Atypical Cushings-need advice!

[tivelnarf]

Hi there. A few years ago, my Corgi was diagnosed with regular Cushings, and this forum saved my life! Who would have thought that now, I would have a different dog, finally just diagnosed with atypical Cushings. My vet told me to start with the Melatonin/Ligans, but also told me I could try Lysodren or Trilostane also. His concern is that since my dog can't be stimmed, that it is impossible to accurately monitor the Lysodren. He has no experience with Trilostane. My biggest concern- the dog is SO FAT and I don't feed him any more than I do my other dogs, who are fine. I am worried that his obesity will cause him to have so many other problems. Second, his appetite is so ravenous, it is upsetting to see. My primary concerns right now are getting his appetite in check and getting his weight down. I can't imagine that the melatonin/ligans will be able to do this alone. What should I do? HELP PLEASE!!

[labblab]

Welcome back! (Although I am sorry that you have need of us once again...)

I am curious as to why your dog cannot be stimmed, and also how the "Atypical" diagnosis was arrived at. Atypical Cushing's refers to the condition where a dog's cortisol level is normal, but there are elevations in other other adrenal hormones that produce abnormal symptoms. The trick is, Atypical Cushing's can only be diagnosed by conducting a stim test which involves "pre" and "post" measurement of all the adrenal hormones, including cortisol. Currently, the only laboratory in the U.S. that can process this test is located at the University of Tennessee at Knoxville. When UTK processes this test, they also include treatment recommendations based upon the results. And for dogs diagnosed with Atypical Cushing's, trilostane is generally NOT recommended because the drug itself inevitably results in the elevation of certain adrenal hormones other than cortisol.

So it will be really helpful if you can tell us more about your dog's symptoms, history, and any testing results. Also, did you use a different username when you were with us last? It would be great if we can locate any previous postings and "link" them up with your new thread here . How did things turn out for your original Cushpup?

Marianne

[tivelnarf]

Hi! Thanks for getting back to me so quickly. I did have a user name and ID, but when I put it in, it said that there were no records. I recall that the colors on here were more of a mustard-yellow and not green as they are now. It was also at least 5 or 6 years ago. Anyway...
ACTH stim showed normal cortisol levels. Dexamethasone suppression- also normal levels. Had an abdominal/adrenal ultrasound. Radiologist said "definitely not cushings, atypical or otherwise, because you would see some sign of it in the adrenals and I see nothing". (this is a guy I usually trust). Saw a specialist (internal medicine) who charged me a fortune and repeated all blood and urine work, said "wow, all clinical signs point to cushings, urinalysis points to cushings, but cortisol levels are within normal limits". he wanted me to repeat the ultrasound but instead I had my vet do a panel and send it to Univ. of Tenn. He called me last week to tell me it was definitely atypical cushings. I have to get the specific results, but I know it seemed like everything except the cortisol was high- I know the estradiol was high, and the progesterone also. I will write with the exact results tomorrow, hopefully. Meanwhile, I have to start him on some kind of treatment.....

[tivelnarf]

Not that he CAN'T be stimmed, just that since his cortisol levels are normal, vet said that we won't be able to know how low he can go before it's too low, etc. In other words, no real baseline to measure progress. I asked him why we can't just use the "normal" as a baseline, but he said since it measures only cortisol, he wouldn't be able to judge what was an effective dose other than clinically, and he was worried he could go too low.

[tivelnarf]

Sorry about all these posts but I keep forgetting to include things... My other dog did GREAT on the Lysodren. After loading, she stayed on maintenance for a couple of years, and then the vet had me take her off to see what would happen, and she held up fine! I guess no measurable regrowth of the adrenals, or whatever. Who knows? I was deathly afraid of the Lysodren back then, and my vet made me even more afraid. But the forum was so reassuring and helpful, it took all my fears away. Vivien (my Cushinoid Corgi) was a real success story on the Lysodren. She passed away about 5 years ago, so I guess that means I was on this forum even more than 6 years ago, possibly 8 years ago? She passed away from causes totally unrelated to Cushings, in that she died in a freak accident, likely caused by her senility (she was 13 and pretty out of it). Thanks so much for asking!

