Adrenal Gland Tumor

[bailey3310]

Hello. I am new to the forums and am looking for any support and advice anyone might have with this new predicament. Here are the facts thus far:

I have an 11 year old Boston named Bailey. Last Friday night, Bailey was up panting for the majority of the night. He also vomitted twice. I rushed him to the vet first thing in the morning. He was treated for pancreatitis, x-rayed, blood-tested, medicated and sent home until blood tests were in. By the next day, he was back to normal. He is has been on thyroid medication for about a year and a half.

The vet called me on Monday to discuss his irregular blood tests. The enzymes in his liver were very high (not to mention his calcium) and he wanted to schedule a blood clotting profile and an ultrasound. He also wanted to do a urinalysis. I took him in for his blood clotting profile and on the following day I dropped him off for his ultrasound. This was difficult for me as I did not know if they would do a liver biopsy or not, they wouldn't know until they had a look. If they did, this meant he would be put to sleep and I am fearful of that. Bailey has several lumps and bumps on him that I have had checked (fatty tumors), but, not removed because at his age, and being a short snouted dog, I just feel uneasy about it and the vet seems to be agreeable.

A small tumor was found on his right adrenal gland. My vet would like to continue with the low Dex testing to confirm cushings, possibly treat hollistically, and do another ultrasound in 90 days. He said if the tumor grew he would suggest surgery.

So, as this type of surgery is major, I knew i would be in need of a vet that would perform it. I started researching and calling a few vets and inquiring about it. My intention was to be prepared in 90 days and have a plan. While calling a few offices in a 60 mile radius, to my suprise, the veteranarian actually wanted to get on the phone and speak with me. We discussed my situation for some time, and although he did not perform this type of surgery, he made it clear to me that if it was his dog, he would NOT be waiting 90 days. He would have the adrenal gland promptly removed--forget the added costs of the low Dex test and the second ultrasound (roughly $375) and get Bailey into surgery. Basically, he tells me my best friend is as good as dead if I don't act now. He gives me a name and number of someone he highly recommends and reassures me that this is going to cost me greatly.

After I cry and wonder and worry and cry..........I call the veteranarian that was recommended to me. She keeps office hours for an hour each day where she will accept calls and questions. I told her my situation and what my vet recommended I do, and her reply is ....."that sounds resonable". That is all she really would say.

At this point I am confused. These tumors are just as likely cancer as they are benign. This surgery is major. Do I put Bailey through this?

Any advice would be greatly appreciated. Thank you.

[Squirt's Mom]

Hi and welcome to you and Bailey! :)

Adrenal based Cushing's is the only form of Cushing's that currently offers a viable cure, as the cause of the condition can be surgically removed. Tumors on the right adrenal, however, are more serious than those on the left adrenal because of the proximity of the right gland to the caudal vena cava, a major vessel that carries blood back to the heart. If a tumor on the right adrenal grows large, it can press against this vein making surgery much more risky.

If it were me, I would take Bailey to a board certified surgeon and let them do their own tests then give me their thoughts. There are several different types of adrenal tumors, not all are Cushing's related. So before making any decisions, I would have someone look at him who could tell me what type of tumor it is, how large it is, exactly where it is, and what they would do if it were their baby. And I wouldn't wait 90 days. ;)

Unfortunately, holistically treating an adrenal tumor is not the best approach - surgery is if feasible. If not, then treatment with either Trilostane or Lysodren will offer the next best approach.

We have several members here who have dealt with ADH, the adrenal form of Cushing's, and some who's babies have another form of adrenal tumors. I am sure they will be along to share their thoughts with you soon.

I am glad you found us and want you to know that you and Bailey are not alone. We will be with you every step of the way, here to offer our knowledge, experience and support. Please ask any questions you may have and we will do our best to help you understand.

Keep your chin up! You are doing a fine job so far. Bailey is lucky to have you as his mom!

