Cushings diagnosis? (Adrenal tumor; starting Lysodren)

[sos]

My 6-7 year old male Rottweiler started drinking excessively about 1-2 months ago. Blood tests were negative. We did more blood work this week and an ultrasound showed a tumor on his adrenal glands. He has been exhibiting more signs of Cushings, but the blood test for Cushing's keeps coming back negative. The vet is fairly certain he has Cushings. The vet said we could do nothing and see what happens in a month or so, surgery which he said is very risky, or start him on Lysodren which would have a 50/50 chance of working. We opted to start him on the Lysdoren. Any comments or suggestions are appreciated. We just started the dose today. Thanks.

[goldengirl88]

Hi and Welcome to the forum. You need to talk to Marianne as her dog had a Pheo tumor on the Adrenal gland. Maybe that is why the testing is coming back saying he does not have Cushings?? I don't use Lysodren and Leslie will help you with that, as Tipper uses Trilostane. I know all this is scary, but you are in the best place you could be on this forum. It is a life saver. You are not alone in this now and we will help you thru this journey. How much does your dog weigh/ Could you get copies of the tests and post the numbers so we can see them and try and determine what is going on? What are all the symptoms your dog is exhibiting? Blessings
Patti

[sos]

He weighs about 78 lbs. It started with the excessive drinking, way more interested in food...following us around the kitchen which he never used to, some muscle atrophy in the head. I don't have the actual test result and numbers, but I'm sure I could get them next week.

[labblab]

Hello and welcome from me, too!

It is actually another one of our staffers, Kim ("frijole"), whose dog suffered from that rarer form of adrenal tumor. I'm betting she will be by before long to tell you more about that.

In the meantime, yes, we would be very interested in the diagnostic test results when you can get ahold of them. If your vet performed the ACTH blood test, unfortunately it does a poor job of correctly identifying Cushing's in dogs who suffer from the adrenal form of the disease. An alternative blood test, the LDDS, is more likely to return a "positive" result in the face of adrenal tumors. So I would be interested in knowing which testing was performed.

Can you tell us what instructions you have been given re: dosing your dog with Lysodren? There is a very specific protocol that you need to follow in order to make sure that your dog does not end up being overdosed on the drug. So please do tell us what dose you are giving, and what you've been told to watch for in terms of signals that your dog has been "loaded" on the drug and the dosing should cease.

Thanks so much for this additional info!
Marianne

[sos]

We are giving him 500mg. twice a day. We are to watch for vomiting, lethargy, shakes. If this occurs, we are to stop the dose, give him prednisone and call the vet.

[labblab]

I will let other folks comment re: the appropriateness of the dose, but I want to caution you that you want to be watching for signs of loading that are not as severe as vomiting/diarrhea and lethargy -- you do not want your dog to advance to that stage before stopping the medication and testing. Here is a link to some classic loading instructions. As you will see, hesitating when eating or drinking less water are signs of loading that you need to monitor closely and that will precede more serious signs of overdosing.

http://www.k9cushings.com/forum/showthread.php?t=181

Please, please read over these instructions carefully. And then feel free to ask any additional questions. We want your dog to be loaded successfully, but we do not want your dog to be overdosed while taking the drug.

Marianne

P.S. I've edited your thread title to reflect your dog's adrenal tumor and Lysodren treatment. Hopefully this will alert other folks to the specifics of your dog's treatment.

[sos]

Thanks for the response and we are keeping a keen eye on him. How soon would he show signs of overloading? Today was his first day. He had two pills 500 mg. each. Still eating and drinking like crazy.

[labblab]

Good morning again from me. To answer your question about time frame: there is no set period in which you can predict that any individual dog will load. We've experienced dogs here who loaded in just 2-3 days, and others who have taken much longer. It is for that reason that you need to watch your dog like a hawk so as to notice any small change that signals he has had enough of the drug.

I am hoping that other Lysodren "parents" will soon be by today to talk with you more, especially about dosing. But I'll go ahead and take a stab at it. You'll see from that link I gave you above that Dr. Feldman recommends a loading dosing formula of 50 mg. per kilogram per day, and then a shift to 25-50 mg. per kilogram as a weekly total during the subsequent maintenance stage. If I have calculated correctly, your dog is starting out close to the lower end of that maintenance formula during the loading stage. So this may mean it will take him longer to load, or he may never load successfully at that dosage and it may need to be increased. I wonder whether your vet has not had a lot of experience with the drug, and perhaps that is why he is starting so conservatively. Or perhaps he still has doubts himself about the diagnosis.

