Cushings with no symptoms?

[Deb101]

Hi, I found this site while looking for answers to my dilemma. I am floundering and someone here might be able to help. Lilly is my 2 year old Yorkshire Terrier that my vet told me tested positive to Cushings during an ACTH test that he performed because she has typical symptoms of Addisons Disease. She has none of the Cushings sypmtoms except lethargy, (in fact she drinks very very little water) even he is perplexed. I have booked her in for a low dose dexamethasone suppression test on Wednesday, It doesn't make sense and I think he should be testing for something else, is there any other diseases that would give a reading of 612 on an ACTH suppression test?
One more thing I have found while searching tonight is a link to hormonal creams used by people. I have been using a natural progesterone cream for years rubbing it on the inside of my elbow joint so it would come into contact with her regularly, could this increase the readings on an ACTH test? I hope you can enlighten me

[mytil]

Hi and welcome to our site, I am sorry you and your pup are having these troubles.

When you are able there are two numbers present in an ACTH test (baseline and post). Also there are letters generally after the number, post those as well (mnol, ug/dl for example).

What prompted this testing? Where there any other symptoms present other than lethagy? Post any high values present on any blood panels your vet performed as well.

Yes, I have seen cases where exposure to topical hormonal creams can cause this.

Symptoms of Addison's disease in canines can include vomiting, diarrhea, lethargy, lack of appetite, tremors or shaking, muscle weakness, low body temperature, collapse, low heart rate, and pain in the hind quarters and Hypoglycemia can also be present.

I have come across some information and found a reference that dogs with whipworms can exhibit the same low sodium and high potassium values found in Addison's disease; their ACTH values, however, will be normal.

I know others will chime in shortly,
Terry

[labblab]

Yes, absolutely, exposure to owners' topical steroidal products can affect pets! As to whether or not progesterone exposure would elevate cortisol, I don't know. But I would think it could certainly produce abnormal symptoms, especially in a dog of such tiny body weight. Perhaps your vet can consult with the researchers at University of Tennessee at Knoxville for more information. Take a look at this thread, scrolling down to the related postings at the bottom:

http://www.k9cushings.com/forum/showthread.php?t=198

Marianne

[Deb101]

Hi Terry, thanks for your welcome. I don't have the information you are asking about re: numbers and values, the vet just tells me the results and quotes numbers which he then explains the relevancy of. I guess he doesn't want to bamboozle me. I don't think they give you a copy of the results in Australia.
This is our story so far.
Lilly came into season on the 25th January after 3 weeks she was licking her vulva more than I thought she should be, so took her up to the vet with a urine sample incase of UTI. This came back clear, so bloods were done, there were a few small abnormalities the vet said, in blood sugar and electrolytes? but the biggest was High T4 a reading of 57 (that was the number he quoted) anything over 50 is apparently high, also a very high progesterone level of 127 apparently proving she was going through a false pregnancy. So he redid the test a month later and the Progesterone had come down a bit but the T4 was still high at 58 so he thought she had hyperthyroidism, so another month and the T4 was within normal range and so was the progesterone, but had a high Reticulocyte count. Lilly did have Diahrea and vomiting and shaking about 10 days before the test but the vet said a bleed would have had to occur within the last two days so he thought it may be an internal thing. The lab said to test for Addisons. Lilly is quite thin, is a very fussy eater refusing food sometimes for a few days unless you tempt her with a tasty treat, drinks miniscule amounts of water, and sometime vomits yellow to orange bile, she became very lethargic during her false pregnancy.
So I took her in for the test and somehow the results came back positive for Cushings with a very high reading of 612??, or so the vet said?
I know I sound quite vague regarding readings etc, but I have been leaving it up to my vet to decipher it all and tell me what to do next until now.

[Deb101]

Thanks Marianne, I will look at that link now. We are in Australia, hopefully there are some experts here he can consult with. Lilly is only 2.4 kgs so yes small amounts of anything can affect her I guess.

[SoggyDoggy]

Hi and welcome from me too, nice to have another Aussie on board, even though the reason for it sucks :p

I have zero idea about what could be going on, but as for not getting the test results, you are certainly entitled to them if you want them. I just asked my vet for a copy and they were more than happy to print them out for me. They don't usually give them unless asked for, but there should be no objections if you ask.

