Yukon, American Eskimo - Experience w/ Lignans and Melatonin?

[labblab]

Under the circumstances, I think your internist’s suggestion to have Yukie’s ACTH analyzed by the University of Tennessee makes sense. Their lab is able to measure the effect of the stimulating agent on a number of adrenal hormones in addition to cortisol. As it turns out, elevations in some of these other hormones can result in many of the same symptoms as are caused by elevated cortisol. Sometimes this occurs even when cortisol levels are normal or only mildly elevated, and therefore treatment other than Vetoryl may be recommended. Since Yukon reacted so poorly to the Vetoryl, this additional information may be useful.

When elevations in other adrenal hormones cause problems, the diagnosis that may be given is “Atypical Cushing’s.” You can read more about this diagnosis here. It can be fairly heavy reading, and unfortunately a lot of question marks yet remain about the cause, significance and treatment of elevated adrenal hormones. But this info may help shed some light on the testing that the internist is suggesting.

http://www.k9cushings.com/forum/show...Hyperestrinism

I do think the results of the ACTH will be useful, especially since this will be the first ACTH for Yukon. In terms of elevated cortisol, the ACTH is less vulnerable to “false positives” than is the LDDS because it is not quite as reactive to the presence of other physical illnesses or stresses. So overall, I think this is a good plan for Yukon.

To me, the only questionable aspect of your internist’s plan is the UCCR if the urine sample was obtained in the office. That test is highly vulnerable to stress so it is generally recommended that the sample be obtained at home when the dog is calm. But perhaps your vet thought, what the heck, let’s go ahead and see how it turns out anyway.

So, in summary, do keep us informed. But I do think the ACTH may be useful.

Marianne

[YukiesMom]

Thank you so much Marianne for the explanation - maybe we will be able to determine what is really going on finally. Also, the UCCR test is being ran from a first morning urine that I collected on his walk when we got up. One thing I have learned is that it is better to bring the urine sample even if they don't use it

I will keep you informed of Yukon's travels - thanks again for the information.

[labblab]

Also, the UCCR test is being ran from a first morning urine that I collected on his walk when we got up. One thing I have learned is that it is better to bring the urine sample even if they don't use it

Perfect! Then the results from the urine sample will definitely be interesting, too.

Good job, mom!!!

[YukiesMom]

I am trying. This is very complicated. I just wish someone could come to a diagnosis. I have been saying for the last two weeks I want to put him on lignans and melatonin. I have been reading about this venue for atypical cushings.

[YukiesMom]

So I went to the Internal Medicine doctor and he got the results of the urine back and confirmed Yukon displayed cushings. He then suggested a stim test that the university of Tennessee does to measure various levels within the adrenal gland itself. I went to my vet and had the test done and she called me yesterday and said three of the levels were high and confirmed pituitary cushings. She said first recommended treatment is trilostane but because Yukon had problems with it there were a few other possibilities. She is forwarding to the internal medicine doctor to see what he suggests. I feel like it is hopeless because he can't take the trilostane.

[labblab]

Hello again, and thanks very much for this update. It will be a huge help to us, though, if you can get a copy of the exact test results from Tennessee. That way, we can better discuss the different treatment options that may be available, given Yukie’s precise elevations. For instance, there is an alternative drug to trilostane that is named Lysodren. It is very effective at lowering cortisol, and also lowers certain other adrenal hormones as well. So please don’t give up hope — there may yet be a treatment plan that can be very helpful for Yukie. But first we need to see those test results ;-).

Marianne

[YukiesMom]

Hi Marianne,

Here are the test results from the University of Tennessee:

RESULT Normal RESULT Normal
(Baseline) Range** (Post ACTH) Range**
Baseline Post-ACTH

Cortisol ug/dL 3.4 <1.0-5.6 13.4 7.1-15.1
Androstenedione Ng/ml 1.11* 0.05-0.36 6.10* 0.24-2.90
Estradiol pg/ml 77.9* 23.1-65.1 77.9* 23.3-69.4
Progesterone ng/ml <0.20 <0.20 1.25 0.22-1.45
17 OH Progerstone ng/ml 0.25* 0.08-0.22 3.03* 0.25-2.63
Testosterone ng/dl <15.0 <15.0-24.0 <15.0 <15.0-42.0

Looks like his Androstenedione, Estradiol, and 17 OH Progesterone are high

[labblab]

Well, those results are very interesting, indeed. In contrast to Yukon’s earlier LDDS test, his cortisol level was not elevated above the normal range on this ACTH. So once again, we must wonder whether his elevated LDDS at that time was a reflection of a stressor or illness other than conventional Cushing’s. Looking at this UTenn profile, we see results consistent with that “Atypical Cushing’s” diagnosis that we talked about earlier — normal cortisol but elevations in other adrenal hormones. Based on these results, I don’t think trilostane would be the top treatment recommendation made by the folks at Tennessee. Instead, a combination of melatonin, lignans, and perhaps a low dose of Lysodren would be more likely. Here’s a copy of their general treatment recommendations for you to view yourself.

https://vetmed.tennessee.edu/vmc/dls...iderations.pdf

I’ll be very interested in the internist’s thoughts about this. But do take a look at this treatment recommendation sheet in advance of your discussion with him or your regular vet. As I say, I do think you have some options available other than trilostane.

Marianne

[YukiesMom]

My 13 year old American Eskimo has been diagnosed with Cushing's disease and after going to an Internal Medicine doctor and getting a test done from University of Tennessee it appears that he has elevated Androstenedione, Estradiol and 17 OH Progesterone levels. Cortisone level was within baseline.

We tried him on 10mg of Vetoryl a couple months ago (he weights 32 pounds) and he was very lethargic and in a daze most of the time. We took him off and that is when I brought him for the testing from University of Tennessee.

The Internal Medicine doctor consulted my vet and advise that I needed to start Yukon on 3 mg of Melatonin 1x a day for 7-10 days and then increase to twice a day and add 25mg of Flax Lignans 1x day.

Has anyone done the same thing for their Cushing's dog? Has it helped?

Thank you,

[YukiesMom]

Hi Marianne,

Yes that is what the Internal Medicine doctor me to do - start Yukon on 3mg Melatonin 1x a day and then in 7-10 days increase to 2x day and add flaxseed lignans. Have you seen this really work on Cushing's Dogs? I am really worried. They did not recommend Lysodren because of all the other issues Yukon is having.