Acth test

[Diego Meirelles]

[LEFT][CENTER]Hello everyone. My name is Diego and I'm from Brasil. Firstly, hope you understand my bad english , and sorry if some words don't be written correctly.

I have a female dog, 8 years, 8 kgs, was taken from the streets 2 years ago. I have diagnosticated that she has Cushing about 2 weeks ago, confirmed with the test of supression with low dose dexametazone. Her adrenal glands are both with 2 cm each, observed in Ultrasonography exam. She is taking 30mg Trilostane, once in a day, its going to complete 14 days tomorrow. She is having quite colateral effects like muscle tremors, isn't eating good...only some chicken meat, or bovine meat.

I was guided to perform as soon as I can the ACTH test, and perform the exams to dose "Na" and "K".

My doubt is about the ACTH test: Must I make the ACTH injected IV or IM ? Does it have difference in the final results? I was told by some people here that if I do it IM, I have to wait 2 hours to collect new blood, and if I do IV I have to wait only 1 hour. What do you suggest?


Thank you for attention and congratulations for the excelent work is made in this forum.

Diego Meirelles

[Budsters Mom]

Hello and welcome Diego,:)
First of all, your English is fine. I had no problem reading it. Please don't worry about that at all. :p

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, but be ready for lots of questions! Others will be dropping in to welcome you also. So again, welcome to you and your precious fur baby and bless you for rescuing her from the streets. Hugs,

[labblab]

Welcome Diego!

I am so glad you are now able to post on the forum! Diego and I have been exchanging some emails through our k9cushings gmailbox, and I know he has several questions about ACTH testing using synacthen. Diego, are you a veterinarian yourself? Is it important that you understand that we are not veterinarians here. We are dog owners. We are so very happy to help in any way we can, but it may be best for you to contact the laboratory that will analyze the ACTH blood samples in order to ask them how the testing should be done. I have already given you one article that may help you.

http://endocrinevet.blogspot.com/2011/03/whats-best-protocol-for-acth.html

Here is some more information that I found from a website for Axion Labs:


Collect fasted clotted blood sample (0 hour)
2. Inject 250 μg synthetic ACTH (Synacthen) intravenously or intramuscularly (use 125μg Synacthen if patient <5kg)
3. Collect second clotted blood sample one hour later.
4. Cortisol is measured on both samples.

Unlike when using Cortrosyn, it looks as though you use either 1/2 vial or 1 whole vial of the Synacthen depending upon whether or not the dog is bigger or smaller than 5 kg.

I'm afraid I do not have time to post more now, but I wanted to welcome you and give you this much information. I will come back, and I know others will be welcoming you, too.

Marianne

[Diego Meirelles]

Hello my friends!

Thank you again for the fast answers!
I am veterinary Marianne, but we have Cushing's case here once in a lifetime! :D

About veterinarians or not veterinarians here, it is no problem! The talking here about information and experiences lived is much more important than you can imagine.At least for me .
The more information and details we talk about here, better known we will be, and in the future will be able to help who needs our help!

I am going to use in my ACTH test, the Cortrosyn. In a book of mine, its written we can use for the test 5ug/Kg of ACTH IV or IM. I called a laboratory here, the cortrosyn presents is 250ug / 1ml. So my dog with 8 kgs will be given 0,16ml (40ug). Detail: its very very expensive here, because its imported from USA or Europe...so... tributes and government taxes are a big problem in here.

Till the time, I am sure I am in the right place to explain my doubts.

See ya.


Diego Meirelles

[molly muffin]

Hi Diego and welcome.

It is important that you give the dose of trilostane in the morning with a bit of food, as normal and then begin the test at around 4 hours after trilostane dose. You will inject, (this is the pre) and then 1 hour later you will draw again for the post result.
I'm not sure if your results will be in ug or nmol units. The range of what is desired results is different for a dog that is not treated and for one who is currently under going treatment. For a dog on treatment, your goal is to not have the Post number be over 9.0 ug with symptoms controlled. If symptoms are not controlled then you want that post number to come down to 5.ug or under.
You do not want them to go too low (Addisons risk) with either the pre or post number, so I think it is nothing under 1.5ug, but I feel better when it's not under 2.0ug for pre or post number, as cortisol levels Can continue to drop even at 30 days from starting medication.

I am so glad you found us. Soon you will be the cushings expert in Brasil!! :) We need more vets who know about this disease.

Welcome again
Sharlene and Molly Muffin

[Junior's Mom]

May I ask why you started at such a high dose. The recommendation is 1mg/lb. Your dog would be 17.6 lbs. Not eating is a sign of cortisol going too low. An ACTH test would be a good idea right now to check the level.