11 yr. Black Lab new diagnosis of Adrenal Cushings

[Lucy'sMom]

Hi, my name is Sabrina and my 11 year old black lab, Lucy, has been confirmed this week to have Adrenal based Cushings. There were 2 separate visits to the vet in the past couple weeks. At the first visit, blood was drawn and tested and found to be 'Way out of Whack' (that was the technical term :-/ and so at the second visit, a dexamethasone test was administered. Based on these two visits, Lucy's vet informed me that she definitely had Adrenal based Cushings. A little history is that Lucy has been diagnosed as "border line Cushings" by 2 different vet hospitals during her annual wellness check routines over the past 4 years so this was not a huge surprise. All her other levels were normal according to the vet at this time.

The main reason for bringing her in for the initial test was because she has become very exhausted over the past few months and panting all the time except when sleeping at night. She has always been such an active happy girl. She has had ACL surgery on both hind legs at 5 and 6 years old and has joint stiffness as well. But this became increasingly obvious that it was not her usual soreness from routine activity and now she can barely get around the block for a walk, poor baby girl. So after I read a hundred posts on this site last night, I felt good about talking to the vet today, at least a bit more educated and he could tell I knew what I was talking about sorta so I think he gave me most of the low down.

Here is the plan...I pick up a scrip tomorrow for Lysodren, 500 mg, which he wants me to give to her 1.5 pill's twice a day to start (1500 mg. per day). I also told him to give me a bottle of 20mg. Prednisone as a precaution, in case she has some side effect. He said I should give her one if anything seems off like weakness in hind end and give her another in a few hours if side effect does not subside with one.

I plan to start the Lysodren Saturday morning so that I can be with her every minute of the next 3 days straight. Also, my vet works Sunday in case anything is weird Saturday so that is good. Then, I told him I want her in there for the ACTH test on Wednesday, just to be safe, whether there is change or not. I will have her tested every week I figure from there.

So he said that after the loading dose has taken effect, we will put her on a regimen which will likely be a weekly dosage but we have to wait and see how the loading doses go.

My Loo has been through so much in her 11 years with her physical health issues, like ACL in both legs and joint stiffness and her vision is getting worse, and I just want her to have a better quality of life but not if it means I am causing more problems she will have to suffer through at the vet. I will be very diligent in her care with the Lysodren but I am scared for her.

Based on this info. do you feel that I have done enough tests ahead of the treatment and that this treatment sounds reasonable? And can you tell me what I might expect in Lucy in the first couple days? Lucy is very happy and hungry normally (accelerated hunger now because of Cushings) and she weighs a little much (90lbs) which she could afford to lose 5 lbs, but she can't exercise so what can I do? I just can't withhold any food now because it is her only excitement as she can't run and play and swim, so a little extra weight is expected.

Also, I am planning to switch her food over to Wellness canned food along with the Wellness kibble which is what my vet feeds his own Golden retrievers. Currently Lucy eats Nature's Choice kibble with boiled hamburger or chicken (and yes, treats). I have seen some good recipes too for more natural which I will start making.

I am so glad I came across this site, and I will take any advice please.

PS: My 4 year old Mini Aussie, Jackson, is now gaining weight too because he doesn't like to go out and play without his mama, Lucy. He literally drags his feet on walk time and wants to go home to Lucy. I've gotta get Lucy back in action for everyone's benefit!

[frijole]

Welcome! I am assuming the two tests were the acth and the low dose dex suppression tests. It would be helpful if you could provide us with the scores/numbers on those tests. Also - since you indicated it is adrenal cushings I would have a sonogram done so that you can confirm there is an adrenal tumor. It also will give you a good feel for the size of the tumor and what else, if anything, is going on with the surrounding organs. Did your vet explain that another option for treating adrenal tumors is to remove them? It would have to be done by a vet with a lot of experience - board certified specialist - but it is an option. Glad you found us ! Kim

[addy]

Hi and Welcome,

Signs of a dog being loaded can be subtle, a pause in eating for a few seconds can be a sign Lucy is loaded. The following instructions will give you an idea of what to look for:




INITIATING THERAPY - THE LOADING DOSE PHASE:

Therapy is begun at home with the owner administering Lysodren at a dosage of 50 mg/kg/day, divided and given BID (twice a day).

Glucocorticoids (prednisone) given together with the Lysodren is not advised during loading, but the owner should have a small supply of prednisolone or prednisone tablets for an emergency.

The owner should receive thorough instructions on the actions of Lysodren and should also have specific instructions on when the drug should be discontinued.

