Bart - 13 year old shih tzu (Possible macroadenoma?)

[Lvmtjessie]

I am a licensed veterinary medical technician. I adopted a shih tzu Lhasa apso mix in 2005. Being suspicious of having cushings, it was not until 2010 until blood work proved my suspicion. During the past 6 months "Bart" has also become a diabetic. Which granted it is very hard to detect a diabetic because both diseases exhibit similar symptoms. Trying to manage a diabetic cushionoid dog is also very challenging.

During the past 1 to 1 1/2 month. Bart started doing odd things. He got to where off and on he was restless, lethargic ( seemed wiped out at times). Checked his blood glucose and he would register normal. Then he seemed to be losing his eyesight. My biggest concern was cataracts from having diabetes. Due to multiple scarring that occurred in his eyes from having corneal ulcers that went untreated prior to me adopting him, I thought maybe it would be difficult to visibly see any noticible changes. Taking Bart to an animal Opthalmologist, there was no reason as to why he appeared blind. Many times I would take him to the clinic I worked and had the 3 doctors there examine him. Still no clue as to why he was appearing to go blind. Then other things started to happen. He started urinating in front of me in the house. He has never done that before. He was always reliable on going through the doggy door. So again I started checking his blood glucose, checking electrolytes, and repeating a ACTH stimulation test in hopes that he was not developing Addison disease. All blood work appeared normal. Next he start demonstrating signs of confusion. He would go out the doggy door and could not figure out how to come back in. I catch him starring at the ceiling at times as if "nobody is home". So again I would take him to the clinic and he was examined by the veterinarians. Still no answer other then maybe he is becoming senile. But all I these symptoms would come and go. It just didn't make sense.

This past weekend I attended a CE seminar for veterinarians and technicians. One of the topics was "Cushings".
So I attended and I sat through the meeting and listened. All of sudden, the Doctor mentioned macroadenoma. And as she described the symptoms I realizes for the first time what was going on with my boy. I was not loosing my mind or being overly extrem about what was going on. After the meeting I went to talk to this amazing doctor. She concluded that he does exhibits all the signs of an animal with macroadenoma.

The next step is to do an MRI or CT scan. I have laid awake during the night thinking this through. Bart is almost 14 years old. If I do the testing all it will do is to confirm the macroadenoma. I won't treat because he is a diabetic, which will make it very difficult to heal from radiation or surgery. But I know now that I am not "crazy". The best part is, is that tomorrow I can go into work and shed some light on this. And maybe by telling the veterinarians of my new information, I hope that they will store in the back of their heads so when the next cushionoid dog starts to do abnormal things or have unexplainable blindness that maybe this "macroadenoma will come to their thought.

I am so glad that I found this forum. So glad to know their are others that have and are exhibiting the same frustration that I have. I sure hope this helps!

[molly muffin]

Hello and welcome

We have some members here whose babies, also have macro tumors and the symptoms you mention are practically the same.

It's good to know you aren't going nuts and to finally figure out what is going on with Bart.

Isn't it hard when they have several life changing things going on with them at the same time. Very frustrating when you are just trying to figure out how to provide the best quality of life for them.

I too have an adopted shih tzu/lhaso mix. I love that combination. Oh who am I kidding, I love them all! LOL

We're really glad you found us too and hope you will post any time you feel like it. Meet some of the other members that are going through the same thing. It makes it easier when you know there are others in the same boat. Rocky though it may be.

Hugs and welcome to you and Bart,

Sharlene and Molly Muffin

[MBK]

Welcome to you and Bart. Cushings is such a strange desease, with so many variations. I don't think there are two identical stories on this forum, although there are many shared symptoms. Bart is lucky to have you and you will know what treatment, if any, is right for him.

[Squirt's Mom]

Hi and welcome to you and Bart!

Unfortunately a small percentage of cush pups do develop these macro tumors and dogs with the brachycephalic skulls seem to be more prone. In the Netherlands, these tumors are fairly routinely removed. However, hypophysectomies are still in the infancy stage in the US tho they are being done and radiation is another option.

Here is a link to our Everything Else section where macroadenomas are discussed by members dealing with them and what they have observed and learned.

http://www.k9cushings.com/forum/showthread.php?t=3567

I'm glad you found us and want you to know that you and Bart are not alone. We will be with you all the way - all you ever need to do is holler. Someone is almost always on.

