New to Forum - Possible Cushings

[Bon]

Hi,

I have a 13 year old female yorkie and we are from South Africa.

Recently, I noticed increased thirst, urination and hunger in her. I thought it could be diabetes and took her to the vet. Her blood glucose was normal, therefore, the vet suspected renal failure or Cushings. The vet drew blood and asked me to bring in a urine sample, which I did.

We received the results last week and values out of range were the following:

Calcium = 2.53 mmol/L (2.00 to 2.50)
ALT = 43 U/L (0 to 25)
Cortisol AM = 243 nmol/l (0 to 0)
Total white cell count = 4.90 x 10^3 cells/microlitre (5.00 to 18.00)
Lymphocytes = 1.59 x 10^3 cells/microlitre (1.75 to 5.00)

The other tests were normal including ucrea/cortisol ratio of 27.30 (0.00 to 30.00). Based on the tests, the vet suspects Cushings but he would like me to bring her in for further clinical examination.

I would just like to ask, if there is any advice on questions I should ask at this follow-up appointment?

Thank you

[labblab]

Hello, and welcome to you and your little girl. In honesty, based on the test results you’ve given us, Cushing’s does not seem to be a likely diagnosis to me. First and foremost, a normal result on a urinary UC:CR test pretty much rules out Cushing’s altogether. That result typically takes precedence over a resting cortisol level from a blood sample. Many factors can affect a resting cortisol level, including how much stress a dog is under when the blood sample is taken. So for the purposes of diagnosing Cushing’s, a resting cortisol level is of little value. A negative UC:CR, on the other hand, makes Cushing’s highly unlikely. Here is a diagnostic statement published by the American College of Veterinary Internal Medicine:


A normal UCCR result is almost 100% consistent with the absence of Cushing’s syndrome in the patient. Further endocrine testing is generally not recommended.

In addition, the vast majority of dogs with Cushing’s exhibit elevated levels of ALKP — sometimes extremely highly elevated levels. They may exhibit mild elevations in ALT, as well. But to exhibit elevation solely of the ALT with normal ALKP — that is not consistent with Cushing’s, either. Given the elevated ALT, I would be wondering more about a primary liver problem of some sort. Elevated ALT is a marker that indicates liver damage or inflammation, and since Cushing’s seems unlikely to me to be the cause, I believe I would want to pursue further liver diagnostics. From the little I’ve read, some liver abnormalities can also be associated with low white cell/lymphocyte counts. So I think the liver is where I’d want to be placing the focus right now.

Marianne

[Bon]

Hi Marianne,

Thank you very much for your response, it is very helpful and much appreciated.

What you mentioned, were things I was worried about namely the normal UC:CR test and if the high cortisol was due to stress when the samples were taken.

I feel better prepared for the next appointment.

Candice

[molly muffin]

I agree with Marianne, the normal UC:CR pretty much rules cushings out. The liver on the other hand could stand to be looked into further and perhaps an abdominal ultrasound would provide more information if that is feasible.