Vetoryl causing Addison's reaction? (6-7 y/o male english bulldog/basset hound mix)

[Apex]

Hi all, my mothers dog was recently diagnosed with pituitary dependent cushing's. After a little research I found this forum and thought I might call upon your experience for some help. My mom is not computer literate and her dog is her world so any information you can give me to relay to her or her vet would be greatly appreciated.

Here are the basics:
* 6-7 year old male english bulldog/basset hound mix
* Weight = about 85lbs
* Diagnosed with Cushing's about a month ago after pre-surgery blood work (was going to have a growth on his arm removed) showed hyperglycemia.
* Started on Vetoryl about a month ago at 60mg bi-daily twelve hours apart. Weekly (or bi-weekly I cant recall) blood tests prompted the vet to up the dose twice - first to 90mg bid, then to 120mg bid. I do not have test data at this time but can request it from the vet if necessary.
* Starting 3 nights ago he has been experiencing the same symptoms every night (only at night, starting around 7pm) - uncontrollable shaking/shivering, refuses to eat, does not want to move, yelps when touched/moved
* Tonight there are 2 additional symptoms - panting, and possible disorientation (he cannot seem to stay still - he will lay down and after 30 sec get up and slowly wander around, then lay down again and repeat the process).
* In the morning he seems better - eats breakfast and takes his Vetoryl, no shaking

Obviously this reaction is causing him not to take his evening Vetoryl dose.

My first thought was painful arthritis at night due to lowered cortisol levels. My mom managed to get him to take dog asprin last night and said he stopped shaking. She talked to the vet today who told her I was "exactly right" about the arthritis and prescribed a medication for pain and another for arthritis. Tonight he displays the same symptoms however it seems impossible to get him to take the pain meds. He just wants to stand in one place or wander around shaking and panting (seems like he doesnt even want to lay down). At one point he was dry heaving. Has absolutely no interest in food.

At this point I am wondering about the possibility of the morning Vetoryl dose causing his cortisol to drop too low at night and cause an Addison's reaction. Then, after refusing his evening dose, cortisol returns to a normal or elevated level by morning and the symptoms alleviate.

Have any of you encountered such a reaction?

Im sure there is information I am leaving out, feel free to inquire if you feel that you may have an idea. Of course, my mom is beside herself watching him like this and feeling like there is nothing she can do. I am going to suggest she take him in to the vet tomorrow, however we are not wealthy and the testing/meds are really starting to add up quick.

Thank you in advance,

C

[mytil]

Hi and welcome to our site. I am sorry your Mom's pup is having these troubles.

Yes, when you can post the results of the tests performed to diagnose the Cushing's and include the high numbers from the blood panel (include the glucose levels as well since you mentioned hyperglycemia).

It seems the dosage is a bit high for a dog his weight. So he is getting 120 bid, right? 60mgs in the am and 60 in the pm and your Mom has stopped giving his pm dose due to recent symptoms, right?

The typical dose is 1mg per pound. What were the results of the most recent ACTH stim test - that is important as it will show the level of cortisol. Too low cortisol can cause these recent symptoms - low cortisol can also affect the electrolyte levels which can be dangerous.

I am also thinking about pancreatitis (swelling/inflammation of the pancreas. There is a higher incidence of pancreatitis in dogs with Cushing’s. Specific testing needs to be done showing elevated amylase and/or lipase levels. It is very painful for dog. Please talk with your vet about this.

There are a number of things that could be happening here though. I agree as cortisol levels drop and arthritis issues surface but he is young and has he experienced any arthritis issues before?

The fact that he returns to normal after the Vetoryl leaves his system would have me worried that it may not be Cushing's and something else.

And do not hesitate to stop the meds altogether for a bit and get him to an ER vet.

Looking forward to those numbers.
Terry

[labblab]

Hello from me, too, and I am very worried that your mom's dog is indeed being overdosed on the Vetoryl. Terry is correct that the manufacturers of Vetoryl are currently advising an initial dosing formula of only 1 mg. per pound, and unless the cortisol level appears to be dropping too low, this dosage should remain unchanged for approx. the first month of treatment. This is because cortisol levels continue to drop downward during this time period, even when left on the same dose of the drug. The fact that your mom's dog has experienced two increases during this first month is extremely worrisome, especially given the whopping size of the dose. To top things off, we have been warned by an endocrinology specialist that dogs being dosed twice daily run a greater risk of adrenal oversuppression and therefore need to be monitored even more closely than those being dosed once daily.

What this all adds up to is great concern in my own mind that your mom's dog is experiencing an Addisonian reaction. I think he needs another ACTH test ASAP, and the trilostane needs to be totally discontinued until the results are known. He may even need some supplemental prednisone to bolster his steroid reserves right now.

Here is a link to Dechra's Treatment and Monitoring Brochure. In the flowchart that is included, you'll see their recommendation to leave the initial dose unchanged during the first thirty days unless there is concern that the cortisol has dropped too low.

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

If you can round up those previous ACTH results, that would be very helpful. Also, what other tests were performed to diagnose the Cushing's in the first place? Elevated blood sugar should not have been the basis for the diagnosis alone, and for that matter, has diabetes been ruled out as the presenting problem instead of Cushing's?

I know these are a lot of questions, but your mom's dog could be in serious trouble from the trilostane right now. When in doubt, it is always safer to withhold the medication than to overdose.

Marianne

[labblab]

Just wanted to add this P.S. that you and/or your mom's vet can contact Dechra directly in order to receive guidance about your mom's dog's situation. As I said above, I don't believe they would have advised initially increasing the dose beyond the 60 mg. twice daily with which the treatment was begun, especially since that amount already is somewhat higher than the 1 mg. per pound formula. But they can advise your vet directly as to how to handle things from this point onward.

http://www.dechra-us.com/Default.aspx?ID=365

You can try calling them directly yourself if you wish. Sometimes they will talk to owners; sometimes they prefer to talk to vets. That part is somewhat frustrating to us here on the forum. But at least you can try to make the initial contact if you wish to do so.

Marianne