Tekno, 5 y/o Staff X: Macroadenoma, completed radiotherapy

[EmCHammer]

Hello everyone

I thought I would join after lurking for a bit even though my dog may not have cushings...

Tekno is a 5 year old Staffie x rescue. He isn't in the best shape in some ways.. we have had him since he was 1 and he was a poundie stray saved from being PTS.

Six months after we got him he had a bad accident, ran into a post and suffered a head trauma, burst C2/C3 discs in his spine and broke his nose. He was paralysed and had to learn to walk again etc - he has very little disc left in his neck spine and has some permanent nerve damage (can scuff toes, falls over sometimes if not balanced etc) and brain lesions from this. We thought that was our run of bad luck over and he leads a normal life really.

Last autumn, when he was only 4 I started to notice he was 'slowing down' and he used to stare into space alot. He has always been a bit reactive with other dogs and he stopped this. I couldn't put my finger on it took him to the vets who started off trying to rule out simple things, such as pain based. X-rays showed up nothing so he went back for an mri during which time he suddlenly got much worse... (problems standing, weak, disinterested in anything, head flinching) this showed up a 1.5mm piturity macroadenoma (and he had had a spinal mini-stroke too which the spinal specialist said would cure itself with rest and time)

He went onto steriods which turned him into a new dog! and we were given the option of radiotherapy which thank goodness for insurance we took up. His steriods were decreased then stopped, the radiotheraphy finished two months ago and here we are. He is sort of back to normal but is much more quiet and serious than his old giddy self but we just have to wait and see now.

The vets or specialist are not worried about testing him for cushings as they say he is showing no signs; and often the radiotherapy can change this so can leave to settle down for a bit.

I just really wanted to see if anyone elses dog had undergone the radiotherapy for a pit. tumour; and also is it likely he would have it and not show any symptoms? His coat is in good condition although he is quite sparse underneath and a shaved patch from a blood test in november is struggling to grow back. He has an insatiable appetite but not increased thirst or peeing.

He isn't as energetic or fun loving as he used to be, he has 'matured' quite alot into a nice well rounded sensible dog, not sure if combination of all he has been through and natural coming into middle age and out of the teenage/ young dog years.

He has always had an insatiable appetite from day 1 (he has had to have his stomach pumped before after breaking into a cupboard and into a sack of kibble), and has always been sparse of fur in his armpits, belly etc since we had him, and there was no tumour when he had his accident MRI. Even if he does have it if no symptoms from reading then they may not do anything anyway?

Just wanted to share experiences really!

Mods can the title be changed as could read he is staffie x pit, rather than what i intended staffie cross, piturity tumour (except I can spell pituritury !)

[StarDeb55]

Welcome to you & your boy! Your boy seems to be one tough customer as he has certainly been through more than most any dog ever.

First of all, I have gone ahead & changed the title of your thread to reflect what you wanted. If this is not exactly right, please feel free to PM me or one of the admin staff, & we can change the title to something else. We have had several members whose pups have undergone radiation for a macro pretty successfully. I'm trying to find a couple of those threads right now. I will say that some of the history of these pups was lost when the old site, cc.net, unexpectedly shut down. Serena is one of these pups.

http://www.k9cushings.com/forum/showthread.php?t=609&highlight=serena

Next is Sammie. As of last October, when Sammie's Mom posted, she was doing great.

http://www.k9cushings.com/forum/showthread.php?t=894&highlight=sammie

You might be interested in reading about Lucygoo. The Goo girl as our members have nicknamed her, was the pioneer in the USA for the surgery to remove the tumor in the pit gland. This surgery is not done in the US, but is common in Europe. She did very well, but unfortunately crossed the bridge several months ago, due a cancer that was not related to Cushing's.

http://www.k9cushings.com/forum/showthread.php?t=534&highlight=serena

Debbie

[EmCHammer]

Many thanks for the change to title; sure it would have been OK but I am in england where the Pitbull is banned - I think they are lovely dogs but you never know over here.

Thank you for all the links will take my time and read through them all later.

When we were referred to treatment they said that no one did the operation in the UK, but there had been success in Holland.

I found this article recently as well, seems that progress and advances are being made all the time...

http://www.nytimes.com/2010/10/26/science/26obdog.html?_r=1

I volunteer for a dog rescue here in the UK and have also just spoken to a lady who lost her dog to a pituritury tumour at christmas - I think its very common but never before coming on here found someone else who has a younger dog and undergone radiotherapy.

