Tigger's A Typical Cushings

[pchristiano]

Just found your site and I'm so glad I did! My 11 year old Yorkie has just been diagnosed with A Typical Cushings. Finally, after a year of going round and round with different Vets and tests. One final consult tomorrow morning and then I need to sit with the info before I decide what action to take.:confused:

[frijole]

Welcome! You are in good hands. Please tell us a little bit about Tigger. Age, size, breed, symptoms.

I assume that you had the testing done by the University of Tenn. Do you have a copy of the lab results? If not, get one from the vet - Dr Oliver usually puts his recommendations right on the paperwork. He is an expert at this. Let us know what he said on the labwork.

Don't worry - Tigger will be fine. Ask questions as you are Tigger's voice in this journey. All the best, Kim

[Roxee's Dad]

Hi,
I just wanted to join in with Kim and welcome you and Tigger. There are alot of good people with alot of experiences here that will help you sort thru all this. Gain all the knowledge you can thru this forum and the links provided.

We will be looking forward to your posting of symptoms that led you to suspect cushings, test performed and test results.

John (Roxee's Dad)

[gpgscott]

Welcome to you and Tigger,

My Moria has been treated for Atypical Cushing's now for nearly two years, she exhibited syptoms for about six months before obtaining a clear diagnosis and beginning treatment. She is doing very well.

Please let us know about testwork and what treatment is being prescribed.

Best wishes. Scott

[lulusmom]

Hi and welcome to you and Tigger

My little Pomeranian, Lulu, has pituitary dependent cushing's with elevation of all adrenal hormones/steroids. So she has both typical and atypical cushing's. I will echo the others and ask that you get your hands on the University of Tennessee adrenal panel results and post them here. Also include the treatment recommendations that should be attached to the results.

If your baby girl has been diagnosed as strictly atypical, with no elevation of cortisol, then treatment is usually a snap compared to those of us who also have to treat for elevated cortisol. Melatonin and lignans, either purified or pressed hull, are the recommended treatment. Both can be purchased over the counter and are pretty inexpensive.

I'm sure sorry that it was necessary for you to find us but I'm glad you did. The more information you can give us, the better able we can provide you with meaningful feedback. Age, weight, symptoms, test results, any other medical conditions, any current meds being given?

Glynda

P.S. Your avatar picture is pretty small but Tigger looks absolutely adorable.

[pchristiano]

Thanks so much...I finally feel like I'm not alone. :)

Tigger is an 11-year old "baby doll face" Yorkie. Last Spring I noticed his coat was thinning at his neck area, skin starting to turn black.

3/08: CBC, Vet Screen & Skin Craping (negative for mites, scabies, etc.)
6/08: Dermatologist performed intense skin scraping, Thyroid Panel #2 (T4. free T4 by E) - tests negative.
7/08: ACTH Stimulation Test
8/08: Urinalysis, Vet Screen w/o CBC, Ultrasound for Adrenal Gland
8/08: Comprehensive exam w/liver chemistries
11/08: Complete Thyroid Panel at University of Michigan
12/08: Dexamethasone Suppression Test
1/09: Urine Cortisol:Creatinine Ratio & Dermatology-Cytology

Last month I decided that I needed to pursue this further & hopefully for the last time. I found a new Vet (my fourth!). Dr. Kay suggested that we do another ultrasound on the Adrenal Gland, Urinalysis and an Adrenal Panel to Univ. of Tenn.

[pchristiano]

The results confirm that Tigs has ADH. His baseline hormone #'s are very high, then they decrease. This seems unusual to me.

Cortisol 58.4 (Base slightly above normal) 133 (post ACTH)
Androstenedione 1.0 (Base above normal) 2.8 (post)
Estradiol 65.3 (Base slightly above normal) 56.1 (post)
Progesterone - did not have enough to spin
17 OH .34 (Base above normal) 1.67 (post)
Aldosterone 21.9 (Base normal) 77.4 (post)
Only the Andro. & Aldo. Baselines are normal - all hormones post ACTH in the normal range.

[pchristiano]

I'm going to talk w/Dr. Kay today...not comfortable with Mitotane & Trilostane. Curious about Aromatase enzyme-inhibiting drugs and Melatonin Implants. Any advise?
Thanks for listening...I have a feeling that this forum is going to be my new "best friend"!
Phyllis

[k9diabetes]

Hi Phyllis!

Welcome to you and Tigger! :)

We try to keep one thread per dog - helps us go back over time and see what has and hasn't been tried and tested. So I hope you don't mind... I merged your threads into one.

