3 year old Bichon diagnosed w/ Cushings, minimal symptoms

[Chrstna101]

Hi everyone,

My 3 year old Bichon, Reggie, was diagnosed with Cushings after an ACTH test. He just started a low dose of Lysodren today - 12.5mg every other day for 10 days (he is 22 lbs) and then he will have his cortisol level checked. Reggie had NONE of the typical symptoms except sparse hair in his lower body. Three vets said it would be a 10% chance it would be Cushings so we were all shocked. I hate that I have to give him this drug for the rest of his life when he doesn't have symptoms but at the same time, I don't want to wait around for them to start either. I am hopeful he will have a normal life but this medication scares me. I will do anything for Reggie and trust that his doctors made the right decision in starting Lysodren.

I am curious to know if anyone else out there had a young dog with this diagnosis without the usual symptoms and what your experience has been.

Thank you so much!

[frijole]

Can you please get the results from the acth test and the blood panel for us? I am asking because you mentioned not having cushings symptoms and also because of the dosage your vet is using. Something doesn't add up.

I used lysodren for almost 5 years and protocol is to give it daily during loading - so an every other day dose is a waste of time. Are you using pills or a liquid form? I ask because a dog 22 lbs would typically start at a dose of 500 mgs a day (one pill). That is based on protocol established by experts over the years. It is weight x 2.2 to convert to kgs. That number x 50 mgs.

Something is missing here. Thanks. Kim

[labblab]

Like Kim, I am very concerned. Since there is no single definitive test for Cushing's, it is a diagnosis that depends as much on the symptom profile as it does on the test results -- especially since the ACTH can register as "positive" in the face of illnesses other than Cushing's. If all you are seeing is some hair loss, I would not yet be starting treatment if this were my dog.

Were there any other abnormalities in your dog's blood or urine studies (I am hoping complete panels were performed prior to a step as serious as starting Lysodren)? How about thyroid level - was that normal? There are certain lab abnormalities that are typically exhibited by Cushpups, so if none were present for your dog, this would be another reason why I would question the diagnosis.

It sounds as though your vet is aiming at a low dose ongoing "maintenance" regimen of Lysodren, which is indeed sometimes recommended for treatment of symptoms caused by elevated adrenal hormones other than cortisol ("Atypical Cushings"). But this diagnosis could have resulted only from a special blood analysis performed by the lab at Univ. of Tennessee at Knoxville.

Can you please obtain and post the actual ACTH results for us, and also any other lab abnormalities that your dog may have exhibited? Bottom line for me is, I would not feel comfortable beginning Lysodren until more puzzle pieces are known. And if hair loss is the only symptom (both externally and internally) I would want a consultation with a dermatology specialist before proceeding onward.

Marianne

[Squirt's Mom]

Hi and welcome to you and Reggie! :)

I'm jumping on the wagon with Kim and Marianne - please stop the Lysodren for now. It is quite risky for a vet to guess at a diagnosis of Cushing's and start treatment. If you could get copies of all the testing done on Reggie that led the vet to this action and post the actual results here, that would help us a great deal. But for now, I would stop the Lyso for sure. These are very powerful drugs that are used to treat this disease and they should never be given without a pretty solid diagnosis.

Looking forward to learning more about Reggie and you as time goes on.
Hugs,
Leslie and the gang

[goldengirl88]

I just wanted to say hello to you and welcome you to the forum. You are already in excellent hands so I will just add a few things . I am with the others on stopping treatment immediately. Can you tell us some history on your dog, it's weight, signs it presented with, and the testing done to confirm Cushings. Please post the abnormal numbers form any testing done, and tell us the normal range given by the lab as they are all different. Everyone will want to see the numbers to tell you what is going on with your dog. These are powerful drugs you do not want to be giving if your dog does not have Cushings. This must be confirmed by several tests, not just a vets assumption. I would be very leary of any vet treating a dog on assumption. Please listen to the panel they know this disease and would never steer you wrong. They have many years of experience with this. There are many diseases that have similar symptoms so please be careful Blessings
Patti

[Chrstna101]

You guys are AMAZING! I love the support, thank you so much. I have requested the results of all of his labs, there has been a ton. Thankfully, I live in Orange County, CA, home to one of the most respected dermatologists in the country. I will be in touch as soon as I have his results, thanks again!!!

[Chrstna101]

I have the results, is there a way to copy and paste them into this thread? If not, I will type them out. Thanks!!

[Chrstna101]

Like Kim, I am very concerned. Since there is no single definitive test for Cushing's, it is a diagnosis that depends as much on the symptom profile as it does on the test results -- especially since the ACTH can register as "positive" in the face of illnesses other than Cushing's. If all you are seeing is some hair loss, I would not yet be starting treatment if this were my dog.

