New diagnosis for Sophie

[stho1228]

My name is Sandy and my 7 yr old Welsh corgie terrier mix has been diagnosed with adrenal Cushings and the vet wants to start her on Mitotane and I am looking for advice.

2014 She had low dose dex test in 2014: results baseline 2.2 ug/dL, 4 hr <1.0 ug/dL, 8 hr 2.0 ug/dL.

Total protein 7.6 g/dL (High reading) Ref Range 7.0 - 7.4 g/dL
ALT 107 U/L (Normal) Ref Range 12-118 U/L
Alk phosphates 1509 U/L (High reading) Ref Range 5-131U/L
Phosphorus 4.4 mg/dL (Normal) Ref Range 2.5-6 mg/dL
Glucose 105 mg/dL (normal) Ref Range 70-138 mg/dL
calcium 10.3 mg/dL (normal) Ref Range 8.9-11.4 mg/dL
cholesterol 343 mg/dL (high reading) Ref Range 92-324 mg/dL.

At that time she had excessive thirst and would eat rather fast but not excessive. We chose not to start treatment at that time to see how she did.

Now 2 years later, her thirst is excessive, cannot eat fast enough and is now eating paper, ear buds, constantly looking for food.
2016 low dose dex done again and results: baseline 5.4 ug/dL, 4 hr <1 ug/dL, 8 hour 2.5 ug/dL.

Total protein 7.5 g/dL (High reading not much change from 2 years ago) Ref Range 7.0 - 7.4 g/dL
ALT 136 u/L [up from 107- 2 years ago] Ref Range 12-118 U/L
Alk Phosphate 3635 U/L [Double from 1509 U/L -2 years ago] (High reading) Ref Range 5-131U/L
phosphorus 6.4 mg/dL (high reading up from 4.4 2 years ago) Ref Range 2.5-6 mg/dL
glucose 44 mg/dL (lower reading than 2 years ago) Ref Range 70-138 mg/dL
Calcium 8.8 mg/dL (lower reading than 2 years ago) Ref Range 8.9-11.4 mg/dL
cholesterol 488 mg/dL (higher reading than 2 years ago) Ref Range 92-324 mg/dL.

I am overwhelmed with the diagnosis and what is best course of treatment. Mitotane looks dangerous on paper and just looking for some guidance. Thank you for this support group! I am so grateful to see other owners are walking down same road as we are starting on.

[Harley PoMMom]

Hi Sandy,

I have manually approved your membership so now all your posts will be seen right away. Also please just disregard the validation email that was sent to you from k9cushings.


Welcome to you and Sophie! Well to my layperson's eyes those most recent LDDS test results point to the pituitary form of Cushing's and not the adrenal type.

Could you edit your post and add the normal reference ranges for those values you listed?... thanks! What sticks out to me are the abnormal values in the her phosphorus 6.4 mg/dL (which I'm assuming is high) and Calcium 8.8 mg/dL (which may be a bit low), can you clarify that for us?

If Sophie does have Cushing's we do understand how frustrating and confusing this disease can be but we are here to help you and trust me, once you understand more about Cushing's your fear will subside.

The two medications that are usually prescribed for Cushing's are Vetoryl/Trilostane and Lysodren/Mitotane, one is no safer than the other. These are strong drugs and both have some pretty scary side effects, however, adverse effects are minimized when the proper treatment protocols are followed. We have many members that are treating their cushdog with either Vetoryl/Trilostane or Lysodren/Mitotane and are experiencing success.

We realize that you may have some apprehensions in starting treatment but you are not alone and we will walk this journey with you. If you have any questions please do not hesitate to ask them.

Hugs, Lori

[molly muffin]

Hello and welcome to,the forum.

Was an ultrasound done to confirm that there is an adrenal tumor? If not I think it would be worth it to get one to verify. Test don't always tell the full story so if that is feasible I think it will give you good bang for the buck.

It does sound like she needs to get started on treatment as she is eating everything but the kitchen sink . Pretty normal for Cushing dogs.