To update and ask questions, etc., just hit the Reply button on this thread and we will build Tigger's history over time.

Best wishes,

Natalie

[pchristiano]

Thanks Natalie...I'm having a hard time working this site. I just changed Tigs picture...not sure why it won't come up. Least of my worried.

[StarDeb55]

Phyllis, before we can offer any meaningful input on those UTK panel results, we need the normal ranges for both pre & post values, along with the reporting units. Also, as several of the others have mentioned, there should have been a treatment recommendations sheet included. Please post what that suggested.

When it comes to the prior testing, it would also help us a lot, if you could post the results of the following tests, including normal ranges & reporting units.:

UCCR
ACTH
Low Dose Dex test
Liver profile results

Welcome from me, too.

Debbie

PS- I forgot the abdominal ultrasound results, too.

[gpgscott]

If the numbers you have posted are from UTK there was also a treatment recommendation.

I don't see anything here that indicates a treatment with either Trilo or Lysodren.

I would hold off until there was a clear diagnosis, this can be maddening and can take several months but it is better than treating with Cushing's specific meds when they are not called for.

Scott

[frijole]

Phyllis,

If I read your information correctly it seems you have done alot of testing and switched vets. It's helpful if we have the big picture.

You did tests which indicate or can indicate cushings early on: acth and the low dose dex suppression test. I ASSUME (but want confirmation) that those tests were negative for cushings and that's why you have continued testing.

I also assume it is your new vet who suggested the Univ of Tenn panel which is the best next step. Like others suggested, please read that result and tell us what Dr. Oliver (from the Univ of Tenn) suggested. I have a friend whose dog was just diagnosed with atypical and right at the bottom were his recommendations for treatment and his name.

You could not be in better hands than Dr. Oliver. He is an intl. expert in this and I would recommend whatever he says to treat. The great news is that oftentimes with atypical you do not have to use the chemo drugs.

Looking forward to an update and welcome aboard! You'll feel much better knowing this group can help AND your dog will get better too!

Kim

[Squirt's Mom]

Hi Phyllis and welcome to you and Tigger! :)

My Squirt is also Atyipcal plus has been diagnosed as PDH. She is on melatonin and purified lignans only at the moment and is doing quite well. Atypical is much easier to treat IMHO and MUCH less stressful without the Lyso for her and me. :D

I have some links on Atypical including the treatment sheet folks have been telling you about. Here are the norms given on Squirt's UTK panel results and I am sure they are the same for you as well since the same lab did the testing....tho it is entirely possible I am wrong about that. :o

Cortisol ng/ml 2.1-58.8
Androstenedione ng/ml 0.1-5.7
Estradiol pg/ml 30.8-69.9
Progesterone ng/ml 0.03-0.49
17 OH Prog ng/ml 0.08-0.77
Aldeosterone pg/ml 11-139.9


Post ACTH (30 min and 1 hr) and normal ranges

Cortisol ng/ml 65.0-174.6
Androstenedione ng/ml 2.7-39.7
Estradiol pg/ml 27.9-69.2
Progesterone ng/ml 0.10-1.50
17 OH Prog pg/ml 0.40-1.62
Aldosterone pg/ml 7.2-398.5

Hope you and Tigger are doing ok and hope to hear from you soon.
Hugs,
Leslie and the girls


Atypical Cushing’s*

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=485128&sk=&date=&pageID=1

http://www.vetcontact.com/en/art.php?a=132&t=

UT Panel
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Steroid%20Profiles%20for%20Diagnosis%20of%20Atypic al%20Cushing%27s.pdf

[lulusmom]

I saw the baseline normal ranges that Leslie posted and according to those, I don't see where any of Tiggers hormones are elevated. I had a panel done for my Lullu in August, 2008 so I am inserting the baseline normal ranges from her results next to the baseline amounts you posted. Again, I don't see where there are any elevations.

Cortisol 58.4 (Base slightly above normal) 4.0-59.9 NORMAL
Androstenedione 1.0 (Base above normal) 1.9-11.9 LOW
Estradiol 65.3 (Base slightly above normal) 31.5-65.4 HIGH NORMAL
Progesterone - did not have enough to spin
17 OH .34 (Base above normal) .08-.69 NORMAL
Aldosterone 21.9 (Base normal) 11-139.9 NORMAL

Here are Leslie's Baseline Normal Ranges and I still don't see any high baseline values

Cortisol ng/ml 2.1-58.8
Androstenedione ng/ml 0.1-5.7
Estradiol pg/ml 30.8-69.9
Progesterone ng/ml 0.03-0.49
17 OH Prog ng/ml 0.08-0.77
Aldeosterone pg/ml 11-139.9

I'm wondering if they have changed the baseline and stimulated normal ranges again since Lulu and Squirt had their adrenal panels done. Can you please post the ranges from Tigger's adrenal panel results? This is all very odd and I'm sure there is a logical explanation but if not, I'd like to do some digging around. I'm sure that Dr. O can shed some light in the situation.

