Number of Cushing's Cases

Re: Number of Cushing's Cases

Luca Poddighe — Wed, 08 Apr 2015 11:04:27 GMT

We do frozen aliquotes too.

Re: Number of Cushing's Cases

Thomas Johnson — Wed, 08 Apr 2015 10:54:59 GMT

[quote user="Martin Atkinson"]

[quote user="Hannah Wynne Richards"]

No point, unless you're doing enough to use up a whole vial in 1 day.

Wynne

[/quote]You can store it in a capped syringe with no air indefinitely (well of course really only 28 days)! and use it again. This is according to the Goddess of endocrinology Krista Visser 't Hooft not something I've made up.

PS hope you liked the pretty red star on your next post.

[/quote]

We were splitting it into 0.2ml aliquots in syringes and freezing it, though we are now using tetracosactide 0.1mg/ml.

Re: Number of Cushing's Cases

Martin Atkinson — Wed, 08 Apr 2015 10:43:37 GMT

[quote user="Hannah Wynne Richards"]

No point, unless you're doing enough to use up a whole vial in 1 day.

Wynne

PS hope you liked the pretty red star on your next post.

Re: Number of Cushing's Cases

Hannah Wynne Richards — Wed, 08 Apr 2015 10:36:46 GMT

PS Hope you won't find this too trdious to reply to.

Wynne

Re: Number of Cushing's Cases

Hannah Wynne Richards — Wed, 08 Apr 2015 10:36:01 GMT

No point, unless you're doing enough to use up a whole vial in 1 day.

Wynne

Re: Number of Cushing's Cases

Martin Atkinson — Wed, 08 Apr 2015 10:06:22 GMT

[quote user="Michael Woodhouse"]

I thought low dose dex suppression was best to diagnose Cushings. ACTH stim to monitor treatment and to diagnose Addisons.

[/quote]I would go with that especially with the recent poor supply of Synacthen. But ACTH stim. test is good for a quick screen especially if you don't want to faff around all day.

Incidentally how many people use the Synacthen saving dose of 5ug/kg rather than the standard 'half a vial up to 5kg and a full one over 5kg?

Re: Number of Cushing's Cases

KMurphy — Tue, 07 Apr 2015 10:27:46 GMT

None for years but 5 at the moment. Single vet practice. Diagnosed with combination of low Dex and ACTH stim usually.

Re: Number of Cushing's Cases

Luca Poddighe — Tue, 07 Apr 2015 08:50:01 GMT

One on the go at the moment. Not have seen a great deal at all in my career probably less than 10 cases in 10 years.

Re: Number of Cushing's Cases

Michael Woodhouse — Tue, 07 Apr 2015 00:03:07 GMT

I thought low dose dex suppression was best to diagnose Cushings. ACTH stim to monitor treatment and to diagnose Addisons.

Re: Number of Cushing's Cases

Noweia — Mon, 06 Apr 2015 20:41:08 GMT

We use ACTH stim in line with Vettest and clinical signs.

Re: Number of Cushing's Cases

james herriot lied — Sun, 05 Apr 2015 23:31:22 GMT

In reply to Noweia:

How do you test for Cushings? I think I've definitely over-diagnosed a few over the years, as we tend to do ACTH stim as a first-line test....

Currently, about a dozen - probably three-quarters of which have iatrogenic cushings (but aren't currently itchy).

Re: Number of Cushing's Cases

grumpyoldman — Sun, 05 Apr 2015 23:25:39 GMT

we have 12 cushingoids on meds probably loads more not . If long term meds are a problem I have in the past done bilateral adrenalectomy and supplemented with fflorinef and pred .those do ok for years too Something to consider if they are thinking of euth on cost grounds. Did that a few times pre vetoryl when the lysodren disappeared . I liked lysodren it worked better and a lot settled on one tablet a week without this endless monitoring . I still use it sometimes if the vetoryl is not making it .

Some labs use 600 other people recommend 550 so there is a bit of a wavy line . anything in the 500+ that is suspicious gets 17 OHp those often stimulate to >9 .

the other problem i see is that the cushings get treated and becomes stable ,then the oa /djd gets worse .