The other option is, maybe ask your vet to call, or get a referal to consult an internal medicine specialist at a university vet school or specialist practice if there is one around. We have one of each in Perth, so there are surely more through NSW or Sydney, just a case of finding the name of who to speak to. I'm sure your vet will know who and what is around for you to find further information, and if he is stumped too, will probably welcome the extra advice. Your vet will then send copies of test results and a case history to whoever you see, which will mean you won't need to start the whole process again. It is worth thinking about as your poor baby sounds like she is having a rough time of it.

Hope you work things out quickly, her photo is precious! Take care.

[Budsters Mom]

Hello and welcome from me too. :)
I am sorry for the reason that brought you here, but so glad you found us. You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. We will do all we can to help. So again welcome to you and Your sweet little fur baby. My Buddy is a Yorky too! Huge personalities in a little package:)

Hugs,
Kathy

[Deb101]

Hi Naomi, Fraser and Oscar, nice to meet you. Pity you live on the other side of the country to me I am on the Central Coast of NSW. Thanks for the info too, I will ring the vet today and ask him to organise a copy of Lilly's results for me.
Lilly is and has been just fine for the last month, that is why this is so confusing.
Hope your lovely Fraser is doing well.

[Deb101]

Hi Kathy and Buddy, thanks for the warm welcome, I hope to have more info for you to help me with soon. You're spot on with your description of Yorkies. lol.
Cheers Debbie and Lilly

[molly muffin]

Hello and welcome to the forum.
You mention that Bood Sugar and elctrolytes were also off?
Diabetes can cause some of the same symptoms. Elctrolytes being off can cause many of the symptoms too.
Also vomiting yellow is bile, pancrease issues, liver, etc. Should all be looked at.
Has your vet mentioned having an ultrasound done? It might help to determine what is gong on inside your precious little girl.
She is adorable by the way. Yorkies are just always so darn cute!
What the numbers on the test actually show will tell us more of what might be going on with your little girl.

Sharlene and Molly Muffin

[Deb101]

Hi, my vet faxed me the results of Lillly's blood tests today but has missed out on sending the results for one of them, the one just before the ACHT test where her reticulocytes were high and the T4 wea back within normal range. So I will ask for that one on Tuesday.
I have to admit they mean nothing to me :(

I don't seem to be able to post attachments so should I type all of the results or only the ones listed outside of the normal range ?

At this point there are results for one urine test and 2 Total health tests INTERP&nbsp and results for Chemilluminescence T4&nbsp (free T4) and the results for the ACTH Stimulation test &nbsp.

I would really appreciate any feed back I can get at the moment as I am so confused, my vet has indicated at first that Lilly may have Hyperthyroidism and then the lab and my vet thought she needed to be tested for Addisons and now he thinks Cushings is likely, my emotions are in a spin. I try to find out what I can about each tentative prognosis and by the time I get my head around it , the next test throws something new into the mix and the prognosis changes . It seems by reading some of the threads here that I am not alone in getting confusing results, so I am hoping someone can recognise something in the results to shed some light. I have learnt so much already from here and I am in awe of everyone on this site the way you cope with some of the things your babies have been through and are still going through. I so wish things could be different for you all. Thanks everyone.
Cheers Debbie and Lilly.

[Mel-Tia]

Hello

Most of the knowledgeable people will still be sleeping but I am here as in uk and ahead of the states :D

Post all the results if you can as they love details for the whole picture.

I know it's hard and confusing, the tests are so important to get a confirmed diagnosis because the drugs they use to treat cushings are powerful

Hopefully it will become clearer for you both soon.

I have to say your little one looks precious in her avatar.

Mel
Xxxxx

[Deb101]

Good morning and thanks Mel, I will get to work, might try and post them as photos and see how they go

[Deb101]

OK,...... I have added Lilly's test results to my gallery as photos, some went up back to front as in order but I have put the page and the date of the test as the file name, I hope that is OK, I will type them if necessary but it will take me at least 2 weeks I fear. lol.

[SoggyDoggy]

Ok, so I don't know what I'm looking at so much with blood tests either, but on the blood panels I would draw folks' attention to the mildly elevated lymphocytes from both feb and march, also mild t4 but am I correct in seeing a zero reading for serum glucose? Obviously the pics are hard to see (even enlarged) as they are low quality being that they are web images, but it looks like repeated tests with a reading of 0.0 As I said, I don't know what this means but it would be something I would question of others that do.