Lysodren administration should be stopped when:

1. the dog demonstrates any reduction in appetite; this might mean just pausing slightly during meal consumption, stopping to drink some water, or stopping in response to the owner's voice.

2. the polydipsic dog consumes less than 60 ml/kg/ day of water.

3. the dog vomits.

4. the dog has diarrhea

5. the dog is unusually listless.

The first two indications for stopping the medication are strongly emphasized because they are common and they precede worrisome overdosages. The occurrence of any of these signs strongly indicates that the end point in induction (loading) therapy has been achieved.

Because of the potency of Lysodren, the veterinarian is encouraged not to rely on the instructions given to an owner. Never provide the owner with more than 8 days of Lysodren, initially. This drug is highly successful in eliminating the signs of hyperadrenocorticism because of its potency coupled with close communication between owner and veterinarian. Either the veterinarian or a technician should contact the owner for a verbal report regarding the dog every day beginning with the second day of therapy. In this way, the owner is impressed with the veterinarian's concern and the need to observe the animal closely.

It is wise for the owner to feed the dog two small meals each day, as previously described. The dog's appetite should be observed prior to each administration of Lysodren. If food is rapidly consumed (with or without polydipsia), medication is warranted.

If food is consumed either slowly or not at all, medication should be discontinued until consultation with the veterinarian.

Usually the initial loading dose phase is complete when a reduction of appetite is noted or after water intake approaches or falls below 60 ml/kg/day.

The water intake in polydipsic dogs may decrease to the normal range in as few as 2 days or take as long as 35 days (average is 5 to 9 days) Owners must continue to monitor the water intake daily until it falls to or below 60 ml/kg/day. Usually the water intake diminishes within days of beginning treatment, but it does not usually become normal until after some reduction in appetite is observed.

A small percentage of dogs demonstrate mild gastric irritation or systemic signs of illness from the Lysodren 1 to 3 days after medication has been started. These signs include anorexia, vomiting, diarrhea, weakness and lethargy.

If any of these signs are observed, the medication should be discontinued until the veterinarian can evaluate the dog. If the signs are the result of drug sensitivity and not because the treatment is complete, dividing the dose further may be helpful; discontinuing the medication for a few days may be necessary.

It is recommended that treatment be initiated on a Sunday, so that if illness develops after a few days, the veterinarian should be available during the regular work week rather than on a weekend.

So watch her like a hawk and when in doubt do not give the pill.

So glad you found us and I hope Lucy returns to normal soon.

Hugs,
Addy

[Harley PoMMom]

Hi Sabrina,

Welcome to you and Lucy! I am so glad you found us and we will help you and Lucy in any way we can. I have replied to some of your questions with my answers in blue.


Hi, my name is Sabrina and my 11 year old black lab, Lucy, has been confirmed this week to have Adrenal based Cushings. There were 2 separate visits to the vet in the past couple weeks. At the first visit, blood was drawn and tested and found to be 'Way out of Whack' (that was the technical term :-/ and so at the second visit, a dexamethasone test was administered. Based on these two visits, Lucy's vet informed me that she definitely had Adrenal based Cushings. A little history is that Lucy has been diagnosed as "border line Cushings" by 2 different vet hospitals during her annual wellness check routines over the past 4 years so this was not a huge surprise. All her other levels were normal according to the vet at this time.

It would really help us to provide you with more meaningful feedback if you could post the results of the test/s that were done to confirm Lucy's Cushing diagnosis. Also could you post the results of her CBC/Chemistry blood panel, we only need the abnormal values with the reference ranges and units of measurments.

The main reason for bringing her in for the initial test was because she has become very exhausted over the past few months and panting all the time except when sleeping at night. She has always been such an active happy girl. She has had ACL surgery on both hind legs at 5 and 6 years old and has joint stiffness as well. But this became increasingly obvious that it was not her usual soreness from routine activity and now she can barely get around the block for a walk, poor baby girl. So after I read a hundred posts on this site last night, I felt good about talking to the vet today, at least a bit more educated and he could tell I knew what I was talking about sorta so I think he gave me most of the low down.

Great job with educating yourself about Cushing's, knowledge of this disease is one of the very important tools that will help you help Lucy.

Here is the plan...I pick up a scrip tomorrow for Lysodren, 500 mg, which he wants me to give to her 1.5 pill's twice a day to start (1500 mg. per day). I also told him to give me a bottle of 20mg. Prednisone as a precaution, in case she has some side effect. He said I should give her one if anything seems off like weakness in hind end and give her another in a few hours if side effect does not subside with one.

