Does my dog have cushings? SBT

[Misty053]

We rescued Misty just over a year ago, she is a spayed SBT, approx 6 but could be older this was just the age registered on her microchip. Misty is 23kg so a little overweight, she has poor skin and bald in several spaces, also a little pot belly so my vet thought she could have cushings. The first blood tests he did for her said her cholesterol is borderline, her liver function is borderline and her kidneys are okay, from this he said she didn’t have cushings. He then tested her hormone, thyroid and cortisol levels, cortisol was high other two okay so now he thinks there may be something wrong with her adrenal glands and wants to do another blood test but sadly can’t do this until the corona virus lockdown is lifted. Do these results sound like they could be leading towards cushings? Any advice greatly appreciated!

[labblab]

Welcome to you and Misty! I can only stop by for a moment right now, but I promise I’ll come back and write more either later tonight or tomorrow. In the meantime, we’re so glad you’ve found us :-).

Marianne

[Harley PoMMom]

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

Could you get copies of all those tests that were done and post the actual results that are abnormal with the reference ranges and units of measurement? If acquiring the copies can not be attained right now, another option could be to call the vet for the actual test names and results or possibly they could email them to you, this would help us a lot.

Does Misty display any of the usual Cushing's symptoms, such as a ravenous appetite, increased peeing and drinking, reluctance to jump on furniture or go up steps, seeking cool places?

I am sorry for the circumstances that brought you here but so glad you found us and we will help in any way we can.

Lori

[Squirt's Mom]

Hi and welcome to you and Misty!

Since we all have enough to be worrying about right now I wanted to add that there is rarely any need to rush into treating Cushing's. Untreated cush pups can and do live years before they are diagnosed and put on treatment. The signs like excess peeing can be a problem for us humans who have to clean up after them but the dog can manage quite well for some time. So try not to let the delay in getting her in to be tested caused added stress in your life. If this is Cushing's, and we will be better able to answer that question once we see those test results Lori asked for and know the signs you are seeing, there is little need to panic about the delay.

I look forward to seeing those test results and learning about her signs soon.
Hugs,
Leslie

[Misty053]

Hello, thank you to you both for your replies. The symptoms you mentioned don't really sound like Misty. The vet thought she may have cushings due to her pot belly and hair loss/thinning. She does always want food but to me that's just staffy behaviour! I now have copies of all the blood work Misty has recently had done so I will attach these. Thank you so much for looking over them as they mean very little to me! :) Christy & Misty x https://imgur.com/a/bu9Puyr

[Harley PoMMom]

Hi Misty,

I'm sorry but members do not have permission to upload attachments so if you would just type in those abnormal values that would be great...as an example: ALT 150 U/L (5-50) Also, include the names of the tests, as an example: ACTH stimulation pre ~ 2.5 ug/dl and post ~ 10.6 ug/dl...thanks!!!

With her skin/hair issues, hypothyroidism could be a possibility, and a pot belly appearance is associated with a low functioning thyroid.

Lori

[Misty053]

Thank you for your reply, here are some of the borderline to high results;
RETIC 119.9K/UL 10.0-110 HIGH
MPV 13.4 fL 8.7-13.2 HIGH
PCT 0.49% 0.14-0.46 HIGH
ALT 124 U/L 10-125 BORDERLINE
CHOL 7.55mmol/L 2.84-8.26 BORDERLINE
Cortisol 155 25-125 nmol/L HIGH

I know you said she could have a low functioning thyroid but her Thyroxine result was 26.9 13-51 nmol/L?

Thank you for taking the time to help, we appreciate it :)

[Squirt's Mom]

I am assuming this was a resting cortisol since there is only one number? If so, then Misty needs to have a full ACTH which will give you two numbers - one prior to the stimming agent and the second after the stimming agent has been injected. This test tells us how much coritsol the adrenal glands are holding. The resting value can change based on any number of factors so isn't really of much value in diagnosing Cushing's. We typically see very elevated ALP along with slightly to moderately elevated ALT and sometimes GGT as well (all liver enzymes). The CHOL is typically elevated as well beyond borderline. So based on what I am seeing here any diagnosis of Cushing's is suspect in my mind.

