Can Cushing's cause anxiety in dogs?

[Hemi's mom]

Hello and thank you for hosting this forum!

I was wondering if anyone can tell me if Cushing's syndrome can cause anxiety. Or, can anxiety cause Cushing's syndrome? I am having my little guy tested this week, but thought I would provide some background info:

I have a 13 year-old lhasa apso/terrier mix (neutered male) who I adopted when he was two and he has always been a barker and quite anxious. Other than than, he has always been a very healthy dog until last year when he developed pancreatitis. Bloodwork showed elevated pancreatic enzymes and slightly elevated liver enzymes. He recovered from that episode and has been on I/D diet since then (no other food and no treats, except for "cookies" that I bake from canned I/D). Then, last month, he had another flare up of pancreatitis - probably due to the stress of recently moving into a new house. Again, blood work showed elevated pancreatic enzymes and slightly elevated liver enzymes. The vet placed him on Denamarin to help improve his liver function and mentioned doing some tests to rule out Cushing's. Since he had no other symptoms and seemed to fully recover from this second episode, I decided to hold off on the testing.

Then, last week, I noticed that my little guy was drinking more water than usual and having some urgency to urinate, so I brought him in and the vet performed a urinalysis - no sign of infection, but the specific gravity was a little low. Looking at the overall picture, it is starting to look like Cushing's and he is going to have the low dose dexamethasone suppresion test this week.

Now I am wondering - could the anxiety be what caused the Cushing's syndrome? Or, could Cushing's have been "brewing" all these years, displaying itself as anxiety?

Thank you for any information you can provide!

Hemi's Mom

[labblab]

Hello and welcome to you and Hemi!

As far as I know, there is no evidence that anxiety causes Cushing's. It is true that cortisol levels do temporarily spike in humans as well as dogs in situations of fear or stress. So that might account for short-lived and intermittent episodes of certain symptoms (I know I personally have to pee much more often in advance of meetings, appointments, etc., that I'm dreading!). But the chronic symptoms and consistently elevated cortisol levels associated with Cushing's result from the effects of either pituitary or adrenal tumors.

Now, as for the reverse, can Cushing's make dogs more anxious? I have no scientific evidence to rely on, but it makes sense to me that if your cortisol level is always excessive, perhaps that could cause you to feel more anxious. I know my own Cushpup was certainly very restless prior to his diagnosis and treatment. He panted all the time and had a very hard time staying settled in any one place.

As far as Hemi, we have indeed been told that Cushing's can leave dogs more vulnerable to pancreatitis. But not all dogs with pancreatitis have Cushing's, so I don't disagree at all with your original decision to postpone testing after the pancreatitis settled. I also understand why your vet is reconsidering Cushing's again, however, now that the increased thirst/urination and elevated liver enzymes are also in play in addition to the rebounding pancreatitis. So it will be interesting to see how the LDDS turns out. If possible, we will want to see the actual numbers for the testing, and it will help a lot if we can also see the abnormal numbers on his previous blood panels. All we need are any abnormals, along with the reference ranges.

Thanks very much in advance for this information, and we'll certainly be watching for those LDDS results. Once we know about the testing, we can talk more about the possibilities and additional diagnostics.

Marianne

[Hemi's mom]

Hi Marianne,

Thank you so much for the warm welcome.

I do not have the results from a year ago, but I know that it was a similar profile - elevated lipase, elevated amylase and slightly elevated liver enzymes.

Here are Hemi's labs:

October 14, 2015 (at Emergency clinic, night of pancreatitis attack) -

Lipase 834.0 U/L (H) [range 100.0 - 750.0]
Amylase 1457.0 IU/L (H) [range 165.0 - 1384.0]
ALT 93.0 IU/L (WNL) [range 12.0 - 118.0]
AST 37.0 IU/L (WNL) [range 13.0 - 67.0]
ALKP 727.0 IU/L (H) [range 5.0 - 131.0]

All other values wnl


Re-test - 11/9/15 (no symptoms, no meds) -

Lipase 437.0 IU/L (WNL) [range 100.0 - 750.0]
Amylase 846.0 IU/L (WNL) [range 165.0 - 1384.0]
ALT 220.0 IU/L (H) [range 12.0 - 118.0]
AST 35.0 IU/L (WNL) [range 13.0 - 67.0]
ALKP 803.0 IU/L (H) [range 5.0 - 131.0]

All other values wnl

11/10/15 - Started on Denamarin (1 hour before breakfast each morning)

11/17/15 - One week on Denamarin - drinking more water, urgency to urinate (due to Denamarin? - as per vet, no)

11/18/15 - Urinalysis
Protein = none
pH = 5
rbc = none
Specific Gravity = 1.025
ket = none
bili = none
glu = none

Question low specific gravity in combination with elevated liver enzymes + pancreatitis episode - need to rule out Cushing's

Thank you,
Michele

[molly muffin]

That does sound like a situation where you would want to rule in or out cushings.