No, you're not alone in the confusing diagnosis, it's actually not the norm around here to find them all that clear cut in fact. Everyone goes through the rigours at some point or other, par for the course almost - that's the hardest bit I think. But I have to follow Sharlene's question too, has your vet mentioned an ultrasound? I would think at this point that a good look around Lily's organs could actually be of assistance in finding out what's going on.

On a different note, I love the agility pic - Super Lily!:D Hope you have a good Sunday.

[molly muffin]

Well, a lot of information included on the test results, so it takes a bit of going through. I'm no Deb (our lab expert) but I took a look. So what I'm going to do is copy here, with dates, the abnormal results and some comments that are noteworthy.

30 May, 2013

ACTH
base 145nmol (15 - 170nmol) converted 5.25 ug
1st 1 hr post 613nmol converted 22.21 ug
hard to read and I think this is comment the first looks like
8gt; 600nmol consistent with hyperA
470 - 600nmol equivocal


CPL 45 range is <- 200 normal

Blood film review. Persistent mild lymphocytosis as previously.
Now the lymphocytes are mildly atypical being medium-sized fragile
cells with irregular nuclear outlines, homogeneous
chromatin, multiple small nucleoli and a minute amount of lightly
basophilic cytoplase. In a young dog - possibly reactive, but suggest
monitor again in a month or so.

15 March 2013

MCHC 383 (320 - 360 g/l) HIGH
Lymphocytes 4.1 (0.9 - 3.5 x10^9/L HIGH
Glucose, serum 0.0 (3.3 - 6.8nmol) LOW
Lipase 761 (77 - 750) HIGH
T4 59 (13 - 52nmol) HIGH

T4 FREE 47.3 (7.7 - 38.6nmol) HIGH

28 Feb 2013

MCHC 366 (330 - 360) HIGH
Lymphocytes 4.1 ( 0.9 - 3.5 x10^9/L) HIGH
Glucose, serum 0.0 (3.3 - 6.8nmol) LOW
Phosphate 3.0 (0.8 - 2.1nomol) HIGH
CA:P Ration 0.9 (1.2 - 3) LOW
Lipase 769 (77 - 750) HIGH
T4 Toal 57 (13 - 52nmol) HIGH
comment of Low glucose and elevated phosphate are likely storage artifacts, but
suggest monitor.
Monitor Lipase in future CPL (DONE MAY 2013, normal)

20 Feb 2013 Urinalysis

specific Gravity 1.056
glucose neg
bil + (small)
Ketons Negative
PH 7.0
Protein ++ (1 g/L)
RBC 5 - 10
WBC 10 - 50

(MY COMMENT - analysis of the specimen is indicative that due to the mixed
flora bacteria seen, this is most likely a contaminated specimen
due to free catch, and that a clean specimen should be submitted)

18 March 2013

Urine culture returns negative for urinary bacterial infections


Consistent high MCHC, is indicative of too much iron in the blood. (too much hymoglobin concentraction in the blood and main component of hemoglobin is iron, maybe why a bleed was considered earlier)

High Lymphocytes usually means that there has been or is an infection that the body is
trying to fight.

The low glucose is definitely of concern, but based on the ACTH test, I don't think you are looking at Addisons and since an ACTH can be high for other reasons if there is a non-adrenal problem going on, I wouldn't treat based solely on this one test.
I think I would pursue an ultrasound at this point and I'd want a pretty thorough one, including internal organs, like pancrease, adrenal glands, kidney, liver, gall bladder And thyroid.

Not sure if this helps or not, you probably already know most of this, but putting it here, will give us a chance to glance over and comment too.

Sharlene and Molly Muffin

[Deb101]

Thanks for taking the time to look at this and comment. A special thanks to you Sharlene, for putting these results up here for me.
Lilly is booked in for a LDDS Test on Wednesday and the vet said an ultrasound could be an option a bit later, he wants o see the results first. I Hope he is right , I have just changed to this vet in January, because my other vet was always too busy and they shuffled you around from person to person with no time to discuss concerns.
Debbie and Lilly

[molly muffin]

I think these test results are very thorough, and they have done follow up testing to see where the values are on the ones that are off. It is Better to run tests and see where you are at. This is a tough one, so I think it is very important that you have a good communication between you to get to the bottom of this.

