Protein loss-tumor in adrenal glands

[lidy]

Hi,
I have a senior dog who loss protein in urine due to tumor in adrenal glands. Benazepril was suggested by vet to reduce protein in urine. Is this medication effective when a dog had tumor in adrenal glands?

thanks

Lilly

[lidy]

Hi,
I would like to know the side effect of Benezepril and would Benezepril increase the size of the tumor?

Many thanks

lillu

[labblab]

Hello, and welcome to you and your dog! Benazepril is indeed a medication that is commonly prescribed to help with excessive loss of protein in the urine. However, ideally, you want to identify and additionally treat the original cause for the proteinuria. In your dog’s case, I’m assuming the cause is a high level of circulating cortisol associated with his adrenal tumor. Is this true? If so, I’m wondering whether you are also giving medication for high cortisol?

I’m not aware of any reason why benazepril would worsen the tumor itself. However, benazepril can carry some extra risk for dogs who are also being treated with the Cushing’s medication, trilostane. Both of those medications can elevate levels of potassium in the body, with resulting problems. So if both medications are being taken at the same time, blood chemistries must be monitored very closely.

It’ll help us a great deal if you’ll tell us more about the diagnosis of your dog’s adrenal tumor, and any symptoms or problems that the tumor is causing for him. And as already mentioned, we need to know what other medications your dog may be taking.

So thank you in advance for any additional information. And once again, welcome!
Marianne

[lidy]

Thanks Marianne

My dog has a cortisol and creatine test it was at 90. The systoms are black dot (I think is yeast) on the skin, his body is warmed after eating, and sometime at night too. He makes a raspy breathing sound, and sometime the breathing is fast. He drinks around 1 half cup of water a day, seems always hunger, urinate frequently every 2 to 3 hour, no painting. He had a a protein loss, and I did an utrasound and find a turmor. Last year, blood work showed ALP is high, vet think it may be cushing. Done blood test this year ALP is in normal range. However He has high potisium which is 5.8 and he has slow heart rate. When stress at vet office, his paulse is at 80. Blood pressure measured and is below 180

I would like to find out more on the side effect of taking benzepril and is it effective when he has hight cortisol because he already had slow heart rate, and worry about the growth of turmor when taking benazepril. Still struggle on what to do, and any opinion would be appreciated?

I also want to know had any ones who dog had adrenal tumor and was on benezepril and how was it turns out. Like to learn more the risk and benefits and then decide. Really need helps

Thansk in advance

Lilly

[Harley PoMMom]

Hi Lilly,

A belated welcome to you and your sweet boy! Did the vet perform an ACTH stimulation test to see how high his cortisol is?

Lori

[lidy]

Hi Lori,

He is not on any medication, and ACTH stimulation test is not perform. He had the tumor on the adrenal glands cortex.
Is benazepril safe to take as potassium level is already high? and any long term side effect?
any advice in appreciation
Thanks

Lilly

[labblab]

Hi again, Lilly. I am not a vet, but I do think there may be a reason to worry about the benazepril if your dog’s potassium level is already high. I encourage you to specifically ask your vet about this, and to ask whether there is an alternative medication that would not carry the same risk about increasing potassium levels even higher.

I am also wondering why your vet is not moving forward with any additional testing regarding the possible effects of the tumor on your dog’s adrenal hormone production. It sounds as though there was some initial testing of cortisol, but it never advanced to any tests that are specific to Cushing’s. If your dog’s tumor is causing the overproduction of any adrenal hormones, including cortisol, he may be well-served by starting other medication. Also, surgery can be considered to remove the tumor, although it can be a very expensive and risky undertaking. All in all, aside from prescribing the benazepril for the proteinuria, it doesn’t sound as though your vet is yet moving forward to directly address the tumor itself and other associated risks that may be caused by abnormal levels of adrenal hormones. Can you press him/her for more information in this regard?

