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