No symptoms do I medicate

[Zoe mom]

Hi I am new to the forum. My 10 yr old schnauzer has been diagnosed with cushings because of her lab work. She is a very small schnauzer 10 pounds. Her routine check in late 2011 had elevated results. She had the ACTh test. Had a test that went to university of Tennessee for results. Had an abdominal ultra sound which did not reveal a tumor but small nodules. She has no symptoms of cushings except her hair thinned but that seems to have stopped no changes there in last year. Otherwise she does not exhibit any of the other signs. She has been taking melatonin and lignans for the past year. She just had a 6 month re check and blood work. The liver levels that indicated cushings were much higher than last time. Vet wants to do another ACTH test and ultra sound then start her on tristostane.
My question is without symptoms should she do the drug. She is active loves to go for runs with me she will do 2 miles. Walks daily.
I am going to get the exact numbers but any suggestions...

[mcdavis]

Welcome to the forum. There will be a lot of far more knowledgeable people than me along very shortly to give you lots of advice. It will be really helpful if you can post the numbers too.

[spdd]

I want to welcome you too. Great people on here to help you with your questions. I'm still looking for answers and they've been a never ending well of information.
The xperts will be along shortly to help you.

[Zoe mom]

Her latest blood work results were as follows;
ALT 398
ALK 4170, it was 1275 six months ago
GGT 45
Her tryglycerides are also high at 864,
Vet was not in today and they did not see the last ACTH test results so I don't have those.
I noticed Molly says her dog has high test results also but no symptoms, are you medicating?
Thanks for the help

[lulusmom]

Hi and welcome to the forum.

Mini Schnauzers are a breed genetically predisposed to hyperlipemia which can cause some of the same blood abnormalities we see in dogs with cushing's. Normal reference range for canine triglycerides is 50 to 150 mg/dl in dogs so at 864 is a severe elevation. We see elevation in triglycerides in cushingoid dogs but not that high. At that level and the breed disposition, I would suspect primary hyperlipidemia which should be addressed. Cushing's can make things even worse so if nothing else, your dog should probably be put on an appropriate low fat diet. Please see below for more information on hyperlipidemia and diet:

http://endocrinevet.blogspot.com/2011/11/best-diets-for-primary-hyperlipidemia.html

It may be that your dog does have cushing's but in the absence of symptoms and other possible source of these abnormalities, I don't believe a cushing's diagnosis can be confirmed. I personally would be hesitant to start treatment if my dog were asymptomatic.

Here is an abstract of a study done on healthy Mini Schnauzers with and without hyperlipidemia. Your vet would probably be able to access the entire study to determine just how high the liver enzymes were in the various groups of dogs:

http://www.ncbi.nlm.nih.gov/pubmed/18167110

Here is another reference paper entitled: BREED-SPECIFIC HEPATOPATHIES written by Susan E. Johnson, DVM, Diplomate ACVIM (Internal Medicine) Associate Professor, Department of Veterinary Clinical Sciences Service Head, Small Animal Internal Medicine College of Veterinary Medicine, The Ohio State University

http://www.cincyvma.com/files/BreedHepatopathies.pdf
Miniature Schnauzers

Miniature schnauzers with idiopathic hyperlipemia, an inborn error of lipoprotein metabolism, commonly have hepatomegaly associated with moderate to severe hepatic vacuolar change [3,18]. Hyperlipemic Shetland sheepdogs (and other breeds?) may also develop this lesion. Vacuoles contain both glycogen and lipid. Affected dogs have moderate to marked increases in ALP activity, much of it due to the corticosteroid-induced isoenzyme of ALP (without evidence of Cushing’s disease). Mild increases in ALT are common. Fasting hypertriglyceridemia is a consistent finding. Mild to moderate increases in cholesterol are seen in many but not all dogs. Proteinuria or microalbuminuria have also been recently reported [19].
Most dogs do not show clinical evidence of hepatic dysfunction. Clinical signs are referable to the hyperlipemia and include recurrent episodes of abdominal pain associated with lethargy, decreased appetite, and vomiting or diarrhea. Pancreatitis is sometimes documented. Some dogs develop grand mal seizures, diabetes mellitus, or renal failure associated with protein-losing nephropathy. Rarely, dogs may develop a nodular liver with stromal collapse and signs of hepatic insufficiency. An association with sludged bile, gallbladder mucocele, and cholelithiasis has also been suggested [18,20].
Treatment revolves around management of the hyperlipemia with low fat diet and lipid-lowering drugs. Corticosteroids should be avoided because they augment glycogen accumulation in the liver. Ursodiol and S-adenylmethionine should be considered for hepatoprotective therapy but no clinical studies have been reported.

