Bear 8 years old pekingese/chihuahua mix might have cushings

[mommabear]

Hello everyone,
I am very confused at the moment and truly very sad at the same time. My dog has been losing hair on the middle of his back and I always wondered why it was. I have two veterinarians at the pet hospital that I go to. One of the veterinarians said it was just because of old age and then the other thought it was because of the liquid frontline but it wasn't it. They tried getting a thyroid sample and it wasn't it. I googled what the other possibilities and Cushing's disease was one of the options. He got the urine cortisol/creatinine ratio done and it was 14. I just got the endocrinology lab case back from college of veterinary medicine university of Tennessee. I do have to mention that my dog is a fear aggressive dog toward people and other dogs. I am wondering if these results would be right even though he was probably really stressed out when these tests were getting done.

The cortisol result for baseline was 6.1 and normal range baseline <1.0-5.6. The result post ACTH 14.2 normal range post ACTH 7.1-15.1.

Androstenedione result baseline .50 and normal range baseline .05-.36. The post ACTH was .91 and the normal range is .24-2.90.

Estradiol result baseline was 69.8 and normal range baseline was 23.1-65.1. The result for post ACTH was 59.7 and the normal range was 23.3-69.4.

Progesterone result for baseline was <.20 and the normal range was <.20. The result for post ACTH was .81 and the normal range was .22-1.45.

17 OH Progesterone result for baseline was .55 and normal range was .08-.22. The result for post ACTH was 2.04 and the normal range for post ACTH was .25-2.63.

Testosterone result baseline was <.15 and normal range was <.15-24.0. The result for post ACTH was <.15 and the normal range post ACTH <.15-42.0.

They put a question mark for "indicate presence of increased adrenal activity" and they added "marginal-early HAC?" I don't know what this means for him.

My veterinarian told me to get Lignan and give my dog 10 mg a day for the next 2 months and see if his hair will grow back. What do you guys think about Lignan? I have read some posts here that some of you guys used something else. My veterinarian said to try Lignan since her husband used it on a patient and worked.

I think the only signs that he has is the hair loss, unsure about the not walking since he doesn't like to walk when it's really hot and there are days when he would walk really far. He's not panting but he does look for cool surfaces. I'm not sure if it's because of his coat and the weather getting hot in California or what.

Also, he has a grade 1 heart murmur that he has had for about 3 years now.

I saw the post that UC Davis is doing clinical trials and I was just wondering if you guys think I should get a second opinion on the matter??

thank you to whoever will answer this

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[DoxieMama]

Hello and welcome to you and Bear! Thank you for providing all this information in your introductory post, it will help the admins and other knowledgeable folks here provide you with the best support.

I don't have a lot of time this morning, nor any suggestions at the moment, but hopefully someone else that does will be along soon. :)

Shana

[labblab]

I just want to welcome you, as well!!! Unforunately, I'm in the same boat as Shana and I have to sign off for a while. But we're really glad you've found us and I will try to come back later on today and add some more thoughts.

Marianne

[judymaggie]

Welcome to you and your pup! My first Cush pup was evaluated by Univ of Tenn and I was very impressed by their thoroughness. Your dog's results are great! From what I can tell, there is not even one hormone that is abnormal. I would be curious why UTenn thought the results indicated the possibility of increased adrenal activity. Has your vet called them to discuss the results?

At the end of the UTenn report, there should be a page/paragraph listing follow-up suggestions. Do you have that?

Melatonin could be what you have seen used along with lignans. These are typically recommended by UTenn when the dog has shown abnormal hormones with normal cortisol levels. I would have to do some research re the use of lignans when hair loss is the only symptom. If your vet has seen good results, then it sounds like it is worth trying.

You mentioned the possibility of stress affecting the test results. I think you would have seen a high baseline cortisol if that was the case. Curious if the skin in the area of fur loss is altered in any way. You mentioned Frontline. Did you switch to something that is not a topical and the fur loss has continued?

Others will be along to give their thoughts.

[labblab]

Hello again from me! Basically, I just want to "second" what Judy has already written. As you may already know from looking over Bear's UTK testing, there are two parts to the UTK hormonal testing. First, a baseline blood sample is drawn before the injection of a stimulating agent. Then, 1-2 hours later, a second sample is drawn and it measures the adrenal hormone production after the administration of the stimulating agent. Usually, it is the second or "post-ACTH" result that is of significance in this situation. And as Judy has already noted, all of Bear's post-ACTH hormone levels seem to be within normal range.

However, it's interesting that I believe nearly all of his resting hormone levels are elevated above normal range, including cortisol. So yes, I'm guessing this may reflect a stress response on Bear's part. But it doesn't change the fact that the post-ACTH results are all within normal range. So even if he was indeed stressed, it didn't product an abnormal result on the significant part of the testing.

So I, too, am not exactly sure why UTK even identified the possibility of early or "marginal" hyperadrenal activity unless somehow they are looking at the elevated baseline levels with some degree of interest.

To be honest with you, aside from the hair loss, there is nothing about your description of Bear's behavior or symptoms that really seems consistent with Cushing's. Does he otherwise seem to be a healthy boy? Is the hair loss presenting any problems for you other than just appearance? If he otherwise seems fine, I don't know that I would be pursuing a Cushing's diagnosis any further at this point. Even if he truly tested postive for Cushing's via bloodwork, I believe most vets would hesitate to initiate any formal treatment unless Bear started to exhibit some other symptoms that are consistent with the disease.

