New member Dutch, a 6 year old labrador, adrenal diagnosis

[Dutchboy]

Hi everyone. My name is Sandy and I have a 6 year old labrador that has just been diagnosed with adrenal cushings. Right now I am in the crying; can't wrap my head around this stage. Our next step is to meet with the specialist for an ultrasound and then possible surgery.

I guess I am interested in your opinions on the surgery vs. treatment with meds at his age. My vet feels that due to his age, it would be better for him to have the surgery and not deal with the drugs for such a long time (again given to him being so young). Just wondered if any of your dogs were dx at such an early age.

His name is Dutch and he is my heart and soul. I rescued him 5-1/2 years ago; I also have 3 other labradors (from lab rescue)...but Dutch; Dutch is my heart.

Thanks everyone and sorry we had to meet this way. :(

[acushdogsmom]

Hi Sandy,

I just wanted to say hi and welcome you to the group. We're very glad that you found us! :)

How did your Vet arrive at the diagnosis of adrenal Cushing's? Do you know which tests were done so far and what those test results were?

If the adrenal Cushing's diagnosis is being based on blood tests alone, you'll need to have it confirmed with ultrasound at least - and you are taking a very wise next step in bringing Dutch to be evaluated by a Specialist. The Specialist to whom you are being referred is an Internal Medicine Specialist, I assume?

My dog was assumed to have an adrenal tumour - from the results of his Low Dose and then also High Dose dexamethasone suppression tests. But when the ultrasound was done, the Specialist could tell that it was Pituitary and not adrenal Cushing's after all and the Cushing's was the type that we could only treat with medication. We treated with Lysodren (one of two effective medications which can be used to treat Cushing's) for more than 6 years, very successfully I might add. :)

So you need to take this one step at a time. Get the diagnosis confirmed and get the Specialist's opinion (regarding the diagnosis and treatment recommendations).

If it is confirmed to be adrenal Cushing's, then yes, in many cases surgery is the best option and can even be a complete cure. We have several members here (some of whom I'm sure you'll be hearing from soon) whose dogs had the surgery and for whom it was very successful. You'd want a Specialist surgeon, not a regular GP Vet, to do the surgery if possible. Most Specialist surgeons work out of Speciality Clinics who can also give the dog 24/7 post-surgical care, which is also very important.

If surgery is (for any reason) not an option, you can try treating adrenal Cushing's with medication. We have had (and still have, I think) several members who are treating adrenal Cushing's with medication.

But let's not even go there yet - let's wait and see if the Specialist confirms the adrenal Cushing's diagnosis and what the Specialist recommends. And please keep us posted. :)

[Dutchboy]

Thank you so much. Yes, my vet suspects adrenal cushings based on the results from the blood tests yesterday from the dexamethasone tests. Off the top of my head I think it read 18.9, 3.7 and 2.4

He had 2 urine tests prior to this that led us to that.

Odd thing is, the only reason I thought to take a urine sample to the vet was that he had some spots come up on his muzzle. I thought he had demodex and knew that older dogs only got it with underlying causes. Turns out the spots were staph and that is doing much better.

He quit playing with my chocolate lab (Zoe) a few years ago and they had previously played a lot. I just assumed he was "maturing". He has always had pee accidents in the house; ever since I adopted him. He really shows no other signs other than being a tad lethargic, and having the occasional pee accidents. He does drink more water than the others but usually only at certain times of the day. He shows no other signs of ANYTHING being wrong.

And yes, we are going to a board certified doc; we are in the Atlanta area and have access to some excellent doctors. That part I am confident with.

Just making the right decision for him is my biggest concern. Assuming that after the ultrasound it IS adrenal cushings.

Thanks so much for your quick response. It means so much to us newbies!

[acushdogsmom]

Do you know if the dexamethasone suppression test result that you just posted was a low dose or high dose test? The Low dose dex suppression test (LDDST) can sometimes show a pattern of suppression that is consistent with Pituitary Cushing's, but if that pattern doesn't show up, or if there's no suppression (or very little suppression) then that non-suppression result could still indicate either Pituitary or Adrenal Cushing's. And as I know from my experience with my own dog, even a lack of suppression on a High dose dex test isn't conclusive for adrenal Cushing's.