Marianne

[lidy]

Thanks Marianne,
I will ask my vet for more information.
is the other test the ACth stimualation. If the adrenal tumor cause high cortisol, then the option in surgery remove the tumor or starting the other medication. May I ask what the medication, is it Vetoryl? (that I read from other post)

thanks Marianne

Lidy

[labblab]

Hi Lidy. If an adrenal tumor is suspected, probably the better diagnostic blood test for Cushing’s would be the LDDS (Low Dose Dexamethasone Suppression Test). The ACTH stimulation test is not as accurate in terms of identifying Cushing’s in dogs who have adrenal tumors (as opposed to pituitary tumors). And yes, Vetoryl is the preferred medication for treating elevated cortisol in dogs who have adrenal tumors but for whom surgery is not a safe or practical option.

Marianne

[lidy]

Thanks Marianne,
With adrenal tumor the secreting cortisol, does that means treating pet with benazepril does not reduce cortisol, and the cortisol still there and giving benezepril to lower blood pressure may not work, is that correct?

Thanks

lidy

[labblab]

The benazepril has no effect on cortisol production. However, it may be helpful in lowering blood pressure and/or lessening the damaging effect that elevated cortisol can have on the kidneys in terms of proteinuria. In other words, it may help lessen the damage caused by elevated cortisol in terms of those specific issues. But only in terms of those specific issues. It has no effect on cortisol, itself, or other types of problems/damage that elevated cortisol can create. So if elevated cortisol is present and is the primary cause of any and all problems, it is desirable to treat that, too. And if the cortisol level becomes well-controlled, the need for the benazepril may end. Maybe yes, maybe no — it all depends on the extent of any kidney damage or kidney recovery,

As we’ve discussed, though, there may be a medication that targets the kidneys and blood pressure that is safer for a dog with high phosphorus levels. This would be regardless of whether or not Vetoryl treatment is started, too.

Marianne

[lulusmom]

Hi Lidy and a belated welcome to the forum.

I am in a similar situation with my tiny senior Pomeranian, Petey, who was just diagnosed with cushing’s by an internal medicine specialist. He had a team of three vets at the general practice facility who I lost faith in and asked for a referral. His gp vet prescribed enalapril for high blood pressure but that was not effective enough. His IMS took blood pressure with a Doppler unit which is preferred for little dogs as the inflatable cuff is simply not that accurate. His bp was 220 so the IMS added amlodipine in addition to Enalapril. His systolic blood pressure was 220 and a recheck after five weeks on amlodipine showed a much improved 160. That was great news but I have concerns about treating with Vetoryl and will be discussing those concerns soon. FYI, most gp vets don’t have a Doppler machine or a high resolution ultrasound machine which are two additional and very good reasons for my request for a referral to an IMS. The gp vet did an ultrasound and said adrenal glands and liver were normal; however, the IMS’ high resolution machine showed slight liver enlargement and the usual hyperechoic (brighter) changes in the liver that is common in cushing’s. Petey is more third cushdog and unfortunately, my experience with their gp vets were no satisfactory either so they had an IMS that associated in with the gp vets. In our experience, there are a good many gp vets that are simply not experienced and educated enough to know all the nuances of the disease. Based on your comment that your vet doesn't know where to go at this point is a good indication she may not feel confident in her ability to properly care for your boy. I give her kudos for admitting it. Has she mentioned that you might consider a referral to a specialist?

It would be very helpful and allow us to provide more meaningful feedback if you could provide answers to the following questions:

1. How old is your dog; is he neutered; what is his breeding and how much does he weigh?

2. Did your vet send you to a specialty facility to have the abdominal ultrasound done? If done by your vet, they may not have a formal interpretation but if so, can you ask for a copy and share it with us?

3. Did you collect the urine specimen for the UC:CR which you stated was high (90)? It is imperative that you collect the urine specimen at home, preferably the first pee of the day before a meal and meds. If the vet collected the specimen, the results of that test are invalid and you should be refunded or your account credited.

