New Member - Atypical Cushings -Hyperestrinism Diagnosis

[Maggie's Mom]

Hi All - glad to have found this wonderful forum & resource. My 9+ year old Bearded Collie, Maggie has lost LOTS of hair on her back, hind legs and her usual furry tale is now "rat-like"; skin is getting scaly, thin & very dry. We have suspected Cushings for months, but vet said she didn't have the other signs such as excessive thirst and panting. After 6 months more, and after diet changes suspecting food allergies; the symptons of hair loss only worsenened. We now have the results back from the Blood Panel + Post ACTH from Univ of Tennessee/College of Vet Med/Endocrinology Dept. The results definitely indicate presence of increased adrenal activity. The suggested treatment is Melatonin (12mg/day) & HMR Lignan (40mg/day).

My question is, has anyone else treated their dog for similar diagnosis and have used Melatonin? If so, did it work to bring the dogs hair coat back? Is there any possibility that we are missing something else here besides Atypical Cushings?

LABWORK: here's her test results for spayed females;* means below/above range:

(Test) (Result) (Normal Range) (Result/Post ACTH) (Normal Range)
Cortisol (17.8) (2.1-58.8) (186.7 *) (65-174.6)
Andro. (.56) (.05-.57) (3.80) (.27 -3.97)
Estradiol (116.0* ) (30.8-69.9) (103.3* ) (27.9-69.2)
Progest. (.14) (.03-.49) (3.12* ) (.10-1.50)
17OHProg. (.13) (.08-.77) (3.79* ) (.40-1.62)
Aldost. (77.5) (11-139.9) (639.4* ) (72.9-398.5)

Results indicate presence of increased adrenal activity. The high aldosterone at stimulation may indicate presences of a primary adrenal tumor.

Maggie has not been on steroids, and is otherwise healthy and active. Her increased appetite is definitely a sympton, besides the hairloss. Last summer she had a urinary tract infection; no other illnesses. I have other blood work results, please let me know if that would help as well. Thank you so much for your help!

[Harley PoMMom]

Hi and welcome to you and Maggie from me and my boy Harley!


I have other blood work results, please let me know if that would help as well.The more we know about your precious girl the better we can help you help her, so yes! If you could post anything on there that is marked abnormal with the reference ranges and the units of measurements (U//L, mg/dl).

Also with Maggie's UTK results there should have been a Dr. comments as to options of treatment, this is usually listed something like "Consider items 1 through 5 on the treatment option sheet attached." Could you post the Dr. comments too.

Was an ultrasound done on Maggie?

We are here for you and Maggie and we will help you in any way we can, so remember you are not alone on this journey, ok? ;):D

Love and hugs,
Lori

[Maggie's Mom]

Hi Lori - thanks for the reply.

As for the Doctors comments on the bottom of the results; I left off "Consider items 1-4 and item 8 on the treatment option". Those options were the (1) Ultrasound/and or Endogenous ACTH (2)Melatonin & (4)MHR Lignans and (8) final option to add Ketoconazole
to treatment plan which we are still considering.


College of Vet Med/Endocrinology Dept – University of Tennessee
Canine Atypical Cushing’s Disease - Diagnostics & Treatment:

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

Also a separate article posted here: http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=485128

Treatment: Maggie is on the Melatonin (12mg/day)and HMR Lignan (40mg/day)

Thank you!

[Maggie's Mom]

Note: the lab results i added with the * - next to them indicate the above normal ranges


Previous Superchem Panel: (Note I am only including out of range values)
ALT(SGPT) 165 (high) Reference Range 12-118 U/L
GGTP 25 (high) Reference Range 1-12 U/L
Cholesterol 385 (high) Reference Range 92-324 mg/dl
Lipase 727 (high) Reference Range 77-695 U/L

T4 1.1 (low/marginal) Reference Range 1.0-4.0 ug/dL
Free T4 (equilibrium dialysis) 27 Reference Range 8-40 pmol/L

All other values were within normal limits

CBC was also within normal limits

[Harley PoMMom]

Other lab results that I was referring to would be a CBC/Chemistry blood panel, did Maggie have one done recently?

