2 year old dog with Cushings

[Courtney]

I adopted a 2 year old male golden in March. He was underweight when I got him. Right away I noticed he drank a lot of water and panted a lot. I attributed it to stress of a new home. He began to lose more weight despite being fed more than he had been previously. Shortly after I started seeing him leak urine while laying down and he was unaware he was leaking. Bloodwork was normal, ultrasound normal, and he concentrated his urine well so diabetes insipidus was rule out. ACTH stim was pursued despite his only Cushings symptoms being PU/PD. I can't remember his pre sample but his post was 30, yes 30! He was started on trilostane. The panting got better and drinking slightly less but still leaking. Increased dose and ACTH stim showed Cushings under good control however PU/PD and urine leaking has continued. Now there is a complete behavior change. Two months after starting trilostane and he is scared of everything and will not walk more than three feet from the house. He used to walk 2-3 miles a day. Could behavior change be trilostane side effect or is something else going on? He is a nervous wreck of a dog and not the same dog I adopted four months ago. I am afraid the behavior change is due to pituitary tumor growing but I'm hoping it's a trilostane side effect and stopping the med will help. It's rare for a dog this young to have Cushings.

[Harley PoMMom]

Hi and welcome to you and your boy!

Awww, bless you for giving this precious boy a forever and loving home!! Can you share more information about your boy so that we can provide you with our best possible feedback? We would really love to see the results of all monitoring ACTH stimulation tests. Also, how much does he weigh and what dose of Trilostane is he taking? Does he have any underlying illness? Is he on any other supplements/herbs/medications? If you could you post the results of any CBC/chemistry blood panel that would be great, we need only those values that are abnormal with their normal reference ranges. Is his Trilostane being given with a meal? And those monitoring ACTH stimulation tests have to performed 4-6 hours post pill, is that being done?

The good majority of dogs, 80-90%, with Cushing's have a very elevated ALP. Other lab anomalies generally found in cushdogs are high cholesterol and triglyceride levels. They also have what is referred to as a "stress leukogram," which refers to a specific white blood cell distribution in the blood. This includes a high total white blood cell count with increased numbers of neutrophils (NEU) and monocytes (MONO) and decreased numbers of lymphocytes (LYM) and eosinophils (EOS). Also, dog's with Cushing's have diluted urine with a low specific gravity. From your post it seems that your boy's blood work and urinalysis does not show any of these abnormalities, is this correct? If so, this seems puzzling to me and makes me question the diagnosis of Cushing's.

I am sorry for all these questions but the more we know about your boy the more meaningful our feedback can be. Looking forward in hearing about your sweet boy.

Hugs, Lori

[tank&kat]

Hi Courtney,

It is rare for a dog that young to be diagnosed but very possible. Weight loss isn't a symptom of Cushing's and I'm concerned that you mentioned a normal ultrasound. Most of the time, if a dog has Cushing's, one or both of the adrenal glands would be enlarged. Can you get copies of the ultrasound report and post here? A CBC and urinalysis should have been done as well to support a diagnosis of Cushing's. Was an LDDS test done or only the ACTH? If the urine is concentrated, the USG (urine specific gravity) would generally be normal and not an indication of PU/PD. How much does your dog weigh? Normal water intake for a dog is around 1 oz/lb. For example, a 20 pound dog should not exceed 20 ounces (2.5 cups) of water per day. Is he having accidents in the house in addition to leaking urine?

The behavioral changes are not likely a side effect of the vetoryl and could indicate there is something else going on with him. Could he have injured himself in any way? My dog used to walk a lot and as of a few weeks ago, he won't go more than a few feet outside the door, but he has obvious hip/arthritis issues. What is he scared of besides walking? Is he just clingy?

~Kat

[Courtney]

His bloodwork was completely normal, no ALT elevation or abnormal values in any way. His urine was dilute but when we did water deprivation test it was well concentrated so that ruled out diabetes. We performed two ultrasounds and they were both normal. He was 65 pounds when I got him and dropped down to 57 despite being fed 4 cups per day. His coat is beautiful and he doesn't have the ravenous appetite of Cushings. Only Cushings symptom is the PU/PD. He has started to gain the weight back, not sure if that's from trilostane working or lack of exercise. Not only is he scared to go outside but behavior inside has changed too. He ripped up my carpet trying to get into his crate when previously he was fine outside the crate and never damaged the house. He is very anxious and sometimes I can't get him to come downstairs to eat or interact with us. ACTH stim was all we performed and his pre value was 10 and post was 30. After trilostane dosage increase pre was 4.3 and post was 3.7. He is not on any other medications though we are considering Prozac for the behavior change. However with the sudden onset of the behavior change we are concerned there is another problem besides anxiety. We are also considering Proin for the urine leaking but again still worried about personality change. He is back up to 67 pounds. Trilostane dose was 30 mg twice a day and then upped to 45 mg. he is not having active accidents in the house, just leaking when laying down and occasionally leaks while walking through the house but never squats or lifts his leg in the house.

