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Thread: Cushings, coritzol, calcinosis cutis, and inflamation

  1. #1
    Join Date
    May 2019

    Default Cushings, coritzol, calcinosis cutis, and inflamation

    Hi everyone,
    Has anyone come across an issue where the high cortisol levels actually helps in managing a paw inflammation?
    My staffordshire bull terrier, Reggie, was diagnosed with Cushings about 6 weeks ago. She is 8 years old, and weights 14kg (approximately 30lbs). She also has calcinosis cutis on her back ().
    Her first ACTH tests results:
    Pre: 247
    Post: 1415
    I believe these are the LDDS results? (I admit the technical side of things completely confuses me)
    She then started on a 30mg dosage of Trilostane.
    Dispute this being the “usual” dosage, it was clear very quickly that the 30mg dosage was too high for her (Although the vets said this was the Trilostane "working"). She became withdrawn (just has a general “down” demeanour), the skin on her tummy became very dark and she lost her appetite (and we had to hand feed her). She also developed an inflamed front right paw (to the point where she lost all the hair on the paw), and the vet wasn’t sure what caused this. The paw also didn’t seem to be bothering Reggie, so we just left that issue alone.
    We did see improvement in her Cushings symptoms her in these first four weeks – her hair regrew significantly, her pot belly got smaller and she stopped drinking excessive amounts of water (although perhaps she has now gone too far the other way and does not drink enough).
    After 4 weeks, we did the second ACTH test, which (unsurprisingly) revealed that her cortisol levels were drastically low. Unfortunately, we had to wait 4 weeks rather than the usual 2 weeks for the second test due to the vet failing to give us complete instructions as to how to take the Trilostane. The second ACTH test results came back:
    Pre: Less than 14
    Post: Less than 14.
    After receiving these results, she stopped the Trilostane for 10 days. We saw improvement in her general mood and appetite, although her water intake remained low. Her front right paw which was inflamed also started getting better – the swelling came down and the hair was growing back.
    After 10 days we restarted the Trilostane, two 7.5 mg twice a day (ie. 15mg per day). This dosage seems more appropriate for her because sheÂ’s more active, but not showing any cushing symptoms. This was 1 week ago.
    However, since restarting the Trilostane, her front right paw seems to be getting more inflamed and is losing hair again.
    I understand that cortisol assists with keeping managing inflammation, but we have a strange situation where the high cortisol appeared to keep her foot inflammation under control.
    I am very tempted to reduce the Trilostane dosage to 7.5 mg once a day – to stop her paw from getting worse. Is this a good idea?
    Alternatively, we can keep going on 7.5 mg twice day for another week and then schedule a ACTH test.
    The vets seem a bit lost with what to do. Over the last few months, they have put her on 4 antibiotics to deal with various bacterial issues (apparently related to Cushings), but IÂ’m not sure if those antibiotics are even workingÂ…. (Frustratingly!)
    Many thanks
    ReggieÂ’s mamma

  2. #2
    Join Date
    Apr 2009
    York, PA.

    Default Re: Cushings, coritzol, calcinosis cutis, and inflamation

    Hi and welcome to you and Reggie!

    Cortisol does have natural anti-inflammatory properties so that high cortisol could of helped with her paw but unfortunately it will make the calcinosis cutis (CC) worse. Was the CC diagnosed with a biopsy?

    Could you do me a favor and check to see if those results you posted are in nmol/L, I'm thinking they are which makes me very worried regarding her last test results. Her cortisol dropped dangerously low which should of prompted a supplementary dose of a steroid hormone such as prednisone. Were her electrolytes checked also? Another thing that concerns me is that she was restarted on the Trilostane before an ACTH stimulation test was performed to make certain her body was producing enough cortisol.

    What I recommend is having her cortisol and electrolytes tested as soon as possible to establish that her system is capable of handling the Trilostane.

    Hugs, Lori

  3. #3
    Join Date
    Apr 2009

    Default Re: Cushings, coritzol, calcinosis cutis, and inflamation

    Hello, and welcome from me, too! I really agree with everything that Lori has just written. If those ACTH results were in units of nmol/L, they were *really* low, as Lori has said. Like her, I worry as to whether Reggie’s adrenal function had rebounded enough to handle starting back with the Vetoryl yet at any dose. Aside from the paw inflammation, is she otherwise behaving normally now — eating and drinking OK, activity level OK? If not, or if she starts backsliding again, I’d really worry that even the decreased dose of Vetoryl is too much for her system to handle right now.