Hugs,
Leslie and the gang

PS. Here are some links on ADH for you to look over -

Newman Veterinary*
http://www.newmanveterinary.com/CushingSx.html#Adrenalecto my
Note: This website contains informative illustrations and diagrams

Mar Vista*
http://www.marvistavet.com/html/body_adrenal_treatment.html

Diagnostic Approach to the Incidental Adrenal Mass
Richard W. Nelson, DVM, Diplomate ACVIM
http://www.vetlatranquera.com.ar/pages/wsava2002/Endocrinology06.htm

[littleone1]

Hi and welcome to you and Bailey.

I know this can be frightening, but it is not a death sentence. Corky is also a Boston Terrier with a right adrenal gland tumor. He does have cushings. Surgery is the best option if a furbaby is a good candidate for the surgery. Corky is going to be 14 in about a week. He is not a good candidate for the surgery due to his age and his other medical conditions. He has been treated successfully with Trilostane for almost 21 months now.

We have several members whose dogs have had successful adrenalectomies. If you decide on the surgery, it is important to have a board certified surgeon. I'm sure others will be along that have been through this.

One of the easiest tests that you can have done is a UC/CR test. It is done using a urine sample, and can either rule out cushings, or show that additional testing needs to be done. Another test that can be done in addition to the LDDS test is the ACTH stimulation test, which gives the cortisol level and is also used to monitor the cortisol level during treatment.

I'm hoping that everything will work out for you and Bailey.

Terri

[lulusmom]

Hi and welcome to the forum.

Terri and Leslie have already given you some great information so my post will be short and sweet, which is not my norm. :D Can you please round up all of the tests that were done on Bailey and post the abnormal values here, including the normal reference ranges?
Is Baily displaying the normal symptoms associated with cushing's like excessive drinking and peeing, voracious appetite, muscle wasting, pot bellied appearance, loss or thinning of coat, skin problems, hind end weakness?

Glynda

P.S. I absolutely agree with Leslie and think you should consult with a board certified surgeon. If you don't know any in your area, you can use the link below to find one. If you will let us know which big city your are near, perhaps we might have a member who can suggest a surgeon for you.

http://www.acvs.org/VeterinaryProfessionals/DiplomateDirectory/

[Buffaloe]

Hello to you and Bailey,

I am sorry you have to deal with an apparent adrenal tumor. My dog had a very large adrenal tumor surgically removed (adrenalectomy) when she was 12. The surgery was very successful and she lived for another 3.5 years with an excellent quality of life. Prior to her surgery, she was just hanging on.

Do you know the size of Bailey's tumor? There might be an ultrasound report available. If you haven't had any cushing's specific testing done, either a LDDS test or an ACTH test would probably be warranted. Because about half of all dogs with primary adrenal tumors test within the normal range on the ACTH, the low dose test might be your best bet.

Bailey's tumor is small; hence, I really don't think you need to be in a big hurry to do anything at this point. Don't get all upset and think you have to do something right away. Your options are to treat the tumor medically (Trilostand or Lysodren) or to have an adrenalectomy. This surgery should only be performed by a highly skilled and experienced board certified surgeon. I guess I think you should have a cushing's specific test performed, then have a consultation with a good bcs. My surgeon told me that all he cares about is the size of the tumor and its involvement with the area blood vessels. I think it is a huge plus that Bailey's tumor is small. I know you will make the right decisions for your boy.

Ken

[bailey3310]

I can't thank you all enough for all of the kind replies. I never expected this kind of welcoming support and information.

First, let me say, that I am so relieved that this is, in fact, not a death sentence. I have spent hours trying to decide if I should act now and if I don't will it be too late? Although I don't want to bring this up, financially this is scary also. We are already in $1k in testing, then surgery (I am thinking 3-5k)? I can't even consult with a surgeon without over a $100 fee. Earlier this year Bailey had a grid keretotomy in both eyes, so we saw a dog opthamologist for several visits, he is doing great, well worth it. Trust me, my Bailey is worth every penny. He is a strong dog and I KNOW we have many years left together, and I'm am going to do everything in my power to make that happen, but, I am not going to lie by saying the financial side of this is not scary or a concern. I will do what is best for him, not what is least expensive first, please trust that.