[Whiskey's Mom]

Hi Courtney & welcome from a fellow Golden owner! Such gentle and loving dogs. I'm so sorry your sweet young boy is having problems. It makes me so sad to see that he's afraid, and not wanting to walk. I was wondering also if he could have hip issues even if he isn't obviously limping he could have pain. And if there's something else going on that's giving him pain could that be related to the urine leaking- like an infection or stones/crystals? Poor guy. What's his name?

[Whiskey's Mom]

Sorry we were posting at the same time so I didn't see that his blood & urine were normal. As well as the ultrasounds. Whiskeys initial symptoms were similar to your boys, the ACTH #s & pu/pd with the leaking while laying down & sometimes while walking. But He did have abnormal blood results though. Hope you get some answers soon. :(

[Courtney]

I work at an animal hospital so I am lucky to get unlimited exams and he is not painful or injured in any way. His UA does not show any infection and ultrasound ruled out bladder stones. I had a dog previously with transitional cell carcinoma so I was worried about that but ultrasound was normal. We performed two ultrasounds, first to investigate causes of weight loss and again a few weeks later to check adrenal glands and bladder. Both scans were normal and showed no adrenal tumor or cause for weight loss such as foreign body or masses. My goldens name is Brody from my favorite movie, Jaws. He is such a sweet loving boy, just something is going on with him.

[DoxieMama]

Hi Courtney, welcome to you and Brody. He is certainly puzzling, isn't he? The leaking might just be because he's drinking so much, though usually the PU/PD is one of the first symptoms to resolve when cortisol is under control.

As for his behavior change... With access to unlimited exams, have you considered an MRI?

You didn't mention anything so I doubt it ... but could something have happened when you weren't home to cause such fear? His attempt to get into his crate and sudden behavior changes makes me wonder if he had a traumatic experience and he just wants to be where he is safe. (My dogs were home alone when the house filled with smoke once due to a kitchen incident :eek:. Now one of them is a nervous wreck any time he smells smoke or hears a beep like the smoke alarm. :()

I sure hope you figure out what's going on with this sweet pup.

Hugs,
Shana

[Courtney]

He was crated a lot in his former home but I didn't want that for him in my home. I crated him when I first got him until I knew he could be trusted. Obviously now he will be crated while I'm at work. He is scared of every noise outside, car door closing, kids playing, etc. I don't not have acces to MRI or CT scans at my hospital, I would have to go to a specialist and I cannot afford that. As far as I know nothing happened in the house that scared him. He used to walk around outside scared of nothing and now it's the opposite.

[tank&kat]

How long has he been on the trilostane? When was the increase to 45 mg bid?

[labblab]

Hello and welcome from me, too. I have to say that I do question the validity of the Cushing's diagnosis, given the absence of so many typical symptoms. As I'm guessing you already know, both the ACTH and the LDDS can return "false positives" in the presence of illnesses other than Cushing's. Given your boy's profile, I have to wonder whether that may be the case.

Given this extreme behavior change, I would be tempted to discontinue the trilostane altogether for a week or so in order to see whether his fear and anxiety abate. If so, at least you'd know that the trilo is related in some way -- either the med itself, or a reaction to lowered cortisol.

I know you said his other labs are normal, but one possibility that occurs to me is hyperthyroidism because symptoms of weight loss, PU/PD, and anxiety are all associated with this condition. You might want to retest his thyroid level because from what I've read, T4 levels can appear normal early in the disease progression. Also, I guess you could ask your vet to carefully palpate Brody's thyroid gland since this condition is caused most often by a thyroid tumor. Just a shot in the dark, but something I'd consider since Brody does not present like a typical Cushpup.

Marianne

[Allison]

Courtney, welcome! Bless you for adopting Brody. Sorry that he's not doing well. I hope you find answers soon.

[Courtney]

I have stopped the trilostane. We are going to send an adrenal panel to university of Tennessee but he has to be off meds for one month. The current thought is it is something hormonal, likely a testosterone issue. Low testosterone can cause urine leaking. Trilostane can increase sex hormones and that leads to behavior changes including anxiety and aggression. I'm hoping this is the answer as testosterone is easy to treat but I won't know for a month. Hoping now that trilostane is stopped I will begin to see improvement.

[DoxieMama]

I'm hopeful right along with you!

[molly muffin]

I'm glad that Marianne mentioned the stopping of trilostane and that you did as that is what I would do too and then the hormonal test. I think it would be well worth it as that seems to me to be a more likely culprit than cushings in this case.
I as wondering about testosterone and the neutering, if he was kept crated because he leaked maybe and if that has been an issue since he was neutered.