    So do let us know about this additional info that Lori has asked about, and also please let us know how Reggie is doing, overall, right now. And then we can go from there.

    Once again, though, welcome!

  4. #4
    Join Date
    May 2019

    Default Re: Cushings, coritzol, calcinosis cutis, and inflamation


    Thank you so much for your responses (and this forum). It's been so helpful me understanding what is happening with my Reggie. Apologies for the delayed response.

    Yes, the test results are in nmol/L. Her electrolytes were not checked at the last blood test - only a ACTH test was performed. When we got the last (and alarming low results), the vet offered some kind of cortisol supplement and said we should stop the Trilostane for 3 days. We followed the vet's advice and Reggie significantly improved over those 3 days. I was very hesitant to put her back on the Trilostane after those 3 days and spoke with the vet who suggested taking her off for a further 10 days.

    The CC was not diagnosed with a biopsy. I didn't even know that was an option. Two vets diagnosed her with CC based on what they saw.

    We took her off for over 2 weeks, and then put her back on again (on a reduced dosage of 7.5mg twice a day) when I made my first post.

    After receiving your response we decided to stop the Trilostane again - this time for several weeks (and potentially indefinitely). Reggie has been doing well over the last few weeks - no real symptoms of Cushings coming back and her CC has also improved drastically (but has somewhat plateaued over the last week - probably because her system is slowing building up the cortisol again). Her paw is pretty good - it doesn't look 100% like the others, but the hair is growing back and it doesn't look swollen (it's still a bit bigger than the others). I do wish she would drink more water though, but it may be that I am used to her drinking lots of water whilst her Cushings was was untreated.

    We are looking to do another ACTH test soon. Unfortunately working full time makes it difficult to do the ACTH test (which can only be done during the week at our vet clinic).

    Thank you again for all your help and support!

    Will be in touch with an update soon!

  5. #5
    Join Date
    Mar 2009
    rural central ARK

    Default Re: Cushings, coritzol, calcinosis cutis, and inflamation

    Hi and welcome to and Reggie!

    Unfortunately CC will not get better without treatment - it gets progressively worse. Since you say her skin has improved off the Trilo I am wondering about the original diagnosis. CC is calcium that gets deposited under the skin and it works its way out of the body THRU the skin causing terrible sores that can cover the whole body if left untreated. So this improvement off treatment is a bit confusing to me if, IF, the CC diagnosis is correct. If possible I would have a derm vet take a look at her and find out for sure what is going on with her skin. There are several skin conditions that dogs can get other than CC and they have nothing to do with Cushing's.

    Some dogs can't handle Trilostane at any dose tho that is uncommon. Typically the reactions you saw are due to the dose being too high. But at 30lbs the 15 a day is below the recommended starting dose of 1mg/lb so it may be that Reggie is simply one of those pups who can't take Trilo. Since you posted in kg VS lbs I am assuming you are in Europe somewhere? If so, you may not have any other option. In the US we have Lysodren that is also used to treat Cushing's and those pups that can't handle the Trilo can be switched to Lyso. There are also dogs who can't handle Lyso and need to switch to Trilo - so we are fortunate here that we do have options.

    What signs did you or her vet see that prompted the Cushing's testing in the first place? Cushing's is one of, if not THE, most difficult canine condition to correctly diagnose because so many other diseases share the same signs AND any other condition can cause false positives on the tests for Cushing's. The LDDS is notorious for that if a non-adrenal disease is present. The ACTH measures how much cortisol the adrenals are holding in reserve and they will hold a lot in reserve if something like a tumor is present. Some dogs get so stressed simply walking in the vet's door that they will get positive results on the ACTH when they do not have Cushing's at all. So if you would let know us a bit of her medical background, especially anything going on around the time she was tested for Cushing's, that would be great. Has she had an abdominal ultrasound?

    I'm glad you found us and look forward to learning more about the both of you as time passes.
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

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