Glynda

[pchristiano]

Thanks Glynda...I'll post all tests tomorrow when I can sit down and concentrate:eek:. Just in from work. Also, Dr. O. is off for a week, although I did email him today to have him take a personal look at Tigger's test. I would appreciate having him give me his interpretation. I have a short day tomorrow so I will post all test results since commencement of this journey. :confused:
Thanks so much!!!
Phyllis

[pchristiano]

Here are all the #'s for the tests:

6/12/08:

Cortisol Serial 2 (ACTH)
Time: 8:30
Time: 9:30
Cortisol Sample #1: 8.9 (HIGH) Reference Range 1.0-5.0
Cortisol Sample #2: 13.1 Reference Range 8.0-17.0


Although his resting Cortisol was high, his post ACTH was in the normal range. The end diagnosis was inclusive for HAC.

Ultrasound done on Adrenal Glands - Glands normal, no sign of tumor. Nodule on spleen.

6/23/08:

Liver chemistries: ALK. Phosphatase 143 (High) reference range 10-150
ALT (SGPT) 318 (High), reference range 5-107

Retested in December, 2009, results were normal.
12/2/08:

Michigan State University - total Thyroid panels. Results all negative for Thyroid disease, either hyper or hypo. Tigger's #'s are perfect!

12/9/08:

Dexamethasone Suppression:
Pre-Dexamethasone 7.2 Reference Range 1.0 - 6.0
Post 4 hour Dex 1.5 " less than 1.5
post 8 hour Dex 1.2 " less than 1.5

Conclusion: Once again, resting # is high, post are normal. It was suggested that further testing required to differentiate PDH from adrenal tumor.

April, 2009:

Ultrasound done to recheck adrenal glands. Slight growth in size of splenic nodule.

University of Tennessee:
Test Result (Base)/Normal Range/Result (post ACTH)/Normal Range
Cortisol 58.4 2.0-56.5 133 70.6-151.2
Androstenedione 1.0 0.05-0.36 2.8 0.24-2.90
Estradiol 65.3 23.1-65.1 56.1 23.3-69.4
Progesterone - did not have enough to spin
17 OH .34 0.08-0.22 1.67 0.25-2.63
Aldosterone 21.9 11-139.9 77.4 72.9-398.5

The Cortisol & the Estradiol had high Baselines. Only the Andro. & Aldo. Baselines are normal - all hormones post ACTH in the normal range.

The results indicate "presence of increased adrenal activity (marginal).

I emailed Dr. Oliver to personally discuss this last test. Hopefully he will call me next week when he returns. I sort of fired my "new" Vet. Her actions with me were insensitive and unprofessional.

In the meantime, I'll check out the links for A-Typical Cushings and will start Tigger on Melatonin & flaxseed Oil w/lignans.

Thank you all for your help!

Phyllis .. & tigger too!

[AlisonandMia]

Does Tigger by any chance get very stressed out at the vets? High baseline numbers can be caused by stress - and can even cause a dog to test positive to Cushing's (elevated cortisol) on testing. We've seen more than a few dogs have very bad reactions to cortisol-lowering meds because of they are diagnosed and treated on the basis of tests that were affected by stress.

It does look like the adrenal over-activity is definitely minimal but even if what has been seen is simply caused by stress the flax and melatonin won't do any harm (whereas cortisol-lowering meds like Lysodren and Trilostane can if the cortisol/adrenal steroids are not actually elevated) which means there should be no downside in starting him on that treatment (flax & melatonin).

Have you had a good quality, high resolution abdominal ultrasound done?