4. Can you please share the results of your boy’s most recent blood chemistry and complete blood count (CBC). These should have been done as part of a senior screening before your vet did the UC:CR. You need only provide the high and low values and please include the reference ranges. FYI, if your dog’s elevated ALKP was due to cushing’s, it would be highly unlikely that ALKP would return to normal without the benefit of cortisol lowering drugs such as Vetoryl (trilostane).

5. With increased drinking and peeing being one of the most common symptom associated with cushing’s, your vet should have done a standard urinalysis as well as a sediment and culture. Was this done and if so, can you share the results with us? In cushing’s, the kidneys often lose their ability to concentrate urine so urine will be dilute and urine specific gravity is usually quite low. If your dog’s urine is concentrated and USG is within normal range, the excessive drinking and peeing is not a true clinical symptom of cushing’s.

6. You mention that your dog had a secondary yeast skin infection. Was this a recent issue or does he have a history of skin problems?

7. Does he have thinning or loss of coat?

I apologize for so many questions but your answers and sharing test results will help us gain a much better understanding of your boy’s case history.

I'm sincerely sorry for the reasons that brought you here and but I'm glad you found us. We all know the frustrations of trying to do what is right for our cushdogs and we'll do our best to help you understand a lot more about the disease and its effective treatments so that you can become an excellent advocate for your boy.

Glynda

[lidy]

Marianne ,
May I ask what is the name of the medication that targets the kidneys and blood pressure that is safer for a dog with high potassium levels?

Many Thanks

Lidy

[lidy]

Hi Glynda,
He is 13 year old neutered dog, Pomeranianm, weighted 15.2 lb
My vet sent me to the specialty facility to have the abdominal ultrasound done. last year there is 1. cm tumor on the right side of adrenal glands and the liver is enlarged and diffusely hyperechoic. The lelf kidney has 0.6 cm infart at its caudal pole (don't know what is that meant), what is that means?
3 . The urine specimen is collected at home, not the first urine. The urine is collected at 11:00 pm.
4. Blood chemistry and CBC test,

This year Last year Reference ran
MCHC 404 431 326-392 g/l
Platelets 804 644 143-448*10^ 9/L
Idexx SDMAV 15 19 0-14 UG/DL
Potassium 5.8 5.3 4-5.4 mmol/L
ALP 146 210 5-160 IU/L

Low value
Glucose 1.9 3.5 3.5-6.3mmol/L
Na:k Ratio 25 28 28-37
Chloride 101 106 08-119 mmol/L
Hematocrit 0.34 0.36 0.38-0.57 L/L
MCV 57.4 55.7 59-76fl

5. Urine concentrated, specific gravity is over 1, no inflection culture is negative
6.the black dot is recent issue - is getting better now. no history of black dot
7. no thin hair or loss of hair. I trim the hair and it growth back.

Glynda, did your dogs loss any protein in urine. and how is his heart rate? did you treat with Vetoryl?, Your dog taked Enalapril, does it increase the potassium level? how much did it increase?
Is cushing dog have slow heart rate?,my dog has a slow heart rate of 48 beats per minutes.

Many Thanks

Lidy

[labblab]

Marianne ,
May I ask what is the name of the medication that targets the kidneys and blood pressure that is safer for a dog with high potassium levels?

Many Thanks

Lidy
I’m afraid I don’t know which medication would be better in this situation. This is something that you’ll need to discuss with a vet. As Glynda has suggested above, now may be the time to ask for a consultation with a specialist who has more experience with managing complicated issues such as this combination of an adrenal tumor and kidney problems.

Marianne

[lulusmom]

Hi, Lidy, and thank you for posting responses to my questions. In order to keep things organized, I've typed my comments in blue within the body of your post below.


Hi Glynda,
He is 13 year old neutered dog, Pomeranianm, weighted 15.2 lb
My vet sent me to the specialty facility to have the abdominal ultrasound done. last year there is 1. cm tumor on the right side of adrenal glands and the liver is enlarged and diffusely hyperechoic. The fact that the liver is enlarged and diffusely hyprechoic would indicate that the tumor on the right adrenal gland is over secreting one or more of the adrenal steroids.

