My dog, Charlie may have Cushing's (11.5 y/o standard poodle)

[Brunemma]

Good morning,

My apologies that this is a bit long.
I have an 11 and 1/2 yr old standard poodle, Charlie. She has been just a bit "off" occasionally recently. 2 weeks ago, she wouldn't eat at all one day and had diarrhoea. She had had spells of intermittent loose poops over the last year or so which we put down to food related problems and these always solved quickly.

I had a standard poodle with Addison's disease who I lost last year and who had the same Dad as Charlie and their mothers were litter sisters. Another half sister we lost with AIHA and cancer a few years ago and her Dad died of renal failure.

So, to be on the safe side we had a full blood panel done, then as her K was on the high side, we did and ACTH test, considering Addison's but the results came back more like Cushing's. Thus we took her for a low-dose dexamethasone supression test and again this looks like she could have Cushing's. I don't have the actual results, but will be getting them hopefully on Tuesday when Charlie goes in for ultrasound of her abdomen, adrenals etc. Possibly will have a CT scan.

My vet think it more likely she has Cushing's but she doesn't have some of the symptoms and he thought she would have high liver enzymes, but these are normal. The only things out of whack were her albumen (on the low side) and wbc (slightly elevated) plus her 'lytes. The second set of 'lytes she had done showed her K to be on the high side still and her Na had risen to above the top of the reference range.
Oh and she has very dilute urine. When we fetched her back from the vet on Thursday, she was a bit hyper but her legs were trembling and she fell down and couldn't stand for long unaided. After we got her home, she drank copious amounts of water, then was ok again.
She has HD and has occasional front leg tremors. Not strong on her pins at times.

I am obviously concerned - don't know if this is what Cushing's is and am worried in case she has an adrenal tumour. Both TJ and Kizzy had adrenal tumours as well as other ones and we lost them both due to this. Is it normal for a dog with Cushing's to appear fine most of the time ? Any advice or suggestions would be very gratefully received.

Many thanks
Pam and Charlie

[mytil]

Morning Pam,

I am glad you found us and welcome. I am sorry to read about the loss of your other dogs -


Is it normal for a dog with Cushing's to appear fine most of the time ?

This is a tough question to answer. Cushing's is a slow progressing condition, and over time the symptoms appear to be age related, so they are missed a lot of times. Hence all the testing we have to do.

Please post those test results of the ACTH and the LDDS when you can. The results really are the only way to tell if your pup does have Cushing's.

There are other conditions that mimic the signs of excessive drinking/peeing (diabetes as well as kidney and liver troubles).

Just FWIW, has your vet mentioned anything about pancreatitis? The symptoms are similar - (infection, lack of appetite, dehydration and electrolyte imbalance).

Again, post those numbers :)
Terry

[Brunemma]

Hi Terry,
Thankyou for your welcome.

I don't think Charlie has pancreatitis - she doesn't seem in any pain at all and my experience with TJ many years ago was that this was very painful. No signs of blood or vomiting either.

I know that the BUN was normal, the liver enzymes, cholesterol also were normal as was the alk phos. Urine though dilute, showed no protein.

I do remember that the vet said that her basal level on the LDDS was higher than for a "normal" dog and after 3 hrs it had dropped, but not as much as it would have done for "normal" then after 8 hrs it had gone back up again.
This is all a new learning curve for me - I can talk Addison's all day long !!

The Na and K are baffling to me as on the first check, her Na was pretty low, but then shot up above the range a week later. I am sorry to be so vague, but will be able to post actual figures hopefully on Tuesday.

Thanks again

Pam and Charlie

[mytil]

Hey again Pam,

No, you are not to worry about sounding vague - a lot of times our pups do not follow the rule books and the symptoms can be very confusing. :rolleyes:

We have a great resources section that you may want to check out. Here is a link to the testing results flowchart for the LDDS results - http://www.k9cushings.com/forum/showthread.php?t=217.

Terry

[Harley PoMMom]

Hi Terry,
Thankyou for your welcome.

I don't think Charlie has pancreatitis - she doesn't seem in any pain at all and my experience with TJ many years ago was that this was very painful. No signs of blood or vomiting either.