Sorry for the long post but I wanted to give you some food for thought and things to talk to your vet about. I am hoping that our members with Mini Schnauzers will drop in and share their experience with you.

Glynda

[Trixie]

Hi Zoe's Mom...I too have a mini schnauzer, she's 9yrs old..weighs about 14lbs now but usual weight is about 12-13 so also smaller than the norm--she's eaten a bit more the last few months.
She had elevated liver numbers at her regular check-up in February this year. At that point she had no symptoms that seemed abnormal...but thinking back on it after the fact she was starting to drink more right around then. She went on a course of liver supplement- Denamarin, which she is still taking now. It helped to lower the numbers after about 7 days but they went back up when she was off of it. You may want to have your dog start taking that asap because it will help while you're figuring things out.

My dog did not have all the Cushings symptoms but those she did have-primarily drinking/peeing/eating started to become more pronounced through March so we tested for Cushings and diagnosed in April. By then the drinking was obviously abnormal.

I am going to read all of what Glynda posted...and thanks all for that info Glynda! I feel like so many of these issues that schnauzers are predisposed to tie into each other a great deal. I think I may have some questions answered by reading these links.

Trixie was always pretty healthy but we did have yearly bouts of tummy trouble which sometimes got pretty bad. She is very sensitive to fats and was often checked for hyperlipidemia and pancreatitis but never had either. She's been on a low fat diet for years now...everything low fat, food and treats. She's in great shape and through all this Cushings stuff she still has plenty of energy and does long walks everyday, the same as your pup...we do 2 miles+ as well...except for today because it's insanely hot here!!

If my dog didn't have symptoms but tested positive I guess I would have to think pretty hard about medicating, though the high liver numbers have to be addressed in some way I suppose. Once you have the acth numbers the experts here will have advice, I'm sure.

Do you ever notice anything with your dog that's even a little out of whack lately?? I didn't at first, just thought she was thirsty from all the exercise and she's always been a chow hound...but now I think those signs were there earlier, I just didn't think much of it until it was hitting me over the head. That took a couple months. As I said Trixie didn't have hair loss, leg weakness, or pot belly and didn't act sick in anyway.
So, now she's on vetoryl (trilostane) since April. Started very low dose and been moving up each month. Tweaking the dose to control the symptoms is par for the course but sometimes frustrating.
She's seems and acts fine, no adverse effects from the medication, but getting drinking/peeing symptoms under control has been challenging.

I hope you can figure out what's going on with your schnauzer and there will be others chiming to help you and make suggestions. I certainly wouldn't rush to medicate yet but you probably need to try and get to the bottom of what's going on. I hope your pup continues to feel well though...thank goodness for that!! :)

Barbara

[Jenny & Judi in MN]

It's always been my understanding that cushings meds don't cure, they just relieve symptoms. I'm no expert but I wouldn't medicate till she was showing symptoms if I were you.

We overmedicated my dog with Lysodren so she has been off all meds since last April. Her IMS told me just to keep an eye on her appetite, and drinking and we'll talk about starting her up again if that starts to get out of hand.

If your dog is happy, I'd enjoy it! if I were you. Judi

[Budsters Mom]

Cushing meds are designed to manage symptoms. I would not treat with medication in absence of symptoms. I would be enjoying it for as long as possible.:) hugs,

[molly muffin]

I think I would definitely take the study that Glynda posted to your vet and review the possibility that this could have more to do with Zoe's issue than cushings.
You said you had the UofTenn testing and are using lignans and melatonin. Did Zoe test positive for high intermediary hormones and normal cortisol levels? If so I would mention that trilostane (vetroyl) is not used in that scenerio, instead if symptoms are not controlled then lysodren is used.
But I think you have to be in symptomatic area for this to be a concern.
As I said first off, take the study in to your vet and cover that first. Schnauzer's can have their own thing going on and that needs to be looked at first.

