Igby - Adrenal necrosis and Supplements

[nellieparker]

Hello all! I am new to forum. My dog Igby was diagnosed with Cushing's about 6 months ago. We have had a hard time getting him regulated on the trilostane. He was doing really well before Thanksgiving, then I took him home to my parents house. The stress of the drive (which he used to love) took him back a few steps. We have had a hard time ever since. His latest test came back within normal range, but his PU/PD is still elevated. The last few weeks he has also become very jumpy. He flinches at little things and hides with certain noises like the oven beeping or the neighbor kids coming over to say hello. His anxiety is pretty high, especially in the evenings. Have any of you experienced this, even with test results being in normal range? And have you had any experience using supplements in conjunction with medication, such as phosphytidylserine or herbs? I haven't spoken with my vet about supplements, but he said to stay at the same dose of meds he is on and give it some time. Thanks for any help or advice you can offer! We are a little desperate and I hate seeing my Igby this way!

[Harley PoMMom]

Hi and welcome to you and Igby,

Could you tell us more about sweet boy? How much does he weigh? What is the dose of Trilostane is he taking and is this being given once or twice a day? If you could get copies of those ACTH stimulation results with their timelines and post them here that would be a great help to us.

For Trilostane to be absorbed properly it has to be given with food, is Igby getting his dose of Trilostane this way? Also, the ACTH stimulation test has to be done 4-6 hours after the dose of Trilostane is given, is this protocol being followed?

In some cush dogs even with treatment the PU/PD may not resolve, which is called renal medullary washout. This means that all the stuff (solute) his kidneys need to concentrate his urine has been washed out for a very long time so the kidneys will take some time to recover. What other Cushing's symptoms did/does Igby have, and have they abated?

Once we know more about your boy hopefully we can provide you with meaningful feedback.

Hugs, Lori

[labblab]

Welcome from me, too! And yes, it will be great if you can get us the actual numerical results, especially for the most recent monitoring ACTH results. It worries me a bit when you say that his result has been within "normal" range, because the desired therapeutic range for a dog being treated with trilostane is actually lower than the normal range that labs print for dogs who do not have Cushing's at all. So if Igby's monitoring test results fall within the printed normal range -- but no lower -- that could explain why his symptoms and behavior are "off."

Marianne

[nellieparker]

I'm sorry it's taken me so long to get back on here, it's been a crazy month. Anyway, to answer your questions Igby is a 55 lb husky/German shepherd mix. His last ACTH was done in early January. Pre-ACTH was 3.4 and Post was 4.6. The range for post is 6-18. He is currently on 135mg of trilostane (90 am and 45 pm with food). I have been researching supplements such as phosphytidylserine and Cushex to help support him and hopefully to lower the trilostane back down to just 90 mg. Since my last post his PU/PD has gotten much better, but he is still 'jumpy' and anxious. He has recently started yelping at random times (standing up, being touched on the head unexpectedly, sometimes while just laying down). I know that the lowered cortisol levels can reveal hidden problems with arthritis and such, I'm just having a hard time telling if it's arthritis or something related to the Cushing's since the yelping is random. Anyway, any experiences with the supplements, the yelping, and maybe a long term pain med like Derramax would be much appreciated!

[Harley PoMMom]

That 135 mg of Trilostane seems high for a dog weighing 55 lbs. Was Igby started at this dose?

His most recent ATCH stimulation test results, pre-ACTH was 3.4 and post was 4.6, are actually perfect. The ranges for a dog on Vetoryl/Trilostane are 1.5 ug/dl - 5.5 ug/dl with a post as high as 9.1 ug/dl if symptoms are controlled.

Is Igby doing any head pressing and/or circling?

Hugs, Lori

[nellieparker]

He didn't start out at that dose, we just gradually increased him until his symptoms started to decline. I agree that it's high, that's why I wanted to try supplements to get him back down to 90mg. Thankfully no head pressing or circling. Just lots of pacing and the jumpiness/yelping. He's become very clingy with me as well. He was always a bit that way, but it has definitely worsened. Thanks for letting me know the ranges for the test. It makes me feel better to know that his are perfect. 😊

[labblab]

Was he on that dose at the time of the January ACTH testing? If not -- if you have subsequently increased the dose -- I would be very worried that his cortisol may have dropped too low during the interim. Symptom resolution is definitely half the clinical picture, but the cortisol levels and basic blood chemistries are very important, too. Those levels may drop too low prior to seeing outward behavioral abnormalities.

Marianne

[nellieparker]

No, he had been on that dose for at least a month before testing. The Vet said she wanted to wait until he had been on a steady dose for that long before testing his levels.

[nellieparker]

Hello all! I have not been on here in awhile. My dog Igby has been doing pretty well on his trilostane regiment for the last couple of years. The last month he has been exhibiting some symptoms that his cortisol levels might be high. He was due for a recheck anyway and so I took him in for a stem test. Surprisingly, his cortisol levels (both pre and post) were low and the doctor is worried about adrenal necrosis. He wants me to ween him off of the trilostane over the course of a week and then recheck levels three weeks after. I am having nightmares of the water obsessed, high anxiety, sleepless, peeing all the time dog that Igby was before being diagnosed! :( Has anyone had a similar experience?!? Suggestions or advice would be helpful!

[Squirt's Mom]

Hi Nellie,

Welcome back!

Can you tell us what the results were along with the reference range from the lab? And can you tell us what signs of over-suppressed coritsol you are seeing - lethargy, loose stools/diarrhea, nausea/vomiting, loss of appetite? Can you tell us what does he is taking now and what his current weight is? In reading back thru your thread it seems there was concern about the dose your baby was taking in 2015....;)

Can you will us in on his history over the last couple years? Any new problems or medications? Surgeries? etc?

With those latest ACTH results we will be able to give you better feedback but without that we are sorta blind. ;) The other info will help a lot, too, tho! :)

Hugs,
Leslie and the gnag

[nellieparker]

His pre was 1.3 on a 2.2 -7 scale and his post was 1.2. That's the weird thing, he isn't exhibiting signs of Addison's or adrenal necrosis. He is (to me) exhibiting signs that his levels are elevated, excessive water consumption and anxiety. Nothing like they were when he was first diagnosed, but noticeably increased. I expected the results to be the complete opposite. He has been pretty stable the last year and a half. He currently takes 67mg trilostane BID on. I will also add that he has degenerative disc disease and is on gabapentin, tramadol, and novox. We also suspect he has some dementia (sundowner's syndrome?) and so is on trazadone to help him sleep at night. He is mostly a hot mess, but it doesn't really faze him. He eats well, plays while laying down, and is generally happy as long as he has me helping him up and moving around.

[molly muffin]

Hello, you don't usually have to wean them off trilostane, you just stop it.
Keep in mind that the symptoms of too low of cortisol is the same as symptoms of too high of cortisol. At those levels he isn't stimulating and hasn't anything in reserve in his adrenal glands, which is why the vet is concerned that the adrenal glands have become necrosis. Which would mean they don't work at all. In which case if they don't come back on their own, you would likely have to start adding in a steroid supplement as a life saving measure. So it is pretty serious to over stimulate. I understand that you are concerned about the symptoms of cushing coming back but it is a life threatening issue "necrosis"