PU/PD case

RE: PU/PD case

Andrew Kent — Sun, 04 Oct 2020 14:20:44 GMT

[quote userid="2792" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29368/pu-pd-case/225629#225629"]I think the major problem we had was that this dog had seen 3 different vets in our practice and think there had been some confusion.[/quote]

That does add an additional layer of complexity!

[quote userid="2792" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29368/pu-pd-case/225629#225629"] Idexx when rung for advice didn't seem to think we should treat for cushings?[/quote]

The diagnosis of Cushing's is always challenging. You already had an adrenal function test supportive of that diagnosis but of course that is only one aspect.

[quote userid="2792" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/29368/pu-pd-case/225629#225629"]We have done the lddst. Which is positive for cushings so we have now started the dog on vetoryl and I think will see how they go from there[/quote]

Sounds reasonable - let us know how things go. Worth reviewing the USG once settled on treatment.

Andy

RE: PU/PD case

Claire Godfrey — Mon, 28 Sep 2020 18:38:27 GMT

Thank you.

I think the major problem we had was that this dog had seen 3 different vets in our practice and think there had been some confusion. Idexx when rung for advice didn't seem to think we should treat for cushings?

We have done the lddst. Which is positive for cushings so we have now started the dog on vetoryl and I think will see how they go from there. As to whether we should be looking for anything else!

RE: PU/PD case

Andrew Kent — Sun, 27 Sep 2020 20:31:55 GMT

Hi Claire,

Apologies for the slow reply.

I guess I rarely find a single urine specific gravity that useful as its much more helpful to see how this evolves over the day. Is it always this dilute or ever more concentrated? I tend to ask owners to collect multiple samples over the day to build a picture of what is going on.

It is possible to see both Cushing's and Diabetes Insipidus together in dogs with pituitary tumours so that would be a possibility.

As it stands you have an adrenal function test that supports a diagnosis of Cushing's so I am not sure an LDDST would immediately help you unless it was normal (as this test perhaps has a higher sensitivity but lower specificity than ACTH Stimulation). I think abdominal imaging would be very sensible as the next step but yes, really this needs to be by somebody who can accurately measure adrenals etc.

If that was really not an option then I suppose measuring endogenous ACTH may have some benefit.

Do keep us posted.

Andy