Iatrogenic Cushing's Syndrome

[Jakes2003]

Hello Everyone. I was wondering if anyone has any experience with Iatrogenic Cushing's Syndrome? Long story short , my lovable Boston Terrier who is 8 - Jakes, has always had chronic skin allergies. For years he had raw paws, raw skin and it was a very big challenge to get him comfortable. Finally Atopica was tried at 20mg a day with Ketoconazole in the AM for his constant skin yeast infections. At the end of this summer my vet tested him for Cushings due to some hair loss. Keep in mind that his skin was now in "better" condition but now hair loss. No infections etc. So they do the blood tests and special cushings test and the conclusion was Iatrogenic Cushing's Syndrome or "Cushonoid". He has ALL the classic symptoms...it's so hard to watch him digress. SO now I pulled him back to every other day on the Atopica and still no change. I am so upset that Atopica could have caused this. Now I want to taper him off it but fear his skin allergies will come back OR it won't help reverse the Cushings. Any ideas from your experience....anything holisitic to get him through this?

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[Cyn719]

Hi and welcome to the forum:) So sorry for the reasons you are here but you have come to the right place. The members here are very knowledgeable and will be along shortly to help answer your questions. If you can post any other information, test results , Jakes weight, his diet - anything you have that will help the members know more about him. This would be very helpful. Hang in there - again others will be along soon.

hugs xo

[jmac]

Hi there,

I would like to welcome you to the forum as well. Unfortunately, I don't have a lot of knowledge about Iatrogenic Cushing's myself, but you have definitely come to the right place! From what I do know (I think), I believe if you stop the treatment with whatever is causing the Cushing's symptoms (Atpoica), it should resolve itself.

Then you are left with the issue of what you do to prevent the allergies and skin infections, which I understand is another major concern. Have you had your dog tested to find out what he is allergic to? I know my Shih Tzu has allergies and we used steroids prior to her Cushing's diagnosis. (It was not caused by the steroid). Now steroids are not an option for her. Instead, we have to use Benadryl or Hydroxyzine, or some other medication, along with some wipes and special shampoos as needed. My parents had a dog with severe allergies and chose to have it tested and gave her allergy shots to control the problem.

The good news is there are many knowledgeable, caring, and dedicated people who are here to help you and can give you more information. I am certain they will be along soon to provide you with some good advice.

Julie & Hannah

[addy]

Hi and welcome from me as well,

Sounds like you have your hands full, I am sorry but I am glad you found your way here. Usually Iatrogenic Cushings is caused by steroids and once withdrawn, the condition goes away.

But then that leaves you in a hard place. How do you control the allergies?

My Zoe has Cushings, not caused by steroids, she also has IBD. I started treating her with Trilostane last June and she is having an issue with allergies now. I am waiting to see a dermatologist. The last few months have not been fun so I can understand how you feel.

Has your vet given you any options? What classic symptoms does your pup have?

Hang in there, the moderators and administrators will all be along soon.

hugs,
addy

[Harley PoMMom]

Hi and welcome to you both!

Iatrogenic Cushing's occurs when a dog is exposed by treatment with corticosteroids, such as prednisone or dexamethasone. These synthetic corticosteroid drugs can be found in ointments, drops, creams for the eyes, ears, etc.

From my reading about Atopica (Cyclosporine), this is not a synthetic corticosteroid drug and should not of caused Iatrogenic Cushing's.

Could you get copies of all test/s that were done on Jakes and post any abnormalities here.

What symptoms did Jakes display that led you or your vet to test for Cushing's in the first place? Does Jakes have any other health issues besides allergies? Is he on any herbs/supplements/medicines?

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[StarDeb55]

Welcome to both of you! I'm in total agreement with Lori, cyclosporine should not be the culprit for Jakes. My first cushpup, Barkley, had very severe allergies, & the only medication that he could be consistently treated with was cyclosporine since it contains absolutely no steroids. Is there any possibility that he is on another allergy medication that may contain a steroid such as Temaril-P?

Debbie

[Jakes2003]

Thank you very much to each of you who presented such a warm welcome. The feedback is great. I am going to try and add the answers to questions posed. One point mentioned by Harley was that she read Atopica is not a synthetic corticosteroid. Also , I went through MANY appt's with a dermatologist trying to trend his skin problems. If anyone needs feedback on that, I can assist where I've had experience. Atopic Dermatitis.
1) I had Jakes tested for Cushings from a recommendation from the Dermatologist. Jakes was doing so good on the meds but for some reason he was losing the hair/fur around his butt and down the back of each his hind legs.
2) He is allergic to grass, dustmites and a list of trees. We tried everything , even allergy shots. :(
3) He is on Rabbit and Potato Low Protein Diet. Has been for years when we started allergy testing. That was too rule out a food allergy.
4) Besides the allergies - no other med conditions.
5) His current symptoms - distended (pot belly). Doesn't play with his sister like they used to. He can no longer jump in the car, or even on the couch. I'm assuming it's because the weight of the potbelly is heavy.
His last appt was 6 months ago. The options my vet gave were to try meds for the cushings . My GUT was telling me it was the Atopica so I said hold off. I tried tapering him off but I saw no turn around. I plan on setting up a follow up appt but I just can't justify putting him on a cushings med and keeping him on the Atopica.