[Harley PoMMom]

The elevated ALT and GGTP are liver enzymes, did your vet mention about starting Maggie on some liver support supplements like milk thistle or denamarin? If not, I would mention this on your next visit.

The elevated Lipase is non specific because there are digestive lipases, intestinal lipases, lipoprotein lipase and hepatic lipase, hormone-sensitive lipase, and lysosomal acidic lipase. Sometimes elevated Lipase is an indicator of pancreatitis but not always and with Maggie having an elevated ALT this could be an elevated hepatic lipase but don't really know.

High Cholesterol is usually the norm for our cush-pups, as is very elevated ALP and a low USG (urine specific gravity), our pups usually have a very dilute urine also.

Are you thinking about getting an ultrasound done?

[labblab]

Hi Maggie's Mom,

I just wanted to "second" the notion of your seeking an ultrasound for Maggie. From their written report, it sounds as if the UTK results could be consistent with an adrenal tumor. And if that is the case, then you might have an entirely different treatment option to consider: surgical removal of the tumor and the possibility of a complete cure for Maggie. And even if surgery did not seem appropriate, additional medication (such as Lysodren) might be helpful for her.

I see that Maggie's ACTH stim results were only slightly elevated. But the ACTH stim test does not always do a good job of reliably identifying dogs suffering from the adrenal form of Cushing's. Given Maggie's high aldosterone level, it sounds as though UTK has recommended either an ultrasound or endogenous ACTH test for Maggie in order to further pursue the possibility that she may have an adrenal tumor. The endogenous ACTH is different from the ACTH stim test that has already been conducted. Unfortunately, it can be somewhat of a difficult and expensive test to run due to the way in which the blood samples have to be collected and transmitted. The abdominal ultrasound seems to be more commonly performed as a differentiating diagnostic. And a "plus" to the ultrasound is that you can get a better idea of the state of other internal organs in addition to visualizing the adrenal glands.

So given Maggie's results and the UTK recommendations, I am thinking that an ultrasound might be a very helpful "next step" for you all...

Marianne

[Maggie's Mom]

Thanks Marianne - will do the ultrasound soon then and keep you all posted. Your advice is greatly appreciated!;)

[Squirt's Mom]

Hi and welcome to you and Maggie, :)

I want to share with you my Squirt's story. She was diagnosed with PDH in 3/08 and after subsequent testing - lots! - a tumor was found on her spleen via an abdominal ultrasound on a high resolution machine (her second one, recommended by UTK/Dr. Oliver). Once the tumor and part of the spleen were removed, her cortisol returned to normal and her diagnosis has been changed from true Cushing's (PDH/ADH) to Atypical, as the intermediate hormones remain elevated.

IMHO and based on our experiences, the ultrasound is an invaluable diagnostic tool when dealing with Cushing's, not only so the adrenals can be seen but as Marianne said and Squirt has proven, so the other organs can be looked at and assessed.

Cortisol is a natural response to stress... in humans and dogs...so the elevation seen with Squirt was in response to the stress of that tumor and not a result of a mal-function in the adrenals or pituitary glands. In fact, I am willing to bet that on any given day, many of the humans here have cortisol levels well above normal as we stress ourselves out with worry for our babies. ;):D

Keep your chin up and let us hear from you!
Hugs,
Leslie and the girls - always

[Bichonluver3]

Welcome from us, also!
Chloe has Atypical Cushing's also. After a couple of weeks on Melatonin and SDG Flax Hulls, she lost her excessive hunger, thirst and peeing. I also think she is regaining some of the fur lost on her back. She still has her pot belly and a lump at the top of each hind leg but she is back to her perky, bouncy self, dancing around her food. She has just been started on a low residue diet and takes glucosamine (like I do!!) for her joints. I am looking into L-Glutamine and CoQ10.
Hope this helps:D
Carrol & Chloe