Young boxer lily diagnosed

[nietodevin]

Cbc and t4

Total Serum Protein6.9 g/dL(5.6 - 7.9)
Albumin3.8 g/dL(3 - 4.5)
Calcium10.8 mg/dL(7.2 - 12.8)
Phosphorus5.6 mg/dL(2.3 - 6.5)
Glucose105 mg/dL(60 - 120)
BUN7 mg/dL (Lo) (8 - 30)
Creatinine0.7 mg/dL(0.5 - 1.4)
Total Bilirubin0.2 mg/dL(0.1 - 0.4)
ALP599 U/L (Hi) (12 - 122)
CK34 U/L (Lo) (58 - 241)
AST (SGOT)11 U/L (Lo) (13 - 52)
ALT(SGPT)84 U/L (Hi) (13 - 79)
Globulins3.1 g/dL(1.8 - 4.2)
A/G Ratio1.2(0.8 - 2.2)
GGT8 U/L(0 - 10)
Amylase627 U/L(454 - 1380)
Cholesterol484 mg/dL (Hi) (124 - 335)
Sodium153 mEq/L(141 - 156)
Potassium5.1 mEq/L(3.8 - 5.5)
Na/K Ratio30Chloride112 mEq/L(109 - 124)
General ResultsJulie Piccione, DVM, MS, DACVPClinical Pathology Section HeadEndocrinologySpecimenTest
NameResultRef. Range- ResultLily - Female-spay - 3 YearsSerum - 1Free T4 (RIA - Free T4)25.64 pmol/L (12 - 33)

[labblab]

When was that monitoring ACTH test performed?

Marianne

[nietodevin]

The test was done this past Friday March 31st

[labblab]

Well, I'm afraid I must say I am stumped, too. Did the initial diagnostics establish whether Lily suffers from a pituitary vs. adrenal tumor?

At this point, I believe I'd arrange a return visit to the specialist in order to get his professional opinion as to what may be interfering with Lily's symptom resolution. Would that be possible for you to do?

Marianne

[LaurieS]

Im so sorry to hear about your girl having been diagnosed at such a young age. My boxer, Charlotte is 7 years old and was diagnosed last December.

I was going to ask the same question as Marianne, was Lily diagnosed with pituitary or adrenal cushings? Charlotte has pituitary cushings and we believe has a macro tumor. Although her ACTH stim tests showed she was responding well to the trilostane, her body didnt handle it. The only symptom that improved was her water intake and after 6 weeks on trilo we almost lost her. Since then we have been treating her as if she has a macro, although we couldnt afford the MRI to confirm. It seems like dogs with macros wont respond to the cushings meds and need to be treated differently so im wondering if that could be the case with Lily.

Laurie

[molly muffin]

Hello and welcome from me too. Have they considered doing a full thyroid profile to see anything specifically might be off there? I just wonder since thyroid is most often associated with aggression.

[nietodevin]

They did a test to determine it was pituitary and then did a ultrasound of her adrenal glands and both were enlarged but no tumors found on them.
I would have to look but would guess they did a full thyroid test because the vet was sure it was her thyroid until I did some internet searching and told her to check for cushings.. the vet and the specialist couldn't believe she was so young and have cushings

[westcoastflea1]

you need to have a complete thyroid test done t3 free t3 t4 free t4 and tgaa find out where the levels are on all if low normal or below normal meds need to be increased acth tests are not very reliable have a uccr done just need a sample of urine first morning catch do 2 or 3 days worth mix together keep refrigerated then drop at vet if test results come back saying your dog is non cushings means you have cortisol under control if it doesnt come back non cushings it means you need to increase meds

[westcoastflea1]

if she cant handle meds try one of the new dopamine agonists cabergoline for one, no side effects and if it works it will shrink pituitary tumor or eliminate it altogether,

[labblab]

...acth tests are not very reliable have a uccr done just need a sample of urine first morning catch do 2 or 3 days worth mix together keep refrigerated then drop at vet if test results come back saying your dog is non cushings means you have cortisol under control if it doesnt come back non cushings it means you need to increase meds

I need to point out that we are unaware of any research that suggests that UCCR analysis is preferable to ACTH monitoring for dogs being treated with either trilostane (Vetoryl) or mitotane (Lysodren). In fact, clinical testing thus far suggests the reverse: that UCCR analysis cannot reliably be used as the basis for decisions regarding dosing increases. Here's a related reply posted by another one of our staffers.

The UC:CR is not recommended for monitoring treatment. I'm including this excerpt from a study and was published in 2009 and titled: Urinary Corticoid : Creatinine Ratios in Dogs with Pituitary-Dependent Hypercortisolism during Trilostane Treatment

Conclusion and Clinical Importance: The UCCR cannot be used as an alternative to the ACTH stimulation test to determine the optimal dose of trilostane, but might be helpful in detecting dogs at risk for developing hypocortisolism during trilostane treatment.

http://onlinelibrary.wiley.com/doi/1...374.x/abstract

Lori

Although perhaps not a perfect monitoring tool, the ACTH stimulation test remains the preferred method for evaluating the appropriateness of dosage increases during the course of trilostane and Lysodren treatment.

Marianne