We are using vetroyl for our dog but either can work successfully. You do always have to follow protocols for each though to be safe.

[stho1228]

We decided against the ultrasound as we would not want to proceed with surgery and put Sophie through that ordeal, which from what I have read is awful.

[stho1228]

I updated the test results with the reference ranges. Thank you for your help with this.

[molly muffin]

I understand not wanting to pursue surgery. We've had several who have had it done successfully though.
Your girl certain does have the hunger that goes with cushings, but there are a couple things on the labs that cause me concern and that I would certainly want to be discussing with a specialist. The low blood glucose and the high phosphorus (which might come down) and specifically the high ALKP, at over 3500. The combination especially of the high liver enzymes with low glucose can be worrying.
Did the vet mention anything about the low blood glucose, which can be indicative of Hypoglycemia.

[Harley PoMMom]

That low glucose level is worrisome to me as well, sometimes vets do miss things so I would definitely bring that to the attention of Sophie's vet.

[stho1228]

Thank you for pointing out the glucose. I will speak to the vet in the morning about that. Should I be seeking out an endocrinologist or specialist?

[lulusmom]

Hi and welcome to you and Sophie.

The results of the LDDS test you posted are consistent with pituitary dependent disease so while I think an abdominal ultrasound is always a good idea, given Sophie's overt symptoms and usual lab abnormalities, I think skipping the abdominal ultrasound is understandable. Unless With respect to the mildly elevated phosphorus, it is not usual to see this in a blood specimen that is hemolized or has sat around too long. Can you check the results to see if the lab noted anything about hemolysis or lipolysis? Unless Sophie was overtly sick when the blood chemistry was done, I suspect the low blood glucose is probably due to improper handling of the blood specimen too. I've shared my life with tiny toy breeds, my own and a steady stream of rescues, so I am intimately familiar with hypoglycemia. If you were to recheck glucose today, it would probably be normal. Regardless, discussing all abnormalities on blood labs with your vet is how you learn and learning as much as you can about the disease will make you a terrific advocate for Sophie.

I am sorry for the circumstances that brought you here but I'm very happy that you found us. We're here to help you in any way we can. I great start would be providing you with some great reading material on Lysodren (mitotane)loading. I suggest you read it and print it out and keep it handy while you are going through loading. I had two cushdogs on compounded mitotane, the active ingredient in Lysodren, and my copy of the Helpful Loading Tips was beyond dog eared. LOL Your role in treatment is to watch Sophie like a hawk during the loading phase. It is within your power to limit and/or eliminate the possibility of any bad side effects. Sophie is the perfect candidate for mitotane because she has a huge appetite and it is the changes, even the most subtle change, in her eating habits that will be the sign to you to quit dosing her. If Sophie is like my dogs, she is a complete glutton who won't lift her head out of her bowl before it's completely devoured and the bowl looks like it just came out of the dishwasher. Right? If she pauses for just a second to look up at you; she finishes her food in 30 seconds instead of 10 seconds and most certainly if she does not finish her food, are all signs she could be loaded and no more mitotane should be given until an acth stimulation test is done. Your vet should not give you any more than 8 days of doses. If Sophie has not shown you any signs of loading in those eight day, you will need to have an acth stimulation test done, preferably on day 10 to see if loading has been achieved. If not, you continue loading. Mitotane is a very serious drug and if you know that going in, you will give it the respect it deserves and you will be a much more effective advocate for Sophie. We're here to help you do that.

Lysodren (mitotane) Loading Instructions and Related Tips
http://www.k9cushings.com/forum/showthread.php?t=181

[stho1228]

We had the ACTH test for Sophie before starting Lysodren.
Pre value 3.3
Post value 16.8

Started Lysodren on 2/27 and had ACTH test done 3/7.
Pre value 1.9
Post value 7.3

I am very encouraged by the significant drop in numbers. We are monitoring water intake to see if that drops.

Are we on the right track?

Thank you!!!

Sandy and Sophie