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Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism/ "Atypical Cushing's"

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  • Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism/ "Atypical Cushing's"

    Here is some information regarding "Atypical Cushing's", including links to information on the testing provided by the University of Tennessee, Knoxville (UTK).

    If a dog continues to exhibit Cushing's symptoms, yet tests negative for Cushing's on the usual tests (ACTH stimulation test and Low Dose dexamethasone suppression test) your Vet or Internal Medicine Specialist Vet may feel that it is a good idea to test for "Atypical Cushing's", congenital adrenal hyperplasia-like syndrome or hyperestrinism. An "adrenal panel" blood test can be sent to the University of Tennessee for analysis.

    Although not actually Cushing's, dogs with these conditions often have many of the same clinical symptoms as Cushing's dogs do, and the treatment is also usually similar.

    A Vet can contact Dr. Jack Oliver at the University of Tennessee for more information.

    Dr. Oliver's Contact information can be found here:

    Here is some information about this "Cushing's-like syndrome" in the form of a Research Abstract of the presentation that was given by Dr. Jack Oliver recently at a meeting of the Society for Comparative Endocrinology in May/June 2005:
    Jack W. Oliver, D.V.M., Ph.D.
    Director, Clinical Endocrinology Service
    The University of Tennessee

    The Clinical Endocrinology Service at the University of Tennessee utilizes steroid hormone profiling in the diagnosis of adrenal disease. Many of the cases received have had preliminary diagnostic workups with either ACTH stimulation or low dose dexamethasone suppression testing that has been negative, but signs of Cushing's disease persist. Many of these atypical Cushing's-like cases will have abnormal levels of adrenal intermediate steroids and sex hormones. Included in the atypical cases are a considerable number of dogs that have hyperestrinism (elevated estradiol levels), with and without increased levels of other steroids. The dogs with hyperestrinism typically present with some or all of the following clinical signs: “Cushingoid” appearance, presence of chronically elevated levels (usually extremely elevated) of serum alkaline phosphatase, hepatomegaly, steroid hepatopathy on biopsy, PU/PD, dilute urine, panting, haircoat problems and skin biopsies that indicate presence of an endocrinopathy. The talk will focus on case presentations that associate clinical signs presented by dogs with primary hyperestrinism (elevated serum estradiol levels), including the association of high estradiol with increased alkaline phosphatase, and the fact that sex steroids can cause elevated cortisol/creatinine ratios. Treatment concerns will be addressed, such as mitotane and trilostane resistance. Other potential treatments for hyperestrinism will be discussed.
    Also see:

    Steroid Profiles in the Diagnosis of Canine Adrenal Disorders.
    Jack W. Oliver, Proceedings 25th ACVIM Forum, Pp. 471-473, Seattle, WA. 2007. of .doc

    Diagnostic Laboratory Insight with Regard to Adrenal Disease.
    Jack W. Oliver, Proceedings 20th ACVIM Forum, Pp. 541-543, Dallas, TX. 2002. Mtg, 2002.doc

    Client Information Adrenal Steroid Profiles in the Diagnosis of Adrenal Disease.

    And a document from UTenn Endocrinology Lab which explains how the tests that they do should be performed:

    (see #3 on the above document link for the explanation of the UTenn Lab adrenal function tests, and specifically, #3g for an explanation of the ACTH stimulation test plus a full adrenal "panel", which includes cortisol and other adrenal hormones)
    Last edited by AlisonandMia; 04-28-2009, 09:31 PM.