Does this sound like cushings?

[BentleyBoo]

Hello! I am new and so glad I found this site and forum. My dog is not yet diagnosed, but I am hoping you all can point me toward or away from cushings based on personal experience.

Breed: Maltese
Age: 11

7/2017: parents visiting, I asked them if my dogs hair looked thinner and his head looks like it shrunk after the groomer (with long hair it wasn’t noticable) they thought I was imagining it. A quick google search came up with cushings and the heat intolerance and water consumption fit, but it was also summer and I brushed it off.

During the past year he has had ear infections that keep coming back which has never been an issue for him before. I ended up in the vet ER on Christmas because his stomach looked really swollen and he was hunched over. They said it was gas and probably a new treat didn’t agree with him.

6/2018 back at the vet for another ear infection. Vet noticed weight loss and swollen belly.ran blood work.

Normal except:
Extremely low albumin
Slightly high ALT
High ALP

I asked about cushings since I never really got that out of my head. Vet said no it was liver related. Set up and appointment with internal medicine. I looked up liver disease and although it’s common I just didn’t think that was it. Bilburin was normal, he is never around anything toxic, etc. I still kept thinking cushings, but the weight loss didn’t fit. He also doesn’t have an increase or decrease in appetite.

7/2018 ultrasound showed a healthy, but enlarged liver, no fluid anywhere, a kidney stone, and nothing else other than an adrenal that may be slightly enlarged. This vet was surprised as he also expected to find signs of liver damage and also fluid.

He decided to run new blood work. Albumin still low, ALT normal, ALP still elevated. Everything else looked good. Tested urine and there was no UTI or other concerns.

This vet mentioned cushings could be the cause of all his issues (swollen belly, ear infections, albumin) but decided to run one more urine test that i am waiting on.

So after reading multiple symptom lists he has:

Excess drinking/urination
Heat intolerance
Unable to climb stairs
Swollen belly
Enlarged liver
Hair loss
Dry skin
Recurrent ear infections

The thing that really doesn’t fit is weight loss instead of gain. Also, the rest of his blood work (cholesterol, etc) was normal. Although, based on the incident on Christmas I cut out treats. This could account for weight loss. Between two vet visits he has gained a few ounces back. I’ve been giving him more treats and some cheese to see if his weight would continue to go down and it did reverse.

Could this be early cushings or am I wasting time going in the wrong direction?

[labblab]

Hello, and welcome to you and little Bentley (I’m guessing that’s your sweet boy’s name ;-).

I don’t have time right now to write as complete a reply as I’d wish, but no, I don’t think you’re making a mistake about including Cushing’s as a diagnostic possibility. Many of his symptoms are consistent with Cushing’s. The major “outliers” are the low albumin and, as you already know, the weight loss. However, it’s not inconceivable that Bentley may suffer from more than one issue. For instance, he may indeed have Cushing’s, but additionally a GI abnormality that might account for protein loss that manifests in both low albumin and weight loss. As an example, there is a disorder named “Protein-losing enteropathy” that might account for the low albumin and weight loss.

If multiple issues are involved, there is a diagnostic dilemma in terms of the Cushing’s in that the two specific blood tests are both vulnerable to producing “false positives” in the face of severe stress or other nonadrenal illnesses. I am guessing that your vet is starting with a “gateway” urine test, the UC:CR. If this test is normal, you can basically rule out Cushing’s. If this test is elevated, then Cushing’s is a possibility and you’d move on to one of the more specific blood tests. But again, other illnesses can elevate that urine test.

Given Bentley’s overall symptom profile, I think it does make sense to consider Cushing’s as a possible diagnosis. But again, I’m not convinced that’s all that’s going on with him. Also, I do have a question in terms of his ultrasound results. Did the internist perform the ultrasound, and if so, what was his/her conclusion about the single enlarged adrenal gland? When dogs suffer from pituitary Cushing’s, both glands are typically enlarged. Enlargement of a single gland could signal an adrenal growth or tumor, although in that event the other gland is often abnormally small or atrophied. Since you’re considering Cushing’s, I’d really want to get a thorough assessment of that ultrasound report on the adrenal glands. That information seems really important to me.

Sorry that I can’t write more right now, but once again, welcome! We’re so glad you’ve found us.

Marianne

[BentleyBoo]

I apologize if my response shows up twice. I think I did something wrong so I’m trying again.

Thank you for the response! It’s very helpful. I wasn’t sure if the low albumin could be something found with cushings dogs, but not directly related. Hopefully he doesn’t have multiple issues going on. His intestines looked good on the ultrasound, but I’m not sure if that picks up PLE. I will focus more on the albumin and see if that leads to answers.

It was the internist. I was so nervous and he was going through 30+ images so I probably misheard. It was probably both adrenals. Although he said if it was cushings it was his pituitary not an adrenal rumor. I don’t know if that is significant.

[labblab]

Hi again! Yes, if your internist said that the images were consistent with pituitary Cushing’s, that means that both adrenal glands were likely enlarged. So that is likely one question answered ;-).

As far as the low albumin, I really don’t know of any specific association with Cushing’s. Who knows, it may just turn out to be an insignificant finding. One of my nonCush Labrador retriever girls went through a period of time when her albumin level was consistently low-normal to being actually out of range. I really worried about it, but it didn’t seem to correspond to any other abnormalities and it eventually resolved. Sometimes stuff like that just happens.

Also, in terms of the weight loss, my Cushing’s dog also lost weight prior to diagnosis, so I know that this is possible. Uncommon, but possible. My dog did have a ravenous appetite, but we never gave him any extra food until we started noticing the actual loss of weight. At that point, we did give him more. Again, I don’t know what was actually accounting for the weight loss other than there must have been some alteration in his metabolism from the disease.

So the bottom line is that I do think it’s reasonable to pursue Cushing’s in Bentley’s case, even though a few wild cards remain. Please do keep us updated as to what you find out.

Marianne