The ALKP often goes up a bit with cushings and with the frequent urination and water drinking, I would probably test too.

As Marianne says, anxiety doesn't cause cushings that I've ever heard but high cortisol could contribute to anxiety, especially in a dog that is normally anxious.

Denamarin is a support for the liver and very good for dogs on cushings, and just dogs getting older as they often need supplement support for various organs, just like we do.

Are you getting the test for cushings done? If so which one, ACTH (2 hour) or LDDS (8 hour). Often vets will do both as the tests tell you different things.

Welcome to the forum!

[Hemi's mom]

Hi Sharlene and Molly Muffin,

Thank you for the warm welcome!

Yes, Hemi is having the LDDS on Wednesday. I don't want to "talk myself into" a Cushing's diagnosis before the testing is done, but taking all his symptoms together, it does seem like Cushing's is a very likely possibility.

I am grateful to all on this forum who have shared their experiences.

Sincerely,
Michele

[Renee]

If I might offer some words of wisdom here.

If the outcome of the LDDS is that your boy does in fact have cushings, please do not make an immediate treatment decision. Take a moment to consider your options and the best course. Some vets push right off with aggressive (and incorrect) dosing. Best to educate yourself about the options and proper protocols rather than completely relying on a vet.

I don't say this to disparage your vet at all -- just it's a sad reality that many vets are woefully uneducated about treating cushings and many pet owners themselves don't know enough about it to recognize when their vet is wrong. You are on the right path by joining here and gather information ahead of the game, so good job!

[Hemi's mom]

Hi Renee,

That is good advice! My first tendency is to want to "fix" what is wrong, but I know this is a complicated disease and it can't be "fixed," but it can be controlled. The most important thing for me is to make sure my boy can maintain a good quality of life for as long as I am blessed to have him.

My vet did call me tonight to go over what to expect. She mentioned that if the LDDS indicates possible Cushing's, she will want to do additional testing to be certain (ACTH and possibly an ultrasound).

I really appreciate having this forum to post my questions because you have all lived through this and experience is the best teacher.

When I get the LDDS results, I will post them.

Thank you!

Michele

[Harley PoMMom]

Hi and welcome to you and your boy from me as well!

I think having an ultrasound performed is a great idea as it can be a very useful diagnostic tool. An ultrasound may show other abnormalities with the internal organs and if the adrenal glands are visualized than this can be an aide in confirming a diagnosis of Cushing's. On my boy's first ultrasound it was noted that he had prior bouts of pancreatitis although he never showed any symptoms of the disease. To validate the ultrasound finding of pancreatitis the vet had a spec cPL test performed and those results confirmed that my boy did have pancreatitis. :eek:

How is your boy acting now, does it seem that his pancreatitis episode is over or is he displaying some symptoms?

Hugs, Lori

[Hemi's mom]

Hi Lori,

Thank you for the warm welcome!

Hemi's pancreatitis has subsided, but his liver enzymes are still elevated and his increase in water consumption and urination have me concerned.

Thank you for sharing your experience with Harley. I hope that he is feeling well and that you both have a very Happy Thanksgiving.

Hemi is going in for his LDDS tomorrow and I guess the results will help guide next steps.

Have a good night!

Michele

[Harley PoMMom]

Although the LDDS is the gold standard test for Cushing's it does a flaw, any underlying non-adrenal illness, such as pancreatitis, can create a false positive result. Since Hemi is not showing any pancreatitis symptoms I'm hopeful that the LDDS test results will be accurate. Keep us informed, please. ;)

Hugs, Lori

[Hemi's mom]

Although the LDDS is the gold standard test for Cushing's it does a flaw, any underlying non-adrenal illness, such as pancreatitis, can create a false positive result. Since Hemi is not showing any pancreatitis symptoms I'm hopeful that the LDDS test results will be accurate. Keep us informed, please. ;)

Hugs, Lori

Thanks, Lori.

Hemi is having the test done now. No food after 7 p.m. last night - he was not too thrilled with me this morning when I drove him to his appointment on an empty stomach so I will bring some I/D cookies with me when I go to pick him up later today. :)

[Harley PoMMom]

Oh man, I do remember Harley not liking the fasting either, he was always a big eater, so I would take along food and water for him and let him have some as soon as he was done. We went to the University of Pennsylvania, School of Veterinary Medicine in Philadelphia and that is a 2 hour drive, one way, from my house :eek:

We would really appreciate it if you would post those LDDS test results when you get them...thanks!