Since Lucy weighs 90lbs (40.9 kgs) she will be receiving 36.7 mgs of Lysodren. Is this to be given twice a day? Dr. Feldman, a renown Cushing's expert, recommends a loading dose as close to 50 mgs/kgs given twice a day. At 50mg/kg, and with Lucy weight of 40.9 kgs, that dose would be 2045mgs, split in two doses and given BID.

I plan to start the Lysodren Saturday morning so that I can be with her every minute of the next 3 days straight. Also, my vet works Sunday in case anything is weird Saturday so that is good. Then, I told him I want her in there for the ACTH test on Wednesday, just to be safe, whether there is change or not. I will have her tested every week I figure from there.

For the ACTH monitoring test results to be optimal, the test should be performed 36-48 hours after the last dose of Lysodren was given. Lysodren has a cumulative effect so it is possible that cortisol continues to drop for a few days after the stim test is done.

So he said that after the loading dose has taken effect, we will put her on a regimen which will likely be a weekly dosage but we have to wait and see how the loading doses go.

My Loo has been through so much in her 11 years with her physical health issues, like ACL in both legs and joint stiffness and her vision is getting worse, and I just want her to have a better quality of life but not if it means I am causing more problems she will have to suffer through at the vet. I will be very diligent in her care with the Lysodren but I am scared for her.

Based on this info. do you feel that I have done enough tests ahead of the treatment and that this treatment sounds reasonable? And can you tell me what I might expect in Lucy in the first couple days? Lucy is very happy and hungry normally (accelerated hunger now because of Cushings) and she weighs a little much (90lbs) which she could afford to lose 5 lbs, but she can't exercise so what can I do? I just can't withhold any food now because it is her only excitement as she can't run and play and swim, so a little extra weight is expected.

Was an ultrasound done?

Also, I am planning to switch her food over to Wellness canned food along with the Wellness kibble which is what my vet feeds his own Golden retrievers. Currently Lucy eats Nature's Choice kibble with boiled hamburger or chicken (and yes, treats). I have seen some good recipes too for more natural which I will start making.

If it were me, I would not change her diet right now. My thinking is that during the loading phase one is looking for any symptoms of their dog being loaded or overt signs of too low cortisol and one of the signs of low cortisol is diarrhea. Some dogs that have their diet changed may experience diarrhea until their system gets used to the new diet.

I am so glad I came across this site, and I will take any advice please.

There is a wealth of information in our Resource Section which I believe will help you learn more about Lysodren and Cushings. Here are some links to get you started: Lysodren loading Instructions and related tips. (http://www.k9cushings.com/forum/showthread.php?t=181),
Cushing's disease and other adrenal gland disorders (Q&A with Dr. E.C. Feldman). (http://veterinarynews.dvm360.com/dvm/Internal+medicine/Cushings-disease-and-other-adrenal-gland-disorders/ArticleStandard/Article/detail/672663?contextCategoryId=40534) and
Links to Cushings Websites (especially helpful for new members!). ( http://www.k9cushings.com/forum/showthread.php?t=180)

PS: My 4 year old Mini Aussie, Jackson, is now gaining weight too because he doesn't like to go out and play without his mama, Lucy. He literally drags his feet on walk time and wants to go home to Lucy. I've gotta get Lucy back in action for everyone's benefit!

Please know we are here to help in any way we can, so don't hesitate to ask any questions.

Love and hugs,
Lori

[littleone1]

Hi Sabrina,

Corky and I also want to welcome you and Lucy. Corky has a right adrenal gland tumor, but he is being treated with Trilostane.

You have gotten some good information. I don't have anything to add, since I don't have any experience with Lysodren. I hope everything goes well.

Terri

[Squirt's Mom]

Hi Sabrina and welcome to you and Lucy! :)

The really nice thing about ADH, adrenal based Cushing's, is that a cure can be affected IF the pup is a good candidate for surgery. Not all pups are. You would need to see a Board Certified surgeon to find out if this is feasible for Lucy - if this is something you might want to consider. ;) We have had several members over the years who have treated ADH medically with Lysodren and with Trilostane with success. So whatever works best for you and for Lucy is the best course of action! I would like to second what Lori has said about the dose of Lyso, tho. 50 mg per lb is the usual dose of Lyso whether in the loading phase or maintenance phase. During maintenance, you will want to give her Lyso at least 2x a week, preferably 3-4x a week instead of just once a week, tho.