Sharlene and Molly Muffin

[Deb101]

Feeling very lonely today. Lilly is at the vets having her LDDS test. The house is so empty.

[Trish]

Awww is she home yet? I am in NZ so it is getting towards end of the working day when I hope you are picking her up!! She will be fine and it will get good to get the latest results. :)

[Deb101]

Hi Trish, thanks for asking. Yes I have just picked her up and she is eating her dinner. We are getting closer to an answer I hope.

[Trish]

Awww how is she doing? Any symptoms still? I bet she is much better now she is home with dinner in front of her!! :)

Make sure you get the copies of results so you can post them here for all the experts to help interpret, hoping you get some answers soon and enjoy having her back, I know it leaves a big hole when they are away even if it is just for the day! I bet the vet nurses loved having a sweetie like her to take care of for the day :D

[Deb101]

Really at this point in time she has no symptoms, she is back to being a ball of energy. She does eat all her breakfast and dinner, which she very rarely did, but I have changed her food and I am hoping it is only because she is enjoying it more. Hopefully the results will be back on Friday.

[Trish]

Great to hear she is doing so well now! I just read back in your thread and it seems like the episode of diarrhea, vomiting and shaking was a couple of months back and then acth was abnormal? has she been good for the last month?? As the others said other conditions can cause false positives with cushings tests, so hopefully whatever was bothering her then caused that result and this one will be all good! No sign of anything to treat at this stage anyway, so that has to be good. :D

Sometimes these babies remain a mystery!

[Deb101]

It seems like an eternity but finally I have the results for Lilly's LDDS test. The vet said they are conclusive with a cushings diagnosis. I am sitting here and my heart is pounding, he wants to talk to the Lab and find out if he should start her on Mitotane straight away. I don't understand the results as she was suppressed for the 4 and 8 hr test?
Below are the results can some one decipher these please and tell me what you think.
Even now there are no symptoms and she is only 2 yrs old..
Lilly was also diagnosed with a high ACHT test results in a previous post

IDEXX LABORATORIES: Adelaide, Brisbane, Melbourne, Sydney Ph 1300 44 3399

VET: PHILLIPS, KEITH LAB No: 2000115066
CLINIC No: S1138 OWNER: LEMANSKI
CLINIC: COAST AND VALLEYS VET HOSPITAL ANIMAL ID: LILLY
UPPER COTTAGE, 141-145 ALISON ROAD SP: CANINE YORKSHIRE TERRIER
WYONG SEX AGE: FE 2Y
NEW SOUTH WALES 2259



COLLECTED: 12/06/2013 TESTS REQUESTED:
RECEIVED: 13/06/2013 Low Dose Dexamethasone Suppression
PRINTED: 13/06/2013


ENDOCRINOLOGY

Test Result Alert Units Reference Range

*CORTISOL RESTING 192 High nmol/L 15 - 170
*CORTISOL 1ST POST 7 nmol/L
*CORTISOL 2ND POST ~
*1ST POST DOSE TIME 4
*2ND POST DOSE TIME ~

General Interpretive Guidelines

Normal dog:
* baseline cortisol 15-170
nmol/L
* 4 hour post-dexamethasone cortisol <28
nmol/L
* 8 hour post-dexamethasone cortisol <28
nmol/L

Hyperadrenocorticism (hyperA):
* 8 hour post-dexamethasone cortisol >38
nmol/L consistent with hyperA
* 8 hour post-dexamethasone cortisol 28-38
nmol/L equivocal

* a small percentage of hyperA dogs may show
normal suppression in a LDDS test. Repeat testing
in 2-3 months time or
an ACTH stimulation test may be useful.
* adrenal function tests, such as the LDDS
test, may yield a false positive test result
(i.e. failure of
suppression) in:
* a sick or stressed dog with
non-adrenal disease
* a dog being treated with an
anticonvulsant such as phenobarbital














IDEXX LABORATORIES: Adelaide, Brisbane, Melbourne, Sydney Ph 1300 44 3399

VET: PHILLIPS, KEITH LAB No: 2000115066
CLINIC No: S1138 OWNER: LEMANSKI
CLINIC: COAST AND VALLEYS VET HOSPITAL ANIMAL ID: LILLY
UPPER COTTAGE, 141-145 ALISON ROAD SP: CANINE YORKSHIRE TERRIER
WYONG SEX AGE: FE 2Y
NEW SOUTH WALES 2259