Pam and Charlie

My boy Harley has pancreatitis and shows no symptoms of it. His recent spec PL test results came back at 547 (0-200). Diarrhea and loss of appetite are strong symptoms of pancreastitis. Severity of the pain depends on the diseased state of the pancreas. There is acute and chronic pancreatitis and both of these can be in a mild or agressive form.

Love and hugs,
Lori

[Brunemma]

Hi Lori,

Hmm - certainly food for thought. I will mention this to the vet on Tuesday also. Would pancreatitis have an effect on the results of either the ACTH test or the LDDS test ?

Thankyou.

best wishes,
Pam and Charlie

[frijole]

Hi Lori,

Hmm - certainly food for thought. I will mention this to the vet on Tuesday also. Would pancreatitis have an effect on the results of either the ACTH test or the LDDS test ?

Thankyou.

best wishes,
Pam and Charlie

Absolutely! Any non adrenal illness can effect the results. I treated a dog with cushings for 4 yrs and then my 2nd dog got diagnosed so I thought I knew a bit about things... HA... Still trying to determine if my dog has cushings after 4 mos and what probably was a false postive on the ldds and 4 acth tests.

She didn't have pancreatitus but she had incidents of inappetance and we found out AFTER a failed attempt to load using lysodren she had the helicobacter bacteria (and bleeding ulcers in her tummy).

I absolutely would never start treating cushings til tummy issues were diagnosed and under control. Kim

[Harley PoMMom]

Hi Lori,

Hmm - certainly food for thought. I will mention this to the vet on Tuesday also. Would pancreatitis have an effect on the results of either the ACTH test or the LDDS test ?

Thankyou.

best wishes,
Pam and Charlie

Kim is correct as any non-adrenal illnesses can create false positives on any Cushing's tests.

This quote comes from Dr. Edward C. Feldman and can be found on page 1560, Section XI--The Endocrine System. Edward C. Feldman, DVM, Dipl. ACVIM, is the chair of the Department of Medicine and Epidemiology at the University of California-Davis School of Veterinary Medicine and a renown Cushing's expert.


As with the ACTH stimulation test results, dexamethasone screening test results can be misleading.
The stress of bathing, hospitalization, illness, and numerous other factors may interfere with the suppressive effects of dexamethasone.

http://www.io.com/~lolawson/cushings/articles/feldman4.pdf

Love and hugs,
Lori

[Brunemma]

Thanks Lori and Kim,

Now, though I am a bit confused - if any non-adrenal ilnesses can affect the tests, what validity do they have in terms of any definitive diagnosis ?

best wishes,
Pam

[Sabre's Mum]

Hi Pam

I would like to welcome you here ... wonderful that you popped over. Once you get the results from the previous tests others can make comments for you. We are a very "results" focused group as it really helps to assist others on their cushings journey. What other "cushings" symptoms does Charlie have that made your vet go down this track?

As said previously ... and ultrasound will really help with the diagnostics. Others may be able to comment on the lab values re liver values. Generally in a cushing dogs the ALP is particularly elevated but I am trying to remember whether there have been dogs here where the values were in the normal range?

There are times when both the ACTH and the LDDS can give you false positives. Unfortunately cushings syndrome is not easy to diagnose ... you generally need a number of tests and cushings symptoms to end up with a diagnosis.

All the best with the ultrasound on Tuesday. We look forward to the results.

Angela and Flynn (our IMHA dog)

[Harley PoMMom]

Thanks Lori and Kim,

Now, though I am a bit confused - if any non-adrenal ilnesses can affect the tests, what validity do they have in terms of any definitive diagnosis ?

best wishes,
Pam

That is an excellent question! It all depends on the illness. Not any Cushing's test is 100% accurate, that is why strong symptoms are a huge part of making the diagnosis.

If the pup has diabetes and the diabetes is well controlled then the ACTH stim test is the best diagnostic test. We usually recommend getting an ultrasound along with a LDDS or ACTH stim test when one is in the diagnostic phase.

If a pup has a non-adrenal illness then, IMO, this questionable diagnosis of Cushing's is better left in the hands of an IMS. An IMS has seen many, many more Cushing cases than one's regular GP and an IMS facility will have the state-of-the-art machines, like an ultrasound, to do diagnostic testing that one can not find in a regular GP office.

[Brunemma]

Hi Angela,
Many thanks to you !!