Re: Number of Cushing's Cases

John Flynn — Sun, 05 Apr 2015 19:36:59 GMT

What's the current thinking on when to start treatment (if there's any consensus!) and do folk typically test to confirm a case even if clinical signs wouldn't warrant treatment at that time?

I saw one min schnauz (suspected) last week that had calcium oxalate removed month previous and still had crsyals and pH6 urine: what's the current thoughts on treating cushings in such a scenario? typically i have on basis that corticosteroids are frequently listed as increasing risk, but have always wondered if the PUPD might not at least offset any such theoretical increased risk?

Re: Number of Cushing's Cases

Braden Collins — Sun, 05 Apr 2015 13:21:43 GMT

Currently have 2 addisons and probably around 6 Cushings on the go - 6.5 vet FTE over 2 clinics. I rekon we have a lot more we are suspicious of but not diagnosed with lab work due to owners finance or other reasons so would be much higher if finances were taken out of the equation.

Re: Number of Cushing's Cases

Charlotte Marshall — Sat, 04 Apr 2015 14:37:33 GMT

We are 5 vets and we have several dogs under treatment for cushings i am not sure of exact numbers but more than 1 per vet. We have about 6 addisonians i think. Quite a few diabetics as well. I have always thought we get a lot of endocrinology cases here. I've seen most types here over the years. Still to get an acromegaly, though I suspect a cat I saw many years ago probably had it I just didn't know to look then!

Re: Number of Cushing's Cases

Martin Atkinson — Sat, 04 Apr 2015 10:54:24 GMT

[quote user="Stephen Courtney"]

I have only one at my small branch - and that is one of only two cases i have ever diagnosed properly, in spite of looking hard. And one of the ws my own dog!

I have had a few more where the diagnosis was likely but the client didn't pursue the matter fully for one reason or another.

Similarly I have only ever diagnosed Addisons once .... in spite of looking hard.

[/quote]I am sole charge and have one dog currently under treatment for Cushing's, the most we've had at one time is 3.

I have one Addison's currently under therapy.

Maybe you have looked but I suspect in general practice Addison's is under-diagnosed because it is often ephemeral or mimics other diseases - likewise Cushings in many cases. Don't they call it 'the great pretender'?

Re: Number of Cushing's Cases

Utlendigur — Fri, 03 Apr 2015 22:43:58 GMT

We ran out of tetracosactide/synacthen last week and were out of 10mg vetoryl on Thursday, so yes, we do seem to have a few (3FTE approx 4-5 cases that I can think of - plus one recently pts). Most are on PDSA, like the equally large number of diabetics...

[quote user="Stephen Courtney"]Things do seem to go in spates however. I remember wondering if osteosarcomas were somehow catching when i had my fourth case in as many days as a new grad...[/quote]

I had 3 insulinoma cases on the go at once - two of which came in in the same afternoon!

Re: Number of Cushing's Cases

Kate Richardson — Fri, 03 Apr 2015 22:11:27 GMT

I don't know numbers but we have quite a number of Cushings cases under treatment, and at least 2 Addisons on the go, one of which is a cat! 6 FTE vets, 1 site practice. Similarly we don't have huge numbers of diabetics!

Re: Number of Cushing's Cases

Michael Woodhouse — Fri, 03 Apr 2015 21:54:59 GMT

We are mainly large animal, and I remember having a vet student who I was giving a brief induction. I explained not a lot of small animal work. That morning the Addison's dog, the Cushing's dog and the dog with Myasthenia Gravis all came to morning surgery. She was in her final year and hadn't seen any of them in small animal practice!

To add perspective I don't think we currently have any diabetics.

Aside - the owner of the Addison's dog had another dog with Addison's about 10 years ago.

I suppose 1 FTE pet vet

Re: Number of Cushing's Cases

Stephen Courtney — Fri, 03 Apr 2015 20:02:57 GMT

I have only one at my small branch - and that is one of only two cases i have ever diagnosed properly, in spite of looking hard. And one of the ws my own dog!

I have had a few more where the diagnosis was likely but the client didn't pursue the matter fully for one reason or another.

Similarly I have only ever diagnosed Addisons once .... in spite of looking hard.

Things do seem to go in spates however. I remember wondering if osteosarcomas were somehow catching when i had my fourth case in as many days as a new grad...