Newly Diagnosed with Cushing's

[mytil]

Hi and a belated welcome from me. I have just a sec but did your vet order an ACTH test when he was feeling so down to check where the cortisol levels were? (and also giving such a large dose for his size).

It would be a good idea to have the electrolytes checked too.

Terry

[Delianouva]

Vet;s recommendations were to stop Trilostane for one week and re-start at a lower dose, (15mg per day) also, when he re-starts Trilostane I should administer Prednisone in case Zane has another reaction. He was supposed to have his ACTH two weeks after he had started his first trial of Trilostane. Can you advise what are the reasons for evaluating his electrolytes? Thanks to all for your help.

[labblab]

I am sorry to say that your vet's advice to give prednisone and trilostane simultaneously makes absolutely no sense. The two drugs directly compete with each other: trilostane lowers steroid levels and prednisone increases them. If your vet is concerned that Zane will have another bad reaction to trilostane at even a lowered dose, he should not be rcommending you give the drug at all! Edited to add: I just re-read your reply, and if what the vet means is that he will give you prednisone to have on hand in case Zane has another bad reaction, it is always wise to have prednisone on hand to give instead of the trilostane. And in fact, Zane may need some supplemental prednisone right now, as I explain in the next paragraphs.

The recommendation re: checking the electrolytes (blood chemistries) stems from the fact that trilostane can also lower aldosterone levels as well as cortisol levels. Aldosterone is the adrenal hormone that regulates the balance of sodium and potassium in the body. If the aldosterone level lowers too much, that chemical balance can get out of whack with resulting serious consequences.

Since a weekend is approaching, I would push your vet to evaluate Zane's cortisol level and blood chemistries ASAP if he has not significantly improved by this noon. Zane should not still be dragging two days after stopping the drug. He may need some supplemental prednisone now, without any trilostane, in order to make up for his natural cortisol production if it has dropped too low. And if his potassium/sodium level is off, there are other supplements that are needed to regain the proper balance.

Marianne

[Squirt's Mom]

I would be pushing NOW for an ACTH and his electrolytes checked. That should have been the first thing they did. Do NOT restart the med until his signs are strong again AND an ACTH shows the cortisol to be elevated again. This is not a drug you can play around with willy-nilly. There are established protocols developed by both the manufacturer and endocrinologists who have been in the forefront with this treatment. If your vet can't get up to speed pretty quick, for you babys' sake find another vet.

[LtlBtyRam]

I will support what the others have said. Remember this is a journey usually an up and down one. We have all been there. We are here for support. Know you aren't alone, keep faith, and remember no vet knows your dog better than you do.

[Lifesvr7]

Is Trilostane the most common "first line" medication? This is most likely what my vet plans on starting my dog on if his test comes out positive. He's doesn't really have clinical signs of Cushings, weighs about 90-95lbs and is currently and uncontrolled diabetic.

[Delianouva]

My mini Schnauzer has been on Vetoryl 5mg for two weeks, tomorrow he will have the ACTH test done, could someone please advise what are the ranges on this test.
Thanks you.

[labblab]

Hello and welcome to you and your boy! Here's a link to a technical brochure published by Dechra (maker of Vetoryl) that will tell you just about everything you might want to know right now. Scroll down to page 11 and you will find a "Treatment and Monitoring" flowchart that details the numbers you are looking for. In general, though, unless cortisol numbers are dropping too low, the recommendation is to leave the initial dose unchanged for the first 30 days prior to increasing. This is because cortisol levels tend to continue to drift downward during the first month of treatment even when the dose is left unchanged.

http://www.dechrace.com/pdfs/vetoryl...alBrochure.pdf

We would love to learn more about your boy's specific situation: symptoms that led you to suspect Cushing's, prior medical history, diagnostic test results, etc. All this info will help us give you our best-informed feedback.

Thanks in advance, and once again, welcome!
Marianne

[labblab]

I just now noticed that you had previously started a thread about your boy back last spring, so I have now merged our two new posts into your original thread. It looks as though he was originally started on much higher doses of trilostane. Can you fill us in re: what all has transpired since you were last with us?

In reading back through your posts from last year, it looks as though Zane was originally diagnosed with Cushing's based solely on some lab abnormalities and the presence of skin bumps. Also, he did not respond well to those higher doses of trilostane -- all of which made me feel nervous about the accuracy of the Cushing's diagnosis at that time. Were those skin bumps ever positively identified as being calcinosis cutis? How about the evolution of any other Cushing's symptoms?

Marianne

[Delianouva]

Good Day!
My guy was started on Trilostane back in Spring 2015 based on labs LDDS, (he had no Cushing's symptoms) his previous vet (since then I changed veterinary) put him on 15mg of Trilostane twice a day, to which he had an awful reaction on the 4th day of taking this med, the medication was stopped and he was diagnosed with diabetes within days of Trilostane being stopped.
I started diabetes treatment, but he has been hard to regulate, (he became completely blind last September).
I found a new internist and she recommended the ACTH test which was done yesterday (he has been on Vetoryl 5mg twice a day for 2+weeks, now his weight is 13.6lbs).
I should receive ACTH lab results today which I will post here, he also had a Cursory Ultrasound, (could anyone advise what this is for?). I apologize for this long reply but I really do not understand a lot about Cushing's and wanted to have an insight from the group for when I speak to his internist.