Dog suspected for Cushings syndrome

Re: Dog suspected for Cushings syndrome

Ruta — Fri, 05 Oct 2012 10:08:41 GMT

Hello,

I have laboratory results. Unfortunately, to call in Germany could be quite expensive and I don't have this possibility. But thank you for advice anyway. So, I hope you will help me a little bit with interpretation.

Before Dex cortisol 249,10nmol/l. I injected 0,02ml i.v. (weight of dog 4kg). After 3 hours, cortisol was 28,25nmol/l, after 8 hours 13,62nmol/l.

So, as far as I could understand, the test is negative.

Now I am thinking to measure thyroid hormones, T4, TSH. Maybe do you any ideas what could be done more? I have feeling that I am going in wrong way. But I can not understand why symptoms is so typical to Cushings and test results are negative.

I would appreciate your help, please write me your ideas.

Ruta

Re: Dog suspected for Cushings syndrome

Virginia Campbell — Mon, 01 Oct 2012 15:16:42 GMT

[quote user="Ruta"] will forward my results to you and will ask help with the right interpretation. Because it is my first patient with suspected Cushings and I would like to avoid mistakes[/quote]

As well as posting on the forums if I have a medicine case that I want help with, I will usually ring the lab where the samples were processed and ask to speak to a pathologist. If your samples go to IDEXX in Germany I guess the international phonecalls could get expensive - but maybe worth emailing the lab if you have questions about the results, if the samples go to a veterinary lab. I've found the pathologists at the various labs we send samples to to be always very helpful about answering questions.

Re: Dog suspected for Cushings syndrome

Alasdair Mathieson — Mon, 01 Oct 2012 15:06:59 GMT

[quote user="Ruta"]

Hello,

It is my first patient, for whom I am suspected Cushings.

Male dog, 11 years old, Jorkie. He came because has bold ears with some crusts. Both ears are totally bold, he also has symmetrical baldness on hind legs. Owner told he has enormous appetite, polyuria, polidipsia, some neurological problems.

I started with blood test. Unfortunately I don't have it with me, but as I remember there was increased ALT and from blood morphology eosinopenia. Other parameters were normal.

The plan is to start with urinary test, X-ray and with ultrasound and then to perform low Dexametason suppression test. And here I have problem. To measure cortisol level is possible only with human medicine laboratory devices. As far as I know I can get false results.

Other problem, we don't have Vetoryl in our country, so colleges of mine recommended to start treatment with Ketoconazol, if I will confirm Cushings diagnosis.

What do you think? Am I right with suspected diagnosis? And is it possible to start treatment with Ketoconazol and later to change it to Vetoryl (owner has some friends in UK and they will ask to send Vetoryl).

I would appreciate your help.

Thanks.

Ruta

[/quote]

Just noticed this post, strikes me you're showing a great attitude under very difficult conditions.

My only thought - what about Anipryl [ Selgian ]? Licensed in USA, [I think], unlike Vetoryl [I think]

All the best.

Re: Dog suspected for Cushings syndrome

Mark Hedberg — Mon, 01 Oct 2012 14:31:43 GMT

[quote user="Ruta"]

The dog became my patient before 2 weeks. I asked owner about treatment with steroids, but the answer was negative. And I would like to believe. But thank you for good idea, Mark.

I found prescription form in your files, thank you so much, Evelyn.

Ruta

[/quote]

You're welcome! Good luck! Also tell the owner to stop any supplements, teas, treats, or that old medicine their uncle said was excellent for skin problems! (Sometimes they say they give no medicine, and then it turns out they use a traditional herb or treatment that isn't 'medicine' to them!)

Re: Dog suspected for Cushings syndrome

Ruta — Mon, 01 Oct 2012 14:24:24 GMT

The dog became my patient before 2 weeks. I asked owner about treatment with steroids, but the answer was negative. And I would like to believe. But thank you for good idea, Mark.

I found prescription form in your files, thank you so much, Evelyn.

Ruta

Re: Dog suspected for Cushings syndrome

Evelyn Barbour-Hill — Mon, 01 Oct 2012 13:41:48 GMT

[quote user="Ruta"]Also I have one big request - could somebody send me the right prescription form that I could ordered Vetoryl? I would appreciate it. I think it is not worth to play with Ketoconazol, especially when there are so many doubts about efficacy.[/quote]

I put my own blank prescription form in "my files" on this site a while ago. I presume it's still there.

Do you have a data sheet for Vetoryl to work out your requirements? If not I'm sure someone can send a copy. Or you could look it up on noahcompendium.com?

[quote user="Ruta"]And one more question - is it possible somehow monitoring Cushings without ACTH test?[/quote]

Sure. Observation and clinical judgment should do pretty well.

