Tigger's A Typical Cushings

[pchristiano]

Just found your site and I'm so glad I did! My 11 year old Yorkie has just been diagnosed with A Typical Cushings. Finally, after a year of going round and round with different Vets and tests. One final consult tomorrow morning and then I need to sit with the info before I decide what action to take.

[frijole]

Re: Tigger's A Typical Cushings

Welcome! You are in good hands. Please tell us a little bit about Tigger. Age, size, breed, symptoms.

I assume that you had the testing done by the University of Tenn. Do you have a copy of the lab results? If not, get one from the vet - Dr Oliver usually puts his recommendations right on the paperwork. He is an expert at this. Let us know what he said on the labwork.

Don't worry - Tigger will be fine. Ask questions as you are Tigger's voice in this journey. All the best, Kim

[Roxee'sDad]

Re: Tigger's A Typical Cushings

Hi,
I just wanted to join in with Kim and welcome you and Tigger. There are alot of good people with alot of experiences here that will help you sort thru all this. Gain all the knowledge you can thru this forum and the links provided.

We will be looking forward to your posting of symptoms that led you to suspect cushings, test performed and test results.

John (Roxee's Dad)

[gpgscott]

Re: Tigger's A Typical Cushings

Welcome to you and Tigger,

My Moria has been treated for Atypical Cushing's now for nearly two years, she exhibited syptoms for about six months before obtaining a clear diagnosis and beginning treatment. She is doing very well.

Please let us know about testwork and what treatment is being prescribed.

Best wishes. Scott

[Lulusmom]

Re: Tigger's A Typical Cushings

Hi and welcome to you and Tigger

My little Pomeranian, Lulu, has pituitary dependent cushing's with elevation of all adrenal hormones/steroids. So she has both typical and atypical cushing's. I will echo the others and ask that you get your hands on the University of Tennessee adrenal panel results and post them here. Also include the treatment recommendations that should be attached to the results.

If your baby girl has been diagnosed as strictly atypical, with no elevation of cortisol, then treatment is usually a snap compared to those of us who also have to treat for elevated cortisol. Melatonin and lignans, either purified or pressed hull, are the recommended treatment. Both can be purchased over the counter and are pretty inexpensive.

I'm sure sorry that it was necessary for you to find us but I'm glad you did. The more information you can give us, the better able we can provide you with meaningful feedback. Age, weight, symptoms, test results, any other medical conditions, any current meds being given?

Glynda

P.S. Your avatar picture is pretty small but Tigger looks absolutely adorable.

[pchristiano]

Tigger's journey

Thanks so much...I finally feel like I'm not alone.

Tigger is an 11-year old "baby doll face" Yorkie. Last Spring I noticed his coat was thinning at his neck area, skin starting to turn black.

3/08: CBC, Vet Screen & Skin Craping (negative for mites, scabies, etc.)
6/08: Dermatologist performed intense skin scraping, Thyroid Panel #2 (T4. free T4 by E) - tests negative.
7/08: ACTH Stimulation Test
8/08: Urinalysis, Vet Screen w/o CBC, Ultrasound for Adrenal Gland
8/08: Comprehensive exam w/liver chemistries
11/08: Complete Thyroid Panel at University of Michigan
12/08: Dexamethasone Suppression Test
1/09: Urine Cortisol:Creatinine Ratio & Dermatology-Cytology

Last month I decided that I needed to pursue this further & hopefully for the last time. I found a new Vet (my fourth!). Dr. Kay suggested that we do another ultrasound on the Adrenal Gland, Urinalysis and an Adrenal Panel to Univ. of Tenn.

[pchristiano]

Tigger's journey - Part II

The results confirm that Tigs has ADH. His baseline hormone #'s are very high, then they decrease. This seems unusual to me.

Cortisol 58.4 (Base slightly above normal) 133 (post ACTH)
Androstenedione 1.0 (Base above normal) 2.8 (post)
Estradiol 65.3 (Base slightly above normal) 56.1 (post)
Progesterone - did not have enough to spin
17 OH .34 (Base above normal) 1.67 (post)
Aldosterone 21.9 (Base normal) 77.4 (post)
Only the Andro. & Aldo. Baselines are normal - all hormones post ACTH in the normal range.

[pchristiano]

Tigger's journey - Part III

I'm going to talk w/Dr. Kay today...not comfortable with Mitotane & Trilostane. Curious about Aromatase enzyme-inhibiting drugs and Melatonin Implants. Any advise?
Thanks for listening...I have a feeling that this forum is going to be my new "best friend"!
Phyllis

[k9diabetes]

Re: Tigger's journey

Hi Phyllis!

Welcome to you and Tigger!

We try to keep one thread per dog - helps us go back over time and see what has and hasn't been tried and tested. So I hope you don't mind... I merged your threads into one.

To update and ask questions, etc., just hit the Reply button on this thread and we will build Tigger's history over time.

Best wishes,

Natalie

[pchristiano]

Re: Tigger's A Typical Cushings

Thanks Natalie...I'm having a hard time working this site. I just changed Tigs picture...not sure why it won't come up. Least of my worried.

