Atypical Cushings with reactivity?

[Kirikoli]

My dog, a three year old American Eskimo, was recently tested for Atypical Cushings because we discovered that she had a weird symptom, an enlarged clitoris, while we were getting her checked for a UTI. Her results just came back and they show that she has elevated hormone levels, which may indicate early atypical Cushings. Specifically they did a ACTH stim test and her numbers are pre (post-) stim:

cortisol 56.1 (101)
androstenedione 0.71 (1.02)
estradiol 48.2 (55.1)
progesterone 0.8 (1.49)
17 OH Progesterone 0.66 (1.99)
Aldosterone 54.3 (91.5)

According to the normal ranges, this places her androstenedione and progesterone high pre-stim and 17 OH Progesterone high post-stim. We are starting her on melatonin and lignans now and will recheck in 4 months because she really has none of the typical symptoms. If she develops them, we plan to test for tumors.

She is, however, extremely reactive and clearly has an anxiety disorder. We adopted her at 8 months and she was reactive from the get-go, toward both people and dogs. We thought at first that her first owners had just messed her up, but we have been working with a great trainer on behavioral modification for over two years now and, while she has made progress, she remains reactive, even toward the trainer she has been seeing over and over. She was on prozac for almost two years and then we switched her to zoloft, which helped her reactivity, though some of it has seemed to channel into anxious behaviors instead (whining, etc).

I'm at a loss. I don't know if her reactivity is connected to the possible Cushings (androstenedione is a precursor to testosterone) or if she even has Cushings. We're just waiting to see if the melatonin helps now, but I've spent some much time waiting to see if things will help her, I just can't help looking for more information. Does anyone have experience with atypical cushings or hormone numbers like these? She has been checked for thyroid problems as well and is generally in good health.

[frijole]

Hello. Before I forget please check for an email and respond so that your responses/posts are automatically approved.

We are very familiar with what atypical cushings is. I assume the panel you had done was performed by Univ of Tennessee Knoxville? Basically atypical cushings is elevated sex hormones but NOT cortisol. If cortisol is elevated it is considered true cushings.

Could you please post the ranges for normal and units of measure for the test? This will help us understand the results better.

I'm sure they told you that melatonin takes a while to work. Did they suggest lignons as well? Normally it's a combination.

Have you had a regular blood panel done? I'm curious if any enzymes are showing out of range - that's usually a good starting point.

What symptoms are you seeing and when did they start?

My Annie was misdiagnosed with cushings - she had a rare adrenal tumor and she had an enlarged clitoris. It was the tumor that gave her elevated sex hormones. I'm not suggesting your dog has a tumor but rather think taking a look at bloodwork might provide some insight.

Tell us more about your dog and the behaviors you are seeing - so that we can grasp it - tell us actual examples. We want to be sure we understand prior to jumping to any conclusions.

Since your dog is young cushings would be rare although we have seen it. By chance does anyone in your household use topical hormone creams? It is proven to affect dogs and I just want to make sure it isn't something as simple as that. We've had it happen to other members.

Glad you found us! Kim

[Kirikoli]

Here are the numbers again with the normal ranges. The test was done at the University of Tennessee.

test -- pre-stim result -- normal range -- post-stim result -- normal range
cortisol ng/ml -- 56.1 -- 2.1-58.8 -- 101 -- 65-174.6
androstenedione ng/ml -- 0.71 -- 0.05-0.57 -- 1.02 -- 0.27-3.97
estradiol pg/ml -- 48.2 -- 30.8-69.9 -- 55.1 -- 27.9-69.2
progesterone ng/ml -- 0.8 -- 0.03-0.49 -- 1.49 -- 0.1-1.5
17 OH Progesterone ng/ml -- 0.66 -- 0.08-0.77 -- 1.99 -- 0.4-1.62
aldosterone pg/m -- 54.3 -- 11-139.9 -- 91.5, 72.9-398.5

androstenedione and progesterone are high pre-stim and 17 OH progesterone is high post-stim.

Yes, we are giving her melatonin and lignans and they said we are going to retest in four months to see if they are working. She has had regular bloodwork done. I didn't see the results but they didn't tell me anything was off.

Her first symptom was increased frequency of peeing (which has since stopped) which prompted us to test for a UTI. They found bacteria, but it was not in her bladder, so not a UTI. They found her clitoris to be enlarged while checking for the UTI, so we decided to test for Cushings. Her only other "symptom" (now that her peeing is normal again) is her reactivity, but that could be caused by many things.

Her reactivity is pretty much fear behaviors. For example, if she sees another dog, she attempts to scare them off by escalating behavior starting with barking, then lunging, growling, snapping etc. This behavior occurs when she is on-leash. She acts similarly toward people if they are too close, acting strange, or confronting her. She is very proximity sensitive and when confronted with something too close, she essentially has a panic attack and goes into fight or flight mode. We have had success in raising her threshold and tolerance, but not in eliminating the reactive behaviors. She also has generalized anxiety, such that before we put her on prozac (and later zoloft) she would almost never relax, barking at sounds outside and being hypervigilant.