Now, about the board certified surgeon. This is not available in my immediate area. I have found a surgeon in Stuart, FL which is about 50 minutes south of my location. I can, however, bring in Bailey's records and consult with a surgeon there ($105).

I made an appointment with a vet that does perform adrenal gland surgery, but, after researching, I do not think he is a board certified surgeon? I'm guessing I should cancel this? Or might a second opinion be good?

Test results, I have left at home today. I only have his urinalysis on hand. The only results that have (HIGH) next to it would be his protein 2+, Reference Range says Neg. The vet did mention this his urine was light (first of the morning) and the other ranges were within normal, although the were in the highs and lows of normal.

Bailey does drink alot of water. But, this seems to come and go. For the past two days I have not noticed alot of water drinking, but, over the weekend of his initial illness he was drinking on the heavier side. I have not noticed any increased urination, Bailey marks on everything under the sun outside, nothing inside.

I will come back with Bailey's blood tests. Sorry I am kind of all over the place right now, I'm confused but much more relieved after finding you all!

Thanks again!

[bailey3310]

I did decide to cancel Bailey's appointment with the new vet that is not a board certified surgeon. I am going to have his LDDS test done first. If I want to use that vet for a second opinion (which is highly possible), then I think having all tests done first will be best. I know I am procrastinating making the appointment for the LDDS testing because Bailey will have to stay at the veteranarian's all day and aside from the ultrasound last week, Bailey has not been in a strange scary place alone since he was neutered almost 11 years ago.

Ken, reading that your dog had a successful adrenalectomy was very comforting. All I am told is that Bailey's is "very small" according to my vet. The ultrasound specialist that came in wrote some notes and sketched each adrenal gland and one looks quite different than the other in his sketch. His comments are "re-check in 3 months, if up, consider adrenalectomy.

Glynda, Bailey's appetite and water intake seems to have increased. I have especially noticed panting. He has not urinated in the house, so I am not sure about increased urination. I do take Bailey to my mother's home during my work hours and she agrees that his water intake has increased. I have noticed in the last year or so that he has not been jumping as high or sometimes missing the couch or bed (not often). I thought he was just getting older. Now about the pot-belly, if you would have asked me this prior to his "pancreatits" episode (or whatever it was ) I would have said yes. Since that episode, maybe I am crazy, but, he has not drank excessively nor does he appear pot-bellied anymore. I decided to cook him a bland diet of boiled chicken and rice instead of accepting "Science Hill's" from my vet. I've since then added carrots and kept him on it since he loves it, stools have been good, gas is non-existant. I am a tad concerned about him getting the right nutrition moving forward though.

Terri, I'm guessing Bailey's urinalysis did not rule out cushings and that is why the doctor wants to do a LDDS? I am looking at his urinalysis right now, and all it says is test requested: urinalysis, nothing more specific.

Leslie, thank you for your clarification about all of this. You have made me understand, where my vet and my own research has failed. There is a surgeon about an hour south of me, it has both board certified surgeons AND oncology. I wonder would that cover all of the bases (as far as also being able to determine the tumor type)? Plus, I didn't even realise this until I called, but, Bailey has already been there as he was treated by their opthamologist earlier this year.

Thank you again Leslie, Terri, Glynda, and Ken.

Btw, I am Gina.

[Squirt's Mom]

Hi Gina,

If feasible, you might consider keeping Bailey with you between draws. The LDDS required three blood draws with several hours between so what some folks do is take them in for a draw then go back home or to the park or even just sit in the waiting room with them to help them stay as stress-free as possible. Not all vets are agreeable to this but most are so it might be worth asking.

Hugs,
Leslie and the gang

[bailey3310]

Thanks Leslie. I think I will call and ask. I hate leaving him there sitting in a cage for 8 hours if he doesn't have to. It just feels wrong.