[stardeb55]

Re: Tigger's A Typical Cushings

Phyllis, before we can offer any meaningful input on those UTK panel results, we need the normal ranges for both pre & post values, along with the reporting units. Also, as several of the others have mentioned, there should have been a treatment recommendations sheet included. Please post what that suggested.

When it comes to the prior testing, it would also help us a lot, if you could post the results of the following tests, including normal ranges & reporting units.:

UCCR
ACTH
Low Dose Dex test
Liver profile results

Welcome from me, too.

Debbie

PS- I forgot the abdominal ultrasound results, too.

[gpgscott]

Re: Tigger's A Typical Cushings

If the numbers you have posted are from UTK there was also a treatment recommendation.

I don't see anything here that indicates a treatment with either Trilo or Lysodren.

I would hold off until there was a clear diagnosis, this can be maddening and can take several months but it is better than treating with Cushing's specific meds when they are not called for.

Scott

[frijole]

Re: Tigger's A Typical Cushings

Phyllis,

If I read your information correctly it seems you have done alot of testing and switched vets. It's helpful if we have the big picture.

You did tests which indicate or can indicate cushings early on: acth and the low dose dex suppression test. I ASSUME (but want confirmation) that those tests were negative for cushings and that's why you have continued testing.

I also assume it is your new vet who suggested the Univ of Tenn panel which is the best next step. Like others suggested, please read that result and tell us what Dr. Oliver (from the Univ of Tenn) suggested. I have a friend whose dog was just diagnosed with atypical and right at the bottom were his recommendations for treatment and his name.

You could not be in better hands than Dr. Oliver. He is an intl. expert in this and I would recommend whatever he says to treat. The great news is that oftentimes with atypical you do not have to use the chemo drugs.

Looking forward to an update and welcome aboard! You'll feel much better knowing this group can help AND your dog will get better too!

Kim

[Squirt's Mom]

Re: Tigger's A Typical Cushings

Hi Phyllis and welcome to you and Tigger!

My Squirt is also Atyipcal plus has been diagnosed as PDH. She is on melatonin and purified lignans only at the moment and is doing quite well. Atypical is much easier to treat IMHO and MUCH less stressful without the Lyso for her and me.

I have some links on Atypical including the treatment sheet folks have been telling you about. Here are the norms given on Squirt's UTK panel results and I am sure they are the same for you as well since the same lab did the testing....tho it is entirely possible I am wrong about that.

Cortisol ng/ml 2.1-58.8
Androstenedione ng/ml 0.1-5.7
Estradiol pg/ml 30.8-69.9
Progesterone ng/ml 0.03-0.49
17 OH Prog ng/ml 0.08-0.77
Aldeosterone pg/ml 11-139.9


Post ACTH (30 min and 1 hr) and normal ranges

Cortisol ng/ml 65.0-174.6
Androstenedione ng/ml 2.7-39.7
Estradiol pg/ml 27.9-69.2
Progesterone ng/ml 0.10-1.50
17 OH Prog pg/ml 0.40-1.62
Aldosterone pg/ml 7.2-398.5

Hope you and Tigger are doing ok and hope to hear from you soon.
Hugs,
Leslie and the girls


Atypical Cushing’s*

http://veterinarynews.dvm360.com/dvm...date=&pageID=1

http://www.vetcontact.com/en/art.php?a=132&t=

UT Panel
http://www.vet.utk.edu/diagnostic/en.../treatment.php

http://www.vet.utk.edu/diagnostic/en...ushing%27s.pdf

[Lulusmom]

Re: Tigger's journey - Part II

I saw the baseline normal ranges that Leslie posted and according to those, I don't see where any of Tiggers hormones are elevated. I had a panel done for my Lullu in August, 2008 so I am inserting the baseline normal ranges from her results next to the baseline amounts you posted. Again, I don't see where there are any elevations.

Cortisol 58.4 (Base slightly above normal) 4.0-59.9 NORMAL
Androstenedione 1.0 (Base above normal) 1.9-11.9 LOW
Estradiol 65.3 (Base slightly above normal) 31.5-65.4 HIGH NORMAL
Progesterone - did not have enough to spin
17 OH .34 (Base above normal) .08-.69 NORMAL
Aldosterone 21.9 (Base normal) 11-139.9 NORMAL

Here are Leslie's Baseline Normal Ranges and I still don't see any high baseline values

Cortisol ng/ml 2.1-58.8
Androstenedione ng/ml 0.1-5.7
Estradiol pg/ml 30.8-69.9
Progesterone ng/ml 0.03-0.49
17 OH Prog ng/ml 0.08-0.77
Aldeosterone pg/ml 11-139.9

I'm wondering if they have changed the baseline and stimulated normal ranges again since Lulu and Squirt had their adrenal panels done. Can you please post the ranges from Tigger's adrenal panel results? This is all very odd and I'm sure there is a logical explanation but if not, I'd like to do some digging around. I'm sure that Dr. O can shed some light in the situation.

Glynda