[Hemi's mom]

I felt so bad this morning. I didn't even dare have a cup of morning coffee because I didn't want Hemi to take that as a "time to eat" signal, but he knew. I'm not as good as a pet mom as I could be because I DID have coffee after I got back home.

I give you kudos for going to U Penn. That is quite a distance, but I've heard wonderful things about their veterinary program.

I hope to get results today and will post them as soon as I can. You and others that have taken the time to view my post are the experts and I would value any advice you would like to share.

[Harley PoMMom]

Oh my, now that you mention it, I remember that guilty feeling of drinking ice tea on our way to Philly, so I wasn't a very good pet mom either :o But hey, we need to stay alert, right? and caffeine helps with that...sounds good ain't ;):D

My general vet does everything but ultrasounds, she told me that their ultrasound machine can not capture good views of those tiny adrenal glands and the other organs so I only used Univ. of Penn. twice for ultrasounds. I do think highly of Univ. of Penn. but since Philly was so far away our vet referred us to Chesapeake Veterinary Surgical Specialists in Towson MD, they have some really great IMS' there too and they are only one hour away!!

[Hemi's mom]

Oh my, now that you mention it, I remember that guilty feeling of drinking ice tea on our way to Philly, so I wasn't a very good pet mom either :o But hey, we need to stay alert, right? and caffeine helps with that...sounds good ain't ;):D

My general vet does everything but ultrasounds, she told me that their ultrasound machine can not capture good views of those tiny adrenal glands and the other organs so I only used Univ. of Penn. twice for ultrasounds. I do think highly of Univ. of Penn. but since Philly was so far away our vet referred us to Chesapeake Veterinary Surgical Specialists in Towson MD, they have some really great IMS' there too and they are only one hour away!!

You are an excellent pet mom - a 2-hour drive requires one to be caffeinated!

I thought I replied earlier, but I must have hit the wrong button. Anyway, I just wanted to let you know that the vet was with another patient when I picked up Hemi and she took a moment to tell me that the LDDS was normal, but I didn't actually get to see the results. She was swamped so she is going to call me Saturday and will share them at that time. She wants to do more testing, but I'm not sure whether she wants to do a high dose test, an ultrasound or something else.

[Harley PoMMom]

Normal LDDS test result,,,hmmm,,,well that's a good thing as the LDDS test is less likely to throw a false negative result so it seems that Hemi may not have Cushing's.....all fingers and toes crossed that this is so.

Will be looking forward to seeing those LDDS test results.

Have a Happy Thanksgiving!!

Hugs, Lori

[Hemi's mom]

Thanks, Lori. I appreciate your help.

Happy Thanksgiving!

Michele

[Hemi's mom]

Although the LDDS is the gold standard test for Cushing's it does a flaw, any underlying non-adrenal illness, such as pancreatitis, can create a false positive result. Since Hemi is not showing any pancreatitis symptoms I'm hopeful that the LDDS test results will be accurate. Keep us informed, please. ;)

Hugs, Lori

Based on the LDDS test results, my vet does not think Hemi has Cushing's. I am relieved, but also baffled because he has so many of the symptoms: episodes of pancreatitis, elevated liver enzymes, drinking LOTS more water (and urinating a lot more, as a result), hungry all the time, thinning hair, pot belly. He is also extremely anxious - above his baseline level of anxiety. My vet is going to run a thyroid panel next and, if that is normal, will do an ultrasound.

For what it's worth, I thought I would share the LDDS results here. I know that there can be false negatives with this test, but I was wondering if you had any thoughts.

Thank you!
Michele

RESULTS:

8-hour post low dose dex <0.5 ug/dL
4-hour post low dose dex <0.5 ug/dL
Baseline cortisol 4.5 ug/dL


Reference ranges:
Both 4 and 8 hour < 1 ug/dL = Normal
Both 4 and 8 hour = 1-1.5 ug/dL = Inconclusive, consider repeating
in 6-8 weeks
Both 4 and 8 hour > 1.5 ug/dL and >50% of baseline = Consistent with Cushing's; consider HDDST to R/O adrenal tumor

Since his 8 hour wasn't > 1.5 ug/dL, I did not include the other reference values.

[molly muffin]

Based on those results it would seem that Hemi doesn't have cushings, however, she might want to do an ACTH test too.
The reason I say that is because my dog Never tested positive on an LDDS. There are 5% of dogs who won't. My dog did post high on the ACTH. Now what that means is that there is Something going on that is causing high cortisol. Then you have to start ruling things out as to what that could be. Her liver enzymes where high too and an ultrasound showed the adrenal glands enlarged. We didn't start her on any medication right away since we didn't know what was causing the higher cortisol (which she consistently was high on). Then other things started occurring because high cortisol does take a toll on the body, and we started her on medication. I think that the medication has helped her and it certainly has helped us control the other issues, like high blood pressure.
So, there are a few things that you want to check out. Yes thyroid, does have many of the same symptoms as cushings, so again, something to look into and watch the glucose as that too causes some of the same symptoms.

