Molly, 13 yr, shih tzu - lhasa aspo - Molly has passed

[molly muffin]

Ultrasound comparions I'm posting the results from 2012 first followed by the 2014 results.


July 15, 2012

liver mildly enlarged, diffusely hyperechoic, and margins are rounded

gall bladder moderate amount of echogenic debris present

bile duct normal

stomach wall measures .25cm to .27cm

spleen normal

left kidney 4.86cm hyperechoic speckling in the cortex and mild decrease in corticomedullary definition

left adrenal gland .80cm and .68cm, mildly enlarged with the caudal pole larger than the cranial pole

urinary bladder wall mildly thickened at the apex .32cm to .43cm, lumen not fully distended

mucosa mildly hperechoic and irregular and two small calculi presnet .18cm and .24 cm

colon normal .14cm - .17cm

right kidney similar to left kidney 4.44 cm length

small non-obstructive calculi present .28cm

right adrenal gland .56cm and .74cm (.69cm and .60cm) and is upper reference of size to mildly enlarged

pancreas normal

small intestine normal .35cm

mesenteric lymph nodes mildly enlarged .33cm by 1.97cm


April 20, 2014

liver is enlarged and hyperchoic with rounded margins

gall bladder has mild echogenic debris, no obstruction

bile duct is normal

stomach is normal and wall measures .28cm

spleen is normal

left kidney measures 5.22cm mild loss of corticomedullary definitions, cortical speckling no obstructive mineralizations and renoliths .16cm by .39cm

left adrenal gland enlarged cranial pole .73cm and caudal pols has a nodule present measures 1.30cm by 1.26cm

urinary bladder wall appears mildly thickened but not fully distended

colon is normal wall measures .14cm

right kidney measures 4.70cm and is similar in appearance to the left, renolith .18cm

right adrenal gland mildly enlarged, .82cm and .93cm

pancreas is mildly mottled

small intestine is normal wall measures .22cm

lymph nodes are normal


Case summary, ultrasound demonstrated mild hepatomegaly with rounded margins and a diffusely hyperechoic echogenicity.
adrenal glands mildly enlarged and a nodule noted on left adrenal gland.

blood pressure measurement demonstrated mild hypertension.

urinalysis demonstrated concentrated urine and proteinuria

liver changes and adrenal gland enlargement could be supportive of hyperadrenocorticism.

Differential diagnoses based on ultrasound include pituitary dependent hyperadrenocorticism with asymmetrical hypertrophy of benign or malignant adrenal nodule (adenoma, functional adrenal tumour, phechromocytoma) or hypertrophy secondary to systemic disease (unlikely).

Previous LDDS normal. Could reflect false negative testing, atypical hyperadrenocorticism or possible that molly does not have hyperadrenocorticism.

If University of Tenn results is negative, liver biopsy may be warranted.

I was VERY sure she told me she thought benign on the adrenal nodule when speaking with her but she clearly writes malignant on the report, so I think I want some clarification on that. Still waiting on UTenn results to come back before any further discussions.

I admit, it is so hard, when molly is running around, playing, bright eyed to even think of a malignant tumor and it has me feeling a bit down every since I read the report last night. It still seems that they don't know what is going on with her, what is actually causing the high cortisol, nor what kind of tumor this is. Plus they seem to say if she does have cushings, she has both pituitary and an adrenal tumor. What the heck!!

I have to go to my other computer to do it, but I will post 3 jpegs of the latest ultrasound report. Hopefully readable as I had to convert from pdf.

hugs all
Sharlene and molly muffin

[Iraklis]

phechromocytoma

Have you looked into this?
http://en.wikipedia.org/wiki/Pheochromocytoma

I noticed one of the symptoms is anxiety ,which could lead to excess cortisol i think

[flynnandian]

I was VERY sure she told me she thought benign on the adrenal nodule when speaking with her but she clearly writes malignant on the report, so I think I want some clarification on that. Still waiting on UTenn results to come back before any further discussions


hi sharlene, that sounds very confusing for you. i hope the other results from the university will put some light on this matter.

luckily molly feels fine!

[molly muffin]

Based on the other dogs that we've had on here with a pheo, Molly doesn't seem to be exhibit the sort of symptoms that might be seen with a pheo, so it isn't my first thought, but it also isn't impossible. No weight loss, no anxiety (that isn't storm related anyhow), glucose is fine, her BP is not overly high and I've seen no sign of bursts of high BP happening. So while neither I nor the IMS are ruling it out I'm not 100% on board the pheo option. Yet. Anything is possible and things change too. I was thinking non functional nodule. As I've never seen a dog with a secreting adrenal tumor pass the LDDS test. They can't suppress usually because it just secrets no matter what. However, that being said, I am thinking one option is that now that this nodule IS there, we'll have to redo that LDDS because it May if that tumor is secreting, no longer be a negative. If it is, then I'm back to thinking non functional, but we'll see. So many questions yet to be answered. I feel like a picture Leslie posted once, I don't know if I'm coming or going at this point.

Sharlene and molly muffin

[Iraklis]

ummm...MRI?
That would answer a lot of questions...

hi sharlene, that sounds very confusing for you.