[Buffaloe]

Hi Gina,

Thanks for the picture of Bailey. He is a great looking boy!

About half of the battle is finding the right veterinary professionals to help you. I think the best diagnostic test for you to have at this point is probably the LDDS test. The other possibility would be the ACTH.

As far as finding the right board certified surgeon, take a good look at the link Glynda sent to you. It looks like there are many dozens of bcs in Florida. I'd have to think there are a few within a couple of hours of you. Maybe one of your vets knows a real, real good one they can recommend. Also, many of the surgeons include their e-mails. They are going to want to see all of the information you have and I think the LDDST results will be very helpful to them. Regarding the consultation...when I took Shi for her consult with the bcs, she spent close to an hour with us and went over everything. It only cost $85 and that was money extremely well spent. If you end up having an adrenalectomy, $4000 is a good estimate of the cost.

It is pretty unusual for them to know the type of the adrenal tumor prior to surgery. There are at least 7 or 8 different kinds and about half are malignant. A skilled surgeon can remove a malignant tumor effectively as long as the cancer hasn't spread. But, as small as Bailey's tumor is, I doubt it is malignant. Of course, you can always decide to treat it medically. I truly believe that today, most of the sharp, young Internists are using Trilostane more often than Lysodren for adrenal tumors.

It sounds like you are feeding Bailey great food. Personally, I never thought much of Science Diet. Hang loose, take your time, do your research and try to work with veterinary professionals you feel good about. Bailey is a lucky boy!

Ken

[bailey3310]

I finally got into to a facility with a board certified surgeon and some internal medicine veteranarians! My current vet was not interested in referring me just yet, so I referred myself. I spoke with my old vet via email, and she thought that finding out what's going on inside of him by an internal med vet might be a good start, so that is what we did.

We spent about three hours yesterday with them, and I am finally feeling that I am on some sort of path. I was very unsettled prior to this, with my vet arguing that he would refer me now, but, that I would be wasting my time this early.

The internal med vet did an ultrasound, cushing's testing, more blood testing and blood pressure tests. I don't believe Bailey's blood pressure has ever been taken, but, the process was pretty neat! His blood pressure was on the high side, but, not alarming. The ultrasound showed some slight enlargement from the other vet's ultrasound and he had some concerns with his prior bloodwork, but, his concerns were very different than our vet's here in town.

At this point we can't tell what is causing the tumor (cancer, overactive adrenal gland or cushing's), but, the doctor did not feel that surgery was my first best option. I appreciated his expanation on why and trust him to move forward with treatment. After his blood tests and ACTH test are in, we are going to hopefully have a solid treatment plan.

[Squirt's Mom]

Hi Gina,

Way to go! :D That's how you take the bull by the horns! :D What a great advocate you are for Bailey!

I am so glad the IMS did such a thorough job in examining him and that you feel good about what he had to say. Let us know what the plan is when you learn it! And keep up the good work!

Hugs,
Leslie and the gang

[bailey3310]

I wanted to update Bailey's condition, in hopes that it might help anyone in the future as well to let everyone who was thoughtful enough to reply in on what I consider great news!

After our appointment with the Internal Med Vet at the end of July(I'll refer to him as IMV from here on), Bailey continued to see him about four more times as they wanted to get a handle on his blood pressure which was on the higher side as well as some additional blood testing. They wanted to test 3 highs in a row for bp, and when we would get to 2, he would test within normal. Ugh!

I would like to quickly add that Bailey had been on thyroid meds for over a year and the IMV decided to cut that dose to 1x per day rather than 2. He did a follow up blood test after cutting the dosage and his thyroid seemed normal so we kept it at that. The reason I bring this up is because I truly believe that this overdosing of thyroid medication is the reason for the cushing-like symptoms. I may be wrong, but, since then, they have ceased.

