Cushings with neurological symptoms

[bitty]

Hi everyone,

Our Pomeranian was diagnosed a couple weeks ago with Cushings. She had had a pot belly for +1 year and we just assumed she was overweight and tried to cut back on her food. She only minimally lost weight so we took her to our vet and he never mentioned the possibility of Cushings. She subsequently developed neurological symptoms..she lost her balance occasionally and would "nod off/space out" a couple times a day. We took her in to an emergency vet one evening after she had a bad episode and they just told us she may have got into a toxin or could have had a stroke. They did blood work and all was normal except her liver enzymes and cholesterol were elevated, but we were told it wasn't too concerning. They recommended we discuss it with our regular vet. We took her to our regular vet and he just thought she may have been having mini seizures and recommended we continue to monitor and possibly start her on seizure medication if it continued to get worse.

In the mean time we moved to a new area and after her neurological symptoms progressed we took her to a new vet (my husband works at this clinic as a manager so are blessed to have accessibility and resources to help Bitty). She immediately recognized the symptoms and signs of Cushings. We did the testing and she was diagnosed. An ultra sound showed she probably doesn't have a tumor on her adrenal glands and given the neurological symptoms we are pretty sure she has a pituitary tumor.

We are now at the point where we have started her on trilostane (started a week ago), Denomarin, and a multivitamin with Vit C and E. Sorry this post is so long but we are extremely concerned and hurt with the diagnosis, especially since we missed the diagnosis for so long and we feel guilty we couldn't start treatment earlier. We are most concerned with the neurological issues since they have gotten worse but our vet says we should focus on the Cushings itself, even though treatment probably won't shrink or slow the growth of the tumor.

We just wanted to get some insight if anyone else has a similar situation--how have vets approached treating pituitary tumors, what are the options for managing both aspects of her condition simultaneously, what is the prognosis of pituitary tumors? Any insight is appreciated. We lost another senior dog in January and we are afraid of losing another one of our babies.

Thank you all for any input or advice!!

[Harley PoMMom]

Hi and welcome to you and Bitty!

Unfortunately I'm at work and have only a moment to post, so in the meantime if you could round copies of all tests that were done on Bitty and post those results here that will help us to provide you with our best possible feedback.

Could you also tell how much Bitty weighs and the Trilostane dose she is taking?

It can be slow around here on the weekend so I will try to make it back later on, and hopefully others will be by to share their advice
and support.

I am sorry for the reason that brought you here but sure glad you found us and we will help in any way we can.

Hugs, Lori

[Carole Alexander]

Hi and Welcome from me too. I want to comment on your concerns about the neurological symptoms that Bitty is experiencing as I am in the throes of dealing with my dog, Skippy's macro tumor. If you know for certain that Bitty has Cushing's and MAY have a macro tumor, I would urge you to research further BEFORE starting the Triolostane. There is evidence that both Lysodren and Triolostane may cause the tumor to grow, more or more rapidly. And, while the Triolostane may initially and modestly reduce symptoms, it may also create new ones. In Skippy's case it was severe tremoring, he stopped eating, severe lethargy, wouldn't walk, all along with the Cushing's symptoms. It took almost six months of incremental increases in doses, many thousand dollars and ultimately an MRI to confirm his macro tumor. I will never know the damage done by the Vetoryl. Many owners don't resort to an MRI to confirm the tumor is a macro. I did as they wanted to switch Skippy from Vetoryl to Lysodren and none of the vets thought he had a macro. Skippy's symptoms are subtle and have been progressive since last November. He stares, walks slow at times, is often non-responsive to commands, won't play, has balance issues, severe back leg weakness, sometimes seems frightened and mostly wants to be left alone and sleep. He is eating but many dogs stop eating or are unable to drink. He tells me when he is hungry, wants treats or to go out to pee. He has lumps on his body and an adenoma on his butt. And this is an improvement over two months ago when I stopped the Vetoryl and began an experimental drug called Cabergoline, a dopamine agonist that is known to work to reduce pituitary tumors in some dogs and people. I could send you a ton of articles on pituitary macro adenomas as I've researched this ad nausea um. But to not overwhelm you with words or content let me also ask: could something besides a macro be causing Bitty's symptoms? What other symptoms, besides balance is Bitty expressing? Is Cushing's confirmed with all the appropriate tests? Finally, your vet is wrong to say treat the Cushing's first. You can't treat Cushing's without treating the macro although endocrine experts are trying dogs on a very low dose of Vetoryl along with Prednisone to reduce swelling and as a palliative approach. There is a post on this forum devoted to macro tumors and many folks have chosen radiation, some with remarkable success and expense. Surgery, removing the tumor and the pituitary, is also an expensive option in some parts of the US and in the Netherlands. As for Skippy and the Cabergoline, he is modestly improved after a month, however; I don't think it is an answer for him. I'm sorry this is so long. I just don't want you to rush to treat if Bitty has a macro.
I understand your fears and confusion; this is an incredibly complicated disease and I'm truly sorry that you are on this journey.

[molly muffin]

I agree with Carole, (skippys mom) if it is at all possible, a CT scan to show the size of the pituitary tumor would be quite helpful to you and to your vet.

If it is a macro tumor they are tricky and there are a couple things you could look into such as radiation treatment.

How old is Bitty and what is Bitty's health outside of cushings like?