How Lyso works is this - during the loading phase the drug will erode a minuscule layer of the outer cortex of the adrenal glands preventing the gland from continuously releasing cortisol - the enemy in Cushing's. Once the desired erosion is achieved, then maintenance will keep the outer cortex erosion at the same level achieved during the load. If the maintenance dose is too low or not given often enough, the adrenal cortex will regenerate allowing the glands to start releasing cortisol at the former uncontrolled rate. At this point, you would more than likely have to do another loading phase. So, the objective with maintenance is to maintain that level of erosion with the proper dose and scheduling.

The others have asked for test results so I won't repeat that but do have a few other questions for you. Is Lucy taking any other meds, supplements or herbs? Other than the ACLs, does she have any other health issues that you are aware of?

I also want to second what Lori said about changing her diet right now. Since digestive upset is one of the main side effects of the treatments for Cushing's and changing feed can also cause this upset, it could present some confusion. You need to be clear whether it is the drug is causing a problem or the feed causing a problem. ;) So, if I were you, I would hold off on a diet change until Lucy is through the loading phase and is settled in on maintenance. THEN you can start to work on her diet.

You are doing a great job of educating yourself. Knowledge is truly key when dealing with Cushing's and the more you know, the better advocate you can be for your sweet girl. Please don't hesitate to ask any questions you may have and we will do our best to help you understand. Keep reading, reading, reading! If you run out of material, just let me know - I have a whole host of links to keep you busy as do many others here. :p We can't have you getting bored, ya know! :D

I am glad you found us and look forward to learning more about the both of you in the time to come.

Hugs,
Leslie and the gang

Here are some links on ADH for you...just in case! :p

ADH
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

[lulusmom]

Hi and welcome to the forum.

The others have already posed the questions I had for you but I would like to expand on Lori's comments regarding the loading dose your vet has prescribed. Adrenal tumors are extremely resistant to lysodren and larger loading doses are necessary. Dogs with ADH are usually prescribed a loading dose of 50mg/kg to 75mg/kg and even then, it is sometimes necessary to increase the dose if the dog is not responding. If Lucy does, in fact, have an adrenal tumor, I fear that you may be looking at a very long loading period because of the very low dose. The majority of dogs have pituitary based disease and since most gp vets have limited experience with cushing's in general, I am wondering if your vet has much, if any, experience with treating an adrenal tumor. You may want to ask that question.

Like I said, a very small number of dogs have an adrenal tumor so I will be interested to see the results of the two tests your vet used to confirm an adrenal tumor diagnosis. Once you posts those, we'll be in a better position to let you know if we feel that adequate testing has been done. With the little information we have, I'd have to say no because you did not mention an abdominal ultrasound. If an adrenal tumor is involved, the vet should have wanted to check the status of the adrenal glands and the surrounding organs for possible matastases.

Just some food for thought here.....more than a few reknown endocrine specialists have switched from Lysodren to Vetoryl (Trilostane) as their number one choice of treatment for an adrenal tumor. The number one side effect of Lysodren is gastrointestinal issues and at the high doses required to get an adrenal tumor to respond, the chances of that side effect and others occurring are greatly increased. Having had the benefit of six years of emmersing myself in all things cushing's, if I were in your shoes right now, before I filled the prescription for lysodren, I would revisit the diagnosis and make absolutely certain that Lucy has an adrenal tumor and if she does, I would consider Vetoryl as a possible treatment.

Cushing's is a very graded disease which progresses at a snail's pace so there is time to make sure the diagnosis is correct and to learn more about Lysodren and Vetoryl.

Glynda

P.S. You mention that Lucy has stiff joints. Dogs with untreated cushing's don't suffer with arthritis because they are self medicating themselves. It is when the cortisol is reduced with treatment that things like arthritis and allergies are unmasked. If your vet has told you that Lucy is in pain or weak due to stiff joints, I would automatically question the cushing's diagnosis.

[Lucy'sMom]

Thanks to everyone for all this great advice. I am going to list answers to the questions and comments here:

- Tomorrow (Sat. morning) I am going to the vet office and get her file so that I can post the actual results from her tests and I will post ASAP. Kim, the Dexamethasone test was definitely done and I will double check that the first was the ACTH and post bad scores.

