New Diagnosis - Macroadenoma

[amf1277]

Hi everyone! I finally ran across the site deep within the bowels of the internet after yet another Cushings search. I don't have all the lab numbers but here's the general overview. I have a 7 year old black lab named Gypsy. She literally went from a dog that was retrieving in the ocean in July to a dog that looked 15 year old by November. In late August/early September, we began to notice a bit of a personality change --- we jokingly said she was depressed. By October, we could tell she was losing weight/muscle. Her first vet appt was 10/4/23. After an initial UTI diagnosis, over lots of testing over the last 3 months, she was diagnosed as hypothyroid and then Cushings and placed on 30mg of Vetoryl/2x day. While her labs were good after the initial 14 day introduction, she acted like she felt worse than ever. We lowered the dosage to once per day but no change. She was SO lethargic and could barely get her to eat. The poor girl has went from 92 lbs down to 77 just 4 days ago. We saw an internist this past week and after consulting with a kidney specialist, they were both in agreement that due to the high cholesterol, elevated liver enzymes and extreme muscle wasting, that she has a macroadenoma. However, the astronomical cost aside for an MRI and radiation treatment, given the physical condition she is currently in, my husband and I can't bring ourselves to put her through all that when we were advised that the prognosis would still be poor. She is already vet weary. After a couple of days of tears and serious convos, we decided that the best thing for her was to not let her keep existing in her sick body for no more than another week or two. That being said, her appetite has improved and is eating better this past week than she has in 2 months ---- eating like you would expect a dog to eat with Cushings. However, we just can't keep weight on her and again, the muscle loss is astounding. She's lost so much muscle even on her face that her bottom lids droop. She will just stand and stare off into space, have to be helped up the steps to get back inside sometimes, move so slowly and stumble, trembles .... it's pitiful to see this in a 7 year old dog.

So that brings me to where my mind has been this past 36 hours. I spoke to my vet today. I said I don't want to get our hopes up but a small part of me wants to try meds again as one last Hail Mary. But she did so poorly on Vetoryl that I hate the thought of potentially putting her through that again only to still have to put her down. The flip side is what if it helps because when we tried it the first time, we didn't realize she had yet another raging UTI until after we decided to stop it. So I'm sure that made her feel worse. The vet said that it probably wouldn't help her but there's always the chance. His final piece of advice was if there's any part of me that wants to try, I will always wonder what if should I choose not to. At the end of the day, I only want what's best for her. I just can't decide if seeing her with the typical symptom of ravenous appetite is just a false hope that I could help buy her more time with meds. Most of the stories I've found here with macroadenomas don't give me much hope.

This is such a horrible, horrible disease that is robbing my family of our best girl much too soon. :(

[Harley PoMMom]

Hi and welcome to you and Gypsy!

I am so sorry that you and Gypsy are going through this, and we will help in any way we can. I surely do understand your dilemma, watching our precious furbabies going through this horrible disease is devastating. Lowering the Vetoryl dosage is an option, studies have found that larger dogs do better with lower Vetoryl dosages, so maybe start out with 20 mg of Vetoryl. With macroadenoma, a steroid is usually given along with the Vetroyl, I would ask the vet about this.

If you could post her blood test results that would be great, we need only to see those values that are out of range with the reference ranges and units of measurement...as an example ALT 200 U/L (50-100)....thanks!

Please know we are here for you and Gypsy and if you have any questions please do not hesitate to ask.

Hugs, Lori

[labblab]

Hello and welcome from me, as well! I join Lori in telling you how sorry I am about Gypsey’s illness, but I’m very grateful that you’ve found us. I have been mom to three Labs myself, and it was my first boy, Barkis, who brought me to this community twenty years ago. I never would have made it through the tough times without the support of my family here, and we’ll do our very best to offer that same support to your family as well.

Barkis was diagnosed with Cushing’s when he was around nine, although in retrospect I know he started showing symptoms earlier which we originally just attributed to low thyroid. He was the first patient in our area to be treated with trilostane, and for a while he did improve. But after just a few months he started exhibiting neurological symptoms consistent with an enlarging macrotumor. I’ve posted his complete story in a reply on the “Macroadenoma” thread found on another one of our subforums:

https://www.k9cushings.com/forum/showthread.php?3567-Macroadenomas

But the quick summary is that my husband and I did not want to put him through the diagnostics and treatment associated with a Macroadenoma, either. So we never knew for certain whether that was the culprit. But no matter what the cause, it was his ultimate total loss of appetite and the ability to drink that forced our decision to release him. Having lived through his decline, my heart totally goes out to you and your husband now. And it also influences my own thoughts about Gypsey’s situation. In honesty, if she is regaining her appetite at the moment, I’d probably hold off on restarting the Vetoryl for a little while longer in order to see whether that’s just a temporary change or instead a genuine rebound. She can continue to survive with unsteadiness, but not if she stops eating and drinking. And if her appetite is finally now improving while off the Vetoryl, I’d hesitate to restart it immediately due to its appetite suppressing action.

If she continues eating for a while longer, then that’s the point where I’d reconsider the Vetoryl. But at a lower dose and perhaps alongside a steroid as well, as Lori has suggested. I know the addition of a steroid seems paradoxical with a Cushpup, but we talk about that combo more on that “Macroadenoma” thread.

I’ll go ahead and close for now, but please know that we’re here to support you no matter what you decide to do. If only we had a crystal ball to guide us! But instead we’re left with uncertainties and all we can do is to try our best with the info we have in hand. So if you do decide to start back with the Vetoryl right now, I know that’s because it seems like the best alternative, and I do understand why you don’t want to leave any stone unturned. But please continue to let us know how your sweet girl is doing, and please give her a big hug from her new family here.

Sending my warm wishes across the miles,
Marianne