Ladies, big hugs to you all! I am so happy to be here with a supportive group. I look forward to all your feedback.
Next visit I will def get a copy of his stats.

Marie

[Jane_scoobs]

Hi, My dog also suffers from Iatrogenic cushings as he is on high doses of predisone. As far as I am aware from reading on the internet and discussions with my vet Atopica should not cause cushings. I have tried my dog on Atopica for this very reason but unfortunately didn't work for him. From what I can remember from discussions at the time, some of the cushings meds will work with Atopica. You will need to discuss with your vet as doses may vary from the norm dependant on the mg of Atopica being given each day. Hope this helps and hope you find out the cause x

[Jakes2003]

Thank you Jane

[marie adams]

Hi Marie & Jakes,

Welcome, I am so glad you found this forum so you can get information from our experts. When I came here they helped me through the journey of Cushings. :)

Does Jakes have a ravenous appetite and is he drinking more water than usually? He might also have hind leg weakness and shaking which can be why he isn't jumping in the car or on the couch. Once I got Maddie's Cushings undercontrol she could climb the stairs better and jump on the bed.

Take care and ask as many questions as you have along the way--everyone here is wonderful and caring...:)

[Jakes2003]

Hello Marie Adams,

YES! You hit the nail right on the head. His hindlegs do quiver. He definetly is always hungry and drinks alot of water.

The more I see the replies the more it makes me want to get him on a med for Cushings. Again, my concern is putting him on the Atopica and the Cush med.... I'll have a better idea after Feb 2nd what I'm going to do. I am meeting with the vet to get his test documents, etc.

Again, thank you everyone!

[Sabre's Mum]

Hi and welcome!

My first thought is to ask you whether you are using or have used any creams on the skin which contain corticosteriods? As Lori mentioned these can also lead to iatrogenic cushings syndrome.

Angela

[StarDeb55]

I totally forgot in my initial response that I posted. Barkley was treated quite successfully with cyclosporine for his allergies, along with a couple of other meds, & lysodren for his Cushing's. His treatment was managed by a derm vet & an internal medicine specialist. The derm vet knew he could not use any type of steroid so that is why we went the cyclosporin route. Barkley did great with his Cushing's for nearly 8 years.

Debbie

[lulusmom]

Hi Marie and welcome to you and Jakes.

I'll try my best not to duplicate the other responses you've already received but will apologize up front if I fail.

You seem to be quite convinced that Jake has Iatrogenic Cushing's despite his having no exposure to synthetic steroids. Did your vet diagnose him or did you assume it was Iatrogenic because of the Atopica? Others have already told you that Atopica should not be causing his problems so I wonder if your vet actually confirmed the diagnosis based on a dulled or flat acth stimulation test result? We'll be able to determine this once you post the results of all testing done on Jakes. Was an abdominal ultrasound done? If so, please post the findings.

Boston Terriers are at the top of the list of breeds who are over represented relative to cushing's so it's quite possible that Jakes has naturally occuring cushing's, in which case, Trilostane or Lysodren treatment can make a big difference in his quality of life.

Will be looking forward to seeing those test results.

Glynda

[Jakes2003]

Hi There

No creams used, ever. He was diagnosed as "cushonoid". I admit I was the one that thought it was the Atopica and when he spoke about med treatment for the cushings, I said..."Let's try tapering him off the Atopica first" to see if it reverses. Also, someone asked about abdominal ultrasound, haven't done one yet.

Thanks to all of you I am finally realizing 1 ) It is possible for him to remain on Atopica and be treated for Cushings.

[Barton]

Hi and welcome. I do not have a lot of knowledge regarding drugs/interactions etc but many others members do. My information in anecdotal and I hope helpful:)

My dog Reggie has been on Cyclosporine for several months (since October 2011). He is on 25MG every other day and that is tapered from 25MG every day. The cyclosporine has not caused any increase in cushing's symptoms in Reggie.

Reggie was not on cyclosporine for skin allergies he had an immune system disorder. He was prescribed cyclosporine after he was diagnosed with Cushing's.

Not sure this is helpful but I wish you well.

[Jakes2003]

Hello Everyone. I grabbed the info from his Dex test. There was alot of info on it. What I managed to copy on to this email is below.
He is going to be seen on Monday Feb 6th as a follow up from our Oct visit to check his weight, etc and my vet and I decided to move forward with Vetoryl. Once Monday comes he'll decide the dosage, etc. I saw some good feedback on this site and another about the med. I explained to the vet that from Oct until now...I really thought it was the atopica increasing the cushings symptoms. After your kind feedback and experience I can now look at this in a new light. Thank you.

