Hello from new member

[BarneysMom]

Hello. My dog is Barney, an 11 year old Yorkshire Terrier. His ALP has been elevated for some time and I am wondering about Cushing's.....His vets are not leaning toward this but it is common in the breed.

Does the cortisol creatinine ratio test rule out all forms of cushing's including the atypical kind? I understand that it does not necessarily diagnose Cushing's, but was wondering if it ruled out all the versions.

Thank you,
BarneysMom

[Harley PoMMom]

Dogs that have atypical cushing's can have positive results from the UC:CR test. So, IMO, if a dog has a negative response on an UC:CR test than Cushing Disease, atypical or conventional, is highly unlikey.

Many issues can elevate the ALP such as gastric problems.

Strong symptoms are a huge part of a confirmed Cushing diagnosis. Does Barney have any Cushing symptoms?

So happy you found us and we will help you and Barney in any way we can.

Love and hugs,
Lori

[BarneysMom]

Thank you for your response. Barney's ALP has gone from the 200s to 671 since December. Lately, his urine stinks. I have taken him for two urinalysis tests and an ultrasound of the bladder but nothing appears wrong. He is urinating a lot and drinking a lot as well.

No one has done any cushings test but he did have an ultrasound of the kidneys and liver in Feb. and the internal medicine specialist thinks that it's a liver issue -- his suspicion is vacuolar hepatopathy -- however, one of the rule outs is Cushings even if I were to confirm this via biopsy (and I'm disinclined to do a liver biopsy due to the risks when the treatment either way may be the same, i.e. liver supportive medications)

I am not understanding why no one wants to test him for Cushings - I was trying to see if I should just push my vet to do the Cortisol:Creatinine ratio test to figure out if I can rule this out.

What do you think?

[Harley PoMMom]

Urine that has a strong or stinky odor should be investigated. UTI's or diabetes come to my mind as a possibility of the stinky smell and the excessive urination and drinking.

Has diabetes been ruled out?

[BarneysMom]

Urine that has a strong or stinky odor should be investigated. UTI's or diabetes come to my mind as a possibility of the stinky smell and the excessive urination and drinking.

Has diabetes been ruled out?

Well UTIs are rule out and diabetes didn't seem to be suspected either. I am so frustrated.

[Harley PoMMom]

Was a recent chemistry blood panel done on Barney? If so, what is his glucose level? Also was glucose found in his urine on an Urinalysis test?

[Eskimo'sMom]

I dont know if this will help, but Eskimo showed clinical signs of Cushings and two tests were given that lead to her not having the disease. It was the ACTH Stim test with the Deprivation test and speaking to a specialist that confirmed she had Cushings. I am now convinced after almost a year of test and research that Eskimo does have Cushings.

I am also not afraid of the disease as I was before.

[lulusmom]

Hi and welcome to the forum.

With the exception of excessiving drinking and peeing, it doesn't sound like Barney has any other symptoms associated with cushing's. As Lori said, symptoms are a huge component of a diagnosis so lack of symptoms may be why your IMS and/or gp vet has not felt the need to test for it. I will tell you that most dogs with cushing's do drink and pee in excess; however, their pee usually has no smell as it is extremely dilute due. I see you had a urinalysis done. Did your vet do an actual culture and did s/he check the urine specific gravity? Can you please get copies of the results and post here?

I also see there was an ultrasound done in February. If the radiologist did a good job, your IMS should have been able to see the adrenal glands and if they were normal at that time, this could be yet another reason why s/he does not feel the need to pursue a cushing's diagnosis. Do you have a copy of the ultrasound findings? If not, perhaps you can get a copy and post the comments here.

Given the information you have provided so far, I am not seeing red flags screaming cushing's and I personally would not feel compelled to spend money on testing at this point. I think we will be in a much better position to offer up more meaningful feedback once you have posted test results and answered our incessant questions. Sorry for the grilling but it's part of the initiation. :p:D:p

Glynda

[BarneysMom]

Hi and welcome to the forum.