ENDOCRINOLOGY

Test Result Alert Units Reference Range

* in cases where there is failure of
suppression due to non-adrenal disease or
phenobarbital, the deviation from
normal is usually not very pronounced

Localising hyperA:
* where there is failure of suppression 8
hours post-dexamethasone pituitary-dependent
hyperA may be diagnosed if any
one or more of the following three criteria
is met:
* 4 hour post-dexamethasone
cortisol <38 nmol/L
* 4 hour post-dexamethasone
cortisol <50% of the baseline cortisol
* 8 hour post-dexamethasone
cortisol <50% of the baseline cortisol
* if none of these criteria is satisfied, the
LDDS test does not differentiate between
pituitary and adrenal-dependent
hyperA (an endogenous ACTH assay, abdominal
imaging or a high dose dexamethasone test may be
useful for
further assessment).
For the endogenous ACTH test, please
contact the laboratory for the special sample
collection protocol.






Authorised by Dr. Mark Carrigan BVSc(Hons) MACVSc Dip ACVP Veterinary
Pathologist Registered Specialist.
If you require further assistance regarding this report please call 1300
44 33 99 to speak with a Pathologist.

IDEXX Laboratories is accredited for compliance with ISO/IEC 17025
(Accreditation No. 10166) in the field of Veterinary Testing.

I am hoping someone has some advice for me please
Cheers Debbie and Lilly

[labblab]

Hello, I am seeing results for Lilly's resting baseline cortisol and also for the first 4-hour draw ("7"), but there is no result listed for the second 8-hour draw ("~"). It is the 8-hour draw that is essential for the overall Cushing's diagnosis. Can you double-check the labsheet for us to see whether there is an 8-hour result listed somewhere?

Marianne

[Deb101]

Thanks Marianne. I see that too now. When I spoke to the vet said the 8 hr test result came back at 46 and it needed to be <38. I will ask him where that result is written and get a copy tomorrow.
Thanks Debbie

[Deb101]

I was told because the reading came back less than 50% of the baseline reading it is positive for pituitory Cushings.

[Deb101]

Here are the 8 hour report it was in my junk mail. Also the Vets recommendations

IDEXX LABORATORIES: Adelaide, Brisbane, Melbourne, Sydney Ph 1300 44 3399

VET: PHILLIPS, KEITH LAB No: 2000115373
CLINIC No: S1138 OWNER: LEMANSKI
CLINIC: COAST AND VALLEYS VET HOSPITAL ANIMAL ID: LILLY
UPPER COTTAGE, 141-145 ALISON ROAD SP: CANINE YORKSHIRE TERRIER
WYONG SEX AGE: F 2Y
NEW SOUTH WALES 2259



COLLECTED: 14/06/2013 TESTS REQUESTED:
RECEIVED: 14/06/2013 Low Dose Dexamethasone Suppression
PRINTED: 14/06/2013


ENDOCRINOLOGY

Test Result Alert Units Reference Range

*CORTISOL RESTING ~
*CORTISOL 1ST POST ~
*CORTISOL 2ND POST 46 nmol/L
*1ST POST DOSE TIME ~
*2ND POST DOSE TIME 8

General Interpretive Guidelines

Normal dog:
* baseline cortisol 15-170
nmol/L
* 4 hour post-dexamethasone cortisol <28
nmol/L
* 8 hour post-dexamethasone cortisol <28
nmol/L

Hyperadrenocorticism (hyperA):
* 8 hour post-dexamethasone cortisol >38
nmol/L consistent with hyperA
* 8 hour post-dexamethasone cortisol 28-38
nmol/L equivocal

* a small percentage of hyperA dogs may show
normal suppression in a LDDS test. Repeat testing
in 2-3 months time or
an ACTH stimulation test may be useful.
* adrenal function tests, such as the LDDS
test, may yield a false positive test result
(i.e. failure of
suppression) in:
* a sick or stressed dog with
non-adrenal disease
* a dog being treated with an
anticonvulsant such as phenobarbital