DEXAMETHASONE SUPPRESSION

PRE - DEXAMETHASONE Result: 3.8 Reference Range : 1.0 - 6.0 ug/dl
POST 4 HOUR Result: 6.3 Reference Range : LESS THAN 1.UG DL
POST 8 HOUR Result : 5.6 Reference Range : LESS THAN 1.5 UG DL

[marie adams]

Hi Marie,

I am so glad you are feeling better about everything. I knew you would get answers here. Working with your vet and having the experts here is a wonderful partnership. :D

Take care!!! :)

[lulusmom]

Hi Marie,

I am assuming the dex suppression results are the "low dose" dex (LDDS), in which case, it is consistent with cushing’s but unfortunately, those results don’t tell us whether it is pituitary or adrenal cushing’s. IMO, you should ask your vet to do an abdominal ultrasound to 1) make that determination; 2) Validate the LDDS and 3) take a really good look at the adrenal glands, as well as surrounding organs, for abnormalities. If the cushing’s is being caused by an adrenal tumor, the first treatment of choice is surgery, which is a permanent cure. Has your vet discussed the two types of cushing’s and all of the treatment options?

You mentioned that Jake drinks and pees a lot. If you told your vet about this symptom, he should have done a urinalysis, including a culture to detect bacteria/infection and to check urine specific gravity. Dogs with cushing’s, who are drinking and peeing buckets will have low specific gravity and dilute urine. Can you please post the results of the urinalysis as well as the blood chemistry that should have been done as routine screening.prior to the LDDS? Re the bloodwork, you only need to post the highs and lows and please include the normal reference ranges.

I apologize for pressing you for test results and more questions but your responses will help us provide more meaningful feedback. I'm even more cautious in a dog like Jake, who presents as a dog with autoimmune disease.

Glynda

P.S. I’ve been meaning to ask you why Jake has been on a low protein diet for so long. Single source protein diets are recommended when trying to eliminate possible causes for allergies but I am unaware of any protein restrictions. My dogs skin and allergies improved greatly when I put them on a higher good quality protein, grainless, commercially prepared raw food. It was pretty amazing actually to see the transformation. At what minimum % constitutes insufficient protein in dog food? I don’t know but I do know that insufficient protein can cause muscle wasting and weakness

[Squirt's Mom]

The NRC (National Research Council) lists a daily recommended allowance for crude protein at 3.28/kg BW (0.75). (BW = body weight) (0.75 is an exponant). They list the minimum daily requirement of 2.62/kg BW (0.75).

These are recommendations for a healthy, adult dog on maintenance feed. Seniors, geriatrics, and pups with health issues may require more protein. For our cush pups, higher good quality proteins and lower fats are recommended.

Hugs,
Leslie and the gang

PS. The NRC recommendations are from their most recent publication, 2006. For comparison, the nutrient analysis you see on commercial dog feed packages from the AAFCO are based on 1975 NRC recommendations. ;)

[lulusmom]

The NRC (National Research Council) lists a daily recommended allowance for crude protein at 3.28/kg BW (0.75). (BW = body weight) (0.75 is an exponant). They list the minimum daily requirement of 2.62/kg BW (0.75).


I am a mental midget with math. :confused: What would be adaquate protein for a 20 pound dog of Jake's age and health status?

[Squirt's Mom]

HA! You're asking me?? :D That takes a calculator than has higher functions than my little + - / * one can do and forget the brain cells!

Surely we have a mathematician or two around here???

He weighs 9.09 kgs! LOL So you would divide the 3.28 by 9.09 x the exponant of 0.75...I think...now I have a headache....

[KarenJ]

Hmmm....20lbs equals about 9kg. So if .75 is the exponent, multiply 9x.75=15? Then 3.28x15=49.2? I think?? Not sure if I read the formula right.:p

Karen

[KarenJ]

Or do you divde 9 by .75?? Better wait for someone smarter than me to respond :D

[Harley PoMMom]

You really need a scientific calculator to figure out your dog's weight to the power of 0.75. If you have Windows, there is a calculator built in that you can change to scientific.

If you're using the Microsoft calculator, make sure it is set to the scientific view. To do this, open the calculator and click on "view". Select "scientific". Enter the kg weight, then click the key with "x^y" on it, then enter ".75" (don't forget the decimal before the 75), then "=". I would round your answer to 2 decimal places.

[Squirt's Mom]

Ok....I cheated....I went to my nutrition instructor. :o

The answer is 17.12 grams per day for a 20 lb dog.

Now, the rest of the story is that this is just a recommendation - not cut in stone. I also remind you this is for a healthy, adult dog - not a cush pup or other dog with health issues; not a puppy, pregnant/lactating, senior or geriatric dog. ;)

And crude protein is just part of a balanced diet - there are 100's of permutations for proteins (specifically amino acids), fats, and carbs.

But, there's the answer to the question of the day in the field of math!