Cushing's without typical symptoms?

[Mugsy's mom]

Hi everyone,
I will try to keep this somewhat brief. We have two seven year old puggles, Mugsy and his litter mate sister zz.
About eight months ago Mugsy started showing signs of hind leg weakness and seemed a bit off. The vet did some bloodwork and found his SAP to be in the thousands. He had an ultrasound and sludge in his gall bladder was discussed- he had the dexamethasone suppression test and the vet reported he tested negative for Cushings. We treated Mugsy for the gall bladder sludge with a heavy course of antibiotics. We switched both dogs to a grain free diet and saw a marked improvement in Mugsy's hind leg weakness.
Fast forward to three weeks ago - mugsy suffered a seizure/episode. He was falling over while trying to walk and his eyes were fluttering up and down. We brought him to an animal urgent care and the er vet believed it was a vestibular episode. She thought we should revisit the cushings diagnosis. We started him on a baby aspirin a day. We changed vets and ran some tests with the new vet. Decreased the baby aspirin to 1/4. Still elevated SAP, a little protein in urine. 7 days later he had another episode. more testing -clean chest X-ray, mildly enlarged liver and extremely high blood pressure. We started him on amlodipine 2.5 mg gor his pressure and continued the 1/4 baby aspirin. He seemed to be feeling like his old self- we were cautiously optimistic until he had another episode tonight. He does not have increased thirst of urinating, does not have a pot belly ( well not any more than his sister !!) and tested negative for cushings with the dexamethasone suppression test.
Please help! Thank you for your time.

[Harley PoMMom]

Hi and welcome to you and Mugsy,

So sorry for the reasons that brought you here but glad you found us.

Since strong obvious clinical symptoms do play a huge part in a Cushing's diagnosis, and since Mugsy does not have obvious Cushing's symptoms, I think it is unlikely that Mugsy has Cushing's.

Was Mugsy's thyroid levels checked? Seizures can be related to thyroid dysfunction.

It is vital to get his blood pressure down so I am relieved to see that he is taking amlodipine, how long has he been taking the amlodipine and when is his BP going to be checked again? The protein loss in the urine was probably secondary and due to the high BP, once the BP is under control for a while I bet that protein loss will go down. Was the protein loss found during an urinalysis or has a UPC (Urine Protein:Creatinine) been performed?

If you could get copies of all test/s that were done on Mugsy and post any abnormalities that are listed along with the reference ranges and units of measurments that would help us to provide more meaningful feedback. Also if you could post the results from any Cushing's tests, that would be great too.

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

Love and hugs, Lori

[Trish]

Hi
This sounds very similar to how Flynn was before we found his adrenal tumour, apart from the seizure episodes. But he also had very high BP which caused the protein in urine plus elevated alk phosphatase which is a liver enzyme (but Flynn had been successfully treated for liver cancer) You said they did an ultrasound, does it mention anything about the adrenal glands? I think you said he had further testing just recently and liver was enlarged, was that repeat ultrasound scan?? I would get the vets to have a very very close look at that scan for any possible tumour in the adrenals, specifically pheochromocytoma. These tumours can cause major spikes in BP which could be causing his episodes and can be very dangerous with heart attacks and strokes a possibility.

My vets told me it is unusual for a dog to have primary hypertension like we often see in humans. Dogs usually have something that is causing a BP problem. When my dog had high BP he had a three scans before the tumour was finally picked up which is why I am suggesting they look at it very closely. He was put onto BP meds and for pheo tumour they need to go on a drug called phenoxybenzamine. Once he was diagnosed they went back to previous scans and could see a tiny spot in the gland which they had not noticed initially. While they were looking at possible diagnosis they also thought he might be cushings and did the LDDS x2 and both times negative. It might not be this, but the similarities with my dog make me suspicious.

Once his tumour was found, he went on and had successful surgery to remove it and is good now. His thread is on here if you would like to read. His blood pressure problems have not totally gone away with the surgery, they think his BP was up for so long with the pheo tumour that he now does have primary hypertension and is managed on amlodipine and benzapril which helps his proteinuria as well as BP. He is doing well on these drugs with no noticeable side effects.. but he did need the phenoxybenzamine as that drug is very specific in helping settle BP caused by the pheochromocytoma.

Good luck with getting a diagnosis.

Here is a link to his thread http://www.k9cushings.com/forum/showthread.php?t=4242

[Mugsy's mom]

Hi Trish,
Thank you very much for your reply. In light of Mugsy's most recent episode, we are having his BP checked again this afternoon. I don't think Mugsy's thyroid levels have been checked, I am going to discuss with the vet today. As far as his urinalysis, his urine was taken directly from his bladder for a clean read- the vet explained they would let it incubate for a couple of days to rule out an infection then proceed with testing. She said it came back okay. I'm am not sure if this was a UPC test (?)
I have requested all of his test results and will pick up today so will be able to give some more detailed/measured answers later.
Thank you again for all of your input.
I'll keep you posted.
Jennifer

[Mugsy's mom]

Sorry, this reply was to Lori!
Trish, I'm working on yours now.... I know I'm a typical newbie! :) sorry

[Mugsy's mom]

Hi Trish,
Thank you for your reply- I am not sure if the adrenal gland was discussed as a result of the previous ultrasound. We had a very bad experience with the "specialist"/Ultrasound doctor and he really focused only on Mugsy's gall bladder. We have not had a repeat ultrasound yet- the enlarged liver showed up on an x-ray image read by the radiologist. I will address the adrenals, specifically the pheochromocytoma as you have suggested today with the vet.
Thank you again for your help.
It's so scary and frustrating not knowing what is wrong with him.
I'll keep you posted,
Jennifer

[goldengirl88]

Jennifer:
Welcome to the group. I wanted to tell you my Tipper has had several vestibular episodes. She puts her head down low to the same side each time, starts wagging her tail a million times a minute, goes in circles and her back leg gives way and she sometimes falls. The first time she did this I was in a panic as it was after her testing at the vets office, and I thought that brought it on. One of the members told me to try and call her out of it and see if she responds. It shows it is coming from a certain part of the brain- I am not sure which, maybe some one can speak to it. She never did this until Cushings. I did read that Cushings can cause these problems, but also older dogs can develop them . I thought it was a seizure too. The last time she did it I held her and her body was still trying to move in circles. I know these episodes are scary. Good luck with your baby. Blessings
Patti

[BostonLover]

Now, I'm wondering if my AnnaBelle had these vestibular episodes. I thought they were seizures, but she wouldn't lose bowels or consciencnous, but her face goes to the ground, and she slowly starts to lose use of her legs. I usually hold her and it seems she is slightly paddling, but maybe she's trying to go in a circle. Once it's over, she's completely fine. :confused: