Newly Diagnosed Pituitary Cushings

[JanShaw]

Good afternoon ~ my name is Janette and my husband and I have a 9 year old Bichon Frise who just recently was diagnosed with Pituitary cushings. This diagnosis and the world of Cushings is new to us and a little overwhelming. A friend of mine who had a great experience with this forum suggested for me to try ... so here I am! I will say, it is nice to know that you are not alone on this journey, which is very comforting.

Rocky was rescued when he was two years old. He is a wonderful, loyal, fun-loving, beach-going dog and brings a SMILE to our hearts each day! About two years ago, he started with frequent utis and on vacation (no less!), we found blood in his urine! The vet by the resort tested and found out he had another uti, which cleared with antibiotics. About 6 months later, he had more bleeding when urinating and our vet at home performed an xray and found stones. We had the surgery in December of 2017 to find out the stones were the oxalate type. Since the surgery he has been on Royal SO and on that food he did not eat too much of it and did not do well on it, so the vet has put him on Science diet cd urinary care and is currently on this food today (wet and dry mixed). He does love the food, but since his surgery, he gained 4 pounds and we remain to this day trying to balance his ph level to avoid future stones, if possible. So, the cushings was found as we were preparing for a dental cleaning and the pre-op blood work showed really high elevated ALPS (1220). The vet suspected Cushings. The 8 hour blood test was performed to determine Cushings or not and the results returned as pituitary gland Cushings. The vet recommended to begin with 5mg of Vetoryl and we should begin that medicine next week. His activity level is great, eats well, plays with his toys and enjoys his walks. He does not drink excessively, but not sure if his pot belly is from the weight gain from the food or cushings. Just seems like a whirlwind from analyzing urine ph levels to try and avoid future stones and now the Cushings. Can the Cushings throw off his ph levels and cause stones? I have read that Cushings can be the underlying cause of stones in some dogs and once the Cushings is controlled with meds, the stones / uti's nightmare will be eliminated. Did anyone have that experience or know if that is true?

Just wanted to thank you for being here and having this forum open ~ just to talk to someone who is traveling down the same road with their fur babies makes all the difference!

[joalgopa]

Hi! Welcome to the forum.

Does Rocky have other visible Cushing signs besides the pot belly? Not all dogs suffer all Cushing symptoms but it's rare to only show the pot belly and not excessive thirst and hunger, hair loss, thin and bruised skin. Maybe it's because it's on its early stages but thankfully you're already treating him.

I'm not sure about pH levels in Cushing patients but my dog Mia did have a mild UTI when first diagnosed and the urine test showed oxalate crystals, although the ultrasound didn't show any visible stones in her kidneys or bladder but the vet said Cushing can trigger stones so we have to be monitoring that. That's my experience so far as I am new in this too, but surely other members can tell you more about it.

[labblab]

Hello Janette, and welcome to you and Rocky — we’re really glad you’ve found us. As far as a link between calcium oxalate stones and Cushing’s, I’ve read that Cushing’s can increase the vulnerability. However, stones are not a common complaint among our members and not an issue that we frequently deal with. To be honest with you, if the presence of stones and an elevated ALP were my dog’s only abnormalities, I would feel very reluctant to launch into Cushing’s treatment. Both the 8-hour LDDS and the 1-hour ACTH can return “false positives” in the presence of bodily stress or illnesses other than Cushing’s. The 8-hour LDDS is especially vulnerable in this regard. For this reason, most specialized clinicians are hesitant to make a Cushing’s diagnosis in the absence of common observable outward symptoms (excessive thirst/urination/hunger, skin or coat issues, panting, hindend muscle weakness, exercise intolerance, seeking cool places, etc.), as well as certain lab abnormalities. As already noted, elevated ALP is common. But also common are mild elevations in other liver markers and high cholesterol, certain abnormalities in white blood cells, and dilute urine.

It may be the case that Rocky exhibits some of these other abnormalities as well? But if not, I’d be very wary about jumping to a conclusive Cushing’s diagnosis. I surely understand your desire to eliminate the stones, but Cushing’s is a disease that is typically slowly developing, so you ought to have sufficient time to make sure that it is truly the culprit here. It’ll help us a great deal if you can obtain copies of his actual numerical test results, and then post any that are abnormally high or low. That’ll give us added info to assist our thoughts and suggestions.

Once again, we’re so glad you’re here!
Marianne

[Harley PoMMom]

Hi and welcome to you and Rocky from me as well!

My noncush dog, Bear, had oxalate stones and his ALP was elevated, so please heed to what Marianne has said, as she has mentioned, Cushing's is a slow progressing disease so you do have time to get a confirmed diagnosis.

Lori

[JanShaw]

Good Evening ~ thank for the responses to my post ~ I have copied some of his lab results that were abnormal from the blood work done 7/19/2018 and from the 8 hour LDDS ...

ALP 1,222 5 - 160 U/L

Cholesterol 359 131 - 345 mg/dL

Total T4

a

1.3 1 - 4 µg/dL 1.6

a Interpretive ranges:

<1.0 Low

1.0-4.0 Normal >4.0 High

2.1-5.4 Therapeutic

Cortisol - Pre

Dex

a

6.4 1 - 6 µg/dL H

Cortisol - 4 hr

Post Dex

0.4 µg/dL

Cortisol - 8 hr

Post Dex

b

7 µg/dL

I apologize if I didn't copy the information correctly ... new at posting lab results ... thank you again for your encouragements and suggestions dealing with Cushing's ...!

[labblab]

Hello again, Janette, and may I say first off how much I love your avatar photo!!! What a cutie Rocky is, and what a great photo of the two of you together :-))))))).

As far as the lab results, you posted them exactly correctly. What we see here are the highly elevated ALP, a cholesterol level that is just slightly above normal, and a thyroid reading that falls in the low normal range. All three of these findings could be found in a Cushpup. But for me, the dilemma remains that they don’t necessarily confirm Cushing’s in the absence of any typical observable symptoms. It’s true that the LDDS is consistent with a dog suffering from the pituitary form of the disease. But again, that diagnostic can return a “false positive” if a dog’s system is unduly stressed from a nonadrenal illness or injury. I’ll grant you, however, that Rocky’s 8-hour result of 7 ug/dL is not a borderline result — it is quite elevated.

I am not a vet, so I am only able to voice my questions/reservations based on what I’ve witnessed here with other dogs. But I’m just saying that I’d personally feel more comfortable with the diagnosis if Rocky’s overall symptom profile more typically reflected Cushing’s. If you do begin treatment, it sounds as though the 5 mg. of trilostane will be a low dose — which is a good thing. Current recommendations for initial dosing are not to exceed a formula of 1 mg. per pound. So I’m assuming that 5 mg. safely places you below that threshold. This is especially good because you will have a more difficult time judging the appropriateness of the dose given the fact that Rocky is not exhibiting observable symptoms of the disease. For dogs with the classic outward symptoms, adrenal response to trilostane can be assessed, at least partially, by observable symptom improvement. In Rocky’s case, it will largely be the reverse — you’ll be focused on making sure he doesn’t exhibit any symptoms of overdose such as loss of appetite, loss of energy, or any other physical degeneration. Hopefully you will also be monitoring his actual cortisol level in response to the medication within at least the first month of treatment — that is a critical piece of trilostane protocol. The other lab abnormalities may be much slower to respond to treatment, and ALP levels often never fully return to pretreatment normal baseline levels in Cushing’s dogs.

No matter what you decide to do, please do keep us updated, OK? As I say, in good conscience I feel compelled to share my concerns about Rocky’s situation. But we’ll be here to help with whatever path you choose.

Marianne