Newly diagnosed Zachary

[letahunt]

My dog, Zachary, has just been diagnosed with PDH based on LDDS test results at 4 and 8 hrs. I am currently discussing treatment options - either trilostane or lysopren.

Zachary's primary symptom has been excessive hunger. He does not drink a lot of water or have skin issues. For his hunger, I recently put him on a higher protein diet (Orijen), and it has at least temporarily reduced his hunger.

Zachary is 14 years old and appears to be generally in good health. He loves his walks and brings a lot of gusto to life (and to my life!).

I do not like the idea of destroying portions of his adrenals to treat the problem with his pituitary; e.g., lysopren. From a theoretic perspective, trilostane sounds better to me, but I do not understand how it can result in permanent adrenal necrosis.

I need advice. Thanks in advance.

Leta

[Harley PoMMom]

Hi Leta,

Welcome to you and Zachary! I am sorry for the reasons that brought you here but so glad you found us.

Since other non-adrenal illnesses, such as diabetes and thyroid problems, share some of the same symptoms of Cushing's it can be one the most difficult diseases to get a confirmed diagnosis for, plus not one test is 100% accurate at diagnosing Cushing's.

Could you get copies of all test/s that were done on Zachary and post the results here with the reference ranges and units of measurements, we only need the abnormal results. We are especially interested in the results of any diagnostic tests that were performed, such as that LSSD test.

Lysodren (Mitotane) and Vetoryl (Trilostane) are the medicines that are most rx'd when a Cushing diagnosis is confirmed. IMO, either medication is safe when monitored appropriately and with owner observation, and each med can have similar adverse effects. So "owner observation" is always a crucial component of treatment.

Each has it's pros and cons, they work differently, they are both safe when monitored appropriately, yet they both can have the same and serious risks and adverse effects.

One or the other may work better for an individual dog.

Another important consideration is the degree of experience your vet has with whatever treatment he/she chooses. Cushing's requires a good partnership with one's vet.

Our Resource Thread has a wealth of information regarding Cushing's, so here's some handy links: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10)

Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

Please feel free to print anything out and if you have any questions, please do not hesitate ask them. And remember we are here to help in any way we can.

Hugs, Lori

[Trixie]

Hi leta,
Welcome to the board though sorry for the reason that brought you here.
I think the seasoned experts on this forum will be most anxious for you to post any/all of the test results you have and will be more able to help and guide you with a bit more information. Blood test, the LDDS test numbers will all be helpful to see.
My dog was diagnosed almost a year ago at age 9. She is currently on Trilostane/Vetoryl. We have been treating with this medication for almost a year now. We took the conservative route and started with low dosing twice a day. Current recommendation is to begin the dose at approx. 1mg per pound of your dog.
It took months of tweaking to get the dose to optimum level controlling my dogs symptoms. The brand name comes in 10,20,30 mg and higher. The generic form-Trilostane can be had in compounded doses to customize for a dose that does not come in the branded medication.
Thus far we have not not experienced any side effects (knock wood!!) and my dog is doing well. Pretty much her usual self, energetic and always ready to play.
I cannot speak about Lysodren but there are many here who have successfully treated with it and I'm sure they will be responding to your post.
What kind of dog is Zachary? It sounds like other than Cushings he is doing great at 14!


Barbara

[molly muffin]

Hello and welcome to the forum. Lori and Barbara have gotten you off to a good start. I will try to answer your question regarding how it is possible for trilostane/vertroyl to cause permanent adrenal necrosis.

This Could be caused by giving a dog too much or too high of a dosage of vetroyl. Since vetroyl inhibits the production of cortisol by the adrenal glands, if you are over dosing and the cortisol goes too low you can cause an Addisions crisis, which usually after a period of time, the adrenal glands will start to make cortisol again, but not always. It is not particularly common to have a permenent state of Addisons but it does happen from trilostane. It also can happen that after being on vetroyl/trilostane for awhile, that the dosage can be decreased and even eventually stopped. A complete stop is very rare, but it has happened. I can think of one dog on the forum, who did not end up needing any treatment for cushings.

We have found that the safest way to use trilostane in particular is by starting at 1mg/1lb and adjusting as needed, based on symptoms and ACTH test results once treatment is started.

Both drugs should be considered safe with a knowledgeable vet and a vigilant/knowledgeable owner working together as a team.

I hope that helps and welcome again to the forum

Sharlene and Molly Muffin

[doxiesrock912]

Leta,
I think that the choice of meds is personal preference on the part of the vet to be honest. Our IMS vet chose Trilostane because she feels the same way that you do and so far, Daisy is doing well. She's been on Trilo since May 2013.

Both medications have risks of course.

[letahunt]

Thank you all for your comments!
Zachary is a smooth haired jack russell terrier. His test results follow:
ALT. 222 ref 12- 118
alk phosphatase. 1041. ref 5-131
bun 34. ref 6-31
bun/creatinine ratio. 31. ref 4-27
cholesterol. 331 ref 92-324
platelets. 707 ref 170-400
LDDS
sample 1. 2.7
sample 2. <0.7
sample 3. 2.8. ref 0.0 - 1.4