Alison

[lulusmom]

Hi Phyllis,

I think it is very interesting that we now have three sets of reference ranges...Lulu's, Squirt's and Tiggers and they are not consistent. :confused: It appears that the 17 OH Progesterone is really the only adrenal hormone that appears to be elevated enough to raise an eyebrow. I would agree with Alison that stress could have been a factor in some of the elevations, especially the estradiol. This intermediate hormone is the most problematic and usually if it is elevated to any extent, you'll see a lot of the same symptoms that typical cushpups (elevated cortisol) have. This includes excessive drinking and peeing, increased appetite and liver abnormalities. Since Tigger's only symptoms seem to be loss of coat and change in skin pigmentation, I would bet that he has what is called pseudo cushing's aka alopecia X. I would also bet that if they had had enough blood to spin that the Progesterone is probably also elevated. I believe these two hormones are typically elevated with Alopecia X.

Has Tigger been castrated? If not, that is usually one of the first things UTK will recommend. I adopted a little Maltese rescue that was dumped at a shelter because he lost all of his hair. He was intact and after being neutered he grew a full and beautiful coat. At that point, the vet knew he had castration responsive dermatosis.

I must tell you that some dogs, especially Pomeranians and others of the Nordic Breeds and Yorkshire Terriers, may have alopecia X and never regrow their coat or they may regrow their coat only to lose it again. My Lulu has excess production of all adrenal hormones and I'm beginning to think that she may never regrow any coat at all.

I did communicate with Dr. Oliver about Lulu's woeful appearance and he said that they have had very good experience with regrowth of coat with melatonin implants. I am going to talk to Lulu's IM about that when we go for her next stim. That's something you may want to consider. I would also suggest that rather than the flaxseed oil with lignans you try the purified lignans or the pressed flaxhull. Flaxseed oil has a limited amount of lignans whereas the other two products have a minimum of 40mg.

I am providing a link to information on canine alopecia that may help you understand a bit more about the condition:

http://www.vet.utk.edu/hairloss/

Glynda

[pchristiano]

Hi Alison & Glynda, Thanks for responding.

Yes, Tigger is EXTREMELY stressed out by going to the Vets. In fact, he knows the exit off the highway and immediately starts shaking. Great observation! This could definitely be the reason for the high baselines. Tigs was neutered at 6 months so that's not the problem and his last clear ultrasound was negative for adrenal tumors. I do agree, I think that Lysodren and Trilostane might be too agressive at this stage. I'll wait to see what UTK has to offer.

I'm familiar with Canine Alopecia X...this was the diagnosis that the dermatologist had given me in December, although she did want to do a skin biopsy to rule out an underlying skin disorder. I'm contemplating having this done when I bring him in for his teeth cleaning.

In the meantime, I went and ordered Cushdrops from PetAlive. If you're not familiar with this product, check out their site. It's a homeopathic remedy to support the adrenal glands. If you are, was it successful to some degree?
www.http://nativeremedies.com
I
'll also try flaxhulls and start the melatonin again. Tigger's hair loss fits the Alopecia X pattern - Neck, rump, flank. His coat is starting to look old & wirey, like an old sheep dog, but his head and paws are full and beautiful.

How old are your babies and what patterns and symptoms do they exhibit?

Phyllis

[lulusmom]

My Lulu was diagnosed with pituitary dependent cushing's and all adrenal hormones are elevated. She is also hypothyroid so she has three strikes against her. Her skin is completely black and the only fur worthy of mentioning is on her head and legs. Her front legs have bands where she was shaven for IV's for hip surgery about a year ago and dental three months ago.

There are more than a few of the so called natural remedies online. I've written to all of them and asked point blank if studies or clinical trials had been done to prove their product's efficacy in lowering cortisol. Native Remedies responded by totally ignoring my very direct question and plying me with the same bull that is on their website. I specifically said that my dogs were being treated with Lysodren; however, I would seriously consider treating them with a natural remedy if documented proof of efficacy was available. The thing I found interesting was twice they mentioned using their product in conjunction with conventional treatment prescribed by my vet. Obviously, it doesn't work all that well if you can't forego conventional treatment. What a crock! I wrote back and said; "SHAME ON YOU!" I recommend that you save your money for the melatonin and lignans.

Glynda

[pchristiano]

Oh well, I got excited and went ahead & purchased the Cushdrops last night, also the Flaxhull. I suppose it can't hurt. I'm open for trying anything that will contribute to Tigs well being (maybe I should take some for myself...I'm going nuts!) Hard to play the waiting game. I just feel that I'm not doing enough even though I've just about exhausted every option.
Sun is out today...might just have to put a :) on my face!
Phyllis

[Harley PoMMom]

Hi Phyllis,

I was wondering how Tigger is doing?

I see you haven't posted for a while :(

Hopefully we will "see" you soon? :)

Take care, Lori and Harley