With the exception of excessiving drinking and peeing, it doesn't sound like Barney has any other symptoms associated with cushing's. As Lori said, symptoms are a huge component of a diagnosis so lack of symptoms may be why your IMS and/or gp vet has not felt the need to test for it. I will tell you that most dogs with cushing's do drink and pee in excess; however, their pee usually has no smell as it is extremely dilute due. I see you had a urinalysis done. Did your vet do an actual culture and did s/he check the urine specific gravity? Can you please get copies of the results and post here?

I also see there was an ultrasound done in February. If the radiologist did a good job, your IMS should have been able to see the adrenal glands and if they were normal at that time, this could be yet another reason why s/he does not feel the need to pursue a cushing's diagnosis. Do you have a copy of the ultrasound findings? If not, perhaps you can get a copy and post the comments here.

Given the information you have provided so far, I am not seeing red flags screaming cushing's and I personally would not feel compelled to spend money on testing at this point. I think we will be in a much better position to offer up more meaningful feedback once you have posted test results and answered our incessant questions. Sorry for the grilling but it's part of the initiation. :p:D:p

Glynda

Thanks for the info. I would post the results but they are all normal with the exception of ALP and ALT so there is not much to glean, and they are in PDF format so I don't know how to do it. His urine is completely normal which is why this is so frustrating because it smells foul. And yes the u/s was normal on the adrenals. I took a chance to post here and ask about the Cortisol / Creatinine ratio test before I started liver treatment since his presumptive diagnosis is vacuolar hepatopathy and I had read that dogs with atypical Cushing's can have vacuolar hepatopathy. So even if I confirm the liver disease by biopsy (which I really don't want to do as there is a risk of bleeding that is increase in a toy dog and treatment would be the same in any event), I would still not know if the VH was due to atypical Cushing's. This is what led me to this forum for info on testing. If it is a matter of a simple urine test to rule out Cushing's, I was thinking it might be worth doing.

[lulusmom]

Can you post the ALP and ALT numbers along with the reference ranges? Just curious but not sure it will change my layman's opinion. If Barney's ALT is mildly elevated, then Barney has the typical cushing's pattern but in the absence of symptoms, there's no need to do a bunch of tests for cushing's. Your assumptions about atypical cushing's are well founded. The Canine Liver Disease Foundation had an interesting blurb on a condition known as Ideopathic Vacuolar Hepatopathy which you might find interesting. I've bolded the sentence that is really important here.


This is a diagnosis frequently observed in older dogs. These cases appear typical of steroid hepatopathies based on histopathologic examination and abnormal serum ALP, but without clinical or laboratory evidence of hyperadrenocorticism. The liver of these dogs contains excess glycogen, and they have laboratory findings of predominately G-ALP isoenzymes. One is unable to make the diagnosis of hyperadrenocorticism based on lack of typical clinical signs and normal conventional adrenal testing (i.e., ACTH stimulation or low-dose dexamethasone suppression test). Several dogs recently discovered having vacuolar hepatopathy and increased serum ALP without overt hyperadrenocorticism have abnormal concentrations in some of the other adrenal steroids (i.e., sex hormones such as progesterone and 17alpha-hydroxy-progesterone). It has been documented that progestin steroids bind to hepatic glucocorticoid receptors and will induce a steroid hepatopathy when given orally to dogs. There is now speculation that increases in progestin steroid hormones may result in the hepatic changes and serum ALP increase. It appears that most, if not all, of these dogs live a prolonged life without adverse consequences from their liver disease. The reason for abnormal progestin levels may be secondary to adrenal adenomas, adrenal enzyme deficiency for converting precursors to cortisol or inapparent adrenal masses. Adrenal adenomas have been shown to secrete high levels of 17-hydroxyprogesterone in dogs.

Treatment for typical and atypical cushing's is not prescribed to cure the condition but rather to remedy the symptoms which are usually more problematic for the pet owner than the dog. Barney has no symptoms so I think there is a very good chance that he has Ideopathic Vacuolar Hepatopathy and if he does, you do nothing or, if he is not already on liver support, discuss this with your vet. I agree with you about the liver biopsy and would pass on that suggestion. I wish I had an answer for the foul smelling urine. Is Barney a big water drinker? If he isn't, is it possible that what you are smelling is a very highly concentrated urine? Have you considered consulting with an internal medicine specialist?