So on to the Specialist, and let's see what happens from there.

One thing for sure, you are not alone on the "journey". We'll be here to help you understand things and we're pretty good at hand-holding, too. :) And we've got members here from all over the world, so you might find someone online here at almost any time of the day or night. :)

[Dutchboy]

I have tried to read so much here today, as well as all over the internet, and of course through swollen eyes from cyring.
I look at my healthy boy and wonder what I am about to put him through.
He is confirmed cushings through the LDDS test...I think it was the low, will have to confirm that.
Now the vet says she suspects adrenal based on his test results and is setting up an appointment for an ultrasound.
I just want to be sure we are following the right path.
I read Princess' thread and am already at that point of someone having to tell me to take time off from the computer and talking about cushings.
I just need some of you veterans to reach in here and grab my hand!!
Again, I think I mentioned he really does not show outward signs other than the pee accidents and he is "lazy"...I just thought he was "mature". :(

[labblab]

Hi Sandy!

Welcome to you and Dutch. Acushdogsmom has already given you some great information, and I just want to reemphasize a couple of things that she has said. First, I think it's great that your vet is referring you to a specialist for the ultrasound and additional feedback. I think that is definitely the right path for you.

And secondly, even though it's hard (:o), try not to assume just yet that Dutch definitely has an adrenal tumor. The "most" that a Low Dex test can do is either strongly point the finger towards a pituitary tumor, or tell you that it could be either pituitary or adrenal. So at this point, the adrenal diagnosis is still a question mark.

And even though surgery can be such a scary prospect -- if it DOES turn out that Dutch has an adrenal tumor -- one bright beacon is the fact that surgery can offer a complete cure.

So hang in there with us, OK? We'll be here to walk alongside you every step of the way. And the first step -- having that ultrasound performed -- sounds like an excellent decision.

Marianne

[Dutchboy]

Thank you both so much for the kind words.

He is scheduled for his appt. with an IMS for Monday morning.
Deep breaths until then!

[Buffaloe]

Hi Sandy,

After a long diagnosis, my dog was finally diagnosed with an adrenal tumor via ultrasound. She had an adrenalectomy at 11.5 years old which provided her a complete cure.

First, it is extremely rare for a six year old dog to get an adrenal tumor. No blood test can definitively diagnose an adrenal tumor and certainly not a low dose dex. supp. test. The most it can do is give an indication that there could be a primary adrenal tumor.

You are definitely doing the right thing by proceeding with a top quality ultrasound. I think you should try not to get too worked up about it yet; wait for the ultrasound results.

Ken

[littleone1]

Hi Sandy,

Corky and I would also like to say hi and welcome you and Dutch to a very wonderful group of very caring, supportive and knowledge people.

I totally understand what you're going through. Corky (Corkster) was diagnosed with an adrenal tumor in September of last year. I know that surgery would be the best option, but because of his age and his other medical conditions, his IMS definitely feels that he is not a good candidate for surgery. At the present time, he is taking Trilostane, which is really helping to keep his cortisol level pretty much under control.

He had several tests done, inclucing an ultrasound and a biopsy. This is what confirmed that he definitely had an adrenal tumor.

There are members here that have had a great deal of success with the surgery.

I wish you and Dutch the very best.

Terri

[frijole]

Hi from me too! Ready to hold some hand and help you get a smile back on your face! I have two dogs and the 2nd one was just diagnosed with cushings. :eek:

My oldest is 16 and 4 mos old and was diagnosed with pit. cushings at 12 1/2. So 4 yrs ago. We treated with lysodren and obviously it helped her lead a normal life. Depending on the sonogram lysodren might be an option for you... just letting you know dogs can lead normal lives.

Keep us posted on Dutch and know we are here to help. Keep the faith. Kim

[AlisonandMia]

I had a similar experience with my dog's diagnosis. Her LDDS test returned a result that indicated Cushing's but did not conclusively indicate pituitary Cushing's. Our vet, who was not that experienced with Cushing's, told me that an adrenal tumor was a strong possibility - scared the living daylights out of me!!! We then proceeded to a high-resolution ultrasound which showed two whopping great big (but otherwise normal) adrenal glands which meant that her Cushing's was pituitary, not adrenal. The feeling of relief was almost worth the stress!

