Mojo the bullmastiff with atypical cushings.

[liz parrish]

Hi, I am brand new to this site. I have a 7.5 year old male bullmastiff. He has been diagnosed with Atypical Cushings. He started having grand mal seizures about 1.5 years ago and so we started our path of looking for what was causing the seizures. We sent the blood work to Tennessee and that's how we diagnosed him with the disease. He originally had elevated estrodial, progesterone, androstenodione, and andosterone (forgive the spelling!).

Since he has been on 12 mg. of melatonin per day (1/2 in the am and 1/2 in the pm) and the flax seed hulls (was 1 1/2 tsp. once per day and just bumped him up to 3 tsp. per day), all these levels went down to normal except for the androstenodione. It went from a range of .73 - 5.0 to 1.2 - 9.3 in six months.

Symptoms:

His seizures have become scheduled at one to two grand mals every 5 - 6 weeks. Always between 8 pm and 4 am.

His body is starting to lose his muscles.

He drinks lots of water and pees a lot.

High blood pressure (between 180 and 240)

Increased shedding and bad coat.

His is on: Pheno barbitol for seizures, fish oil, I-Phenypet (an amino acid for brain support), milk thistle to help his liver with all the drugs, pro-biotics, (he has had lots of antibiotics), flax seed hulls and melatonin.

He seems to have allergies also. Feet are inflamed (he wears socks to protect him from the harsh ground as he gets sores). Yeasty too!

I feed him Taste of the Wild (protein varies as we mix it up)

HELP!

My vet does not want to dive into chemo type drug as his cortisol levels are on the low side of normal and we are afraid of kicking him into addison's disease by dropping his cortisol too low.

Any advice?

Signed,

Mojo's Mom:

[Roxee's Dad]

Hi Liz,
I would like to welcome you and Mojo. I am sorry that Mojo is having so many various problems. Hang in there, I'm sure there will be more members chiming in to help but we all do tend to ask alot of questions.


With Mojo's androstenodione increasing, I was wondering if he has been neutered or is he a still intact male?

[liz parrish]

He is balls removed. Is that dis-intact?

Neutered.

:)

[MiniSchnauzerMom]

Hi Liz,

Welcome to you and Mojo! There are several members who have Atypical pups (although I'm not one of them) and I'm sure they will be providing you with feedback.

Has your vet considered treating Mojo's elevated blood pressure? I'm not a vet but I do know that constantly elevated blood pressure can cause problems with the kidneys. Since Mojo has multiple issues have you considered a consult with an Internal Medicine Doctor?

Hope your Mojo is doing well tonight.

Louise

[Harley PoMMom]

Hi Liz,

Welcome to you and Mojo from me too! My boy Harley is considered Atypical, all of his hormones are elevated at pre, but only his estradiol is elevated at post...very elevated. Great job on getting them hormone numbers down, especially that estradiol, that one can be a bugger to get down.

Louise is so absolutely correct about the high blood pressure. My Harley is on meds for high blood pressure, my boy was having problems because of his high blood pressure, now that he is on his meds for it the issues are under control. If it weren't for Louise and some others lovenly urging me to get Harley's BP checked and under control my poor boy would still be feeling so yucky.

As far as the androstenedione hormone, I have no advice as to how to lower it, my best advice would be to ask your vet to email Dr. Oliver and ask his opinion.

I am so glad you found this forum, these people here are amazing...so knowledgeable and they have collective years of Cushings experience and wisdom under their belts. You have definitely come to the right place for help. They have helped my boy Harley and me tremendously.

Hugs.
Lori

[liz parrish]

Thanks for your advice. Yes, he has seen an internal medicine doc. VMSG, Dr. Ortega in Oxnard (Ventura?). She is the one who did the deep ultrasound and confirmed what the blood tests from Tennessee said. The blood pressure is a recent finding. Another endochronologist who my vet consults with recommended we take it and figure out how much water his is drinking. If either of these are abnormal, we will proceed to another treatment. I don't know what that is yet. We are double checking the blood pressure by having me take it at home when he is the most relaxed (not an easy thing to learn!). I will know more after this weekend when the vet will have had a chance to talk to the endochronologist. THANKS!!!!

[liz parrish]

I did not know that about the kidneys! Thanks for that heads up. The blood pressure is a recent finding. I am taking it at home overnight to see if he is more relaxed and has a lower blood pressure at home. He does but it is still at 160 - 180. We are measuring the water consumption this weekend (when we can be home all day and keep the other dog separated). The endochronologist wanted these amounts to see if we should move on to another treatment. I don't know what that is yet. I'll post after I find out what she says to my vet. Thanks!!!!!!!!