The lelf kidney has 0.6 cm infart at its caudal pole (don't know what is that meant), what is that means? I believe infarct is short for an infarction. This is when an area of an organ is not getting enough blood supply which can cause a serious problem. This is an issue you should be discussing with your vet.
3 . The urine specimen is collected at home, not the first urine. The urine is collected at 11:00 pm. Collecting urine at 11:00 pm is not optimum but not sure it would invalidate the results. Did you refrigerate the specimen until you took it to the vet the following morning?
4. Blood chemistry and CBC test,

This year Last year Reference ran
MCHC 404 431 326-392 g/l
Platelets 804 644 143-448*10^ 9/L
Idexx SDMAV 15 19 0-14 UG/DL
Potassium 5.8 5.3 4-5.4 mmol/L
ALP 146 210 5-160 IU/L

Low value
Glucose 1.9 3.5 3.5-6.3mmol/L
Na:k Ratio 25 28 28-37
Chloride 101 106 08-119 mmol/L
Hematocrit 0.34 0.36 0.38-0.57 L/L
MCV 57.4 55.7 59-76fl

Those results aren't screaming cushing's to me but not every dog has every abnormality we see on blood labs. I wish my dog's labs looked that good.

5. Urine concentrated, specific gravity is over 1, no inflection culture is negative Specific gravity of water is 1.000 and most labs consider normal USG to be above 1.015 so >1 doesn't tell us whether the urine is concentrated or dilute. Anything below 1.015 would indicate urine is dilute to some degree. Is there an actual number on that test and if so, can you please share. If your dog's urine is concentrated, that would most likely rule out excessive drinking and peeing as being a clinical symptom of cushing's.

6.the black dot is recent issue - is getting better now. no history of black dot If cushing's was the cause of the black dots, I don't believe they would not have resolved without treatment. I'm therefore not certain these were a symptom of cushing's.
7. no thin hair or loss of hair. I trim the hair and it growth back. "Normal" regrowth of hair in a dog with uncontrolled cushing's is rare. My dog's right front leg has been bald for three months after being shaved for a splint.

Glynda, did your dogs loss any protein in urine. and how is his heart rate? did you treat with Vetoryl?, Your dog taked Enalapril, does it increase the potassium level? how much did it increase? My dog's heart rate is normal but his blood pressure was off the charts. His gp vet put him on enalapril which was not completely effective. His specialist took his pressure with a doppler and his bp was still over 200 so she put him on amlodopine (in addition to enalapril) which dropped bp to 160. His potassium was within normal range on his last blood labs done on 11/15. Petey has really high triglycerides and platelets so he is also on Plavix to lower his risk of stroke and blood clots. His urine test on 11/15 showed no protein in his urine which I attribute to good control of his blood pressure.

Is cushing dog have slow heart rate?,my dog has a slow heart rate of 48 beats per minutes. If your dog's heart rate is persistently low, there is either a problem with the heart that may not be a problem or it could be caused by an underlying disease and I don't believe cushing's is one of them. I highly recommend that you ask your vet for a referral to an internal medicine specialist who will most likely do an ecg. Since the abdominal ultrasound was done over a year ago, a specialist would almost certainly want to do another one to check for changes in the adrenal tumor. Sometimes adrenal tumors are incidental findings and are not functional so it's possible your dog may have pituitary dependent cushing's or he may not have cushing's at all. I want to mention that 50% of functional adrenal tumor are malignant so the prognosis is not favorable. What changes in your dog's quality of life have you seen in the last year since your vet visualized a mass on the adrendal gland? If a dog is a good surgical candidate and finances allowed, surgery can be a cure. However, this surgery is one of the riskiest and should only be performed by a board certified veterinary surgeon who has lot of experience with particular procedure. If surgery is not an option and symptoms are problematic, the first line of treatment would be Vetoryl (trilostane). Of course, discussing treatment options is premature as your dog would have to have a low dose dexamethasone suppression test (LDDS) to confirm a diagnosis. I personally would let a specialist do that test and discuss any appropriate treatments with you and your gp vet.

Many Thanks

Lidy