- When he told me it was Adrenal, I asked him how sure he was about that and he said 99% sure based on numbers and types of tests (no ultrasound was done). I also wondered about sonogram after reading here so I am kinda curious why he didn't suggest it as well. Although, he assured me he was so sure. He is not that type of board skilled surgeon so yes I would have to find one and then decide on surgery which scares me and Lucy is fed up with surgeries too. (he brought in a specialist to do her ACLs years ago). Lucy is a basket case at the vet now too fyi. It's heartbreaking taking her there. But we do what we must.

- I asked him very specifically how many Cushings patients he has treated and he assured me the number was well over 100. He said it was quite common unfortunately and not an easily treatable disease (not a favorite if he had to pick one).

- I told him I was leaning toward the Vetoryl (Trilostane) from my readings as it seemed so safe, and he said that he is not comfortable with it because he has come across some stats or stories including sudden death that he can't personally confirm but that makes him nervous enough not want to take the risk. I was kinda surprised as most things I've read have been fairly positive, at least safe. At the end of our 20 min. phone talk he ended up telling me that the other vet in his office is opting to use the Trilostane (Vetoryl) over the Lysodren at the present time. He said he is waiting for his colleague to switch over eventually to the Lysodren as the results are more effective and predictable. That was kinda interesting I thought. I know the other vet too...both seem competent from personal experience. Interesting they have different opinions in same office though.

- Leslie, Lucy is taking supplements and 1 med. I give her 1 multi-vitamin, 4 glucosamine chondroitin tabs per day (Trader Joe's Brand), 1 1200 mg Fish Oil vitamin per day, and I just started squirting salmon oil in her food too. I have also been giving her Tramadol for a while, lately (2) 50 mg. ea. per day to help with her leg soreness which my vet attributes to the ACL and arthritis he says she has developed from past surgeries.

- Glynda, I also wondered about Lucy's soreness/ stiffness since the Cushings should help in that regard with all the cortisone it is generating. Hmmm. Well she has been diagnosed as borderline Cushings for quite some time (3-4 years) even by another vet testing her with a regular check up blood panel when I had some fatty wart tumors removed from her paw. But I know that is no guarantee. I am beginning to lean toward getting that sonogram and making POSITIVE it is the adrenal tumor. I think I will go to a different vet maybe to do this just to get another opinion as well.

- Leslie, you mention that during the loading dose and maintenance period that unless the Lysodren is administered regularly etc. after loading that things could return to the original state and that loading may have to begin again. So I am wondering about the risk of just trying this Lysodren...I did fill the prescription yesterday but I haven't started. Was going to do it over this 3 day weekend when I can be with her non stop. Tuesday I have to work in day but my daughter will watch her for most of the time that day. I don't want to treat Loo like a guinea pig though so I am thinking I am going to wait to start based on everyone's concerns here.

- Thank you for links too everyone and the loading info, Addy. I am really getting an education here! I don't think I will run out of material anytime soon.

- And Lori based on the conversion, yes you are right it is low, 1500mg per day to start the load dose. My vet even assured me he was starting her low dosage, lower than recommended just to be safe. But that is one whole pill lower??? Hmmm. But I am more comfortable with lower than higher. I also made him give me a bottle of prednisone (20mg pills) in case. Thanks for mentioning that about the ACTH test and waiting for 36 hours or so after load. I would have had her in there even when I was still loading her, just to make sure that she was OK but sounds like that would not yield very accurate results anyways and I don't want to overly stress her out dragging her down there every few days. Plus my vet will think I am one of "those". :)

- And no I will not change her diet right now for sure. You are all correct in that I should be able to monitor any change in diet and not smart to change food if I am trying to get an accurate read on her intake and output so I will wait on that.

- Terri I was wondering about Trilostane and how Corky is doing on that drug? Have you seen good results? The Trilostane just seemed safer to me. I have to spend more time here and figure out how to find everyone's stories etc. :)

Thank you again everyone...so appreciated! And I will get test scores to post tomorrow morning, and I think I am going to postpone beginning the Lysodren loading dose even though my family is so anxious for Lucy to start feeling better right NOW! So hard watching her feel so uncomfortable and not be able to play and have fun.

All the best,
Sabrina

[labblab]

Dear Sabrina,

Welcome from me, too! You have already been given lots of good information, so I will only add a couple of additional thoughts. First of all, I agree that it is wise to postpone starting treatment until you feel really confident about the testing results and treatment options. However, even if an adrenal tumor is confirmed, I do understand that Lucy may not be a good surgical candidate due to her age and overall medical condition.