Let us know what the next step will be.

[Hemi's mom]

Thank you for letting me know about your experience with the normal LDDS.

I will keep you posted on the thyroid panel results and next steps.

I appreciate your help!

Michele

[labblab]

Under these circumstances with such strong symptoms, I believe I'd want to consider an ACTH stimulation test, as well. As Sharlene says, there is a small percentage of dogs who test negative on the LDDS who still go on to be diagnosed with Cushing's on the basis of alternative test results.


If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.

http://veterinarymedicine.dvm360.com/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

Unfortunately, the ACTH stimulation test is relatively expensive, and you may want to opt for the ultrasound first before progressing to the ACTH due to its broader diagnostic value. But if the ultrasound reveals enlarged adrenal glands in the absence of any other causative abnormalities, I believe I would perform an ACTH.

Marianne

[Hemi's mom]

Hi Marianne,

I agree with you and Sharlene. The vet suggested the thyroid panel first because it is just something that she would like to rule out and it will be least stressful for Hemi. I think her plan is to do the ultrasound next and then the ACTH for the reasons you've stated.

One thing the vet mentioned is that cognitive dysfunction could also be in the mix. She might consider trying him on anipryl. If Hemi's issues are related to his pituitary and not his adrenals, the drug could have a dual benefit.

Any thoughts on this?

Thank you,
Michele

[molly muffin]

Well, the anipryl only works in small percentage of dogs for their cushing symptoms. Many take vetroyl and novofit in combination so that could be an option.

[Hemi's mom]

Well, the anipryl only works in small percentage of dogs for their cushing symptoms. Many take vetroyl and novofit in combination so that could be an option.

That is very true, but anipryl has proved helpful in treating cognitive dysfunction in senior dogs (Hemi is almost 14).

Just to update: Hemi had a thyroid panel, x-ray and ultrasound

T4 1.20 ug/dl (range 1.00 - 3.80)
TSH 0.44 ng/ml (range 0.01 - 0.50)

He is WNL but at the high end for his TSH, so the vet is going to start him on a low dose of thyrozine

X-ray - normal - except liver is a little enlarged (not abnormal for older dogs)

ultrasound - normal - good visualization of both kidneys and adrenals - liver, pancreas, gallbladder, urinary bladder all look fine

Which brings us back to cognitive dysfunction and maybe very early Cushings.......or not.

So.....Hemi will stay on the denamarin and thyrozine for the next three months and I will observe closely for any changes.

Thank you for your help!

Michele

[labblab]

So Hemi's adrenal glands were not enlarged and had a normal appearance on the ultrasound? If so, I agree that Cushing's becomes less likely unless Hemi is in a very early stage. It'll be really interesting to see whether you see any improvement after starting the thyroid supplement.

Marianne

[Hemi's mom]

No, there was no enlargement of the adrenals. Hemi's liver looked slightly enlarged on the X-ray, but that was the only abnormality.

I started Hemi on the thyrozine today (very low dose - 0.05 mg/day for 30 days, then 0.1 mg/day, then retest). I really don't think it's his thyroid based on his symptoms, but my vet told me that hypothyroidism can manifest itself in a variety of ways.

[molly muffin]

It might be worth it to try the anipryl.

You can order the novofit for cognitive function from amazon.ca. We've had other members use it with some success.

[Hemi's mom]

It might be worth it to try the anipryl.

You can order the novofit for cognitive function from amazon.ca. We've had other members use it with some success.

Thanks, Sharlene. That is good info!

Even though the tests are all negative, I really think it is something more than "doggie dementia". Hemi was sick again this weekend - vomiting one time and then diarrhea on Saturday night. I'm not sure if he had another flareup of pancreatitis, but he seemed to be OK by Sunday morning. I allowed him to have water only all day on Sunday and then allowed him a little canned I/D on Sunday evening. No more vomiting or diarrhea, but when I gave him his Denamarin tablet this morning, it was in his stool about 2 hours later - totally undigested. I called the folks who manufacture the drug and found a very helpful person who told me they make a chewable Denamarin so I asked my vet to order some.

I have an appointment to bring Hemi back in on Wednesday.

Sorry for the rambling - I am just at a loss for what could be going on.

[molly muffin]

How is Hemi doing? Hope things are better? Any possibilities yet on what might be going on?