In my experience too...ultrasounds and vets doing them tend to give rise to more questions than answer them...and their conclusions are vague and sometimes misleading...

[beaglemom3]

Based on the other dogs that we've had on here with a pheo, Molly doesn't seem to be exhibit the sort of symptoms that might be seen with a pheo, so it isn't my first thought, but it also isn't impossible. No weight loss, no anxiety (that isn't storm related anyhow), glucose is fine, her BP is not overly high and I've seen no sign of bursts of high BP happening. So while neither I nor the IMS are ruling it out I'm not 100% on board the pheo option. Yet. Anything is possible and things change too. I was thinking non functional nodule. As I've never seen a dog with a secreting adrenal tumor pass the LDDS test. They can't suppress usually because it just secrets no matter what. However, that being said, I am thinking one option is that now that this nodule IS there, we'll have to redo that LDDS because it May if that tumor is secreting, no longer be a negative. If it is, then I'm back to thinking non functional, but we'll see. So many questions yet to be answered. I feel like a picture Leslie posted once, I don't know if I'm coming or going at this point.

Sharlene and molly muffin

Sharlene, I know exactly how you are feeling, you are describing my Snuggles, he has no outward pheo tumor symptoms, no weight gain, no bp spikes, no panting, etc etc so far and he was diagnosed with it back in October 2013. and he did test positive for Cushings back then, which pheos can do that too.


I hope Molly does not have a pheo,
but I would suggest having either the plasma free blood test or the urine test to see if Molly does have a pheo, at least you will be able to know one way or the other. From what I have read both are fairly accurate.
and I agree too an MRI would give more info than the ultrasound as it did in my case with Snugs and Branny and it confirmed the urine test results which was positive for a pheo.
Thinking of you and Molly HUGS

[labblab]

Hey Sharlene, I don't know if it will make you feel better, but the original report references either a benign or malignant adrenal nodule. So I'm banking on "benign!"

Marianne

[molly muffin]

OMG you are right Marianne. I think I was upset when I saw malignant and somehow my brain blanked on the benign. So she did say, she thinks likely benign. whew that is a huge relief actually. Thank you, thank you for reading the report and catching that.
Now I feel like I can breath again.
I actually walked out of the house when I read that and got in the car and did some retail therapy before coming back home to finish typing.

Super Big hugs
Sharlene and molly muffin

[Trish]

Hi Sharlene

UPC comments: To me the protein is low in the UPC but the Cr is a little high, when Flynn has had results like that the ratio goes higher, I think it has a lot to do with his level of hydration at the time. I know this test is meant to take that into account, but I have noticed the fluctuations in the Cr can make it differ a lot. 2nd to last UPC was the best ever for him and the Cr was in the 1200 range, when it has been up in the 1600 range like Molly's is then I have found a higher ratio. I did not let him drink too much on the good one and he got a much better result. Molly's Sp gravity is good and great no sign of UTI.

US comments: I am glad Marianne put you right with the benign comment!! That must have made you feel much better, funny when we get info overload sometimes we focus on the bad bits! I am with you and not real confident of the pheo diagnosis. One thing I would want clarifying is can they differentiate where the adrenal nodule is situated ie if it is arising in the medulla of the gland it makes it more likely to be pheo. I am not convinced of the efficacy of the either the blood or urine testing for pheo's, they just do not have the numbers in the studies. Both his surgeon/IMS involved in the adrenalectomy said it is a dodgy due to that, plus there are no definite reference ranges for these tests in dogs. I also asked the new IMS about this and he said the same that there is hardly any blood/urine testing being done because of this. Humans yes, but it appears to me there is more research needed in this area for dogs and I hope in the future there are better tests so the veterinary specialists are more confident with their use. I would be interested to hear what you find out about this from your IMS. What made them suspect Flynn's was the ultrasound/CT and also his clinical symptoms ie hypertension. But pheo symptoms in dogs are often episodic and as you say Molly has not shown any of them. Most articles say that a definite diagnosis for pheo is only made on histology when it is removed, until then it can be speculation. I would be inclined in a non-symptomatic dog to rescan in 3 months and see what was happening. I would want to check if there were any signs of any spread if it was malignant eg get a CXR to check lungs, or if they decide to proceed to CT to get a better picture of adrenal mass then get the chest done at the same time which was what was done for Flynn. Hopefully you get the atypical results back soon and then can move on from there. In the meantime I am going to go for the adenoma too, they are more common afterall in our pups and Molly can just join Flynn on the monitoring programme as he also has one on his remaining adrenal and its not doing anything. Great no lumps in the liver!! But agree biopsy could give more info there. x

[goldengirl88]

Sharlene:
For what it's worth I researched the tests available for pheos and I personally decided not to do one with Tipper because of all the false positives they can have. Then I would be crazy thinking my dog had a pheo when in fact she might not. When are they going to get clarification to you about the malignant part? It is hard to believe sometimes all that can be going on inside our babies, but it seems Molly is doing well according to the reports. I pray this is just an adenoma like they think about Tipper's. Blessings
Patti