I now know that a good percentage of dogs with PDH (Pituitary Dependent Hyperadrenocorticism) will have an LDDS test result that does not confirm that it is PDH - and that quite a few people are led to believe, on the strength of this, that their dog has an adrenal tumor - and very often this turns out to not be case (PDH is a lot more common that ADH (Adrenal Dependent Hyperadrenocorticism)). Although the LDDS can conclusively diagnose PDH (in some cases) it cannot conclusively diagnose ADH - and not all GP vets necessarily appreciate this. If the LDDS doesn't conclusively point to PDH then you need to proceed to the ultrasound.

Like Ken said - try not to worry to much at this stage. You are a long way from having a confirmed diagnosis of an adrenal tumor.

Alison

[Dutchboy]

You guys are awesome! I wish I could give you all a huge hug for your kindness. I have to get to work, but want to participate with more of you and what is going on with your pups.
Thank you again for your support!!!

[Casey's Mom]

Welcome to you and Dutch - he is a beautiful boy.

We are all here for you and rooting for you Dutch so just keep asking questions. There are people here with many years experience dealing with this disease in all of its many forms to help you.

Love and hugs to you,

[Dutchboy]

Could someone help me with these low dose dex test results. Dutch and I are seeing the IMS Monday; I've just been revisiting things...yeh, I know, I should wait...but it's a nervous mom thing.

Baseline 18 (which my vet said huh?) unusually high
4 hour 3.7
8 hour 2.8

I was trying to read that chart someone posted and it looks to me like this would point to PDH???

All his regular bloodwork is in line...nothing out of sorts...that's why this is so puzzling. His TSH did some back only slightly elevated but T3 and T4 were fine. My vet is leaning towards thinking it might be thyroid related; but again, we will see with the IMS says.

Thanks, everyone!

Hope you guys have a good Mother's Day!

Sandy and Dutch

[AlisonandMia]

I'm not particularly great at interpreting LDDS results:o:p but to me those results don't scream "adrenal tumor a strong possibility". But nor are they conclusive for PDH. In fact with that unusually high pre level (could be stress, psychological or even some other medical issue) I'd think a false positive would be a possibility. That is why you need further testing - at least an ultrasound and almost certainly an ACTH stim test as well, just to be sure.

Alison

[Buffaloe]

Sandy,

I am really glad you will be taking Dutch to see an Internist Monday. I'm going to try to give you a layman's explanation of the LDDS test: It is an 8 hour test. Pre dexamesthasone blood is drawn (baseline #). Then a low dose of dex. (steroid) is injected and blood is drawn after 4 hours and after 8 hours. The test measures the dog's adrenal gland's responsiveness to the steroid (dex.) in the blood.

A normal dog will stop producing cortisol in response to the steroid in his blood. A cushing's dog will not react to the steroid as much and his adrenals will continue to produce cortisol. It can sometimes destinguish between pit. and adrenal cushing's because dogs with adrenal tumors do not suppress as much as pituitary dogs...even with the steriod injection, dogs with adrenal tumors can still produce plenty of cortisol.

I'm no expert at interpereting the LDDST but Dutch's 4 hr. and 8 hr. #'s are way below his pre #. To me, those #'s indicate quite a bit of suppression which would point away from the presence of a primary adrenal tumor.

I think you should do some research yourself prior to your appointment with the Internist. Read about the LDDS test, cushing's disease in general and adrenal tumors. Take some notes. You want to be able to understand what the Internist says and ask the right questions. As I understand it, it's really rare for a six year old dog to develop an adrenal tumor. I think Dutch is gonna be just fine; he'll probably be retrieving and getting into the water every chance he gets for many more years.

Ken

[Dutchboy]

Thank you all SO much! I will certainly be back Monday afternoon to give you an update. I am feeling a bit better reading more and trying better to understand the testing. I'm glad my vet admitted she was not an expert at deciphering the tests and sent me to the specialist!
Thanks again, guys!

