Tuffy, 14 yr old shepherd husky--Cushings?

[Tara_Mtl]

On May 6th my beloved Tuffy had 6 seizures--4 small ones and 2 large ones. They were terrifying. He began on potassium bromide and has not had a seizure since, though the meds gave him terrible side effects (severe muscle weakness, collapse, confusion). His dose was greatly reduced and his symptoms have mostly resolved. We still don't know what caused the seizures, though. The vet said it could be that he ate something toxic, or due to his age, a brain tumor.

All his tests came back normal except for liver enzymes (liver function tests came back fine). Two years ago they were high (800) and were attributed to his age and now they're at 1600. The vet suggested doing an ACTH test that involved two blood tests. The first one came back normal and the second came back slightly abnormal. The vet said he didn't present as a typical Cushings patient and said he didn't suggest further testing. My cousin who has had two dogs with Cushings sent me a list of Cushings symptoms. I wnt through them, and the list below has the symptoms that I've noticed in the past several months. As I have 2 dogs and 4 cats, I couldn't be sure who was drinking so much water, but I just noticed that I was having to fill the dish much more often; I since narrowed it down to Tuffy. Now it's hard to tell if his thirst is because of the meds (potassium bromide is almost pure salt). Also, his dog bed would have accidents on it, but it was occasionally, and I always thought a cat had peed on it (not that they usually do this, but I knew Tuffy would be mortified at peeing in the house). Anyway, this is what I've noticed (he has all of the following to various degrees):

• increased/excessive water consumption (bad)
• increased/excessive urination (marked increase in asking to go out)
• urinary accidents in previously housetrained dogs
• increased/excessive appetite (asks for breakfast and dinner all the time)
• appearance of food stealing/guarding, begging, trash dumping, etc. (VERY BAD!!!)
• loss of muscle mass, giving the appearance of weight loss (a friend said it looked like he lost muscle mass in his legs)
• bony, skull-like appearance of head (not excessive, but there has been a change)
• exercise intolerance, lethargy, general or hind-leg weakness
• new reluctance to jump on furniture or people
• excess panting, seeking cool surfaces to rest on
• symmetrically thinning hair or baldness (alopecia) on torso (slight, on his "waist" and tail)
• other coat changes like dullness, dryness
• slow regrowth of hair after clipping
• thin, wrinkled skin
• susceptibility to infections (I think he's had urinary issues)
• seizures

What do you think? What should my next steps be? If it is Cushings, then time is of the essence, isn't it?

Thanks in advance,
Tara :)

[Wylie's Mom]

Hi Tara & Welcome,

I'm not familiar enough about seizures & potassium bromide, but for the other items you mentioned, Diabetes, Hypothyroidism & Atypical Cushing's do have several similar clinical symptoms. I'm not a vet or expert on distinguishing exactly which symptoms are more prevelant for each particular one, but I would guess that your vet has checked for Diabetes & Hypothyriodism. Many vets are not familiar with Atypical Cushings. Hopefully, you're in the U.S. (easier)... the only place known to test for Atypical is the Univ. of Tennessee, Knoxville (UTK). Your vet would want to do UTK's adrenal panel. The UTK panel is basically an ACTH stim test, but in addition to cortisol, they measure 5 other hormones - Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone. (High levels of these hormones can cause similar symptoms as Cushing's.) Your vet would draw the blood, do the injection, prepare the samples & send them to UTK for evaluation. Here are some links to information & specific instructions for your vet:

Info for you and your vet - read "STEROID PROFILES IN THE DIAGNOSIS OF CANINE ADRENAL DISORDERS":
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php

Submission form for your vet to fill out (these are only the costs that UTK would charge your vet, additional charges would include your vet drawing the blood, injection, prep & shipment – for example, my vet would have charged me about $300+ (not just $135) for the “Adrenal Panel – ACTH Stim” :
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endosubform06.pdf?r1

Instructions for vet on how to collect & prepare sample (if your vet has questions, UTK phone number is on this sheet):
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endo_tests_info.pdf?r1

Hopefully, this helps, if Tuffy is Atypical, the treatment is so much cheaper and less scary than regular Cushing's;).

And there usually is not a huge rush... regular Cushing's & I believe Atypical Cushing's, are slow diseases... the most important thing at this stage is to get an accurate diagnosis.

-Susy

Also, if you could, please post the test results that have been done so far (ACTH stim or LDDS; if Urine Cortisol Creatinine Ratio UCCR was done; & blood work - history of elevated items would be good for now), include units and reference ranges. If you don't have copies of them, you should get copies from your vet for your own records... they could come in handy if you ever needed to go to a different vet during an emergency.

[Squirt's Mom]

Hi Tara,

Welcome to you and Tuffy! :)

The signs you have posted are consistent with Cushing's, but as Susy said they could also be indicative of several other conditions. The seizures are not usually seen with Cushing's unless there is a tumor on the pituitary that starts to grow and press on the brain. But we have learned that each pup is different and that many don't read the rule book! ;)

One of our members, Sue, and her baby, Zoe, deals with bromide levels, Cushing's, plus others and I'm sure she will be along to share her extensive experiences with you soon.

Along with diabetes (both DM - diabetes mellitus, and DI - diabetes insipidus) and thyroid problems, I would have the liver thoroughly checked out - including the gall bladder.

As for the next step, I agree with the full adrenal panel from UTK to check for Atypical Cushing's. It has the same signs as true Cushing's but doesn't typically test as positive for the condition with the usual cush testing. This is a test you want to have done before any treatment for Cushing's is started. If later down the road you find that the signs are still not controlled with the usual meds, you would need to stop treatment for 30 days, have the UTK panel done, then start at the real beginning. This is especially true if Trilostane is going to be considered if Tuffy does indeed have Cushing's.

So, the first step is to continue testing...rule out other possibilities, then have the UTK panel done, and finally an ultrasound on a high resolution machine depending on what UTK recommends. Your vet can refer you for the U/S and for any other specialty needs you may require as testing proceeds. Susy has given you the info on getting the UTK panel run, which several of our vets here have used with success. If your vet has never heard of Atypical or the UTK panel, don't panic. I and others were able to educate our vets on the condition and testing. :p

Eduction is a big deal around here. We always tell new members to start reading and asking questions. You are Tuffy's only voice, her advocate, so the more you know the more confident you will be in these roles. Our Resource section is a good place to start. You can find it here:

K9C Resource section:
http://www.k9cushings.com/forum/forumdisplay.php?f=10

Please ask questions and we will do our best to help you understand. If we don't know, then we will start researching and learn together. That's what family is all about - helping each other whenever we can.

I am glad you found us and look forward to learning more in the future.

Hugs,
Leslie and the girls

[Tara_Mtl]

Thank you both for your quick responses. I've been at a loss as to what to do next. I'm in Montreal, Canada, but I'm sure that my vet would send the results to UTK if I asked him to. I feel like I dropped the ball on this 2 years ago when Tuffy initially had high liver enzymes...I suspected Cushings then. And if it is that or Atypical Cushings and it need not have proceeded to seizures I will be very upset with myself. Tuffy is such a good boy and deserves much better than that. I will get the test results of what he's had done so far and post the results ASAP... Thanks again--good to know we aren't alone...:)

[Wylie's Mom]

Hi Tara,

There is form for shipments outside of the U.S. to UTK:
http://www.vet.utk.edu/diagnostic/endocrinology/shipping.php

You're definitely not alone;)!
-Susy