IDEXX LABORATORIES: Adelaide, Brisbane, Melbourne, Sydney Ph 1300 44 3399

VET: PHILLIPS, KEITH LAB No: 2000115373
CLINIC No: S1138 OWNER: LEMANSKI
CLINIC: COAST AND VALLEYS VET HOSPITAL ANIMAL ID: LILLY
UPPER COTTAGE, 141-145 ALISON ROAD SP: CANINE YORKSHIRE TERRIER
WYONG SEX AGE: F 2Y
NEW SOUTH WALES 2259



ENDOCRINOLOGY

Test Result Alert Units Reference Range

* in cases where there is failure of
suppression due to non-adrenal disease or
phenobarbital, the deviation from
normal is usually not very pronounced

Localising hyperA:
* where there is failure of suppression 8
hours post-dexamethasone pituitary-dependent
hyperA may be diagnosed if any
one or more of the following three criteria
is met:
* 4 hour post-dexamethasone
cortisol <38 nmol/L
* 4 hour post-dexamethasone
cortisol <50% of the baseline cortisol
* 8 hour post-dexamethasone
cortisol <50% of the baseline cortisol
* if none of these criteria is satisfied, the
LDDS test does not differentiate between
pituitary and adrenal-dependent
hyperA (an endogenous ACTH assay, abdominal
imaging or a high dose dexamethasone test may be
useful for
further assessment).
For the endogenous ACTH test, please
contact the laboratory for the special sample
collection protocol.


This is the 8 hour result to be interpreted with the 0 & 4 hour result on other email.

Combined wqith the ACTH response test they confirm HyperAdrenocorticism. The combined interpretation is that it is pituitary dependent HyperAdrenocorticism, which will respond readily to mitotane, a chemical which reduces the hormonal production of the Pituitary.

There is the option of referral to SASH as the further workup that can be done includes CT scanning &/or MRI. I can organise a referral for that if you wish.

I am happy to proceed in either direction- either symptomatic management with Mitotane, or else referral for scans.

Regards Keith

[labblab]

OK, then it is true that the LDDS is consistent with pituitary Cushing's. But just as is the case with the ACTH, the LDDS can return a false positive in the presence of other physical issues or stress. If Lilly's overt symptoms have all currently resolved, if she were my dog, I would just sit tight for the time being. I would be very, very hesitant to start mitotane under these circumstances because the initial loading is judged by changes in excessive thirst and appetite -- neither symptom being evidenced by Lilly at this time.

Marianne

[Deb101]

Does anyone think the MRI or CT scan would be worthwhile or even an ultrasound. They would have to be done and SASH (small animal specialist hospital) in Sydney. What else could cause a false positive for the ACHT and LDDS? Sorry for all the questions, I know everyone here is trying to care for their very own cushings babies. I feel so helpless ATM, that's all.
Cheers Debbie and Lilly

[frijole]

My Annie had a total of 7 false positives on both the acth as well as the LDDS tests. I went to a teaching hospital with top notch equipment and it was the abdominal ultrasound film that gave me answers. She had a very rare adrenal tumor (not the cushings kind). so yes - I would recommend having one done. But I had symptoms and was trying to find answers. You have no symptoms right? Scratching my head on that. Kim

[molly muffin]

I had an ultrasound done and I do believe that they can be helpful. It shows you what is going in inside. Liver, adrenal glands, pancreas, gall bladder, spleen, all of those can be seen on a good ultrasound and rule out possibilities and show you where to focus.
The best thing is that the result comes back as absolutely perfect and nothing wrong, which of course doesn't answer your question of what could be causing both LDDS and ACTH to be high.
I'm not sure, possibly any other adrenal illness.
It Could be cushings, but without symptoms, it's hard to treat, since that is what you are treating. Especially with mitane that needs to be monitored closely in the loading phase, and you do that based upon when symptoms change, even a tiny bit. That would make it tricky to get a load without overdosing. (you might not know when the load is complete).

hugs,
Sharlene and Molly Muffin

[Deb101]

Thanks for the info Kim and Sharlene, I will see if I can get an ultrasound done. The MRI is going to be $2200 AUD, so really want it to be useful in this diagnosis.
Kim, what made you keep looking past the test results, with so many positive results?. I will read your story when I get a chance. I can tell you are going to be an inspiration to me.
Debbie and Lilly.

[frijole]

:D Warning my thread is like 200 pages long. Yeah it took us a long time to figure things out.

