My 12 year old German shorthaired pointer was diagnosed with Cushing's as of yesterday and I'm not sure how to proceed. Due to my research, I feel like maybe his case is not the norm but maybe I'm just being naïve.
In January, I noticed an increase in drinking from my boy Trigger. My brother had Trigger's uncle and he was a year younger than Trigger and just recently passed from Cushing's disease, so I am slightly familiar with the symptoms of Cushing's. The week I noticed Triggers increase in drinking I started carefully looking for other signs. On a run in December, I remember looking at his tail from behind him and noticing a tiny bit or bare skin showing where it had used to be fur. Thinking back to that time and putting it together with the newly increase in drinking, it instantly sunk in. On 1/24, I had bloodwork done at my primary vet. The results did come back with signs of CushingÂ’s, but obviously further testing was needed. On 1/24 the blood levels that stuck out was ALT 327, ALP 626, GGT 24 and CHOL 368. Fast forward to 2/14, an ultrasound revealed no tumors but an enlarged liver and Adrenal glands. "Hepatobiliary - The liver is diffusely moderately enlarged and hyperechoic with smooth rounded margins. Adrenals - The adrenals are moderately generally enlarged, bilaterally, measuring 1.1 cm (left) and 1.3 cm (right) at the caudal pole; the glands exhibit otherwise unremarkable features." Since no tumor was found we did an ACTH test. Cortisol level pre ACTH is 6.0 and post is 33.7. Along with all the information, the blood work from 2/14 reads ALT 169, AST 28, ALP 521, GGT 20, CHOL 331 and Spec cPL is 212.
As of now, just the very tip of his tail and a small spot on his head has some hair loss (less than a square inch) and the increase in thirst. I feed him in the morning before I leave for work at 5am but the majority of the time he won't really eat until the second I come home. He gets excited and then eats which is around 4 and then he gets his actual dinner around 5-6. Weird eating times, I know. So personally, I think if he had an increase in hunger symptom, then he wouldn't leave the food sitting all day waiting for me to get home but then again this has been his routine all his life.
He has had some heart issues in the past 3 years that are for the most part under control thanks to 10mg of Vetmedin twice a day. He still has a level 4 heart murmur but gets an ecogram done every 6 months until this last one came back great so we pushed it out to a year (this coming September). Along with the Vetmedin, he takes fish oil, Dasuquin (for his arthritis) and the newly prescribed Denamarin as of a few days ago.
I don't think I'm missing anything given his current situation. Even though he is 12, he is a GSP which are high energy dogs. He has a decent amount of daily energy and if it wasn't for the arthritis, I think he would have the drive to run multiple miles a day like we used to in his younger years. We do a few miles twice a week now and he jogs/speed walks but doesn't run anymore. We did do hunting trips this past fall and winter but way less miles to keep him from having hard recovery days.
With no tumor on the adrenal gland and with them being slightly enlarged, it was explained to me that there could possibly a tumor on the pituitary gland which is making the adrenal glands overproduce causing the enlargement of these glands. So IÂ’m assuming Trigger is classified as having the pituitary version of CushingÂ’s? My specialist that did the ultrasound is suggesting no treatment at this time (besides the Denamarin for the liver) as the treatment really only treats the symptoms and not the actual disease. She is saying this is the very beginning of CushingÂ’s disease with Trigger. I should recheck blood work and urine tests in 2-3 months even if symptoms donÂ’t progress and base the next steps off of those numbers. She states, the average lift expectancy after being diagnosed with CushingÂ’s is 2 years. The reason it is 2 years, is because the majority of dogs that get it are senior dogs and that is about how much time they have left and that typically, they would die from old age or other complications and they donÂ’t normally die due to the sole reason of having CushingÂ’s. Does this sound accurate?
I guess my question is, how should I proceed? On a scale of 1-5 (1 being early stage and 5 being the end) where would you guys rank his journey with Cushing's based on these numbers? I have a phone meeting pending with my primary vet as well once he goes over all the numbers just to get a second opinion and to have more input. I know this is a lot to digest but any info/advice is gratefully appreciated more than I can ever express.
Update 6/2/23
It's been 4 months aka time for another blood/urine test to see how Trigger's internals are doing and how Cushing's is progressing in my boy. Here is a recap with the abnormal levels for a quick reference -
Blood test 1 in January: ALT 327, ALP 626 and GGT 24.
Ultrasound/blood test/ACTH test in February: Ultrasound - The liver is diffusely moderately enlarged and hyperechoic with smooth rounded margins. The gallbladder is unremarkable. - The adrenals are moderately generally enlarged, bilaterally, measuring 1.1 cm (left) and 1.3 cm (right) at the caudal pole; the glands exhibit otherwise unremarkable features. Mildly hyperechoic generalized hepatomegaly; bilateral mild to moderate adenomegaly. Collectively most compatible with Cushing's disease.
Mildly hyperechoic generalized hepatomegaly; bilateral mild to moderate adrenomegaly. Collectively most compatible with Cushing's disease. Cortisol pre ACTH - 6.0 , post ACTH - 33.7.
Blood test 3 in June : ALT 187, ALP 565 and GGT 18
There are some thyroid related concerns in this 3rd blood test. I will post the levels that are abnormal from this last blood test here but as a reference, I will put what those values were in [brackets] as of the 2nd blood test in February which were all within normal values.
phosphorus 6.3 [February test value 3.7], potassium 5.8 [February test value 4.7], na/k ratio 26 [31], cholesterol 463 [331], triglyceride 308 [103] and T4 .5 [1.4].
I am waiting for one more test result to come in that will provide in the vets words "will determine if Trigger's thyroid levels are something we need to treat/diagnose or his thyroid levels are abnormal due to Cushing's". I don't know the exact name of this test but my understanding is that it is just another more detailed blood test they are running but I am not 100%. A mixed bag here as to the liver values haven't changed much in 4 months which is good but either Cushing's is starting to impact his thyroid or I could have another issue on top of Cushing's. Figured I would chime in with an update on my situation.