[EmCHammer]

I have read on a few posts about leg shaking or trembling. Tekno does this alot but always thought it was nerve damage

[EmCHammer]

Hello there

I would like to ask the advice and opinions of the forum members.

I have a just turned six Staffordshire Bull Terrier cross; who became ill when he was aged 4, and diagnosed with a pituritury macroadenoma at christmas last year.

He also has brain lesions from a bad accident and head trauma he had when he was 2.

He did not appear to have any of the signs of cushings; just the tumour.

He had radiotherapy for it and I was told a year was the average life expectancy after radiotherapy... he is now 11 months post treatment and doing well.

I asked about Cushings at the time and the specialist who did the radiotherapy said that the treatment can change things anyway so if we wanted to test best to wait until things had settled down; and no one seemed to think he had cushings (he is under the care of the regular vet, spinal vet and the oncology people) and we didn't think alot more of it.

He doesn't have any of what i recognise from reading on the net symptoms apart from an insanely ravenous greed/appetite, he is alot more laid back/ not quite lethargic but he has been through alot. The only other thing that rang a bell was when he was shaved for bloods and anaesthetic it took months to grow back which I didn't realise could be a sign. he often stops on a walk and refuses to carry on.

He has no thirst/ peeing, no pot belly or coat changes?

he has been through alot but not sure if we should test him for Cushings...

I know teh test involves bloods but not sure exactly how it all works.

My other question is the oncology department have told me about some dogs with much worse symptoms of the adenoma than he has, which appeared to be caused once the dog started treatment for Cushings; i.e. that the over production of steriods kept the tumour size in check as an anti inflammatory; once this was brought under control the tumour rapidly expanded making the dogs really ill.... I don't know if this was some one off examples they were talking about or a common theme....

Considering he is doing so well (touch wood) atm and I don't want to mess with him if he is doign so well; I don't know whether to leave be and stop worrying and enjoy him for who he is these days; or to have him tested... but have that concern mentioned above.

Moderator Note - I have merged your latest post about Tekno with his original thread. We like to keep all the info about each pup in one thread so it is easier to look back at the history if needed.

[Squirt's Mom]

Hi,

Since he is doing well, especially in light of all he has already been through, I would leave him be if he were mine. I wouldn't put him through the stress of more poking and prodding and vet visits than I had to. ;)

Most pups with Cushing's have the pituitary form - meaning there is a microscopic tumor on the pituitary gland. Treatment controls the signs this tumor causes but does not treat the tumor itself. On rare occasions the micro tumor will become a macro tumor.

Hugs,
Leslie and the gang

[EmCHammer]

Thank you for your quick response and merging of threads ;)

I think I am, like we all are, are just trying to make sense of things and looking for answers when things are not clearcut. I am happy to leave be but his obsessive obsession with food (can I say that :D) is hard sometimes...

Tek won't steal off the counter or plates but out on a walk his entire mission is to inspect every bit of rubbish/litter to see if it contains food and his walk is trotting from one place he has ever found food to the next in a series of inspections of his food hotspots its like he has checkpoints he has to go round every day. If i try to walk in the more nature reserve part of the park he stops point blank and refuses to walk.

he has had to have his stomach pumped after breaking into the kibble sack when he was younger, gorging himself silly. He did the same thing to a lesser extent a few weeks ago at my dog sitter; found the half open weak cupboard door, broke in and filled himself silly on the kibble. (he was a barrell with 4 waddling legs)

I know as part of the bigger picture he is here, happy and doing well... and for that I am so happy; the food thing can be managed but I worry its an underlying cause of something else that will harm or set back my boy.

[lulusmom]

Hi and welcome back to the forum. Glad to hear from you and I'm very happy to hear that Tekno is doing well, with the exception of his ravenous appetite.

The thyroid gland is regulated by the pituitary gland so Tekno's radiation therapy could have caused a serious malfunction of the thyroid gland, ultimately causing hypothyroidism. A raging appetite is a common symptom of hypothyroidism whereas PU/PD (excessive drinking and peeing) is not. If I were in your shoes, my first step would be a thyroid panel. If hypothyroidism has already been ruled out, then if and when Tekno's foraging for food becomes a serious problem for you, talk to your vet about doing an acth stimulation test to check cortisol levels.

Glynda

[labblab]

For what it is worth, my two non-Cushpups (both Labradors), also view their daily walks as "buffet tables," and try to scrounge every possible disgusting bite from every possible location :o. This is especially challenging if they are off-lead. So I often keep them on their leashes just to stop them from doing this (they know where to find every pile of rabbit poop in every meadow :eek: :eek:) I think Gynda's advice is sound about testing for hypothyroidism. If that is not the culprit, I do understand your reservations about starting Cushing's treatment solely due to appetite issues. I wanted to comment on this question.


