Cushings in 9 year old Brussels?

[KatTeacher]

Hi Everyone,

I have been reading here for a while, but this is the first time I am posting. My family's 9 year old Brussels Griffon named Cinderella has been dealing with some unidentified health issues for almost a year now, and I'd love some advice for those of you willing to give it.

Cinderella was brought into the ER about a year ago because she seemed to be in distress. The ER vet noted her hair loss and enlarged liver during her exam. They conducted a LDDS test a few days later which came back negative and referred her back to her general vet. Since then, her veterinarian has performed a variety of tests: a repeat LDDS, ACTH, UCCR twice, bloodwork, etc. Her ACTH came back positive in May. Pre-cortisol levels were at 4.9 and post cortisol levels were at 32.3. However, at the time, her vet said there was only a 30% chance the results were truly correct, and we continued to look outside of Cushings for answers.

Cinderella had a thyroid panel done in October which showed she may have hypothyroidism, and she was put on soloxine. Since then, she has become more active, and we have seen some growth in her hair. At the same time as the thyroid panel was done, urine samples showed she had a high level of protein loss in her urine. I believe it was 2.6 or 2.9. I can't be sure. And she was also diagnosed with high blood pressure. She was put on meds for both and while her blood pressure has decreased, her protein loss has not. An ultrasound was also done which showed enlarged adrenal glands but no tumor.

After her general vet consulted with an endocrinologist, she now wants to start her on Trilostane. For a period of time, her vet and a fellow vet in her practice had continually ruled against Cushings despite the positive ACTH stim test, but now seem to think Trilostane is necessary, and I'm not sure what to do. She has always been an excessively hungry dog, and while she does appear to drink a lot of water, she doesn't urinate excessively. Her liver and kidney levels are both normal.

Do you think we should begin the trilostane or seek a second opinion from an internist?

Thank you :)

[molly muffin]

Moderator’s note: In order to complete your registration, you need to check your emailbox (or spam folder) for a communication from us. Once you respond to that email, your membership will be finalized, and anything that you post will become visible on the forum immediately. Until that time, your replies must be manually "approved" by a staff member before they are visible to the public -- so there may be a bit of delay between the time that you write your replies and the time that you actually see them.

If you have already received and responded to the confirmatory email, please be patient. Your registration will be finalized shortly…Thanks!

[Meg_Elizabeth]

Welcome to the site! im so sorry to hear your baby is struggling. Seems to be a lot of confusion in terms of a diagnosis and treatment plan.

In terms of consulting an internist, I say go for it! It never hurts to get another opinion. Even though both the vet and endocrinologist agreed on Trilostane, you want to be absolutely sure before you start medication. Especially if your pup is already being treated for other conditions.

Cushings is an expensive disease and you want to save as much money as you can if that happens to be the diagnosis. A different vet or internist may have more/better options for you. It never hurts to hear them out! Knowledge is power. Many vets are inexperienced when it comes to Cushings so the more opinions, the better!

Sending love and blessings!

-Meg and Abby

[KatTeacher]

Thanks for responding! Yes, there has definitely been a lot of confusion. Her vet has said all along nothing seems clear cut one way or the other with her. She has been great and has spent a lot of time with Cinderella and a lot of time talking on the phone and meeting with me to go over labs and other results, but her confusion has shaken my faith a bit. I don't want to offend her by seeking another opinion, but I'm nervous to start her on trilostane without a definitive diagnosis. She has also mentioned that Cinderella may have atypical Cushings as her LDDS came back negative twice but didn't feel as though sending her bloodwork to the University of Tennessee was necessary. I've read that lysodren is the better drug to use with atypical Cushings, so I have concerns over why we would use Trilostane instead.

I feel like I could pull my hair out from all of this confusion and stress!