CoGeo
02-18-2013, 06:58 PM
Hello,
My 11 year old Yorkiepoo was diagnosed with cushings on Jan 25th. we did an ultrasound, and learned that she had the rarest of rare cushings, in which they found tumor on her left adrenal, and nodule on her right adrenal gland. My vet said this was extremely rare, and though he is very well versed with Cushings, he recommended that I seek second opinion from a specialist. I am posting to this forum, because I am so confused and torn as to what to do for my little girl. she is my heart and soul, and I am scared and so very nervous about what is in our future. I am wondering if anyone else has gone through a similar experience, and can share what I could experience over the next few months, what i should do etc. We are leaning towards the surgery (and we are ok with the expense) but my heart is heavy in trying to make the right decision for Coco.
the following is her medical report as well as what the Specialist's recommendations:
"Coco is an 11 year old Yorkshire terrier mix that was referred for evaluation due to a diagnosis of Cushing's disease and a finding of bilateral adrenal masses. She has a previous history of a left RACL repair and hypothyroidism for which she receives 0.05mg thyroxin BID. She presented recently for a routine geriatric evaluation. The owner believes that she has always drank alot of water but she seems to be drinking noticably more than the other dog. She also seems to be begging more for food. In addition the owner notes that her hair is thinning on her ears and tail. A CBC and chemistry were normal. Urine was dilute at 1.022, but otherwise normal. Based on her clinical signs, a LDDST was performed and was diagnostic for Cushings disease. THe pattern (4.3, 3.4, 3.7) was suggestive of adrenal based disease. An abdominal ultrasound was performed and found a large adrenal mass on the left and a 1cm adrenal nodule on the right. There was also some evidence of mild chronic renal changes.
On physical examination Coco was bright and alert. She has a slightly thin hair coat and pendulous abdomen. There is some thickening of the left stifle. Heart and lung sounds, peripheral lymph nodes and abdominal palpation were unremarkable. T 101.7, P 119, R 30 Wt 2.28
Unfortunately, there is not a way to determine if the adrenal masses are cortical or medullary without histopathology. There are several possible combinations of what may be occurring:
-two adrenocortical carcinomas
-two adrenocortical adenomas
-one carcinoma, one adenoma
-one carcioma, one pheochromocytoma
-one adenoma one pheochromocytoma
This gives us several options:
-remove both adrenals and treat as hypoadrenocorticism (we have done several bilateral adrenalectomies here with good outcomes - all dogs). I consider this the most aggressive, but also the most likely to eliminate the problem.
-remove the large mass and re-evaluate for Cushing's or monitor for signs of a pheochromocytoma afterward to determine if the 1cm nodule is functional. If it is, it could be treated medically (still would not know if it were malignant), or a second surgery could be performed.
-treat medically with the knowledge that if it is a pheochromocytoma or an adenocarcinoma, metastasis could be expected within 6 months to one year, as well as the knowledge that not all adrenal tumors respond to lysodren.
My particular recommendation would be the first, more aggressive option. The cost and risk of removing both adrenals is not significantly more than removing one. I also sought the opinion of our other internist. He would lean more toward the second option because often adrenal nodules are benign. I discussed all of these options with the owner and we are sending her an estimate for a bilateral adrenalectomy. I also asked Dr. Mison to look into the feasibility of a partial adrenalectomy on the right side. Meanwhile, [/I]regardless of the choice of surgery, medical management is indicated.
Lysodren will be compounded into 100mg/ml solution - give 1/2 ml twice for induction, then 1/4ml four times per week for maintenance. Not all adrenal tumors are responsive, and some require much higher doses of lysodren than are typically used with pituitary dependent disease."
thanks for reading, and appreciate any feedback.
My 11 year old Yorkiepoo was diagnosed with cushings on Jan 25th. we did an ultrasound, and learned that she had the rarest of rare cushings, in which they found tumor on her left adrenal, and nodule on her right adrenal gland. My vet said this was extremely rare, and though he is very well versed with Cushings, he recommended that I seek second opinion from a specialist. I am posting to this forum, because I am so confused and torn as to what to do for my little girl. she is my heart and soul, and I am scared and so very nervous about what is in our future. I am wondering if anyone else has gone through a similar experience, and can share what I could experience over the next few months, what i should do etc. We are leaning towards the surgery (and we are ok with the expense) but my heart is heavy in trying to make the right decision for Coco.
the following is her medical report as well as what the Specialist's recommendations:
"Coco is an 11 year old Yorkshire terrier mix that was referred for evaluation due to a diagnosis of Cushing's disease and a finding of bilateral adrenal masses. She has a previous history of a left RACL repair and hypothyroidism for which she receives 0.05mg thyroxin BID. She presented recently for a routine geriatric evaluation. The owner believes that she has always drank alot of water but she seems to be drinking noticably more than the other dog. She also seems to be begging more for food. In addition the owner notes that her hair is thinning on her ears and tail. A CBC and chemistry were normal. Urine was dilute at 1.022, but otherwise normal. Based on her clinical signs, a LDDST was performed and was diagnostic for Cushings disease. THe pattern (4.3, 3.4, 3.7) was suggestive of adrenal based disease. An abdominal ultrasound was performed and found a large adrenal mass on the left and a 1cm adrenal nodule on the right. There was also some evidence of mild chronic renal changes.
On physical examination Coco was bright and alert. She has a slightly thin hair coat and pendulous abdomen. There is some thickening of the left stifle. Heart and lung sounds, peripheral lymph nodes and abdominal palpation were unremarkable. T 101.7, P 119, R 30 Wt 2.28
Unfortunately, there is not a way to determine if the adrenal masses are cortical or medullary without histopathology. There are several possible combinations of what may be occurring:
-two adrenocortical carcinomas
-two adrenocortical adenomas
-one carcinoma, one adenoma
-one carcioma, one pheochromocytoma
-one adenoma one pheochromocytoma
This gives us several options:
-remove both adrenals and treat as hypoadrenocorticism (we have done several bilateral adrenalectomies here with good outcomes - all dogs). I consider this the most aggressive, but also the most likely to eliminate the problem.
-remove the large mass and re-evaluate for Cushing's or monitor for signs of a pheochromocytoma afterward to determine if the 1cm nodule is functional. If it is, it could be treated medically (still would not know if it were malignant), or a second surgery could be performed.
-treat medically with the knowledge that if it is a pheochromocytoma or an adenocarcinoma, metastasis could be expected within 6 months to one year, as well as the knowledge that not all adrenal tumors respond to lysodren.
My particular recommendation would be the first, more aggressive option. The cost and risk of removing both adrenals is not significantly more than removing one. I also sought the opinion of our other internist. He would lean more toward the second option because often adrenal nodules are benign. I discussed all of these options with the owner and we are sending her an estimate for a bilateral adrenalectomy. I also asked Dr. Mison to look into the feasibility of a partial adrenalectomy on the right side. Meanwhile, [/I]regardless of the choice of surgery, medical management is indicated.
Lysodren will be compounded into 100mg/ml solution - give 1/2 ml twice for induction, then 1/4ml four times per week for maintenance. Not all adrenal tumors are responsive, and some require much higher doses of lysodren than are typically used with pituitary dependent disease."
thanks for reading, and appreciate any feedback.