Re: Newly diagnosed with Cushings
ACTH Stimulation (taken on 7/23/2019)
Pre-Sample = 1.7
Sample post ACTH stim gel = 2.9
(Samples taken 2 hours apart. Vet says this is "good regulation".
This is within normal range for a pup being treated with Vetoryl. That normal range for the post number just so you know is 1.45ug/dl - 5.1 ug/dl. That post, or second number, can go as high as 9.1 ug/dl if and ONLY if all signs are well controlled. The ranges posted from the labs do NOT pertain to a dog being treated for Cushing's - they represent a normal/non-cush dog. Winnie's pre number of 1.7 is getting in the too-low range for a pre but the post number is the critical number.
In the lab work posted she doesn't present with some of the lab values we normally see such as very elevated liver enzymes, particularly the ALP (or ALKP). In addition to elevated CHOL we often also see abnormal levels of the BUN, TRIG, GLUC as well as abnormal levels of eosinophils, lymphocytes, and monocytes.
It seems the only tests run to diagnose Cushing's were the UC:CR and the LDDS - both good tests but NO test can 100% diagnose Cushing's. It takes a battery of tests PLUS signs to arrive at a semi-solid diagnosis. Fun, huh? Even knowledgeable canine endocrinologists admit Cushing's is one of the most difficult and confusing canine disease. YAY!
Winnie is younger than the typical cush pup however one of our admins had a Pom who was confirmed at the age of 3 so it can happen. But Lulu was almost textbook for the disease and Winnie is not.
You said this came on almost overnight - that does not happen in Cushing's. It is a very slowly progressing condition taking years to do any damage that is truly observable. Most people think their dog is simply aging, not sick, and are surprised when the vet runs normal labs for something like a dental then tells them Cushing's seem likely. In your shoes I would definitely want the abdominal ultrasound - and make sure it will be performed on a high resolution machine so all the organs, like the tiny adrenal glands, can be seen as clearly as possible. And I would want to make sure ALL other possibilities for the signs you are seeing have been ruled out before I restarted treatment for Cushing's...at any dose. DI, diabetes insipidus or water diabetes, can cause the excessive drinking, urination, and leaking. Polyphagia, or excessive appetite, can be caused by many other things in addition to Cushing's. But that's me - my first cush pup was diagnosed with Cushing's but they found a tumor on her spleen that caused all the cush test to return fals-positives. Once the tumor was removed those tests returned to normal. She later did develop true Cushing's but she did not have it when first diagnosed with it. My second cush pup was completely misdiagnosed due to a host of diseases and conditions that also caused false-positives. Her necrosis proved her adrenals were normal, ruling out Cushing's as one of the conditions she had lived with. So don't rush into believing Winnie has Cushing's - take the time to rule out other things. Cushing's disease is rarely life-threatening but treating a dog with these powerful drugs for Cushing's when they don't actually have the disease can be.
Keep reading and asking questions...we will be here!
Hugs,
Leslie
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