[BarneysMom]

Can you post the ALP and ALT numbers along with the reference ranges?

ALP = 671 (range 5-131)
ALT = 174 (range 12-118)

One month prior
ALP = 441
ALT = 119 same ranges

[BarneysMom]

Can you post the ALP and ALT numbers along with the reference ranges? Just curious but not sure it will change my layman's opinion. If Barney's ALT is mildly elevated, then Barney has the typical cushing's pattern but in the absence of symptoms, there's no need to do a bunch of tests for cushing's. Your assumptions about atypical cushing's are well founded. The Canine Liver Disease Foundation had an interesting blurb on a condition known as Ideopathic Vacuolar Hepatopathy which you might find interesting. I've bolded the sentence that is really important here.



Treatment for typical and atypical cushing's is not prescribed to cure the condition but rather to remedy the symptoms which are usually more problematic for the pet owner than the dog. Barney has no symptoms so I think there is a very good chance that he has Ideopathic Vacuolar Hepatopathy and if he does, you do nothing or, if he is not already on liver support, discuss this with your vet. I agree with you about the liver biopsy and would pass on that suggestion. I wish I had an answer for the foul smelling urine. Is Barney a big water drinker? If he isn't, is it possible that what you are smelling is a very highly concentrated urine? Have you considered consulting with an internal medicine specialist?

He is a big water drinker, and he pees a lot. I would say that I think we've been leaning toward a greater bit of drinking and peeing, but it's so hard to be sure. The urine smell is not that of a concentrated urine. I have two other dogs and his urine just smells abnormal. It's also something different than his urine of the past 11 years.

And thank you for the bolded sentence :)
The ACVIM vet did suggest we start Ursadiol and Denosyl for his liver.

[lulusmom]

Like I said, I wish I had an answer for you about the foul smelling urine. If you haven't had Barney on a round of antibiotics, that might be worth a try.

[Harley PoMMom]

I was wondering if you noticed a foamy urine while Barney is urinating? Also what color is Barney's urine? Sometimes foul smelling urine can be a symptom of an underlying kidney problem.

[BarneysMom]

I was wondering if you noticed a foamy urine while Barney is urinating? Also what color is Barney's urine? Sometimes foul smelling urine can be a symptom of an underlying kidney problem.


No, his urine is normal in color. I took him to the vet today, I asked her to run a cortisol creatinine ratio. She does not think he has symptoms to lead toward cushing's. I will post the results.

Thank you all so much so far!!

[Roxee's Dad]

Hi Barneys Mom,
A Belated welcome from me. Regarding the urinalysis, did the vet do a culture? I ask because I could swear my little one had a UTI due to the discoloring around her little private parts..... Vet tested her urine twice and said no infection.. the 3rd time I asked for a culture and an infection was found and with medication, it was cleared up quickly.

[Harley PoMMom]

I agree with John, the culture and sensitivity test could be beneficial at determining if any bacteria is present because a free-catch urinalysis does not always show if an UTI is present.

[BarneysMom]

We did two urinalysis - both were taken by sterile technique (cystocentesis) and were clean. I told her it's gone on too long, and she agreed the smell is funky. We are just treating with 3 weeks of antibiotics. Not ideal to treat without proof but I know my dog and his urine is not right and antibiotics won't hurt.

I am hoping to have the results of the UCCR tomorrow. After talking to you guys, it seems my vets are right on with this and he's not Cushing's w/o symptoms but I'll update as soon as I know the results.

[lulusmom]

This method of collection is done for routine urine analysis as well as urine culture and sensitivity. Do you know for certain that a urine culture was done on at least one of the two urine specimens? I'm glad that you are going to try the antibiotics and I'm keeping my fingers crossed that you'll see improvements.

[BarneysMom]

This method of collection is done for routine urine analysis as well as urine culture and sensitivity. Do you know for certain that a urine culture was done on at least one of the two urine specimens? I'm glad that you are going to try the antibiotics and I'm keeping my fingers crossed that you'll see improvements.