Treatment with lignans and melatonin does seem to be basically benign, so you probably don't have anything to lose by trying them. But my personal opinion is that further Cushing's diagnostics right now would likely be a dead end.

Marianne

[mommabear]

Judy Maggie- If there isn’t even one hormone that is abnormal does that mean he doesn’t have Cushing’s disease at all or it’s just in the early stage of Cushing’s disease?
My vet didn’t call them. She just looked at the results and saw what they put and told me to use lignan. They made comments saying “baseline cortisol, androstenedione, estradiol, and 17-OHP concentrations are elevated. Deviation from reference intervals is marginal to moderate. Baseline cortisol may be elevated due to testing stress. Estradiol is not a specific indicator of adrenal activity since it may also be synthesized by other tissues such as adipose tissue or skin. A consideration may be to further investigate hyperadrenocorticism with a dexamethasone suppression test or retest with an adrenal panel in about 6-8 months if you continue to suspect hyperadrenocorticism. Alternatively, for elevated steroids some veternarians consider items 2-4 on attached sheet if clinical signs of hyperadrenocorticism are present.
They gave treatment options where positive results of increased adrenal activity are present: ultrasound/endogenous ACTH, melatonin, melatonion implants, lignan, maintenance dose of eysodren, lysodren, trilostane, ketoconazole, and selegiline.
Yes, I switched to bravecto and we tried to see if it was because of the frontline but his hair didn’t completely grow back. There were only a few hairs.

[mommabear]

Lablab-
I wonder why they based it off the first result of the baseline rather than the post-ACTH. If I am just following the post-ACTH then does that mean he doesn’t have Cushing’s disease or does he have it??
Was the resting hormone levels based from the pee sample or a blood sample?
Is it normal for veterinarians to be basing if off of the elevated baseline? The vet was just referring to the baseline and not the post-ACTH.
Yes he seems like a healthy boy. He does have a grade 1 heart murmur for the past 3 years. He has a limp when he walks slowly but it doesn’t bother him at all and I am giving him glycoflex to help him with that. The hair loss doesn’t present any problems for him other than just appearance. Should I just ignore the results and just assume that he doesn’t have Cushing’s disease? Should I make sure and get a second opinion on the matter?

Are these all of the symptoms?
• increased/excessive water consumption (polydipsia)
no
• increased/excessive urination (polyuria)
-no
• urinary accidents in previously housetrained dogs
-no
• increased/excessive appetite (polyphagia)
-no
• appearance of food stealing/guarding, begging, trash dumping, etc.
-no
• sagging, bloated, pot-bellied appearance
-no
• weight gain or its appearance, due to fat redistribution
- only gaining weight because he is on a new nutrition diet for his heart and needed to get back to his weight of 16-18 pounds.
• loss of muscle mass, giving the appearance of weight loss
-no
• bony, skull-like appearance of head
-no
• exercise intolerance, lethargy, general or hind-leg weakness
-he’s willing to walk but sometimes he doesn’t walk really far. I think he would walk half a mile or just down a street but would walk more in another area. I also use a stroller for him just in case if he wants to rest.
• new reluctance to jump on furniture or people
-no
• excess panting, seeking cool surfaces to rest on
- it seems like he been hopping off the couch lately and laying on the floor. I might not sure if it’s because it’s hot in my room or what.
• symmetrically thinning hair or baldness (alopecia) on torso
-losing hair on back
• other coat changes like dullness, dryness
-no
• slow regrowth of hair after clipping
-no
• thin, wrinkled, fragile, and/or darkly pigmented skin
-no
• easily damaged/bruised skin that heals slowly
-no
• hard, calcified lumps in the skin (calcinosis cutis)
-no
• susceptibility to infections (especially skin and urinary)
-no
• diabetes, pancreatitis, seizures
-no

[labblab]

All of the UTK results are based upon bloodwork and not urine. The UTK results are not consistent with a Cushing's diagnosis since none of the post-ACTH values were elevated. So, per those results, no, Bear does not have Cushing's. However, many of Bear's baseline levels were elevated, which may be due to stress or instead some type of early-stage adrenal overactivity that may end up worsening. If Bear exhibited additional symptoms of Cushing's now, or if he goes on to develop them in the future, it might make sense to perform an alternative diagnostic blood test (the LDDS), or to repeat the ACTH later on.

However, my personal opinion (and bear in mind I am not a vet), is that in the total absence of any Cushing's symptoms other than hair loss, I would not pursue a Cushing's diagnosis any further right now. Even if Bear were to end up testing positive on an LDDS, for instance, I believe most vets who are experienced with Cushing's would still hesitate to treat him for the disease in the absence of overt symptoms. None of the diagnostic blood tests are perfect and can mistakenly come back "positive" for Cushing's even when the disease is not present. The tests especially make mistakes in animals who are highly stressed at the time of testing. The initial urine cortisol/creatinine test that your home vet perfomed is especially vulnerable to stress. So if it was me, I'd table the diagnosis for the time being unless you start seeing other symptoms of the disease.

As far as the lignans, I don't believe there is any harm that can come from giving it a try. So if you want to continue using that for a while in order to see if you get any improvement, you can certainly do so.

Marianne