In that vein, I am nervous over the fact that your vet has started you on this treatment while only feeling "fairly certain" that your dog's adrenal tumor is actually producing excess cortisol. Also, I am not sure that the surgical option is being fairly represented to you. It is true that it is risky, but it can provide a permanent cure that can also be life-saving, especially if the tumor is cancerous. Given the young age of your dog, it might be an option you'd want to pursue. There is also an alternative Cushing's drug, trilostane, that is now favored by some clinicians for treatment of adrenal Cushing's because Lysodren seems to require increasingly higher doses (with greater risk of side effects) to control that form of the disease. I am not sure what your vet means by saying that Lysodren has a 50/50 chance of working, but I do want you to know this alternative drug option exists.

All of this leads me to wonder whether you'd be better served by gathering some additional diagnostic and treatment information at this stage of the game. For instance, given the fact you know an adrenal tumor is involved, you may want to consult with a specialist who has more experience with this type of problem. It would involve additional expense up-front, but could save you money in the long run and give you more peace of mind that you have chosen the treatment that is most appropriate for your dog's situation. If you are interested, we can help you try to locate a specialist in your area.

Marianne

[Squirt's Mom]

Hi and welcome to you and your baby! :)

The loading dose is 50mg per kg per day so at 78 pounds, your baby would have a starting dose of 1772.72, which would round down to 1500mg a day (78 / 2.2 x 50). The vet has started him on 1000mg a day, which is a lower loading dose so it may take a bit longer to achieve the load. Once he is loaded, the maintenance dose is based on 25-50mg per kg per WEEK but most vets keep the same amount for maintenance as used for the load, 50mg/kg/week.

I'm with Marianne, not sure what your vet meant by "50/50 chance" but that doesn't inspire confidence in the vet for me as it's not very reassuring for you and is misleading. There is no cure for Cushing's EXCEPT in 2 forms - the Iatrogenic which is caused by steroid use and "cured" by weaning off the steroids AND the adrenal based form, which the vet thinks your baby has, by surgical removal of the tumor and adrenal gland effected. It is a complicated and often extremely risky surgery but pups do survive and live for several more years. Medical treatment via meds is used often in adrenal based Cushing's when pups are not a candidate for the surgery or the parents can't afford to have it done. Lysodren or Vetoryl (Trilostane) will work to control the cortisol but neither will cure so odds don't really play into Cushing's treatment. ;)

It would help us a GREAT deal if you could get copies of the blood work done and post the actual results here. You NEVER treat a dog for Cushing's because you are "fairly certain" it has Cushing's! :eek: These are very powerful drugs and the vets simply cannot guess at the diagnosis then throw these drugs at the dog. That is extremely concerning to me.

Did they find anything else abnormal on the ultrasound? It would help if you would post any comments they make about the organs they saw, too.

A little more info on things to watch for - vomiting, yes, but also nausea without vomiting, loose stools and diarrhea, loss of appetite - add these to the list the vet gave you to watch for that might indicate an overdose, ie the cortisol has gone too low. You do NOT want your baby to have any of this. These are NOT the signs that your baby is loaded but signs the load has gone too long.

The signs that mean the load may be achieved and you stop giving the Lyso are very subtle. It could be something as small as looking up from his feed bowl when before starting treatment he would wolf it down in a hurry. Or he goes to the water bowl less often or stays for a shorter time drinking. So it is important to know his eating and drinking habits before starting treatment so you can notice these small changes that could mean the load is achieved. When you see these signs, you stop the Lyso and call the vet for an ACTH to check the levels in 2 days. Each Lyso pill works for 48 hours and you want the ACTH at the peak time. ;)

Because Lyso works for that length of time, any time you have doubts or concerns do not give the next dose. Call the vet and let them know what is going on. And, we will be here to ask questions of and to tell what you are seeing that is worrying you and we can help.

I know this is overwhelming and scary right now but you and your baby are in great hands here. We will be with you all the way. Never hesitate to ask questions! We will do our best to help. You are not alone on this journey.
Hugs,
Leslie and the gang

[goldengirl88]

Marianne:
Sorry I inadvertently put your name in instead of Kim's.
Patti

[labblab]

Marianne:
Sorry I inadvertently put your name in instead of Kim's.
Patti
Patti, that is no problem at all! ;) :)

I'm betting Kim will stop by here herself before long.