No, we did not do the culture at all. We should have the second time and when we talked about it on Saturday, we just said let's do antibiotics. It's not ideal but the sample that I brought for the UCCR test was not sterile and I just am tired of dealing with it so I pushed for the antibiotics. I am glad I did, because I could be imagining it, but I think the smell is already gone after three doses. She gave him clavamox and wants him on it for 21 days to make sure we cover it.

I should have my results today. I am hoping that his liver values have not gone up and that the UCCR test is normal.

[BarneysMom]

Barney's Results:

Cortisol 2.3 (urine) [Range 5-55 ug/dL]
Creatinine 39.3 (urine) [Range 100-5-- ug/dL]

Coristol/Creatinine Ratio: 18 [High]

Interpretive Comment: <13 Cushings highly unlikely
>13 consistent with but not diagnostic for Cushings, consider the ACHT or LDDS test

[lulusmom]

Unfortunately (or maybe it is fortunate), the UC:CR was done while Barney had an active UTI. This infection would definitely cause a high ratio.

[BarneysMom]

Unfortunately (or maybe it is fortunate), the UC:CR was done while Barney had an active UTI. This infection would definitely cause a high ratio.

Assuming the numbers are valid, even though the ratio is high, it seems it is because the cortisol # was so low to drive the ratio up, correct? I guess I just don't understand the test really. The other odd thing is that his liver enzymes dropped in two weeks just due to an ingredient change in his food. His ALT went to normal and ALP backed off by 223 points down to 448. It is starting to look like his liver elevations are just due to his liver and due to something else but I'm not sure yet.:confused:

[BarneysMom]

It's been 2.5 years since I first visited this site. At the time, my dog had some smelly pee and was drinking more, along with an elevated AlK phos.

His alk phos has climbed to the 800s. When it was in the 700s, the vet dermatologist suggested I look for cushingsas he was having some mild but repeat staph infections on the skin. I took him back to IMS who did an ultrasound. The adrenals were normal, and I was discouraged from doing further testing.

Fast forward........

Now 13 year old Barney started to have some sort of strange neuro symptoms like a tremor or seizure. My vet said it was IVDD disease and pain in the neck but I didn't think so. I took him to a neurologist earlier this month and decided to do neurological testing (MRI and spinal tap). This ruled out a pituitary gland tumor and some more horrific brain diseases.

I found a video of a cocker spaniel having a similar type of head tremor (my dog has both a head tremor and a more involved body twitch as well). The cocker spaniel was diagnosed with epilepsy, and later found to have cushings syndrome and put on veteroyl and lived nicely afterward for 6 months.

So I started to think more about this cushings and atypical cushings and the neurologist agreed the tremor could be due to some other disease. Last night, Barney had the ACTH test and the adrenal panel that is being sent to Univ of TN.

I have to wait a week or so. What do I need to know? Can anyone break it down for me in a simple way? I have read about some of the versions of atypical cushings that could match, but honestly, it is really hard to totally understand it.

Thanks everyone and I'll post my updates when they come.

[goldengirl88]

Just wanted to welcome you to the forum and say I am sorry your baby is having trouble. Leslie on here is really the one you need to talk to about Atypical she knows all about it. I unfortunately cannot recommend anything about that particular kind of Cushings, but will offer you some tips to make your life easier. Keep a doggy diary every day to refer back to , and always get copies of all tests you have done as the other members will want to know the numbers. Just know that you are not alone and everyone here will help and support you. I hope to hear that your baby is doing well soon. Blessings
Patti

[addy]

hi, glad you are back,

Atypical is when intermediate hormones are elevated and cortisol is not.

I would think you still would be seeing other symptoms. Repeated skin infections can lead to testing of Cushings. Derm vets are being adviced to start looking down that road more often these days. At least according to the articles on DVM 360.

I m not sure I would leap from tremors and elevated alkp in the 800's thought to Cushings, even atypical.

I think we need to see more recent test results and wait for the adrenal panel from UTK.