Anyone have a dog with Cushings Disease??

[rg_girlca]

Hi there;

My sister's dog has been diagnosed with Cushings Disease and I would like to know if anyone here has a dog with the same disease and what treatment your vet has put them on and what results your dog has gotten from it.

I have read up on this Disease, but would like to hear first hand from others who is going through this with their dog.

Thank you for any information or comments that you may have.

[Freedom]

Sorry, no direct experience.

Neighbor had a dog develop it. Age is one factor, and how advanced when it is diagnosed is one.

I know you said you have read up on it. Here is another link:
http://www.bichonfriseusa.com/articles/cushings.htm

Prayers for the dog, and for your sister.

[rg_girlca]

Thank you very much Freedom for your reply and your prayers.

I really appreciated the link also as it gives very detailed information more than what I found.

Sonia is 9 years old and was diagnosed with Cushings about 3 weeks ago, plus diabeties. My sister though had to rush Sonia to the vets last Monday as it seemed she was having some kind of seizure, but she was actually going into diabetic shock and thankfully my sister got her to the vets in time to save her. She is now on insulin twice a day and her medication for the Cushings, Lysodren, will be cut to once a week. As of Wednesday, my sister said that Sonia was doing better. I pray she continues to do so for many more years to come.

[flip195]

So sorry to hear this.
I have a cushings dog, diagnosed 4 years ago, so I know how it hits hard when you hear those words.

When talking to the vet ask about TRILOSTANE first< it does less damage than most other cushings drugs. I also know a pharmacy where you can get it compounded fairly cheaply.

Be sure to read up on everything you can, before chatting to the vet, if they suggest lysodren it kills the adrenal gland so there is no going back with that, try the mild drugs first.

Diagnosis: Initially, Cushing's may be generally suspected based on the typical clinical picture described above: a middle-aged or older, potbellied, hungry, thirsty dog with a sparse haircoat. Routine bloodwork may reflect elevated liver enzymes (especially serum alkaline phosphatase), cholesterol, and blood glucose. Some white blood cells may be elevated (neutrofils), and others decreased (lymphocytes, esinophils). A urinalysis may reflect high levels of protein and low specific gravity (dilute urine). X-rays or ultrasound may show an enlarged liver or either enlarged or atrophied adrenals. 50% of adrenal tumors may appear mineralized. Although one could do a CT scan to search for a pituitary tumor, this is not a common diagnostic procedure. All of the above suggest the presence of Cushing's, but specific lab tests can help to further pinpoint a diagnosis. These tests include a urine cortisol/creatinine ratio test, an ACTH stimulation test, and low and high dose dexamethasone suppression tests. There is no single test to diagnose Cushing's, and Cushing's disease is often difficult to accurately diagnose.

Urine Cortisol/Creatinine Ratio Test: Considered a screening test, this cannot diagnose Cushing's, but it can rule it out. A urine sample is examined for the relative amounts of cortisol versus a normally excreted protein metabolite, creatinine (the latter is used to control for the degree of dilution of the urine). The greater the ratio, the higher the cortisol level. High cortisol in urine is suggestive of high cortisol in the bloodstream. Many conditions other than Cushing's disease can cause false positives, so this test is not considered diagnostic. Nonetheless, if the cortisol/creatinine ratio is okay, the dog is not likely to be Cushingoid, so this is a good screening test.

ACTH Stimulation Test: A blood sample is taken as a baseline. Then, a dog is given an injection of ACTH, the hormone which stimulates the adrenals to release cortisol. One to two hours later, blood cortisol levels are measured. Given that a dog with Cushing's has a constantly overworked, overproducing set of adrenals, the cortisol reserves are much greater, and the Cushingoid dog will be able to respond to the ACTH with greatly elevated cortisol output. This test doesn't differentiate between forms of Cushing's (adrenal vs. pituitary). It is considered diagnostic 80-95% of the time. Half of adrenal tumors will not respond on this test, and 15% of dogs with pituitary tumors will not respond. Nonetheless, it is an easy test and is often used along with a low dose dexamethasone suppression test to diagnose the presence of Cushing's disease. It is also used as a monitoring test for dogs who are being treated for Cushing's disease with Lysodren.

Low Dose Dexamethasone Suppression Test: This is considered the best test with an estimated 90-95% ability to diagnose Cushing's disease. A fasted dog has a blood sample taken as a baseline in the morning. A small amount of dexamethasone, a synthetic glucocorticoid, is injected, and follow-up blood samples are taken 4 hours and 8 hours later. A normal dog's body will perceive the presence of dexamethasone and suppress cortisol output throughout the test. Cushingoid dogs will not suppress blood cortisol in response to the dexamethasone injection, because their feedback mechanisms are not working properly as explained above. This test does not differentiate between forms of Cushing's disease (adrenal vs. pituitary), although it may be suggestive. Dogs who suppress at 4 hours and rebound at 8 hours usually have pituitary tumors.