In addition, we've noticed lately that her behavior depends on the time of day, more than we ever noticed before. She is fine with us for most of the day and best in the morning, but in the evening, she becomes more touchy and will jump at things that wouldn't bother her earlier in the day.

It's all very complicated and I could probably write a book about it at this point. I'll stop here, but I'm happy to answer more questions.

[labblab]

By any chance, are you or anyone in your family using a topical hormone cream, lotion or gel? If so and if your dog licks (or otherwise comes into contact with) your skin, the hormone may be affecting your dog adversely. A strangely swollen vulva can be a symptom of topical hormone exposure. For more info, go to this thread and scroll down to the posts at the bottom:

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

Marianne

[Kirikoli]

I read about that and we don't use anything like that as far as I can tell.

[frijole]

Laughing at myself for Kentucky vs Tennessee... UTK... so yes this is the test I figured it was.

I edited my previous post as you and Marianne were posting... same question came to mind re the hormonal cream. Kim

[Kirikoli]

Laughing at myself for Kentucky vs Tennessee... UTK... so yes this is the test I figured it was.

I edited my previous post as you and Marianne were posting... same question came to mind re the hormonal cream. Kim

I wish it was as easy as a hormonal cream, but we don't use anything like that. :( Also, as far as her reactivity, she was reactive to day we brought her home, so if they are linked, it's nothing we've done.

[molly muffin]

Hello and welcome from me too. We do have several here who are quite familiar with atypical cushings. As Kim has said, it would be super helpful to see the actual test results and anything that might be high/low with normal range included.
We're a very supportive bunch around here, so any question you might have feel free to ask.
Again, welcome
Sharlene and Molly Muffin

[Kirikoli]

Thanks for the welcomes. :) I posted her test results with normal ranges a few posts up.

I'm mainly looking for anyone who has experience with these particular elevation hormones (androstenedione and progesterone) and bonus if anyone is familiar with Cushings being related to behavioral problems. At the moment, I'm not even sure if this is Cushings (I've looked at some of the other atypical numbers and haven't seen the same hormones elevated) and since she isn't showing other symptoms, my vet thinks it's premature to do more tests or use harsher medicine. So we are trying the melatonin/lignans.

It's also just nice to have people to talk to about it. It's hard enough finding people to talk to about dogs with behavioral problems, much less possible rare diseases.

[frijole]

I've been here for over 8 yrs reading and I can't recall a time where atypical cushings presented reactive behavior.

[molly muffin]

LOL looks like we were all posting at the same time. :)

I would think that there is a possibility that the hormones at least contribute to the severe reactivity, especially in light of the timing during the day. Is that new since you started the lignan and melatonin? Noticing the different times of the day when she is more reactive.

It is possible that her hormones have always been off to some extent. Do you know the parentage at all? If the mother was reactive, especially during pregnancy?
I'm just throwing out some ideas right now.

Sharlene and Molly Muffin

[molly muffin]

Kim, you don't think that elevations up and down and hormones that were always off could have contributed?

I was just thinking of how hormones affect humans, and it can make them jumpy, nervous, depressed, all kinds of things, so I am wondering I guess, if they could affect a dogs responses.

Sharlene

[frijole]

As I stated earlier, to be clear and you may know this already but atypical cushings is not the same as cushings. atypical is where androstenedione and progesterone is elevated. True Cushings' dogs can have those elevated hormones but it is the elevated cortisol that deems a dog cushinoid. The test results indicate to me that the cortisol is not elevated so therefore you are dealing with atypical cushings. The protocol for treatment is as you are doing.

Dogs with elevated cortisol do have some behavioral issues because the cortisol makes them hyper. It is particularly noticeable at night but it shows up as pacing. The behavior you described is not typical of a cush dog.

Kim

[Kirikoli]

LOL looks like we were all posting at the same time. :)

I would think that there is a possibility that the hormones at least contribute to the severe reactivity, especially in light of the timing during the day. Is that new since you started the lignan and melatonin? Noticing the different times of the day when she is more reactive.

It is possible that her hormones have always been off to some extent. Do you know the parentage at all? If the mother was reactive, especially during pregnancy?
I'm just throwing out some ideas right now.

Sharlene and Molly Muffin


Sharlene and Molly Muffin

We just got the diagnosis yesterday and just started the melatonin/lignans, so it's not due to that. We have always noticed it a little, but it seems more pronounced now, perhaps because her behavior has gotten better overall with training. We also switched her to zoloft a few months ago, which seemed to really help, but now I am wondering.

She was a BYB dog who was bought and then abandoned by some idiots who shouldn't have been allowed near a dog, much less to own one. We don't know her parentage, but I know her "breeder" was also an idiot, so it wouldn't surprise me if her parents were also reactive. It is unfortunately not all that uncommon in Eskies anyway, since they were bred as watchdogs.