[Harley PoMMom]

Hi Liz,


The endochronologist wanted these amounts to see if we should move on to another treatment. I don't know what that is yet. If that other treatment is the use of Trilostane, I want to inform you that Trilostane elevates one or more of the intermediate/sex hormones in your pup, since Mojo already had pre-existing elevated hormones and you got Mojo's numbers down to normal on all but the androstenedione, I would hate to see you lose that ground for the rest of them.

Hugs.
Lori

[Greyhound mom]

Liz,
I have a greyhound with atypical...we've only been under treatment for a few months so I don't have much advice but I do have a question.
How much does Mojo weigh? How long was he on the flaxhulls/melatonin before you saw his numbers go down?

Thanks, and best of luck with Mojo...
Kim

[MiniSchnauzerMom]

Liz,


We are measuring the water consumption this weekend (when we can be home all day and keep the other dog separated). The endochronologist wanted these amounts to see if we should move on to another treatment. Will be interested in hearing what the endo has to say about this. Has Mojo been checked for Diabetes and has he had his thyroid function checked....and was everything normal? Hopefully between your vet and the endo this would have been done.

160-180 bp is still up there. Munchie's specialist has a whole routine for taking his bp as he gets so stressed out it has elevated up to 200 but if she leaves the room and lets him sit there with me and the auto bp machine is doing it's thing, taking the readings, all ends up quite normal. During your home testing are you getting him soothed and calm then taking several bp measurements during a 10-20 min. time frame? The initial putting the cuff on and noise the machine makes upsets Munch at first but then those readings go down. If after all the calming and taking of his bp the results are still high, Mojo's vet will most likely be looking at some type of treatment to bring those numbers down - and this would be a good thing.

I do so hope for Mojo that those grand mal seizures can somehow be brought under control. One to two gran mals every 5-6 weeks has got to be very hard on your boy. Zoe's Mom (Sue) has dealt with Zoe having seizures in the past. Maybe she will be able to give you some helpful feedback. I'll send her a PM.

Louise

[Wylie's Mom]

Hi Liz & Welcome,

I think Lori’s suggestion of contacting Dr. Oliver is your best bet. Most of the Atypicals we see here have problems with estradiol. I really don’t know what level of concern there is for high androstenodione when estradiol levels is controlled (since androstenodione is a precursor to estradiol & testosterone, and I’ve only read concerns of high levels of the latter two hormones). Dr. O can probably shed some light on this and may have some other treatment suggestions.

Could his shedding and bad coat be related to the allergies? Has hypothyroidism been ruled out? What were all the antibiotics for?

-Susy
BTW - It sounds like you’re a wonderful mom to Mojo;).

[zoesmom]

Hi - I'm the Zoe's mom that Louise mentioned. Zoe's had similar type seizures as Mojo's starting at around age 6. Thyroid levels can definitely affect that, but since you have an IMS, I would assume that they've checked Mojo for low thyroid???? That could also affect the coat issue.

Zoe isn't atypical but has pituitary-dependent cushings. When she started on trilostane at age 9, the seizures increased slightly. And then she had one that lasted 12 minutes. Otherwise, they were more frequent mini-type seizures, basically. Our vet suggested we start her on bromide (sodium, not potassium) for the seizures, and that was because she was taking the trilostane. Also, because PB can be hard on the liver and a cushings dog already has a compromised liver. At some point, can't remember when exactly when, I began giving zoe melatonin also --- for not only the seizures (it's thought to help but not by itself, of course) but also because she was on trilostane - which can affect some of those secondary hormones that cause the atypical cushings. Since she's been on the bromide and the melatonin, she's only had one small seizure and that was when her bromide level fell off for some unknown reason.

You say Mojo's cortisol is not high. How low is it, exactly, if you know?? And if it's low and he's still drinking a lot, I wonder if he could have diabetes insipidus?

I always believed Zoe had that, but she was never tested for it. I understand that it can sometimes be caused by the same pituitary tumor that causes cushings. DI is not serious and doesn't even need to be treated unless the drinking and peeing is too much for the owner. The treatment is simple (but the drug, I think, expensive). We just let Zoe go along for years, drinking like a fish. Actually, we've stumbled on an unexpected cure for the excess drinking (which only slightly improved on the cushings tx). We started her on a drug called tylan for an intestinal issue and it cured her life-long overdrinking. She now even concentrates her urine a little bit better, though still not quite up to normal.