Re: Dog suspected for Cushings syndrome

Mark Hedberg — Mon, 01 Oct 2012 10:15:28 GMT

Has he always been your patient? Could it be that he was treated by a different vet surgeon in a different practice for skin conditions with large doses of steroids? Alternatively, is the owner giving any non-prescription complementary medicines? (Perhaps this is unlikely, but I've heard of it, anecdotally)

Re: Dog suspected for Cushings syndrome

Lorna McHardy — Mon, 01 Oct 2012 10:07:15 GMT

[quote user="Ruta"]

And one more question - is it possible somehow monitoring Cushings without ACTH test?

[/quote]

Clinical symptoms, in particular PU/PD, appetite, and skin condition... obviously, that'd be a bit of a subjective thing, but then again, if ACTH stim isn't available, it should at least give a reasonable indication of what's happening, and if the ideal isn't available, you work with what you've got!

Good luck :0)

Re: Dog suspected for Cushings syndrome

Ruta — Mon, 01 Oct 2012 09:43:38 GMT

Thank you so much for your support. Yes, sometimes is quite difficult to work when you don't have right devices. But I will try to perform low Dex suppresion test and will see what results I will receive.

As far as I know from books, I need to get more than 40nmol/l cortisol level to confirm diagnosis, after 8 hour Dex injection i.v. I am planning to inject 0,01mg/kg and then to take blood samples after 3h and 8h. I will forward my results to you and will ask help with the right interpretation. Because it is my first patient with suspected Cushings and I would like to avoid mistakes.

Also I have one big request - could somebody send me the right prescription form that I could ordered Vetoryl? I would appreciate it. I think it is not worth to play with Ketoconazol, especially when there are so many doubts about efficacy.

And one more question - is it possible somehow monitoring Cushings without ACTH test?

Thank you very much for your answers, ideas and your time.

Ruta

Re: Dog suspected for Cushings syndrome

ilanit — Mon, 01 Oct 2012 05:35:01 GMT

We don't have a vet lab available either, but we send it abroad (Idexx Germany). Usually get results within a week, which is ok for Cushing, because it's not an emergency. So maybe that would be an idea?

No experience with Ketoconazole, but to my understanding from text books it's not so effective in most dogs and you have risk for hepatic injury. I would try to get vetoryl from internet.

Good luck!

Re: Dog suspected for Cushings syndrome

Evelyn Barbour-Hill — Mon, 01 Oct 2012 01:01:45 GMT

Is it possible for you to write a prescription for Vetoryl, so that your client can get it from an internet pharmacy?

Re: Dog suspected for Cushings syndrome

Evelyn Barbour-Hill — Mon, 01 Oct 2012 00:12:19 GMT

I would think that the expected cortisol results in the test, if there is hyperadrenocorticism, would be so gross that you could rely on the result, as long as you have canine reference figures. Only if the result was "borderline" or "equivocal" would you need to worry. No? (Richard Fox, forward please).

I have no hesitation in reaching for the textbook when faced with anything endocrine. This is what mine says are the disadvantages of ketoconazole:

1. The cost

2. Adverse effects (which are uncommon, but may be vomiting, anorexia, diarrhoea and hepatotoxicity)

3. One third to one half of dogs fail to respond

4. Twice daily dosing, for life

Start at 5mg/kg bid for 7 days in case of intolerance, then go up to 10mg/kg bid.

I'm only quoting the textbook, I've no experience.

Re: Dog suspected for Cushings syndrome

Michael Woodhouse — Sun, 30 Sep 2012 22:48:23 GMT

Cortisol is cortisol and I am not aware of a vet specific assay.

Re: Dog suspected for Cushings syndrome

Nicola Lawlor — Sun, 30 Sep 2012 22:12:56 GMT

Mitotane is also known as Lysodren or opDDD. If you do use this then take care when handling this drug - gloves should be worn and take care when dosing the animal as in my experience the risk of overdosing and causing an addisonian crisis was real. Regular ACTH stimulation tests need to be done to check the response to treatment.

No experience of using ketoconazole sorry.

Hope someone can answer your other questions.

Re: Dog suspected for Cushings syndrome

james herriot lied — Sun, 30 Sep 2012 21:53:39 GMT

Blimey, and I thought we had it difficult.

Sounds like you've worked hard to find a way through the problems here, Ruta - I have great respect for that. I have no idea what the problems of using a human lab machine for dog bloods are, provided you have some reference ranges for dogs to look at.

The signs themselves are pretty consistent, although there are of course other things which will cause PUPD, skin problems and neuro signs. Get on and do the test, see where you are then.

Have you also come across mitotane? We used to use it before we had vetoryl. I must admit, I have no experience with ketoconazole.