High Dose Dexamethasone Suppression Test: Once a dog has been diagnosed as Cushingoid, this test can be used to differentiate between forms of Cushing's. Similar to the low dose dex test, a fasted dog has a baseline blood sample taken in the morning. The dog is then given a large dose of dexamethasone. Blood samples are taken 4 hours and 8 hours later. A dog with an adrenal tumor will not suppress at all. His adrenal tumor simply doesn't "care" about the level of blood cortisol; it keeps pumping out cortisol. A dog with a pituitary tumor still has some limited ability to respond to feedback and thus should respond to a high dose of dexamethasone with a suppressed cortisol level. Approximately 15%-20% of dogs with pituitary tumors will not suppress on a high dose dex test; these dogs generally have large macroadenomas.

Treatment consists of several different options. Depending on the type of disease, surgery can be performed. If an adrenal tumor is identified, then surgical removal may be a viable option. There are several different forms of tumors that can invade the adrenal gland and their treatment will be based on the particular tumor type. There are a few surgeons that have successfully performed surgery to remove the affected pituitary gland in the pituitary form of the disease. However, this is a very specialized procedure and is not commonly performed in the pituitary form of the disease.

Nonsurgical treatment is the most often used treatment for most cases of canine Cushing's disease.

Non surgical treatment is the most often used treatment for most cases of canine Cushing's disease. About 80% of the cases of Cushing's disease in the dog are of the pituitary type, and since both the adrenal and the pituitary type will respond effectively to some of the oral treatments, many veterinarians do not perform the diagnostics necessary to distinguish between the two different forms. There are currently several different oral medications being used to treat canine Cushing's disease.

Lysodren: Until recently, Lysodren (also known as mitotane, and o,p'-DDD) was the only treatment available for pituitary dependent Cushing's disease. It is convenient to use and is relatively inexpensive and is still probably the most widely used treatment. The downside of this drug is that it can have some serious side effects and regular blood-monitoring needs to be performed. During the initial phases of the therapy, the dog must be very carefully monitored, and there must be close communication between the veterinarian and the owner.

The use of Lysodren is somewhat like chemotherapy. It works by destroying cells of the adrenal gland that produce the corticosteroid hormones. As the number of corticosteroid-producing cells is reduced, even though the pituitary gland continues to produce excess ACTH, the adrenal gland is less able to respond, so the amount of glucocorticoid being produced is reduced. The problems arise when too much of the adrenal cortex is killed off. The animals may then need to be placed on prednisone, either short or long term. The Lysodren is initially given daily while the animal is being monitored for a decrease in the symptoms (water consumption, appetite). On the 8th or 9th day of the initial therapy, the dog needs to be examined and an ACTH stimulation test is performed to determine if the drug is working. If the goal is achieved, maintenance therapy is started. If the goal has not been reached, then the dog generally remains on the daily medication for 3 to 7 additional days and is rechecked until the proper results are achieved. If the dog becomes lethargic, vomits, or has diarrhea, or if the treatment does not work by 30 days, then the treatment plan is reevaluated. If treatment is successful, then symptoms should resolve within 4 to 6 months. A certain percentage of dogs will relapse and need to undergo the daily therapy again at some point in their lives. If a dog ever becomes ill while on Lysodren, the Lysodren should be stopped immediately and the dog should be examined by a veterinarian. The dog will need to be on Lysodren for the rest of his life.

Ketoconazole: Ketoconazole is an oral antifungal agent that has been used extensively since the mid 80s. One of the side effects of ketoconazole is that it interferes with the synthesis of steroid hormones. It therefore gained some popularity as a treatment for Cushing's disease. However, it is rarely used today.

L-deprenyl (Anipryl): L-deprenyl (Anipryl) has been advocated for the treatment of Cushing's disease in dogs, but its effectiveness has come into question.

Trilostane: Trilostane is a newer treatment that is used to treat some dogs with Cushing's disease. alternative treatment for dogs with adrenal tumors. As with Lysodren, the dog is reexamined repeatedly during the initial phase of treatment, and ACTH stimulation tests are performed. In many cases, after several months of therapy the dose needs to be increased

When my old girl was diagnosed I researched the heck out of it.
Some of the info is a little outdated.

But the trilostane (vetoril) has been used for many years in the UK with a lot of success.

I had to find a place to compound it, because they don't produce it in the States yet.