New to this Forum-with Ollie a Cushings Dog, False Positive Cushings

[alleng8304]

My rescue dog, Ollie, a 9 year old Norfork Terrier dx with Cushings in April 2018 by LDDS and started on low dose Trilosane 5 mg. He also has a dx of diabetes. His clinical signs were always hungry, bloat belly, hair loss, drink a lot of water, elevated liver enzymes. He is not a real active dog so it was hard to determine if he was lethargic. He reiceives 4.5 units of Vetsulin q12 and a prescription dog food to help maintain his glucose levels.

My concern is that diabetes could also generate a false positive Cushings. Although he has all the clinical signs of Cushings -how would one know if there was a false positive? Hw will be due for another ACTH stim soon. Thanks you

[Harley PoMMom]

Hi and welcome to you and Ollie!

Yep, those tests for Cushing's can yield false positive results when a non-adrenal illness is present and unfortunately the LDDS is one that is more likely to do that. The symptoms that Cushing's produce overlap with the same ones of diabetes so the recommendation is when diabetes is in the mix and Cushing's is suspected the first thing to do is to get the diabetes under control before performing any tests for Cushing's. However, since Ollie is already on treatment for Cushing's we've got to move ahead and look at the overall picture. How hard was it to get his blood sugar regulated? And how are his symptoms now? Could you post the results of all the tests that were done on Ollie, you need to only post those values that are abnormal with the reference ranges and units of measurement. Also, could you post the results of any monitoring ACTH stimulation tests he has had done? Is Ollie taking brand-name Vetoryl or is his Trilostane compounded? And is he getting his Trilostane with a meal?

We have a sister forum that deals with canine diabetes so I do urge you to join there also, in this way we will have the best of both worlds...here's their link: http://www.k9diabetes.com/ Please know we will help in any way we can and if you have any questions do not hesitate to ask them.

Lori

[alleng8304]

Lori- Thank you so much. Ollie has been a difficult case. He was dx with diabetes in January. We started him on 4 units of Vetsulin daily and went up until we hit 15 units. Results were erratic where we would get Urine strips of negative to 500. We now do Vetsulin q12 4.5 units and use a Glyco balance meal like Royal Cannine. I do blood sticks 3x per week and urine strips 3x a day. He has been staying in the 150-250 range. Since we just started this, same dose of insulin at each dose, my plan is to let the insulin/meal settle in for 2 weeks. I would not say that he is under control but getting there.

Yes we have done LDDS and Acth stim and I will get those values back to you tomorrow. I have had 3 dogs (poodle mixes) with Cushings-one lived 12 years and one 14 years. I asked the vet if Cushings is in my walls or something. I live in a rural town and the vet I love and has helped me in tough spots but he is no specialist. I have a PhD in medicine and I never thought that it would be that hard to get Ollie under a good control. I am also on the sister site. Again, many thanks

[Harley PoMMom]

One important thing I wanted to mention is that diabetic dogs should have their Trilostane twice a day as this helps to keep a tighter control of the cortisol.

[alleng8304]

Lori-

Going to vet Wednesday. I will ask the vet why he thought my muti-poo (Opie) had Cushings- may have been an altered chem profile. He has no symptoms- period. Off Trilosane since June 20th and no ill effect

As for Ollie- 9 yro Norfork Terrier
I finally got is diabetes under control-took 6 mo. He get 4.5 units of Vetsulin q12 and meals q12 with a Royal Cannie Gylobalance in an effort to prevent sugar shock. For the last two weeks his urine and bld glucose stays under 200 and usually in the range of 120-150. My plan was to do a Fructosamine which should tell me if he is in good control or not. for past 2-3 weeks. Numbers should be between 265-280. I was going to do a 12 hour curve but his veins in the ear are very embedded. I will also ask vet about his hair falling out (on back) and cataracts. His right eye seems worst (mature)- cannot see close vision only further away. I was thinking of trying Lomax eye drops (has good reviews)

In April 2017-LDDS done cortisol ug/dl 9:30 am=7.5, 1:30 pm=5.3, 5pm=5. In May ACTH Stim 10:45=9.2, 11:45=9.6

Thats it Thanks Ollie

[Harley PoMMom]

Hey Allen, I just wanted to make sure you saw this post of mine.

One important thing I wanted to mention is that diabetic dogs should have their Trilostane twice a day as this helps to keep a tighter control of the cortisol.

[alleng8304]

I did Thanks

[alleng8304]

Ollie went to vet this morning. His meds include Vetsulin 4.5 u q12, Denamarin alternate 1 tab & 2tab daily, Ocu-glow daily, trilostane 5 mg daily. Food is Royal Cannin Glycobalance. Labs today- Glucose=61, I finally think he is under control. Glucose runs between 61-121. All under 200. I may cut back to 4 U q12.

ALP=181, ALT=183 both high but lower than June which was 2356 and 439 respectively -Denamarin? BUN went up to 41 was 37 in June.? Drew blood for Fructosamine- will have results on Friday- looking for a number below 265. Left eye mature cataract-only has peripheral vision. Immature in right-better vision. Considering a trial of Lanomax drops in left eye only. Test for Glaucoma good- 20 in both eyes

Ok clinicians, what are your thoughts. Many Thanks-Allen and Ollie

[Harley PoMMom]

Everything looks pretty good to me. If his blood sugar would ever start to get out of control you may want to look into giving his Trilostane twice a day to get a tighter rein on the cortisol, I do see from his last ACTH stim in May that his cortisol levels were in the high therapeutic ranges for a dog on Trilostane but if it works why rock the boat...Great job, Allen!!

[alleng8304]

Update: Ollie's Fructosamine was 250 reference range of 150-350. So good control. I read somewhere that ACTH stim should be performed 2-4 hours after Trliostane administered? is there a reference for that? Thanks Allen & Ollie