Let us know how that drinking test goes. I used to measure out 12 c. of water in one of those giant measuring cups at the start of each day (and fill Zoe's water bowl from that, as need be) and then I'd measure what was left at the same time the next morning and write down what she'd drank for the 24 hours. (Some days we'd go over that 12 c. - this on the trilostane - as it was much higher before.) Zoe weighs 77 lbs, so a mastiff, I'm sure, drinks way more~! The formula for normal water consumption is 1 c. for each 10 lbs of body weight. So for Zoe, she should've been drinking about 7 - 8 c. of water a day. Sue/Zoe

[ventilate]

Hi and welcome from me and mine; I have 2 giant schnauzers that have DI, what Sue was talking about, Nike also has Pit cushings and has been treated for about 3.5 years now and doing great. she will be 13 years old in Oct. anyway both are being treated for the DI, and it can be expensive. but all the drinking and peeing was not good for me and haveing to get up at noc and let them out made me a wreck at work and when they would pee in the house I know it made them feel bad. With the drops they are normal or close to it. Nikes last urine specific gravity was normal. Kenais my other giant his is still a bit low but much better. it is caused from not enough antidiuretic hormone so give the synthetic hormone and it can fix it.
I also wanted to mention my male has high BP his was up to 240, I think my vet told me it should not be over 160 even in a stressed dog. He is on a lot of BPmeds to keep it down. But not only can high and low BP affect the kidneys but the kidneys can affect the BP. So it can get very complicated, glad you have an IMS involved.
Good luck, sorry I cant answer any of your questions but if they diag your dog with DI, I would be happy to give you more info on it.
Sharon, Nike and Kenai

[liz parrish]

Thanks! Mojo has been treated for hypothyroidism for years. Monitor it about once per year. Water test is still in progress. Not very impressive so far. Blood pressure down lower since I took it at home. Vet says he does not have diabetes. I think I will look into that Dr. I know he has allergies. Did the immuno shots for years, never really helped. His feet are red and itchy and have sores on them. That is a constant problem - we put socks on his feet and powder them and wash them, etc. I really appreciate all your help and will research all that you give me. Did I mention that I have another bullmastiff? My female Roxy is healthy and v. happy!

[liz parrish]

Anti biotics for many infections over the years. Ear, skin mostly. Also, almost died of a spider bite at age 3 months - that was four antibiotics, injectable.

Lots of tries to keep him off antibiotics too. :) Liz

[liz parrish]

Hi Liz & Welcome,

I think Lori’s suggestion of contacting Dr. Oliver is your best bet.

Where is this vet located?

[StarDeb55]

Liz, Dr. Jack Oliver runs the endocrinology lab at the Univ of Tenn., Knoxville where all of the full adrenal panels are done. He is probably the foremost expert in the world on Atypical Cushing's, & Cushing's in general. He is more than happy to consult with both treating vets & owners at no charge. He can be reached at the following e-mail:

joliver@utk.edu

If you have the original case # from UTK on the adrenal panel that was submitted on Mojo, you will need to include that in your e-mail.

This is the general info link for the lab at UTK. I'm pretty sure if you want to explore it further, you can find further specific contact information.

http://www.vet.utk.edu/diagnostic/endocrinology/index.php

Debbie

[liz parrish]

Thanks Debbie! I just got the water consumption amounts measured over the weekend. My vet is gone until Wednesday. I will make sure he gets the contact info for the vet. I know he is consulting with an endochronologist but not sure who. :) Thanks for your help!

Liz with Mojo the bullmastiff

[gpgscott]

Hi Liz,

Sorry I have not seen your issue until this evening.

You have had lots of input, we are all probing a bit to try to understand. None of us are Drs. but we have found that frequently people who are not Drs. can take more time and delve into details that can help inform ourselves and thus our Drs., and help the treatment.

The first thing I would ask is that you post the results of the panel which disclosed the Atypical Cushing's, not just elevated/normal, but the actual numbers. There will be six hormones assayed and a pre and post number for each. There also would have been a treatment recomendation. If you did not receive it you should ask for it.

I have to say that you are reporting symptoms which are consistant with elevated cortisol which is although the nastiest of the adrenal hormones also the one most responsive to treatment in my view.

Please let us know more and thanks for joining.

Scott

[liz parrish]

Hi there! Okay, got the numbers for you.

