Corkster - adrenal tumor/3x daily trilostane (Corky has been released)

[littleone1]

I just got a copy of Corky's LDDS test.

Results Reference Range Units
Cortisol Sample 1 7.3(High) 1.0-5.0 ug/dl
Cortisol Sample 2 Dex 6.2(High) 0.0-1.4 ug/dl
Cortisol Sample 3 Dex 5.7(High) 0.0-1.4 ug/dl

[gpgscott]

Hi Terri,

Although you cannot tell conclusively from an LDDS this one tends to make me think adrenal as there is no sign of supression.

I just need to say that many Drs. seem to believe that Trilostane is 'easier' on the pup and there is just no objective fact to that position. In fact with multiple health issues I veiw Lysodren to be superior due to the singular manner in which it addresses the issue of overproduction of cortisol. Problems attributed to Lysodren are almost always related to low cortisol which is not a side effect of Lysodren administration but a side effect of Lysodren over-administration. I am not a Dr. but I have heard from many members and know that the action of Trilostane is very complicated compared to Lysodren. Please continue to be open to Lysodren if the Trilostane does not bring about relief for Corky.

You have not mentioned that a stim will be done prior to beginning treatment. It is my opinion that any dog which is going to be treated with Trilostane should have the UTK full adrenal panel to baseline the 6 adrenal hormones which Trilostane affects. You can find out more about this in our Resources area, follow this link, http://www.k9cushings.com/forum/showthread.php?t=198

You might also ask your Dr. about trying melatonin instead of the acepromazine. My mom has a bichon which is terrified of storms also and she reacts very well to the melatonin and it does not place burden on the liver like the ace.

Scott

[littleone1]

Hi Scott,

Thank you for the information about Melatonin. Since July 1st, Corky has only had 1 3/4 pills of the Acepromazine. I believe that one of the reasons for the lower amount this year is that Corky is losing his hearing. I'm really glad you let me know about Melatonin.

Along with the biopsy, he also had an U/S which, on nine sides, did show an adrenal tumor. The first choice was to do an adrenalectomy, which the IMS did not feel was feasible for Corky, with everything else that he has going on. I'm going to give the Trilo a shot, but I still have the Lysodren, which I will use if the Trilo doesn't help. He isn't going to have another ACTH Stim test until he's been on the Trilo for approximately 10 days. I'm keeping track of how much water he drinks daily. I've been measuring the amount of food he gets every day, and watching how he is eating.

I really appreciate your input. Even though I got so much valuable information earlier this year, I really feel that I'm starting all over again. I just want to do what's best for Corky, so that he can live the rest of his remaining time with a good quality of life.

Terri and Corky

[Harley PoMMom]

Hi Terri,

Scott gave you alot of really good advice, especially about the UTK full adrenal panel, Trilostane will raise one or more of these intermediate/sex hormones.

I had the full adrenal panel done on my boy Harley, he is Atypical and PDH, but his estradiol hormone is very elevated. I was considering starting him on Lysodren then I had a ACTH stim test done on him, he stimmed within the normal ranges so as of right now Harley's treatment consists of melatonin and flax hull with lignans.

Harley used to be terrified of thunder storms too, since he's been on the melatonin he's not afraid of them any more. He's not zoned out from the melatonin, I guess it just calms them.

Love and hugs.
Lori

[littleone1]

Hi Lori,

Thank you for this information. I need to take a little time to digest all of this information. My brain doesn't function as well as it use to. I'm starting to get very confused. I'm just not sure what to do! Corky has been to his regular vet and an IMS. I was hoping that his IMS would know the best procedures.

Terri and Corky

[Harley PoMMom]

Hi Terri,

I know this is alot of information to digest, it was for me also...so let's both take a deep breath...whew!

Now, Harley's regular vet didn't know about the UTK full adrenal panel, heck I don't think she was familar with the intermediate/sex hormones and their "play" within the cushings, especially when it comes to ADH.

Lets see if I can explain this right and if not I do hope someone will interfere...Corky's adrenals secrete 6 hormones, cortisol of course being one of them, but there are 5 other ones and they are Androstenedione, Progesterone, 17 OH Progesterone, Aldosterone, and Estradiol. Now estradiol can be secreted else where besides the adrenal glands but the other ones are primarly secreted by the adrenals only.

When a cushpup has an adrenal tumor, this tumor can make the adrenals secrete these hormones more and these hormones become elevated. Trilostane, the way it works, blocks these hormones , for lack of better words, pathways, and then these hormones build up in your pups system.