I don't think that I mentioned this, but, Bailey also had the ACTH testing, and although we knew that the other test is better, at the time I was traveling an hour each way and the IMV thought lets start with this test. Well he did not test in the positive range or the negative range, he scored a 20 which is smack dab in maybeland.


Well, a few weeks ago, almost exactly four months from his ultrasound with the IMV, we did our second ultrasound. Now, I asked the IMV once again when he did this, if the tumor has grown, would surgery be an option? My IMV, is either not keen on this type of surgery (although there are two Board Certified Surgeons at the hospital), or not keen on surgery on Bailey and all of the details surrounding his tumor. In other words, he was not pro-surgery for us.

I was worried at this time, because I knew the outcome of this ultrasound was going to be a preface for our future.......what was the outcome going to prepare me for?

Well, the tumor had not grown at all. I felt very fortunate, with a 50/50 chance of a cancerous tumor, that luck was on my side (for once, I tend to have really bad luck in Vegas)! Although, it is not set in stone that this isn't cancer, I suppose, it sounds like it to me! I am not going to count my chickens before they hatch......but, I am going to cherish more time with my Bailey in a healthy condition.

P.S. I hate to jinx myself, but, this dog has been like a puppy again. He plays more, and is strong on his walk. He still sleeps most of the day, but, there has definitely been a nice change. I sometimes wonder, and being inquisitive, want to know exactly why, but, I choose to stay a little ignorant right now and just enjoy.

Thank to all and Happy Holidays!

[lulusmom]

Hi Gina and welcome back!

Thanks for the great report on your precious pup. As I recall, the last time you posted, Bailey's appetite was normal but he may have been drinking and peeing a bit much. The latter most certainly can be due to too much thyroxin which will flip flop a dog from "hypo"thyroid to "hyper"thyroid. A hyperthyroid dog will always have PU/PD (excessive drinking/excessive peeing). I am hoping that this unresolved symptom has been address with the change in thyroid meds, the tumor remains nonfunctional and that Bailey remains the young pup he has transformed into since we heard from you last. That is great!!!!

Glynda

[MBK]

Hi, Gina -

I just caught up on your story and can relate to much of it. I have a soon to be 14 year old Jack Russell Terrier, Alivia, who was diagnosed with a right adrenal tumor about 10 months ago. She had some inconsistent testing and surgery was suggested as option, but like you I was terrified to put her through that at such an advanced age. I have been told by several vets that it is a difficult surgery and even harder on a small dog. She also developed pancreatitis - although hers was severe and she was hospitalized for 5 days. Ali has had high blood pressure for quite awhile but it is under control on Amlodopine once a day.

I was ready to start treating Ali and had even purchased the medication when her symptoms (including her pot belly!) seemed to go away. Her bloodwork is now almost all normal and she is showing no cushing's symptoms! Her IMS has said that she cannot explain it other than to say she had a miracle. I'm not going to question it anymore at the moment and just hope her good health continues and enjoy and appreciate the time I have with her.

I feel very fortunate, as I am sure you do. It is so nice to read another happy story. Merry Christmas to you and Bailey!!!

[bailey3310]

Thanks lulu's mom! I am just hoping that the symptoms are kept at bay for some time and although I can't count on it, I hope that they were all a result of the thyroid dosage. I certainly hope that his tumor never becomes active, but, I won't be blindsided by anything at this point.

Wow MBK, we have been on similar paths (and I'm originally from Butler PA btw). I struggled hard with the idea of surgery, but, I needed a vet that I trusted to tell me that this was his best option at a healthy life and no vet that I trusted would tell me that . I even made it clear on several occassions to my specialist that if he thought that was our best shot, then I was all in. Like I said before, I have no idea why he was not pro-surgery. I drove an hour to see him each way, I studied their website, they had several board certified surgeons on staff, they seemed pretty state of the art as far as vet care. It is a question I can't seem to find the answer to. Congratulations on Alivia's turn around! Miracles happen with our little angels too!

TGIB!! Thank God It's Benign (my vet that I was working with via email sent that to me). Let's hope it's true!