[frijole]

Kim, you don't think that elevations up and down and hormones that were always off could have contributed?

I was just thinking of how hormones affect humans, and it can make them jumpy, nervous, depressed, all kinds of things, so I am wondering I guess, if they could affect a dogs responses.

Sharlene

Perhaps - I just don't recall a case where that was an issue. Heh I'm over 50 so it's not like I remember everything. :D Kim

[Kirikoli]

As I stated earlier, to be clear and you may know this already but atypical cushings is not the same as cushings. atypical is where androstenedione and progesterone is elevated. True Cushings' dogs can have those elevated hormones but it is the elevated cortisol that deems a dog cushinoid. The test results indicate to me that the cortisol is not elevated so therefore you are dealing with atypical cushings. The protocol for treatment is as you are doing.

Dogs with elevated cortisol do have some behavioral issues because the cortisol makes them hyper. It is particularly noticeable at night but it shows up as pacing. The behavior you described is not typical of a cush dog.

Kim

Yes, I don't think she has normal Cushing, just possibly atypical. I think it could be linked to her behavior because androstenedione breaks down into testosterone in the body.

[molly muffin]

LOL Kim!

I was doing some searching on aggression, especially fear aggression, which is what you think she has rather than dominance aggression?
There is a paper on diet, specifically protein levels in relation to fear aggression. You might find this interesting if you haven't already read it.

http://www.ehow.com/about_5373273_foods-cause-aggression-dogs.html




According to research by Dr. Nicholas Dodman at Tufts College of Veterinary Medicine in 2000, fear-aggressive behavior was significantly reduced in dogs fed a low (17%) protein diet when compared to medium (25%) and high (32%) protein diets. The same study concluded that dietary protein had no effect on dominant-aggressive dogs.

This study confirmed numerous earlier studies linking high protein levels with different types of aggression. The speculation is that high protein levels in the food provide an over-abundance of amino acids, essentially crowding out the amino acid tryptophan. Tryptophan is essential for seratonin production, which has a calming and stabilizing effect on canine behavior.

Sharlene and Molly Muffin

[Roxee's Dad]

Just a thought... maybe just grasping at straws, but their is an interesting article in our resources section about behavior in dogs with thyroid issues by Dr Jean Dodds DVM. May be worth a read.



http://www.k9cushings.com/forum/showthread.php?t=1627

[addy]

I'll chime in here, I have and old email from Dr. Oliver at UTK because Zoe was a bit reactive and had high estradiol and other intermediate hormones as well as cortisol. We started with only melatonin and lignans and that brought the estradiol down to normal after 3 months and she calmed down. Even her groomer asked- what did you do to her? Dr. Oliver said that it is like menopause where the hormones get out of whack and he he did not dismiss it at all. I think the email is at work. I'll try to find it Monday when I go back to my office and post his thoughts on it.

And as John already mentioned, Dr. Dodd has wrfitten articles about thyroid issues and reactivity.

OF course, you would still need to work on the reativity with behavior training.

[Kirikoli]

LOL Kim!

I was doing some searching on aggression, especially fear aggression, which is what you think she has rather than dominance aggression?
There is a paper on diet, specifically protein levels in relation to fear aggression. You might find this interesting if you haven't already read it.

http://www.ehow.com/about_5373273_foods-cause-aggression-dogs.html



Sharlene and Molly Muffin

I wasn't aware of that study. It's only one study and the sample size was small, but it can't hurt to lower the protein in her diet and see if it helps. I'm going to call our vet and see what she say about it. Thanks!

About the thyroid, yeah, I read Dr. Dodds' book last year and we had a blood sample sent out to her lab in California. My dog tested negative for any thyroid problems.

I'm glad to hear that melatonin/lignans helped some behavior problems, that's great! I wish it was a few months from now already so I could tell if they're going to help my dog.

We have made a ton of progress with behavioral modification training, so I would definitely continue that. If a miracle occurred and she suddenly got better, I would enroll her in a more normal training class. She loves to learn and would be an excellent agility dog.

Here's a picture for everyone's troubles. Her name is Psyche and she's an awesome dog aside from her problems.

http://farm9.staticflickr.com/8491/8305058969_ee036dc3d2.jpg (http://www.flickr.com/photos/kiri_koli/8305058969/)
PI Secret Santa 2012 (http://www.flickr.com/photos/kiri_koli/8305058969/) by Kiri koli (http://www.flickr.com/people/kiri_koli/), on Flickr

Edit: hm, not sure why the picture isn't showing up, but you can click the link, it's hosted on flickr.

[frijole]

OMG she is beautiful. I want to hug her! Love the name. I used to call my Annie psycho at times. LOL Thanks for sharing the photo. Kim

[molly muffin]

She's gorgeous!! Thanks for posting

Sharlene and Molly muffin

[Budsters Mom]

What a beautiful girl with such an adoring look in her eyes.:)
Thanks for sharing.:)

Hugs,
Kathy