Regarding medication choice, like Glynda, I'm also aware that many specialists are now primarily recommending trilostane for both pituitary and adrenal Cushing's. However, it's my understanding that some adrenal tumors actually shrink through the use of Lysodren, which is not the case with trilostane. In my own mind, this might be a reason for favoring giving Lysodren a try if you do settle upon moving forward with medication and Lucy does suffer from an adrenal tumor. Since I have never had the occasion to discuss this issue with my own vet (Lysodren's potential to shrink or limit the growth of some adrenal tumors), I cannot give you any specifics re: statistics and pros-and-cons. But it is an issue that I would want to talk over if my dog was diagnosed with an adrenal tumor.

Like the others, I will be very interested in Lucy's actual test results.

Marianne

[frijole]

:D As you can see - there is no 'rule book' for cushing's. Each dog is different. But back to the ultrasound... I'll share my experience(s) - two dogs - both diagnosed with cushings (different times). Neither time did the vet do an ultrasound - probably because his office did not have the equipment to do it. First case - no biggie because my dog did have cushing's. Second case - my dog was misdiagnosed. I gave lysodren to a dog that didn't have cushings! I ended up taking her to a board certified specialist and had to drive 5 hrs each way (closest one) but it was worth the effort. If I had done that earlier on I would have saved thousands of dollars (I had like 7 total false positives for cushings) AND time and STRESS.

The ultrasound helps confirm/or not the diagnosis and it gives the vet a feel for what is going on with the surrounding organs. It should be done on a high resolution machine and frankly I prefer specialists because they have people trained on how to read the ultrasounds. (the one I had done locally missed what was wrong with my dog but Kansas State got it right)

As you can see - it is a disease that is easily treated but not so easily diagnosed so you want to make sure you get it right and the person driving the bus is seasoned. My two cents. Kim

[littleone1]

Hi Sabrina,

Corky has been taking Trilostane for 21 months, and he has been doing very well on it. His IMS felt that Trilo would be easier on him because of his age and his medical issues. His dosage has had to be adjusted several times, but Corky has had no problems with the increases. His clinical signs are under control until his cortisol level increases. Once he starts a higher dosage, his clinical signs are under control again.

[Lucy'sMom]

http://samshots.smugmug.com/Animals/Lucys-Lab-Results/17850284_WxnvZm

The link above will take you to the test results from Lucy's two tests which I have posted online. Moving your cursor over the pic will allow you the option to view it in a larger window. If you have a chance to take a look I would be most appreciative. Thank you so much! When I saw the Triglycerides and Glucose I was really surprised. I am thinking the Glucose must have been an error. But seems like Diabetes is something I should specifically test for as well maybe?

Thank you,
Sabrina and Lucy

[Lucy'sMom]

Hi Sabrina,

Corky has been taking Trilostane for 21 months, and he has been doing very well on it. His IMS felt that Trilo would be easier on him because of his age and his medical issues. His dosage has had to be adjusted several times, but Corky has had no problems with the increases. His clinical signs are under control until his cortisol level increases. Once he starts a higher dosage, his clinical signs are under control again.
That is great news about Corky. I am happy to hear that Trilostane has been working so well for so long! Very encouraging...Thank you

[labblab]

Hi again, Sabrina.

I will leave it to others to comment on the significance of such a low glucose level, other than to say that low glucose is the opposite of diabetes. I don't know much at all about hypoglycemia (low blood sugar), but I've got to agree that Lucy's result is certainly far below the norm.

But as far as the results of her low dose dex test, I am now very confused by your vet's interpretation that Lucy's Cushing's is adrenal based. These are her results per your lab summary:

Baseline: 3.2 ug/dl
4 hr level: 1.2 ug/dl
8 hr level: 2.3 ug/dl

With those results, she meets both of the laboratory's listed criteria for PITUITARY Cushing's: a four-hour level that is <1.4, and either a four-hour or eight-hour level that is <1/2 of the baseline value.

I am not seeing any other results for a Cushing's-specific test, so I am really puzzled as to how/why your vet is concluding that Lucy has the adrenal form of the disease....:confused:

Marianne

[Lucy'sMom]

Hi Marianne,
Yes, I completely agree with you on the Adrenal vs. Pituitary. Once I understood what I was reading I was just saying the exact same thing to my family. Vet is working tomorrow I am going to call him. As far as the glucose goes, I seriously think that they mishandled the testing there. The hyperglycemia could be in part to her not having any food since the previous night but 19 is crazy. I think it is just plain wrong. I was interested in the Triglycerides level at 600 something and high on cholesterol too.

Thank you!
Sabrina