Diagnosed with cushings.. but no symptoms???

[Brewster's Mom]

Hi.. my dog, Brewster was diagnosed with cushings in July. I took him for his yearly immunizations and the vet did his yearly wellness panel. Two years ago his ALP was at 465. Last year it dropped to 265. This year it was at 960! All of his other results were in the normal range. So the vet did a bile acid test and cortisol/creatinine urine test. The urine result was just slightly above normal. This led the vet to do the ATCH test. That result was slightly below the "confirmed" diagnosis, but high enough that the vet did the low dose suppression test. The vet quoted "result was consistent with a dog that has pituitary cushings". However.. Brewster does not display any symptoms of cushings. NONE! He only drinks 6-8 ounces of water daily. He is not panting, has no hair loss, no pot belly (his weight has remained constant for 4 years), no excessive eating, and is high energy (he is a 9 year old shih Tzu/bichon and we still walk 4-5 miles daily). Since he has no symptoms, my vet and I discussed it and we are opting out of the cushings meds for now. Will reconsider when he starts showing symptoms. I WAS giving him Bravecto. I gave him his 3rd dose on June 20. The blood panel was run on July 12. I have researched Bravecto and many have reported high ALP results as an adverse reaction. So could it be possible that the Bravecto is behind all of the below/slightly above test results??? I have been giving him milk thistle and SamE to detox his liver, and am thinking about having him retested. Or.. is it just that it is early in the cushings process. The vet never did an ultrasound. Maybe I should request one to be done?? I find myself staring at him looking for cushings symptoms.. and I am driving myself crazy!!!

[Harley PoMMom]

Hi and welcome to you and Brewster!

In the early stages of Cushing's symptoms may not be seen and the medications used to treat Cushing's do not cure it they are given to help abate the symptoms and get control of that elevated cortisol. So, since your boy is not displaying any Cushing's symptoms I wouldn't treat either in spite of the positive LDDS test.

Could you share other details about Brewster because the more information we know the better our feedback can be, ok? So for starters, we would really like to see those LDDS and ACTH test results so if you could post them that would be great. Also what were the results of the bile acid test? Does Brewster have any underlying health issues, and if so, what are they and what medications are being given? Was an urine sample taken for an urinalysis and if one was done could you post those findings too?

Regarding his high ALP, so many other things can cause elevations in that enzyme, like certain medications and gastric problems. I am not familiar with Bravecto so if your research of this medication found that it did increase the levels in the ALP than it could be that it is responsible for the added activity in that enzyme. Giving the milk thistle and SamE, I think, is the proper approach right now and if this were me, I would run another CBC/chemistry blood test in about 4-6 months to see if any changes did occur. And if there are noticeable difference in any chemistry/CBC levels then depending on those changes I would then probably proceed to have an ultrasound performed.

I can tell how much you love Brewster and I understand the worry you are feeling about your precious boy but seeing that he is asymptomatic I truly believe a wait and see approach would be an appropriate move at this time.

If there are any questions you have please do not hesitate to ask them and know that we are here for you and Brewster and will help in any way we can.

Hugs, Lori

[molly muffin]

Hi and welcome to the forum.

My dog didn't have symptoms for a few years after she was thought to have cushings. Her ALKP was high too, but as Lori mentioned that can be caused by other things and then again you can have false positives on tests too.

So I too agree with the wait and retest and see how things go. It is what I did and what I would do again.

[Brewster's Mom]

I have asked the vet's office for copies of the results of all of his tests.. but so far they have not gotten back to me. His ALP was 960. His urine cortisol/creatinine test result was 40. His ATCH test result was 21.8. The vet never gave me the result of his low dose suppression test. Just said it was "consistent of a dog with pituitary cushings". I have no idea what his bile acid test result was. Brewster does not have any underlying health issues except for arthritis in his right shoulder. He is taking 25 mg of Rimadyl daily. Has been taking for 2 years. But the vet said that if the liver was affected by the Rimadyl his ALT would be high.. not his ALP. All of his results were in the normal range except for the ALP. I plan on taking him for another blood panel, and possibly another ATCH test in December or January. That would be about 6 months.

[Brewster's Mom]

I took Brewster for a 2nd opinion with a internal medicine vet. He is AAHA Accredited.. and specializes in cushings/addisons and diabetes in dogs. We went over all of his test results from the previous vet. His bile acid test was normal. His low dose suppression test results were "marginal" : His first result was 2.8 . His second result was 1.3 (after they suppressed his cortisol). His 3rd result was 1.8. He said this could easily be a false positive. However he ran another blood panel.. a much more comprehensive one. His ALP went up from 960 to 1100. However, there were no other cushings markers in his results. Also did a urine dilution test.. and that was normal. However there were some crystals in his urine.. but he said he is not too concerned about this right now.. and not going to treat. So Monday he is scheduled for an ultrasound.

[Squirt's Mom]

OH I am so glad you went to this vet! Sounds like your baby is in good hands. I agree with not treating right now. Keep in touch and let us know how things are going, please. Even if Brewster never develops Cushing's ya'll are family now and we will want to know how he is doing. So please let us hear from you!

Hugs,
Leslie and the gang

[molly muffin]

How did the ultrasound go today?