Cushings disease?

Re: Cushings disease?

scatty — Wed, 24 Apr 2013 12:14:50 GMT

Thanks everyone. I will wait and re-test. I forgot to mention that there was a 6 month time delay between the alizin being given and the surgery as she came from another vets. Hence she hadn't had any recent drugs in the system that had could have affected the liver (or recent corticosteroids) but I agree that having a really chronic pyometra would certainly affect her so I want to allow her time to settle down after the hysterectomy.

Thanks for the advice!

Re: Cushings disease?

ilanit — Wed, 24 Apr 2013 05:44:59 GMT

I came across this in the Ettinger the other day. It makes sense. So even if it has Cushing there's no need to rush into potential harmful treatment. I would do as above, wait and see. If the dog still has issues later on can repeat tests. Would probably start with just checking specific gravity in the urine. If it's concentrated it's not very likely to have Cushing.

"A survey of internists and dermatologists revealed that more than 50% of board-certified specialists would not treat a dog that has no signs or only minimal clinical signs despite abnormal biochemical and/or endocrine tests consistent with PDH. Treatment of HAC is never a benign procedure and should not be initiated unless the dog shows unambiguous clinical signs of the disease."

Re: Cushings disease?

Andrew Kent — Tue, 23 Apr 2013 20:37:17 GMT

[quote user="Julian Earl"]

Is it urinary 17-OHprogesterone the best rule out test? I might not have that right but I think it's that.

[/quote] Urinary cortisol:creatinine ratio would be the best rule out test in that if it is very low it is very unlikely to have Cushings. But with concurrent disease it is likely to be high and so of minimal value. Though if it was low now it might be helpful!

PS good to see you back on the forum Julian!

Re: Cushings disease?

Julian Earl — Tue, 23 Apr 2013 19:34:02 GMT

Is it urinary 17-OHprogesterone the best rule out test? I might not have that right but I think it's that.

Re: Cushings disease?

Christopher Saul — Tue, 23 Apr 2013 19:13:37 GMT

Juat going to add my voice to the wait and see camp. I don't think you have any specific evidence for cushing's disease at this point; remember non-adrenal illness (such as a grumbling pyo) can cause false +ves on tests for cushing's. I would let things settle down and then repeat a full minimum database (CBC, biochem, bile acids etc) and then maybe do dynamic endocrine tests if those are suspicious for cushing's at that point

Hope this helps

Chris

Re: Cushings disease?

Martin Atkinson — Tue, 23 Apr 2013 16:25:01 GMT

I really can't see anything in your results that would lead me to think this was Cushings even without the complicating factors, the Alizin could have caused your liver changes, so without a doubt Andrew is right - wait and repeat tests if it is showing clinical signs of HAC in a couple of months.

Re: Cushings disease?

Andrew Kent — Tue, 23 Apr 2013 12:29:10 GMT

Is the owner concerned about the clinical signs?

the one thing I wouldn't do is a trilostane treatment trial as I don't think we can be sure enough about the diagnosis yet.

personally I would let things settle down after the pyo and then repeat some testing - bloods, urinalysis, lddst. There is no hurry to make the diagnosis and I think at the moment the concurrent disease makes your findings hard to interpret.

Andy