[frijole]

:) Checking in and thanks for adding the lysodren to the thread title.

I agree with what the others have said re the starting dose.

I find it strange that you started dosing without having a firm diagnosis other than an ultrasound. Did you not do an acth test? I think you said you did ldds tests.

Not all adrenal tumors result in cortisol production. My dog Annie had a pheochromocytoma and was misdiagnosed as having cushings. One simple question - does your dog have rapid breathing episodes that come and go or high blood pressure?

I was out of town yesterday and am going to a concert and will be back to check in this evening. Thanks Kim

[labblab]

Yay, Kim, glad you're checking in here! :)

Quick testing recap for you: we're not sure right now what blood test/s were done. Sos is going to find that out for us this week. In the event it was the ACTH and it was negative, I'm suggesting that a LDDS might actually have been a better choice in this case since we know there's an adrenal tumor and the ACTH often fails to identify adrenal Cushing's. But we'll see what the test results actually were.

Marianne

[sos]

Sorry, I'm starting to get a little overwhelmed by all the responses. I know that an ACTH test was done this past week. There were a lot of blood tests done a few weeks ago, but I'm not sure what they were. I believe they were sent to Tufts. I live in the Cape Cod area and have quick access to Boston. But on that note, I do have a lot of confidence in my vet down here. Some of the things he told me I may not be quoting correctly, as I said, my head is kind of spinning right now.

[molly muffin]

Hi sos and welcome to the forum.

The others have already given you the pertinent parts, so I'll just stick to saying, welcome and that we all came to be here, while in a state of pure scared for our furry freinds. The good news is that with cushings, proper treatment, a good vet that understands cushing and cushings treatment and dogs can live out their normal life span.

There are a few things that need to be figured out in your case. The tests and the results will give us an idea of where you are and what next steps you might want to consider and talk to your vet about. We offer guidance and support to help you get through these crazy days. :)
Once you have a firm plan in hand, then you'll feel a lot better about things.

Welcome.
Sharlene and Molly Muffin

[lulusmom]

Hi sos and welcome to the forum.

I know you are already on overload but I wanted to add my two cents and hopefully not put you in complete tilt mode. :D

Based on what you've told us, I think I do understand your vet's approach to treatment and in my opinion, the 50/50 proposition may be a bit optimistic. If your vet did an acth stimulation test and the post stimulated cortisol was within normal range, that would not be uncommon for a dog with an adrenal tumor. The acth stim test is very likely to yield a false negative result but it could also be an accurate result, if the tumor is not secreting cortisol. I believe Kim has already mentioned this possibility. Your vet may think the latter is the case and has prescribed a low loading dose, hoping that it will be enough to reduce the excess amounts of all of the adrenal hormones that the tumor is secreting. The problem is that adrenal tumors are extremely resistant to Lysodren and normally requires doses greater that the usual 50mg/kg loading dose to be effective. You may be wasting money every time you give your dog a pill but it's too early to tell.

Has your vet discussed the possibility of surgery with you? If your dog is a good surgical candidate, it can be a permanent cure; however, it is costly. If you can afford it, you may want to consider consulting with a board certified surgeon. It is a risky surgery; however, the risks are much lower if the tumor has not spread into the vena cava, and/or the surgeon is a seasoned veteran in performing this surgery. There are a few surgeons in So Cal that treat these surgeries like a piece of cake. If you are anywhere near So Cal, let me know and I'll give you the name of one of the best in the country. If surgery is out of the question and your dog is not responding to Lysodren, you should talk to your vet about the possibility of trying Vetoryl (Trilostane). When this drug was first approved, it's use was restricted to dogs with elevated cortisol caused by both pituitary and adrenal tumors but with more studies and experience since becoming FDA approved, some specialists are now very comfortable prescribing Vetory for dogs with atypical cushing's. Atypical cushing's is diagnosed when a dog presents as cushingoid, including the usual blood and urine abnormalities, yet cortisol is normal, but one or more of the sex hormones are elevated. These sex hormones can cause identical symptoms as typical cushing's.

I hope all of that makes sense.

Glynda