Hugs,
Leslie and the gang

[labblab]

Welcome back to you and Bart. I notice this afternoon that you have posted a new reply on the "Macroadenoma" thread that Leslie directed you to earlier. I am leaving your new reply in place there, so that other members who are researching macroadenomas will be able to reference Bart's story. However, for anybody who wishes to offer you direct feedback and suggestions, I am directing them back here to your original thread that is Bart's alone. I've also taken the liberty of revising your thread title to reflect your concern that Bart is indeed suffering from a macroadenoma. So that everybody can be brought up-to-date re: Bart's situation, here's the text from your new reply:

Hi, I am new to the forum. I have a shih-tzu named Bart who has cushings and diabetes. Within the past month he has started exhibiting odd behavior. Star gazing, lethargic, his right eye appeared weak. Through this month I feel as if he has been declining. I work in a vet office (I am a licensed veterinary medical technician) and I went to a continuing education conference in Birmingham Alabama ". The conference I choose was on cushings. To my amazement, when the Veterinarian started talking about macroadenomas, she mentioned a lot of symptoms Bart was exhibiting. I mentioned it to the vets where I work and they shrug their shoulders and say; "maybe, but doubt it".

Within the last 2 weeks, Bart has gone blind. On physical exam there is no obvious reason for him being blind. Now ( this is weird) but when I call him, he can hear me, but he cannot distinguish where the sound is coming from. Even being 1 foot in front of me he cannot find me with me calling out his name loudly.

He has been potty trained, but within the past 3-4 weeks, he just lifts his leg and urinates where he stands. I won't lie, I am scared that I am losing my baby. His decline is fast.

I wonder if I should stop the trilostane since it suppresses the cortisol in his body. Maybe the over production of cortisol is what kept the tumor in check. I have not had a CT or MRI done. I am sure this is what he has. I won't treat because of his diabetes. The diabetes will make it hard for him to recover. I have been talking with an associate professor at Texas a&m who specializes in internal medicine and macroadenomas. She is certain that Bart has this.

Has anybody else have one of their dogs experience weird stuff like this?

Marianne

[labblab]

Now I'm back with a few thoughts of my own to add!

First off, I'm so terribly sorry about Bart's decline. Since you were reading through the "Macroadenoma" thread, you probably had the chance to read my replies there about my own Cushpup who was lost to what we also assume was an enlarging pituitary tumor. For the reasons that I discussed there, my husband and I also decided against imaging the tumor, so we can never know for sure whether or not that was the problem. But he also declined very rapidly, and exhibited a whole range of neurological abnormalities. We reached the critical point when he could no longer eat nor drink.

As far as what to do re: the trilostane, I do not have the answer for you. In fact, I would be very interested to know whether the specialist at Texas A & M has a recommendation in that regard. I would guess that the best approach may be patient-specific -- depending very much on the specific symptoms and behaviors that seem to be rendering a dog most comfortable or uncomfortable. As far as what we did with our own Cushpup, I'm going to quote a reply that I recently posted on another member's thread:

The bottom line was, we tried both routes: continuing to treat with trilostane versus withholding it. For us, withholding the trilo did not visibly help with the neurological problems. And when he was off the trilo, he resumed Cushing's symptoms that were making him miserable such as non-stop panting and muscle weakness. So it was a difficult proposition to try to keep him comfortable. As a compromise, we went ahead and resumed the trilostane, but at a lower dose.

I don't mean to tell you this to discourage you. But just to say that I don't think there is a single best answer in this situation. It all depends upon how each individual dog responds to the presence or absence of the medication and the best quality of life possible during the time frame that you have to work within.

One of our members has told us that her specialist even opted to treat her dog's macrotumor with both trilo and also supplemental prednisone at the same time. I've guessed that the purpose was to keep the steroid level under some semblance of direct control. In other words, the supplemental prednisone could be dosed at a specific and consistent level whereas uncontrolled cortisol could not.

Once again, my heart goes out to you. I will never forget how agonizing it was to see the progressive changes that were taking place in my boy. Please continue to update us with any developments, info, or decisions, OK? And please give Bart an enormous hug for me.

Many hugs to you, too.
Marianne

[frijole]

Welcome. You are so fortunate to be close to A&M and their specialists. I don't have first hand experience but wanted to post another possibility and that is SARDS. Sometimes cushings is diagnosed instead of SARDS. Here is a link. Keep us posted ok? Kim

http://www.k9cushings.com/forum/showthread.php?t=213