[Misty053]

Okay thank you for your reply you are very knowledgeable! So which tests would you now be asking for? The vet was going to test the adrenal glands but would you suggest the full ACTH first, I really want to avoid any unnecessary tests not only because misty gets very worked up but already spent over £200 on blood tests in the past two month. Is the high cholesterol related? Is this something that needs looking into also? Thank you!

[Squirt's Mom]

The only other test I might want to do at this point IF any at all would be an abdominal ultrasound. This test would give the vets a look at her internal organs to see in anything was happening internally like a tumor, etc. This would need to be done on a high resolution machine and few GP vets have that type of equipment so you would probably need an IMS - Internal Medicine Specialist. If there are other troubling changes in her physical being or behavior, an IMS is who I would take her to anyway. If the skin issue is getting worse then a vet who specializes in dermatology is who I would want to see. Does she show any signs of allergies? Some allergies can affect the skin.

The ACTH would be useful if there were more signs of Cushing's or Addison's or Diabetes which I don't see. But honestly, unless there are some signs you haven't mentioned that are concerning I don't think I would do any further testing right now. It is possible there is something brewing like Cushing's or Hypothyroidism and a little more time will allow more signs and more physiological changes to occur resulting in labs that would offer more of a clue. As long as she is eating and drinking good, acting much her usual self, and able to sleep I don't think I would be overly concerned at this point.

The extra weight and pot belly could be the food she is eating or a result of how she is fed. Free feeding causes weight gain in many dogs. Free feeding is when a bowl of food is always available - the bowl gets empty and it is refilled so the dog can eat whenever they wish. Most Terriers I have met LOVE to eat! :D So free feeding is especially hard on those type dogs. Another thing is the amount recommended on the dog food package. Sometimes that is too much for a dog and needs to be cut back a little bit. If I fed my Pug according to package guidelines she's be so fat I'd have to carry her to the food bowl! :rolleyes::D And of course treats and nibbles between meal contribute to the daily calorie intake. I'm not saying any of this is a factor for your sweet girl but just food for thought in case something with her food intake could be playing a role in the pot belly and weight gain.

Marianne and/or Lori may be seeing something I'm not so I hope they will chime in soon with their thoughts.

You're a good mom so try not to worry overly much. These are hard times for us all we can only do the best we can. Misty knows you are doing everything you can to make her life the best possible and no one could ask more.

Hugs
Leslie

[labblab]

Hello again! I’m sorry it’s taken me so long to get back here, but Leslie has done a magnificent job of covering the bases. I totally agree with everything she’s written; Cushing’s does not seem very likely to me right now, either. I believe I’d also hold off on more involved testing until/unless more symptoms or abnormalities emerge that are consistent with the disease.

As Leslie has written, a resting blood cortisol level doesn’t mean much, diagnostically. However, if you do want to move forward with a bit more testing now, either the ACTH stimulation test or the Low Dose Dexamethasone Suppression test (LDDS) are the two diagnostic blood tests that would be more informative in that regard. There is one alternative urine test that you might consider first, however. I just wrote about it a few days ago in a reply to another member:


Hi again! There is one other alternative “gateway” test that you could consider. It’s called the UC:CR, or urine cortisol to creatinine ratio. We’ve been told that the best method by which to conduct this test is for the owner to collect a urine sample at home on three successive mornings, pool the samples together, and then take them to the vet for analysis. The samples should be collected with the least amount of stress involved as possible. This is why they should be collected at home and *not* at the vet’s office. If the ratio comes back within the normal range, Cushing’s can pretty much be ruled out definitively. If it shows an elevated proportion of cortisol, then Cushing’s is a possibility, but not proven, and you’d then still have to advance to either the LDDS or ACTH. However, I did want to offer this test to you as an additional possibility. It’s likely much less expensive than the LDDS or ACTH if it rules out Cushing’s, but it would be an added expense if you have to move on to the LDDS or ACTH in addition.

However, it’s just a thought, and here’s a link that explains it in more detail. One note: the link only references collecting a single urine sample for analysis. As mentioned above, we’ve been told by experts that a pooled sample from three mornings is more accurate.

https://vcahospitals.com/know-your-pet/urine-cortisol

Marianne

As you continue to think things over, do feel free to keep any questions coming.
Marianne