Suspicion of Cushing's in my dog, a new diabetic. Questions about work up

[ukjenn231]

Hi! My sweet boy Tucker, a 10 year old Maltese, was recently diagnosed with diabetes. It was kind of an incidental finding on labwork.

At the time, the vet also noted an ALP value of 829 and mentioned he may have Cushing's. His ALT was 95, GGT 12, all other lab values on the chemistry and hematology panels were normal as well. I'm a nurse and I'm familiar with both diabetes and Cushing's, but I've been doing more reading. The vet recommended the dexamethasone suppression test and an abdominal ultrasound.

Tucker hasn't really had any Cushing's symptoms. He did present with increased thirst and increased urination but ever since we have put him on insulin this has basically resolved. We haven't quite regulated his sugars yet, and the vet is pushing the Cushing's work up because he says it could make the diabetes harder to control. I'm a little skeptical because we have only done one insulin curve after the initial dosing and I know it takes time to figure out the right dose.

The vet didn't really explain much about Cushing's, so I have been reading and I know it can be caused by the pituitary or adrenal site. My questions before pursuing a costly and potentially stressful work up on my dog are always: What will this find, and what will we need to do about it?

My questions....
If my dog is not presenting with any other signs of Cushing's, is it necessary to proceed with the work up now? Would it be reasonable to recheck the ALP after a period of time, or would there basically be no other explanation for an elevated ALP?
Can the dexamethasone test diagnose Cushing's? Or will the abdominal ultrasound be necessary regardless?
What are the treatment options? Can Cushing's be controlled with oral meds solely or would surgery be part of the treatment plan?

Thank you all in advance. I trust your opinions more than my vet unfortunately. I know that vets are knowledgeable and I'm thankful for all the advances that make these work ups possible, but I have to be informed in my choices for my pup as I would be for myself...

[Harley PoMMom]

Hi and welcome to you and Tucker!

You definitely want to get that diabetes under control before having tests for Cushing's performed because any non-adrenal illness can yield a false positive result. The elevated ALP can be caused by the diabetes so I do agree a recheck on that ALP after the diabetes is under control would be a better plan forward instead of having any tests for Cushing's performed.

The low-dose dexamethasone suppression test (LDDS) does have the ability to differentiate between the adrenal or pituitary form of Cushing's but it is more likely to cause a false positive result when any other health issue is present in a dog. The other test for Cushing's is the ACTH stimulation and is the one I would recommend for Tucker once his diabetes is more controlled and Cushing's is still suspected.

If it is the adrenal form of Cushing's and the dog is a good candidate for this type of surgery than an adrenalectomy is a cure however this is a very serious and very expensive surgery which only a well seasoned surgeon should perform. The two medications that are mainly prescribed for Cushing's are Vetoryl/Trilostane and Lysodren/Mitotane, one is no safer than the other. These are strong drugs and both have some pretty scary side effects, however, adverse effects are minimized when the proper treatment protocols are followed. We have many members that are treating their cushdog with either Vetoryl/Trilostane or Lysodren/Mitotane and are experiencing success.

I apologize that this post is so short as I am on my way out but please know we are here for you and will help in any way we can. One other recommendation I have is to join our sister site that deals with canine diabetes, they are a wonderful group and are very knowledgeable, here's their link: http://www.k9diabetes.com/forum/

Hugs, Lori

P.S. ~ I have manually approved your membership so please just disregard the validation email that was sent to you from k9cushings.

[Squirt's Mom]

Hi Jenn and welcome to you and Tucker! :)

If I were you I would not pursue testing for Cushing's at this point. All too often a diabetic dog will present with cush signs then they disappear as the BG is regulated. In addition the diabetes has the potential to skew the test results right now. Once his is well regulated THEN if the signs and labs indicate the possibility of Cushing's the testing can be done. But most critical is getting the diabetes regulated. As a nurse you understand this disease can be quickly life-threatening if not controlled...there is rarely any rush to treat Cushing's. So focus on the diabetes for now and then look at Cushing's later if need be. I want to give you the link to our sister site, K9Diabetes - the EXPERTS on canine diabetes. Please register with them asap and start talking - you will find much support and great info there!

http://www.k9diabetes.com/forum/

(but that doesn't mean you get to leave us! You and Tucker are family now and we want to hear from you every now and then to let us know how he is doing!)

OH! just so you know, Cushing's in humans presents and is treated differently than in dogs. Other species such a horse and ferrets also get Cushing's but the disease is not the same for them as for dogs or humans either. A very strange disease, this Cushing's! ;)

Glad you found us and want you to know we will be here anytime you wish to chat!
Hugs,
Leslie

[labblab]

I’m so glad Lori and Leslie have already given you such a great and informative welcome! I “third” everything they’ve said, and also just want to add a link to an article written by noted veterinary endocrinologist, Dr. Mark Peterson. It offers additional confirmation for the notion of holding off on Cushing’s diagnostics for the time being. We are well aware of dogs who do suffer from both diseases, but it doesn’t sound as if you’re yet at the point where Cushing’s testing may be required.

https://endocrinevet.blogspot.com/2012/01/q-diagnosing-cushings-disease-in-dogs.html

Marianne

[molly muffin]

Hello and welcome from me too. I'm going to 4th what Leslie and Lori said. I'd go with getting diabetes under control first. If it is impossible to get the diabetes under control, then you could look into cushings.
If the diabetes is under control, and the liver enzymes remain high, then you could look into cushings.
I definitely recommend joining our sister diabetes site ad they have quite a bit of knowledge that could prove helpful.

[ukjenn231]

Thank you all for your replies. I will have to be assertive and talk to my vet about the work up. I feel comfortable with holding off on it for now, so thanks so much for input, it makes me feel more at ease!