[labblab]

Thanks so much for this additional info. It wil be great if you can post the UTK test results tomorrow, along with any treatment recommendations that they may have included.

In addition to treatment with melatonin/lignans, an option sometimes recommended for Atypical dogs is to start a "maintenance" dose of Lysodren. For dogs with elevated cortisol, Lysodren treatment begins with a "loading" phase which involves a higher daily dose of the medication. For dogs with normal cortisol levels, a lower dose of Lysodren is given on a weekly basis and this treatment protocol can alleviate symptoms, since Lysodren also lowers almost all other adrenal hormones in addition to cortisol. And on the lower maintenance dosing regimen, the cortisol itself is not allowed to drop too low. The cortisol level can always be checked via periodic stim tests, as can the levels of the other hormones. So I am not certain as to why your vet is feeling concerned about the ability to monitor your dog's cortisol level. But once again, we will know a lot more after you are able to post the UTK results and recommendations tomorrow.

And it sounds as though you were a member of our caninecushings.net forum, which sadly closed down for active posting a while back. But we are really glad to have you back with us, here at our "new" home! What treatment route did you pursue with your original Cushpup?

Marianne

P.S. I see that while I was slowly typing away, you've already answered several of my questions! Truly, it is possible to successfully treat Atypical Cushing's with maintenance Lysodren dosing. But once again, we can talk about that some more tomorrow.

[tivelnarf]

Thank you so much, you are the best! I am sitting here reading about SDG vs. HMR lignans, who would have thought? I feel like my brain is going to explode! Knots of pine trees? And I thought I'd heard everything!!! I will run over to the vet tomorrow and get the UTK panel results. He didn't tell me that it came with recommendations; but I will see and get them. My cushy boy was an SPCA rescue, I got him about a year ago. He had been in the SPCA once before that same year, was adopted,but returned there after 6 mos. because of urinating in the home.... that didn't concern me at the time because I figured I could train him properly, but now I guess this is what was really going on. Well, at least I got him, as opposed to another wrong person. It's so sad, whenever he has an accident in the house, he gets so scared and cowers, despite my reassurances. I guess the prior owners must have really been horrible to him when he peed in the house, poor little thing. Now I just take him out twice as frequently as I do my other dogs, and that seems to be doing the trick. Talk again tomorrow. Thanks you are truly a godsend!

[Leena]

Hello!
I am curious, what symptoms does your dog have with the atypical??? I have a dog who might also have that, but have not done the testing yet due to money...Wierd thing is, her stim was positive but the urine test was neg!!! I know how confusing this all is! I am curious to see what your dogs results were as well...I hope that the folks here can help you with this!!!!

[labblab]

Here's a link to UTK's most recent list of all potential treatment options associated with abnormal adrenal hormone elevations. They will usually include a similar list along with your dog's individual testing results and highlight the specific recommendations that seem most appropriate based upon your dog's profile. So this is what you'll be looking for tomorrow:

http://www.vet.utk.edu/diagnostic/en...ings201107.pdf

Marianne

[addy]

I am sitting here reading about SDG vs. HMR lignans, who would have thought?

Hi,

The HMR lignans are not as likely to cause loose stools while the SDG lignans may so if your pup has any intestinal problems, mine has colitis/IBD, it may be better to use the HMR if you can find a capsule or powder close enough to the correct doseage needed. Unniversity of Tennessee did all the homework for you on the link provided by Marianne. I started my pup with the Vitacost SDG lignans then switched to the Heartland powder as the filler in the capsules seem to bother her stools.

You'll figure it out. It starts out sounding like Greek but slowly makes sense

Hugs,
Addy