Need advice please

[Mishl888]

I have a 15 year old Shitzu. She was diagnosed with Cushings three months ago. I started her on Trilostane and have had problems ever since. Her dose has been adjusted and we have had regular blood tests but the side effects of the trilostane are so upsetting. She has lost her appetite, vomiting, and has a difficult time walking. She staggers, almost looks drunk. I stopped the Trilostane today and do not want to put her back on it. Long story short The vet wanted to run the ACTH test and keep her overnight for IV fluids and also give her steroids. Her bloodwork showed low blood glucose levels, no signs of dehydration and her electrolytes were ok. I did not let her stay overnight. I feel like I have put her through too much already. She is home with me back to drinking a lot and has not eaten today. Don't know what to do for the best

[molly muffin]

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Sharlene

[molly muffin]

Hello and welcome. I wanted to go ahead and post quickly, it sounds like her cortisol has gone too low.

A steroid rescue dose is often needed and can be life saving when cortisol goes too low and an ACTH test needs to be done ASAP. I'm very concerned.

She should not be wobbly, vomiting, as this is a sign of over dose and is very serious. The good thing is that her electrolytes are stable and that was checked, but an ACTH should have been done today, and prednisone (steroid) given to perk her back up. How long she would need to be on that is dependent on how low she has gone and how long, if ever it takes her adrenal glands to produce cortisol.

Cushings can be tricky, but once you are stablize she should be fine. This however is a crisis and has to be gotten through first.

How much vetroyl was she on? What is her weight? Do you have any of the ACTH test results used to diagnose and for monitoring as that will help us to help you more.

If at any point during the night she appears too lethargic, cannot get up, vomits, she needs to go back to the vet ER to get the prednisone immediately. This is serious, but she can come through it okay.

Sharlene and Molly Muffin

[Harley PoMMom]

Hi and welcome to you and your girl from me as well! I have manually approved your membership so you can just disregard the email notification from us. So sorry for the reasons that brought you here but glad you found us.

I agree with Sharlene in that it sounds like your girl's cortisol has dropped too low. Stopping the Trilostane was the right thing to do but I believe your girl might need some prednisone to make her feel better. Did the vet prescribe any prednisone for you to keep on hand?

Could you tell us more about your girl such as her weight and the dose of Trilostane she was taking? Also if you could get copies of all tests that were done and post any abnormalities that are listed that would help us a great deal, we are especially interested in the results of any monitoring or diagnostic tests for Cushing's...thanks!

We are here to help in any way we can so do not hesitate to ask all the questions you want.

Hugs, Lori

[labblab]

I have a 15 year old Shitzu. She was diagnosed with Cushings three months ago. I started her on Trilostane and have had problems ever since. Her dose has been adjusted and we have had regular blood tests but the side effects of the trilostane are so upsetting.
Hello and welcome from me, too. I think one key question here is, what have been the "regular blood tests" that have been guiding the dosage adjustment? Given your description of her behavior, if the bloodwork has not included monitoring ACTH tests, we must wonder whether her cortisol level may have been oversuppressed all along the way by the trilostane, regardless of the status of her electrolytes. Here's a quote from the U.S. Product Insert for brandname Vetoryl:


A post-ACTH stimulation test resulting in a cortisol of <1.45 μg/dL (<40 nmol/L), with or without electrolyte abnormalities, may precede the development of clinical signs of hypoadrenocorticism.

Your vet was doing the right thing by recommending ACTH testing now, especially if it has not been performed in the past. It is very important to know the status of your dog's cortisol production, because supplemental steroid may indeed be necessary to sustain her until her own adrenals rebound. If she does not normalize today, I really think you need to return her to the vet.

If she has, indeed, been overdosed with the trilostane, this problem can be addressed and rectified. So there is no reason to give up hope that her disease ultimately can be better managed on a lower dose of trilostane. But if her cortisol is too low right now, this is a crisis situation and needs to be addressed ASAP.

Marianne