Hello and welcome from me, too! I'm afraid I'm not familiar with these new radiation techniques so I cannot be helpful in that regard. But after reading your introductory post, I do have a couple of other questions that have cropped up in my own mind. First, can you tell us more specifically about any testing that was performed at Tennessee that has led them to conclude that Ralphie's problems are secondary to a macrotumor as opposed to lack of control of the Cushing's? Also, can you give us a more complete history of his trilostane dosing and monitoring ACTH tests? Actual test numbers and dates would be great!

Your description of the initial crisis that led to discontinuation of the trilostane could definitely correspond with an Addisonian situation wherein Ralphie's cortisol dropped too low and/or his levels of postassium and sodium became unbalanced. This can happen at any time during trilostane treatment and at any dose, so I am wondering whether he had monitoring testing performed right at that time to clarify that the problem was something other than low cortisol or an imbalance in his blood chemistries secondary to the medication. If, in fact, he was overdosed at that time, it does not necessarily mean that he cannot tolerate trilostane at all -- just that the dose needs to be lowered. His current lack of energy, loss of muscle strength, and possible calcinosis cutis could all be consistent with a rebounding cortisol level that is now too high once again. Lack of appetite is indeed unusual in a Cushpup, but we have seen it on occasion. How is Ralphie's appetite doing right now?

You are right that a macrotumor can be a game-changer in terms of resuming Cushing's treatment. But that's why I'm hoping to get more info about your visit to Tennessee. With whom did you consult, and did they perform testing that makes them think that a macrotumor is likely? Did they actually confirm this with a CT or MRI image of his head?

Thanks in advance for any additional info!
Marianne