I think the reason the vet went down this route is probably my fault as much as anything - with having my Addisonian, TJ, so closely related to Charlie. When I took her in, I asked for a full blood panel doing including 'lytes. The K was 6.2 (3.6 - 6.6) and Na 149 (142 - 157). This prompted the discussion about her having the ACTH test.
Then a week later, the 'lytes were Na: 161, K: 6.3.
I didn't understand how the Na could rise up so much.

My vet did the ACTH test and though I haven't got the exact figures in front of me, it was something like this:
Basal reading of 400 which went up to 839. Haven't got the actual ref ranges other than the pre-stim one's max was 200 and the post stim either 400 or 600. (I will get the actual ones next week). Thuis clearly nit Addison's but suspicions then off Cushing's.

Thus we then went to doing the LDDS which showed she had high basal cortisol again and after 3 hrs, this dropped, but not as much as it would have for a "normal" dog. After 8 hrs it had gone back up to almost the same as at the start of the day.

I know it will mean more once I post the actual figures. The only other symptoms are very dilute urine, occasional diarrhoea, urinating and drinking more intermittently, occasional pot belly appearance and inthe last couple of weeks has been off her food - will just eat in the evening and is very picky. She has slight facial paralysis whcih has been ther several years (am convinced I caused this when we were playing and we went for the same ball at the same time and my foot caught her face).

So basically I haven't got a clue - thus I am here :rolleyes::o
best wishes,
Pam and Charlie

[Brunemma]

That is an excellent question! It all depends on the illness. Not any Cushing's test is 100% accurate, that is why strong symptoms are a huge part of making the diagnosis.

If a pup has a non-adrenal illness then, IMO, this questionable diagnosis of Cushing's is better left in the hands of an IMS. An IMS has seen many, many more Cushing cases than one's regular GP and an IMS facility will have the state-of-the-art machines, like an ultrasound, to do diagnostic testing that one can not find in a regular GP office.

Hi,
Charlie is going in to our vet hospital on Tuesday for her ultrasound and will be assessed by one of the partners who specialises in endocrinology. The practice has many sites, but the main one which is the hospital has excellent facilities.

I am hoping he will be able to sort out our Charlie.
Trouble is, most of the time, she seems fine - it is just the odd thing that isn't right. Maybe it is aranoia setting in:o

Thankyou for your response

best wishes,
Pam and Charlie

[Harley PoMMom]

Hi Pam,

Is Charlie on any medication or is she taking any herbs or supplements?

My boy Harley also suffers from high blood pressure, he take meds to control this and these meds do alter his lytes.

[Brunemma]

No, she isn't on anything.

She has occasionally had metacam for her hips, but very little recently.

She has just been out and done a small but fairly loose yellowy poop. This is the only one she has done today - though better than the ones done yesterday but then she has only had chicken and rice to eat for the last 2 days. She did at least want her tea tonight which is a good sign. We can check our clocks by Charlie usually - always stands up and heads towards the kitchen at 5.25 p.m. on the dot !!

I have asked the vet to check her blood pressure when she goes on Tuesday. It doesn't appear that this has been done yet.

best wishes,
Pam and Charlie

[Harley PoMMom]

This article below, that I will provide a link to, has alot of info about diarrhea. :eek:

Has Charlie's stool been tested recently for parasites and giardia?


Diarrhea
http://www.vetmed.wsu.edu/ClientED/diarrhea.aspx

[Squirt's Mom]

Hi Pam,

My Squirt is a good example of the effects of non-adrenal illness.

She was originally diagnosed as having PDH via an LDDS and an HDDS...both positive for PDH. She then had an ultrasound which confirmed PDH based on the size and appearance of the glands themselves. Then she had the full adrenal panel at the Uni. of TN in Knoxville (UTK) which came back as positive for PDH plus showed 4 of the 5 intermediate hormones were elevated as well. UTK recommended another ultrasound to rule out ADH and when the second ultrasound was done, a splenic tumor was found. The tumor and part of her spleen were removed and her cortisol returned to normal. It has remained in the normal range since then and that was in 9/08. Her intermediates remain elevated so she is Atypical but the original diagnosis of PDH is now in question.

Cortisol is one of the fight or flight hormones and anytime our bodies are under stress, cortisol is released. This is true whether it is external or internal stress. Because Squirt's body was under stress due to the tumor, her body was releasing cortisol continuously and in excess, causing all of her cushing's tests to come back as positive since they test cortisol levels.