First off I had a cush dog named Haley and treated her successfully for 4 1/2 yrs. Annie started inhaling food intermittently and peeing on occasion in the house. Her hair thinned. To be honest I thought she had atypical cushings (not the same as real cushings) We did the traditional tests and they both came back positive for cushings so we started treating with lysodren. L O N G story but a few days after starting lysodren I had to put Haley down (she was 16 1/2 and her body just gave out). Well Annie quit eating and so I kept thinking she was 'loaded' (meaning her cortisol was under control) so we'd do tests and there was no improvement so we'd up the dose and then same thing. This went on and on - the drug wasn't working. Well in dogs that don't have cushings that is what happens (I learned).


Actually I had an ultrasound done about that time and they only captured one of the adrenal glands - missing of course the one that had the tumor on it.

Meanwhile the dog just quit eating. She was starving but she'd take one bite of food and then spit it out and look at me with those eyes. I was opening 4-5 cans of food every meal and I did this for like 2 years.

My vet was swamped and said "what do you want me to do" and never even thought of referring me to the university hospital where he graduated... grrrrr...

I took her to another vet in a larger town 2 hrs from here and she took one look at everything and said - you are 3 hrs away from the university of Kansas vet school - you need to go there. I literally had to go out and by underwear so i could overnight and extend my trip... I was there for 2 days.

They were terrific. They discovered multiple things going on and I wish I had gone there earlier. I just gave you the very short version because we were stumped for a very long time. I threw thousands of dollars away with all sorts of tests.

So my advice is if you suspect something is going on - take notes of everything with details, dates, test results etc so you can refer to it all later. Video any 'events' that are hard to describe to the vet. Lastly but most important - if you think you need to - get a referral to a specialist or go to a teaching school where the best and the brightest are available. Sometimes it just takes a new set of eyes OR better equipment. :)

I sure hope you figure out what is going on. I know that it can drive you crazy! Kim

[labblab]

Really at this point in time she has no symptoms, she is back to being a ball of energy. She does eat all her breakfast and dinner, which she very rarely did, but I have changed her food and I am hoping it is only because she is enjoying it more. Hopefully the results will be back on Friday.
I absolutely don't discount the value of an abdominal ultrasound because I think internal imaging can provide very useful diagnostic information when a dog remains unwell or symptomatic. But I agree with the comments that have already been made above -- in the absence of symptoms, it is hard to know what it is that you would be treating at this time. When a dog truly has Cushing's, you do not see rapid and spontaneous improvement in the absence of treatment. This is the main reason why I am discounting the likelihood of Cushing's in your case.

If you have the means to perform the ultrasound and it would bring you peace of mind to have the additional information, then I agree you should pursue it. But I also think it would be reasonable to just take some time out to carefully monitor your girl for any changes. If she is truly back to normal again, it is hard to think that she is suffering from a serious chronic illness.

Marianne

[Deb101]

It is hard to believe she has anything wrong with her. I don't want to bury my head in the sand though in light of the 2 different diagnostic test giving positive results. What damage could I do by not treating her early if it is cushings. I don't want my lack of action to cause a bigger problem down the track. Considering that I took her to the vet originally for symptoms like lack of appetite, not drinking, lethargy and/or depression during what turned out to be a phantom pregnancy....or was it??? just because the progesterone was high in light of these last tests does that really prove a phantom pregnancy or could the high levels of progesterone been a symptom of cushings??

[labblab]

Yes, if a dog has Cushing's, adrenal hormones other than cortisol may also be elevated. Sometimes those hormones may even be elevated in the absence of any cortisol abnormality. In that event and if the elevations are causing Cushings-like symptoms, the diagnosis here in the U.S. can be "Atypical Cushings." My concern with making any Cushing's diagnosis with your dog, however, is that she does not exhibit any outward symptoms that are typical of the disease. In fact, the earlier acute lack of thirst and appetite are contrary to a Cushing's profile. Since she is now better, I have to wonder whether or not there was some infectious or inflammatory process going on earlier that caused those symptoms and are still having lingering effects on the blood testing.

I would never want to tell you to hold off on treatment and/or diagnostics that you would later regret. But given the fact that Cushing's is generally a slowly progressive syndrome, I would think there is a greater risk in rushing into mitotane treatment for a dog who doesn't truly have the disease than there is in waiting for a month or two in order to better assess any genuine abnormalities.

Marianne