Were there any other abnormalities in your dog's blood or urine studies (I am hoping complete panels were performed prior to a step as serious as starting Lysodren)? How about thyroid level - was that normal? There are certain lab abnormalities that are typically exhibited by Cushpups, so if none were present for your dog, this would be another reason why I would question the diagnosis.

It sounds as though your vet is aiming at a low dose ongoing "maintenance" regimen of Lysodren, which is indeed sometimes recommended for treatment of symptoms caused by elevated adrenal hormones other than cortisol ("Atypical Cushings"). But this diagnosis could have resulted only from a special blood analysis performed by the lab at Univ. of Tennessee at Knoxville.

Can you please obtain and post the actual ACTH results for us, and also any other lab abnormalities that your dog may have exhibited? Bottom line for me is, I would not feel comfortable beginning Lysodren until more puzzle pieces are known. And if hair loss is the only symptom (both externally and internally) I would want a consultation with a dermatology specialist before proceeding onward.

Marianne

Reggie had surgery in November to remove a benign hair follicle tumor, pathology was consistent with endocrinopathy, clinical findings noted partial hypotrichosis, which is what led to ACTH testing.

The ACTH was performed at the College of Veterinary Medicine, University of Tennessee, Knoxville

Cortisol baseline result was 75.4, normal range is 2.0 – 56.5. Post ACTH was 198.8, normal is 70.6 – 151.2
Androstenedione baseline result was 2.38, normal range is 0.05-0.36. Post ACTH was 5.29, normal is 0.24-2.90
Estradiol baseline result was 87.9, normal range is 23.1 – 65.1. Post ACTH was 65.2, normal is 23.3 – 69.4

Other lab notes: The lab results indicate presence of increased adrenal activity. Glucocortoid and sex steroid pathways are affected. Although, estradiol may contribute to clinical signs it is not a good indicator of adrenal activity, since it is also secreted by peripheral tissues (adipos, skin); in this case the source is not known.

Based on these results, the dermatologic specialist and Reggie’s regular vet decided to start on the lower dose of Lysodren. He will have a 2 hour Cortisol check in 2 weeks, also being performed by University of Tennessee, Knoxville.

Reggie is 22 lbs.

I would love your thoughts based on the above, thank you so much!

[molly muffin]

Hi and welcome

With the labs you only need to post the abnormal results with the range.

Normally this is what we do, a style like this:
11/20/2013

ALT 250ug (50 - 160ug)
ALKP 1000 (300 - 700ug)
just as an example of style
ACTH
pre
post
LDDS
0 hr -
4 hr -
8 hr -
with ranges.

Sharlene and Molly Muffin

[molly muffin]

Looks like we were typing at the same time :)

So, yes based on the ACTH results, cortisol is high.

Was an LDDS test done also? Normally they do both to confirm a cushings diagnosis, since it's one of the more difficult to actually diagnose. Especially based on age and lack of normal cushing symptoms, I'd think they'd want to be very sure before starting lysodren, which is pretty powerful drug.

I ask because cortisol can be raised if anything else is going on too and not Just cushings.

I'll let the others who have the experience with lysodren speak to dosage amounts, but basically with lysodren, you load for a number of days, until you notice the sign of loading being complete, this could just be a look up at you and not gobble food, then 48hours later you have an ACTH test to see if loaded, then go to a maintenance dose every 2 - 3 times a week.
However, without the typical symptoms that could be very difficult to even gauge. (when loaded)

How soon after the surgery was the ACTH test done?
Have they run a thyroid panel and verified no diabetes?

Welcome again to the forum,
Sharlene and Molly Muffin

[labblab]

Thanks so much for the test info, and it does make a lot more sense of things. Whereas the traditional approach has been to await the emergence of more overt symptomology prior to treating, I am aware that more aggressive early intervention is now being advocated by some specialty vets, especially by derm vets who strongly suspect Cushing's is the basis of distinctive skin/coat issues (such as calcinosis cutis, or the pathology of the hair follicle tumor in your dog) even though other classic symptoms are not evident.

Per the testing, your dog did exhibit mildly elevated cortisol in addition to the other two elevations. So the low-dose ongoing maintenance Lysodren approach sometimes recommended by UTK makes much more sense to me now (as opposed to a traditional "load"). I'm still scratching my head a bit, but it sounds as though you have a very capable consultant on board. So please do keep us updated throughout the treatment process. I will be very interested in how things go!

Marianne

[frijole]

Is the dose liquid lysodren? Or tablets? Thanks! Kim