Re: Cushing's and Diabetes, what's been your experience?
Hi Daisy's mom,
Let me add my welcome to you and Daisy!
The problem with the LDDS is that it IS so sensitive. Cortisol will rise naturally in response to any streesor...even just visiting the vet's office. That is cortisol's job; it is one of the fight or flight hormones. So the LDDS, and ACTH, will pick up that elevated cortisol BUT neither test can tell us why that cortisol is elevated - only that it is elevated. The LDDS has a quirk in that while it is the gold standard for diagnosing Cushing's in otherwise healthy dogs it is more likely to return a false positive in a dog who has any other illness present - like diabetes. In dogs with diabetes the ACTH is the preferred diagnostic test for this reason - you can't get an accurate result with the LDDS in a diabetic dog. So this is one red flag on the Cushing's diagnosis for me.
You said the ultrasound showed normal adrenal glands...second red flag. In a dog with Cushing's the adrenals are almost always enlarged because those glands are working very very hard to produce and release all that excess cortisol. They are either both enlarged or one enlarged with the other very small or even atrophied. So normal appearing adrenal glands red flag #2.
While Daisy was hospitalized her liver enzymes were very high but then returned to normal on the next test in Sept...3rd red flag. The ALP in particular is almost always extremely elevated in a cush pup and it does not return to normal without treatment and sometimes not even then. It would be much more likely that 5000 or so level seen in the hospital would have remained or increased by Sept., not returned to normal. So red flag #3 on the Cushing's diagnosis.
If you could get copies of the lab work from Jan of this year and post the abnormal results here that would be huge help. We look for specific values on the super chem, or wellness check as my vet calls them (this test shows things like the liver values, BUN, CHOL, CREAT, etc) and the CBC which shows things like leucocytes, monocytes, eosinophils, etc.
Now, all these red flags that I have may well by my over-active mind because I have had 2 dogs misdiagnosed with Cushing's. One tested positive on all the tests but all were false positive because of a tumor on her spleen that was removed, returning her cortisol level to normal. She did eventually develop conventional Cushing's with elevated cortisol but the second baby never had Cushing's as proven via a necropsy (autopsy for animals). So I am always overly cautious when it comes to diagnosing Cushing's, especially based on one test and doubly when the pup has anything else going on, like diabetes.
I'm glad you found us and look forward to seeing those other test results so my mind might find some peace.
Hugs,
Leslie
"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.