 2014 UC Davis. Decision made that her situation was too complex to treat, vets expected her eye to become painful within weeks. Headed home to enjoy our remaining time together with lots of spoiling.
• Significant neurological impairment upon return home after tests - circling, knuckling, collapsing, inability to eat or drink. I set Pansy free from her failing body at the local emergency vet just before midnight March 27.

Symptoms exhibited, in order of appearance

• Hind leg weakness, first noted as legs sliding outward on hardwood floors
• Dull coat
• Lethargy
• I don't know if this is related but her spit got kind of sticky - when she groomed her front legs the fur would be stiff instead of soft
• Significant and rapid hearing loss. What hearing she had was very non-directional. At times I would call from right behind her and she could hear something but would run away looking for me, unable to tell where the sound came from
• I did not get this confirmed by vets but I feel she also had diminished sight and possibly smell
• Panting on even light exercise
• Muscle wasting
• Weight loss
• Decreased appetite (although like me, she always wanted pizza)
• Increased drinking (over a gallon a day)
• Occasional nosebleeds, more frequent in cold weather
• Recurrent UTIs
• Indoor accidents and occasional urine overflow leakage
• Muscle atrophy and decreased stamina - we used to walk 2-2.5 miles a day and near the end it was a struggle for her to walk a mile
• Shivering/tremors across shoulder blades while inhaling, always while laying down (video here https://www.youtube.com/watch?v=YV7mc78B1UM )
• Seizurelike events (2, one with loss of consciousness)
• Calcinosis cutis (visual confirmation by UCD, no biopsy done)
• Red irritated eye (mass behind eye was causing it to bulge outward)