[littleone1]

Hi Sandy,

I'm not great at interpreting test results either. When Corky had his LDDS test done, his levels were 7.3, 6.2, and 5.7. The interpretation that the lab provided stated that if the cortisl level was less than 1.4 after 4 hours, and less than half the baseline level at either the 4 or 8 hour post test, that it would be consistent with PDH. Corky's results were definitely showing that he had adrenal Cushings. He also had additional testing and an ultra sound, which confirmed that he has adrenal Cushings, as he has an adrenal tumor.

I hope this might be helpful. We'll be waiting to see what your IMS says.

I hope you also have a Happy Mother's Day.

Terri

[AlisonandMia]

Yes, Corky's LDDS results are very typical for an adrenal tumor - mind you many a dog with eventually-confirmed PDH has had a similar-looking LDDS test result so even that isn't conclusive - thus the need for more testing, particularly ultrasound.

Alison

[Harley PoMMom]

Hi Sandy,

I suggest you read this article, I found it helpful to me for trying to interpret the LDDS test. It is in our Resource Thread along with many other helpful articles. ;):)

ClinQuiz: Interpreting low-dose dexamethasone suppression test results
http://veterinarymedicine.dvm360.com/vetmed/Medicine/ClinQuiz-Interpreting-low-dose-dexamethasone-suppr/ArticleStandard/Article/detail/580093

Hope this helps.

Love and hugs,
Lori

[littleone1]

Sorry to post on your thread, Sandy.

Hi Alison,

That's why Corky's IMS had other testing done, along with the U/S. She also felt that it was very important to do this.

Terri

[Dutchboy]

GREAT NEWS!!!

NO ADRENAL TUMOR!

You guys were right!

And...the IMS seems to think that he threw a false positive based on the high stress of being in the kennel. They took another urine sample, but right now we are just thanking God for the good report. The doc said he would not rule out cushings down the road, but would not treat right now as he does not exhibit ANY outward signs.

We stopped on the way home for hot dogs and fries! :)

I can't think you all enough for your support and holding my hand these past few days. I will be back checking in on the dogs I've been reading about here and will keep them in my prayers.

Thanks again to all of you!

Sandy and Dutch

[mypuppy]

Hi Sandy,
Welcome to you and your precious boy Dutch from me and my chocolate lab Princess. I can completely relate to you when you say Dutch is your heart and soul--so is my Princess. I know I am a bit late in posting and from reading the most recent posts it seems like great news for Dutch. I think I can speak for everyone here on the forum that we love to hear good and healthy news with all our pups so I am extremely happy for the both of you. I think you mentioned in one of your earlier posts having read a bit on my thread. I know it is so easy to get overwhelmed with all this cushings condition but as time passes and you get more educated things start making more sense, trust me. I understand the cushings and adrenal tumor were ruled out which is fabulous but has your Ims suggested or ruled out other conditions based on Dutch's symptoms? Diabetes mellitus, diabetes insipid us, UTI? Again Im not up to date with your thread but just making sure I mention these unless someone hasn't already. For now Enjoy your boy to the fullest and keep us informed on his progress. Best regards and belly rubs to the Dutchboy. Hugs Jeanette and licks from the choco lab.

[Dutchboy]

All his bloodwork showed no signs of diabetes, etc. They did take more urine and blood to double check though. I bascially said; do everything; check everything, just want to make sure.
He does feel like he has environmental allergies; which we already knew.
Thanks so much being such a caring bunch of people here!

[Casey's Mom]

Wonderful news!!

[EllyAugie]

Hi Sandy, I was very happy to read your wonderful news about Dutch. I also wanted to let you know how comforting I found your kinds words to be about Augie. It touched me that in your days of overwhelming worry you were able to help me as well. I felt that each one of you were angels surrounding me to get me through this very difficult time.
Thank you.
Give Dutch a big hug from us telling him how happy we all are to hear the good news.
Elly

[Franklin'sMum]

Hi Sandy,

Congrats to you and Dutch on such GREAT news!!! :):):) I'm so happy for you both. Now, relax, breathe, and continue to enjoy your boy, and your other furbabies, too.
Again, (squealing with joy icon) woo hoo!! :):)

Jane, Franklin and Bailey xxx
________
Ship sale (http://ship-sale.com/)

[zoesmom]

Such good news. We love that around here!!!! Hugs to Dutch! Sue