February:

Cortisol (all numbers are baseline, then post ACTH) 23.8 - 101.2
Androstenedione .73 - 5.0
Estradiol : 91.1 - 92.4
Progesterone: .26 - 2.55
17 OH Progesterone: .15 - 2.59
Aldosterone: 65.6 - 547.5

August's numbers:

Cortisol range 17.0 - 64.5 (baseline and then post ACTH)
Androstenedione range 1.2 - 9.3
Estradiol 85.8 - 73.1
Progesterone .14 - 1.87
17 OH Progesterone .11 - 3.59
Aldosterone less than 11 - 166.4

I can send you the normal ranges, if you need them. I have company that just showed up so I should go. Thank you again!

Liz - Mojo's mom.

[StarDeb55]

Liz, please do post the normal ranges, when you have the time. It is always helpful to post that information along with the reporting units as this can vary from lab to lab.

Debbie

[Harley PoMMom]

Hi Liz,


I can send you the normal ranges, if you need them.I think you might have to, just incase mine are different, they are from 5/09.

Cortisol range 17.0 (2.0-56.5) - 64.5 (70.6-151.2).
Androstenedione range 1.2 (.05-.360 - 9.3 (.24-2.90).
Estradiol 85.8 (23.1-65.1) - 73.1 (23.3-69.4).
Progesterone .14 (.03-.17)- 1.87 (.22-1.45).
17 OH Progesterone .11 (.08-.22)- 3.59 (.25-2.63).
Aldosterone less than 11 (11-139.9)- 166.4 (72.9-398.5).

Love and hugs.
Lori

[liz parrish]

Lori, thanks. Here are the normal ranges for the tennessee lab:

Baseline Post ACTH
cortisol 2.0 - 56.5 70.6 - 151.2
androstenedione .05-.36 .24 - 2.90
estradiol 23.1 - 65.1 23.3 - 69.4
progesterone .03-.17 .22 - 1.45
17 OH progesterone .08-.22 .25 - 2.63
aldosterone 11 - 139.9 72.9 - 398.5


Thanks for all your help.

Liz Parrish

[Harley PoMMom]

Hi Liz,

What did the treatment option sheet say that came with your results?

Love and hugs.
Lori

[liz parrish]

The treatment option page said:

1) Ultrasound and or endogenous ACTH. To rule out primary adrenal tumor. I had this done and that is when they made the final diagnosis of atypical cushings.

2) Melatonin. This we are doing.

3) Melatonin implants. Have not done this yet.

4) Lignan. (This is supposed to inhibit aromatase enzymes (lowers estrodial) and 3 beta HSD enzyme (lowers cortisol). This comes from flax seed hulls which I am giving him.

5) Maintenance dose of Lysodren. This will drop his cortisol levels so we don't want to use this because his cortisol levels are already in the lower end of normal.

6) Lysodren. A higher dose. Same reason as above that we don't want to do it.

7) Trilostane. Frequently increases estradiol and androstenedione as well. His androstenedione is the one that has increased three times with the last test. So, this would not be a good option.

8) Ketoconazole. ???? (alternative cushing's treatment) he has atypical cushings. Don't know why this would work. I think this is an antifungal.

9) Selegiline (Anipryl) Alternative Cushing's treatment (he has atypical cushings)

10) Hormone cream exposure. Don't need this as his estrodial and progesterone levels are fine now.


www.vet.utk.edu/diagnostic/endocrinology for further treatments, drug sources, hyperestrinism and review articles.

Hope this helps. I am currently lost with all of this.

Thanks for all your help.

Liz (Mojo's mom)

[gpgscott]

Hi Liz,

The list you have posted is the entire treatment regimine. Not all of these options would be indicated.

There should be a summery of which options and in which order are suggested given Mojo's test.

Scott

[liz parrish]

Sorry, I don't have that summary. I do know that they wanted to start with melatonin and flax seed hulls, which is what we are still on. Lysodren and Trilostane have both been mentioned by the internal doc and the homeopathic / western doc in LA. My vet wants to stick with the treatment that will not affect the cortisol levels because when these drop below normal you have a very sick dog. Thank you for your help.

[gpgscott]

Liz,

I would ask for the treatment recommendation which is what I was referring to earlier.

This will be authored by either Dr. Oliver or an associate whom he trusts.

The treatment being suggested as you are relating it sounds reasonable but I am bettin' there is more going on which you should be aware of.

Scott

[Harley PoMMom]

Hi Liz,

That summary we are talking about should be at the bottom of your test results page.

I had Harley's estradiol rechecked on 7/29/09, (only his estradiol this time), on the bottom of Harley's test results it says:

"Comments: The estradiol value is elevated. Consider items 1 through 4 on the treatment option sheet attached." Then it's signed by Jack W. Oliver.

Do you see anything like this on your test results for Mojo?

Love and hugs.
Lori