New here - Louie age 13 small poodle (mix?) with Cushings

[mojomom77#]

Hi, so glad to find this forum. So Louie is recently diagnosed but the low-dex test came back inconclusive for type (conclusive that he has Cushings; inconclusive if adrenal or pituitary). I don't have any details on his test or bloodwork so please feel free to let me know what info I should be asking for and I'll get it. He has classic symptoms btw - excessive thirst/peeing; hunger, panting, just noisy breathing in general, and starting to get a bit of a pot belly; also hind legs showing some weakness.

He was tested after pre-anesthesia bloodwork for another procedure showed high liver enzymes. The other procedure was to have a skin wart removed that would not stop off and on bleeding for months. Then after the Cushing's diagnosis, he randomly developed a problem in his right eye with blood in the eye. At the same time he had a suspicious lump on top of his head, of course on the right side of his head, but it is unknown if this bump is related to bleeding in the eye. No bumps falls, etc that we know of. The lump was infected and receded with antibiotics. He is seeing a vet opthalmalogist for the eye and it appears now that the retina is detached and he is blind in that eye; he is on steroid eye drops and they seemed to work and the bleeding/redness was gone until it wasn't - it came back while we were out of town (dog sitter) and the vet is keeping him on the eye drops for now. Nobody has expressed any suggestion that this is in any way, shape, or form related to Cushings by the way. So at this point a mystery.

My main question today to start - in order to identify his Cushings type, we can have an expensive ultrasound done. Since 85% of cases seem to be pituitary, is this necessary vs just starting him on the meds? Pros/cons or is this not even a question I should be asking? Thank you!!

[labblab]

Hello and welcome to you and Louie! Before writing a lengthier reply of my own, I have a couple of quick questions to ask you. First, how long ago did you first notice the outward Cushing’s symptoms? Then, how long ago did Louie start taking the steroid eye drops? And finally, was the LDDS (Low Dex) test performed while he’s been taking the steroid drops?

The reason why I ask about the timing of the symptoms, testing, and steroid drops is because supplemental steroids taken for a period of time can cause Cushing’s symptoms in an otherwise normal dog. Supplemental steroids can also skew the diagnostic test results. And for a dog who actually does have naturally-occurring Cushing’s, the addition of a steroid medication will likely make the symptoms even worse because you’re increasing the excessive amount of circulating hormone/steroid even higher.

I know there are times when the benefit of short term steroid treatment outweighs the negatives for a Cushpup, and I’ll assume that Louis’ eye treatment is one of those situations. But as I say, before writing more, knowing the timeline of Louis’ treatment and testing will be helpful to me.

And once again, welcome to you both!
Marianne

[mojomom77#]

Hi and thanks!

Cushings symptoms like more drinking and peeing started last fall/winter and progressed from there. I was thinking maybe diabetes?

Timeline below - note he was diagnosed and symptomatic of Cushings well before the eye bleeding and steroid eye drops.

June 10th -pre-op bloodwork prior to removal of a bleeding wart; vet noticed increase in liver enzymes and we started piecing together Cushings symptoms including increased thirst, peeing, food anxiety/hunger, panting, noisy breathing.

July 1 - Low Dose Dex test
July 24 - Retinal bleed
July 25 - Steroid eye drops started
Aug 9 - follow up with vet opthalmalogist

I did call the vet eye doc last week b/c the retinal bleed continues so she wants him to stay on the eye drops. I asked if there were any concerns with him being on them this long and was told it was necessary to try to save the eye.

[labblab]

Thanks very much for this additional info. It does sound as though this is one of those situations where the importance of giving the steroidal eyedrops outweighs any temporary worsening of the Cushing’s symptoms. And it’s helpful to know that the original testing and symptoms did precede the eyedrops. So we can now move forward under the assumption that the diagnosis is accurate.

As far as sharing test results with us, it would be helpful to see the actual numbers from the LDDS test, along with a listing of any abnormal readings on Louie’s other blood/urine panels. We only need to see values that are too high or too low, along with the lab’s normal reference range. There are certain abnormalities that often occur with Cushing’s, and it helps us to see whether or not Louie’s labs fit within that profile. You’ve already mentioned elevated liver enzymes, for instance, and that is definitely a common Cushing’s abnormality.

And now, finally turning to your original question: is there value in determining whether Louie has an adrenal tumor vs. a pituitary tumor? You’re correct that the same medication can be used to treat either condition. However, Cushing’s caused by an adrenal tumor can actually be cured by successful tumor removal. This surgery is very expensive and is significantly risky. Depending upon age and general physical condition, not all dogs are even considered to be reasonable candidates for surgery. If surgery is something you would want to consider, though, then an ultrasound would definitely be valuable. Abdominal ultrasounds can also convey useful information about the status of other internal organs in addition to the adrenal glands, such as the liver, kidneys, gallbladder and spleen. We often say here that an ultrasound can offer a lot of bang for your buck. But for many people, those “bucks” can be needed for spending elsewhere. And if adrenal surgery is not a consideration regardless of the presence of a tumor, then there’s also likely less of a need to know whether or not it actually exists.

I personally think that an ultrasound can be a very valuable diagnostic tool, in general. But we certainly have many folks here who undertake treatment without opting for the expense of an ultrasound. So whatever you decide in that regard is really up to you, and we’ll understand whichever route you choose to go.

Marianne

[mojomom77#]

Thank you for the reply. Below are some test results that I have:
LDDS test:
Cortisol baseline: 3.1 - reference value 1.0-6.0 ug/dL
Cortisol - 4 hr post dex - 4.1
Cortisol - 8 hr post dex - 3.7

Bloodwork:
Hemoglobin - 13.1 (Low) (ref 13.4-20.7 g/dL)
Reticulocyte Hemoglobin 22.9 (Low) (ref 24.5-31.8 pg)
WBC - 19.6 (high) (ref 4.9-17.6 K/uL)
Monocytes - 2.293 (high) (ref 0.13-1.15K/uL)
Eosinophils - 1.509 (high) (ref 0.07-1.49K/uL)
Platelets - 78 (low) (ref 143-448 K/uL); with a comment that scanning of the blood film revealed adequate platelet numbers. due to clumping, the aut platelet number cannot be accurately determined)
Potassium - 3.9 (low) (ref 4.0-5.4 mmol/L)
Na: K Ratio - 39 (high) (ref 28-37)
Chloride - 107 (low) (ref 108-119 mmol/L)
ALT - 288 (high) (ref 18-121 U/L)
ALP - 1369 (high) (ref 5-160 U/L)
Triglyceride - 481 (high) (ref 20-150 mg/dL)
Lipase - 351 (high) (ref 0-250 U/L)

Thanks for the info on value of ultrasound. Am leaning towards it. Waiting now on vet trying to talk to eye vet for a consult.

[labblab]

Thanks again for this additional info. I’m definitely not an expert on lab interpretation, but it does look as though Louie shares several abnormalities common to Cushing’s. As you already know, his LDDS results are indeed consistent with Cushing’s, but do not help us to differentiate between pituitary vs. adrenal forms.

Out of his other bloodwork, several of the abnormalities are just slightly out of range so I’m not focusing on them. Of those that are more significantly out of range, the elevations in white blood cells, monocytes, ALT, ALP, and triglycerides are regularly seen with Cushing’s. We do seem to often see higher lipase levels, too, perhaps in conjunction with some inflammation of the pancreas — or perhaps, not.

Anyway, Louie’s overall profile does support the Cushing’s diagnosis. So now I think we’ll all be poised to follow your next steps forward. Please continue to update us!

Marianne