Lysodren, on the other hand, has the opposite effect, it lowers cortisol, progesterone, androstenedione and 17-hydroxyprogesterone levels but not estradiol. That is where the melatonin and the flax hull with lignans come into play, they help to lower the estradiol.

OHGosh, I hope I didn't confuse you more.

If you have any questions, please, please ask. There are people here much more knowledgeable then me here that are more than willing to help you.

Love and hugs.
Lori

[Buffaloe]

Hi Terri,

I think you are doing an outstanding job of taking care of Corky. My dog, Shiloh, had a very large, malignant adrenal tumor surgically removed from her left gland three years ago. She'll be 15 in less than two months and is doing well and enjoying her senior years.

My surgeon owns two wonderful facilities in Phoenix and I think he is just as sharp as they come. I decided way back then that he's the one I'm trusting to take care of Shiloh for the duration. He has Internists (IMS's) at his facility and I'm sure they are involved with the adrenal tumor cases that are treated medically. I've picked his brain some and here are some things he has told me:

Tumors in the right gland are more difficult to remove than in the left.

At any given time, they are treating about six dogs medically (either Lysodren or Trilostane) for adrenal tumors at his facilities.

There are about five things they look at to determine whether to treat the adrenal tumor initially with Lysodren or Trilostane.

They always do a full adrenal panel prior to treatment because one of the five things they look at is the situation with the intermediate (sex) hormones. If some were elevated (in which case he'd probably choose Lysodren), he likes do have a second adrenal panel done after a few months of treatment.

The younger Internists tend to prefer Trilostane, the older ones Lysodren.

Every adrenal tumor is different and no two respond to medical treatment the same.

The medicines just treat the symptoms of an adrenal tumor. But he added that you just never know. (miracles, anyone?)

If a dog has elevated aldosterone (one of the five sex hormones) the bad effects of high aldosterone can be counter-acted very effectively with an anti-aldosterone drug.

They will start with Lysodren or Trilostane and then switch to the other drug if the dog isn't showing good improvement in symptoms.

Personally, I think it is good that you are starting Corky on Trilostane. I'm sure your Internist has good reasons for doing so. I strongly agree with Scott and Lori that you should have a full adrenal panel done on Corky at some point. It is very valuable to know what is going on with the intermediate hormones. It doesn't cost alot more than the ACTH test and it gives you the cortisol reading, plus the other five hormones. Maybe after this next ACTH test you have the adrenal panel done instead. The downside is that it usually takes 8-10 days to get the results back. I agree with your choice to treat Corky medically rather than having an adrenalectomy. I think you just want your boy to be as happy and comfortable as possible for as long as possible. Bottom line, you're doing great with Corky and if he doesn't respond to Trilostane as well as you had hoped, you can switch to Lysodren.

All the very, very best to you and Corky.

Ken

[littleone1]

Hi Lori,

Thank you for this information. I will talk to my IMS about it. I will also inquire about the UTK full adrenal panel. This really helped me get a better understanding of what could be going on with Corky.

Terri

[littleone1]

Hi Ken,

Thank you so very much for your words of assurance. I really appreciate it. I know there is so much to learn about Cushings and the treatments. I am going to ask my IMS about having the full adrenal panel done. I have been reading all kinds of information about Cushings and the treatments. It does get mind boggling at times. I've been trying to sift through the information to get to the point where I can have a good understanding of what's going on. The information you gave me does help.

If you don't mind me asking, Who is the IMS that you go to? I noticed that you are in Phoenix, and I'm in Scottsdale. I actually live in the Phoenix boundaries, but I have a Scottsdale mailing address.

Thanks again.

Terri

[Harley PoMMom]

Hi Terri,

I, too, wanted to comment on the excellent job you are doing in taking care of Corky.

I really do feel that Ken has more experience and knowledge with cushings and the effect that Trilostane will have on it. Ken and his beautiful girl Shi have, shall I say, "been there." I only have my opinions.

I truly do believe tho, once you've read and read you'll know what to do...go with your gut feeling and your heart. You can't go wrong.

I don't want you to think that I'm trying to sway you away from using the Trilostane, because I'm not, ok, I think both Trilostane and Lysodren are very excellent and powerful drugs to use for cushings, it's just they work in different ways, and alot of people don't realize that, I didn't at first.

Love and hugs.
Lori