My other question is the oncology department have told me about some dogs with much worse symptoms of the adenoma than he has, which appeared to be caused once the dog started treatment for Cushings; i.e. that the over production of steriods kept the tumour size in check as an anti inflammatory; once this was brought under control the tumour rapidly expanded making the dogs really ill.... I don't know if this was some one off examples they were talking about or a common theme....

Considering he is doing so well (touch wood) atm and I don't want to mess with him if he is doign so well; I don't know whether to leave be and stop worrying and enjoy him for who he is these days; or to have him tested... but have that concern mentioned above.


What the oncology department has said regarding the benefit of steroids in the treatment of symptoms caused by enlarging tumors is born out by the experience of other members here with dogs suffering from neurological problems. We have seen prednisone prescribed for dogs suffering from enlarging tumors, even when still being dosed with trilostane. I think the reasoning for this (the combination of the trilo and the prednisone together) is to keep the steroid dosing at a consistent and predictable level. Thus, for dogs with known cortisol elevation, the trilo keeps the natural cortisol level in check while a specific dose of prednisone can be added for the anti-inflammatory benefit.

As far as the potential for Cushing's treatment to actually hasten the growth of pituitary tumors, this does seem to be true, but I believe this is largely due to disruption of the ACTH feedback loop. Here's a related research study:

http://www.ncbi.nlm.nih.gov/pubmed/19041802


Trilostane-induced inhibition of cortisol secretion results in reduced negative feedback at the hypothalamic-pituitary axis
Domest Anim Endocrinol. 2009 Jan;36(1):32-44. Epub 2008 Nov 11.
Teshima T, Hara Y, Takekoshi S, Nezu Y, Harada Y, Yogo T, Teramoto A, Osamura RY, Tagawa M.
Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan

Cushing's disease caused by pituitary corticotroph adenoma in dogs is usually treated by medical treatment, and the efficacy of this treatment has been reported. However, controversy remains as to whether reduced negative feedback through the inhibition of cortisol secretion, similar to Nelson's syndrome, may appear as an adverse effect.

The purpose of this study was to investigate the effect of reduced negative feedback through the inhibition of cortisol secretion by daily trilostane administration on the pituitary-adrenal axis in clinically normal dogs.

Dogs were administered 5mg/kg trilostane twice a day every day for 8 weeks (n=8) or 16 weeks (n=3). After the initiation of trilostane administration, plasma adrenocorticotropic hormone (ACTH) concentrations were increased remarkably.

As assessed by magnetic resonance imaging (MRI) during administration, the pituitary became enlarged. After trilostane administration, the cytoplasmic areas of the pituitary corticotrophs were increased and the ratio of pituitary corticotrophs to all cells in the anterior lobe was greater in the trilostane-treated dogs than that in untreated animals.

In addition, histological examinations revealed bilateral adrenal cortical hyperplasia. Using real-time PCR quantification, the expression of proopiomelanocortin (POMC) mRNA in the pituitary and ACTH receptor (ACTH-R) mRNA in the adrenal gland was greater in the dogs treated with trilostane than in untreated dogs.

These results indicate that reduced negative feedback induced hyperfunction of the pituitary corticotrophs and pituitary enlargement in healthy dogs. These changes suggest that the inhibition of cortisol secretion by trilostane may increase the risk for accelerating the growth of corticotroph adenomas in dogs with Cushing's disease.

I want to stress that this possible effect probably should not be a reason for owners to opt out of Cushing's treatment for otherwise strongly symptomatic dogs who don't exhibit neurological issues. Regardless of the cause, it is not common for canine pituitary tumors to enlarge to a size sufficient to cause major neurological problems. And so when weighing quality of life issues, it is important to consider the damage/discomfort that is known to be associated with untreated Cushing's in symptomatic dogs. My own dog was miserable prior to starting trilostane treatment. He then had several months in which he rebounded prior to exhibiting serious neurological abnormalities. So even had I known that the trilostane might hasten the growth of his enlarging tumor, I still would have chosen to treat for those months in order to relieve him of his awful Cushing's symptoms.

But in the alternative, since Tekno is already known to have suffered from a macrotumor, I don't believe I would opt for Cushing's treatment now unless he exibits symptoms that affect his qualify of life.

Marianne