So even tho 5 tests showed PDH, she apparently does not have it, but it was the excess cortisol caused by the splenic tumor making those test come back as positive.

I hope this helps!
Hugs,
Leslie and the girls :D - always

[Brunemma]

Thankyou for these replies.
Your help and thoughts are worth a great deal to me. I spend many hours a day helping people with Addison's dogs and I know how important it is to have the right info - but I have failed here at the first hurdle as I don't have it all.

No Charlie hasn't had her faeces tested - I took a sample in but the vet decided not to check (don't know why). I did mention whipworms to him, but he says he knows of no cases of these here.
I will have a look at the link you sent me.

Very interesting about other things affecting the cortisol levels. I must be being thick at the moment. Having dealt with Addison's for 12 years, I should have known to put more together re. the effects of stress and cortisol etc. It just didn't click that it could affect the LDDS test, so this is certainly something I need to discuss with my vet next week. I will have to write this down and send it with Charlie when she goes in.

Many thanks once again - I will check in again tomorrow.

very best wishes to all,
Pam and Charlie

[Squirt's Mom]

Hey Pam,

Here are some links on Anipryl as promised:

Anipryl

http://www.marvistavet.com/html/body_anipryl.html

http://www.vetinfo.com/dlysodren.html

http://www.vetinfo.com/managing-cushings-syndrome-in-dogs-with-anipryl.html

http://www.lbah.com/anipryl.htm

http://www.pfizerah.com/product_overview.aspx?drug=AR&country=US&lang=EN&species=CN

Hugs,
Leslie and the girls :D - always

[Brunemma]

Thanks Leslie for these links.

I have just been emailed the LDDS test results:

ENDOCRINOLOGY
Basal cortisol * 320 nmol/L High (27.5 - 125 )
Cortisol 1st Post Dex * 172 nmol/L High (<40 - )
Cortisol 2nd Post Dex * 281 nmol/L High (<40 - )

CLINICAL COMMENTS
The results are consistent with hyperadrenocorticism.
I would appreciate any comments on these please.

I have also asked the vets to email me the results of Charlie's full bloodwork.

I would be very interested in how any of this - including the dilute urine could be consistent with chronic pancreatitis.

She is eating chicken and rice and any meat I give her. She is still turning her nose up at the treats she used to love - and maybe had too many of. She isn't drinking to excess now.

I think maybe I should say that we lost our 16 yr old, Maddi as well as our Addison's boy, 13 yr old TJ within 4 days of each other last July. We had no idea until the vet came to see to Maddi, that there was something seriously wrong with TJ and following scans, we discovered 3 tumours, all of which could have burst at any point. Charlie kept us going after this - along with our 4 yr old standard, Tommy (but he has behaviour issues). Thus I think Charlie has been a bit spoilt with the treats at bed time. She also had surgery tp remove a sebaceous adenoma from her eyelid in January, then further dental surgery to remove a number of teeth.

Many thanks
Pam and Charlie

[Brunemma]

Sorry, just me again.

Have just checked a sample of urine with the Siemens multistix and got these results:

Negative for Glucose, ketone, blood, nitrite

TR IND ( trace ?) for protein and leucocytes
PH - 5 (bottom of the test range)
SG - 1.01

Does this add up to anything to anyone ?? Most looks pretty normal to me, so unsure if a Cushing's dog would look any different. I know this is not as accurate maybe as a vet checking this out, but gives an idea of what is what I think.

best wishes,
Pam and Charlie

[gpgscott]

Hi Pam,

The LDDS does support a suspicion of Cushing's but I think with such a high baseline it also indicates other medical stress. And Cushpup's almost always have a thirst issue.

I am glad you are pursuing further diagnostics, please continue to let us know.

Best to you and Charlie. Scott

[Brunemma]

Hi Scott,
In terms of other medical stress - what sort of things are you thinking about ?

I know it is the vets job to work out what is wrong, but sometimes it helps to go in with ideas doesn't it ?

Many thanks

best wishes,
Pam and Charlie

[Sabre's Mum]

Hi Pam

I have been on holiday and just wanted to check on how you are going with Charlie?

Angela and Flynn