As far as Molly goes, no I am not treating her for cushings at this time. Her LDDS tests have all come back negative and her symptoms don't include drinking and eating outragiously or accidents in the house. I'm reluctant to start medications without knowing for sure what is going on with her.

Hope that helps!

Welcome to the forum!
Sharlene and Molly Muffin

[doxiesrock912]

I've always heard not to medicate until there are symptoms, The meds control the symptoms, they're not a cure.

[Zoe mom]

Thank you for the help

[Zoe mom]

Hi again
Here are the results from her last ACTH test done 3/12
Cortisol. 78.5-211.3
Androstenedione 0.67-3.81
Estradiol 81.3-74.3
Progesterone 0.47-2.47
17OH progesterone. 0.28-1.93
Aldosterone 23.9-169.6
The blood work was sent to a lab at the university of Tennesseee my vet said they do a more extensive work up. Results said indication of moderate to severe adrenal activity.
I still don't think I want to medicate without symptoms. My start on denamarin to lower the liver levels and retest in a couple months
Any additional thoughts?
Thank you for all the input it is helpful

[Squirt's Mom]

Thanks for the info but would you double check the numbers? It looks like the normal ranges are here but Rosie's results are not. Should look something like (EXAMPLE) -

Cortisol 367.2 78.5-211.3
Androstenedione 2.94 0.67-3.81

The first numbers would be her results (the 367.2 and 2.94) with normal ranges following.

Thanks!

[Zoe mom]

The numbers I gave are the baseline and post scores not the ranges. She was above normal in all areas

[addy]

If I use the normal range from my pup's test in 2010 this test would look like this:

Cortisol ng/ml 78.5* 2.1-58.8 211.3* 65.0-174.6
Androstenedione ng/ml .67* 0.05-0.57 3.81 0.27-3.97
Estradiol pg/ml 81.3 *30.8-69.9 74.3* 27.9-69.2
Progesterone ng/ml 0.47 0.3-0.49 2.47* 0.10-1.50
17 OH Progesterone ng/ml .028 0.08-0.77 1.93* 0.40-1.62
Aldosterone pg/ml 23.9 11-139.9 169.6 72.9-398.5
* Above


Cortisol. 78.5-211.3
Androstenedione 0.67-3.81
Estradiol 81.3-74.3
Progesterone 0.47-2.47
17OH progesterone. 0.28-1.93
Aldosterone 23.9-169.6


unless the normal ranges changed

[Squirt's Mom]

ahhh...very good, Addy!

[Zoe mom]

Yes that is what the results look like. The normal ranges have not changed

[Squirt's Mom]

Ok, Mom,

With the elevated cortisol results, Zoe does have conventional, not Atypical, Cushing's. This result makes it conventional Cushing's even tho some of the intermediates are also elevated -

Cortisol ng/ml 78.5* 2.1-58.8.....211.3* 65.0-174.6

The elevations in the intermediates - the estradiol, progesterone and 17 OH progesterone (only the second number counts as an elevation) - can be treated via lignans and melatonin, a typically benign treatment. The combination of lignans and melatonin are what UTK recommends for the intermediates. If you would like help with the doses, let us know. You will also find them on the sheet from UTK that comes with the test results. If I were you, I would start the lignans and melatonin along with the Denamarin. Then if the signs become stronger, you can start looking into additional treatment.

If we can help, let us know!
Hugs,
Leslie and the gang

[addy]

That is pretty much where we were three years ago. I waited a year before starting treatment. I had to work really hard on getting my Zoe's IBD under full control which took me a long time. That was more worrisome to me than her Cushings as her symptoms were mostly hair/coat and the start of hind leg weakness. Little by little her symptoms started developing. My girl's blood work was faily normal as well, so that is a bit different from your case.

The melatonin and lignans controlled her estradiol right away, brought down a bit of the other intermediates, but did not do much for them really, and her cortisol went higher, and my girl's cortisol was much higher than yours to start.

Hugs

[Zoe mom]

Thank you. She has been taking the melatonin and lug and for the past 7 months. I am starting the denamarin this week and she will do another ACTH test in a couple if weeks.