Why are my diabetic senior dog's Cushing's tests inconclusive?

Hi there. It would help to know what specific tests have been done so far. The most common test used to diagnose Cushing's disease is called a low-dose dexamethasone suppression test (LDDST), but an ACTH stim test or urine cortisol/creatinine ratio can also be used in some cases, especially if initial LDDST results are inconclusive. I'm not sure what was found on her ultrasound exams, so I can't comment on that without more information. But if she hasn't had an ultrasound done by a board-certified radiologist, this would be a reasonable next step to consider. Since getting a diagnosis has been such a challenge for your pup, I would consider requesting referral to an internal medicine specialist at this point. He/she can evaluate Hanz, go over all of his previous testing and lab results in detail, and help you determine the best way forward from here.

This could be a possibility. If your vet thinks Cushing she could be complicating her diabetes, you could consider testing her for cushings. If she definitely has cushings then you can start treating her for that. In the meantime, y'all will need to work on getting her diabetes under control. Another option would be to see if there is a specialist (internist) near you that could take over her case to help you get the DKA under control while also diagnosing and treating for cushings if needed. The main difference between a specialist and a general practitioner is that the specialist specializes in these complicated metabolic diseases and usually have facilities and specialized equipment that can care for them 24 hours if needed. If there is a cost concern and yall are unable to get the DKA under control and she is continuing to decline then yes, I would consider euthanasia. Unfortunately, even with intensive care and extensive testing, sometimes these guys don't improve and continue to decline no matter what we do. I know this is a difficult time and decision. Just know that you are doing the best thing for her whatever you decide. I hope this helps and know we are thinking of you. Hugs!

Hi there and thank you for posting your question. The medication used to treat Cushing's disease can cause some pretty serious problems if not monitored appropriately. Unfortunately, the blood testing to monitor Cushing's is expensive. For the first two to three months I will perform this particular test called the ACTH test to monitor the response to treatment and to make sure that the medication is not causing the reverse problem called Addison's disease. If the dog is well regulated I might spread out the blood test to once every 6 months to ensure that the values are regulated. Of course, this is something that you will have to discuss with your veterinarian who is ordering this blood test up every few weeks. Every doctor is different with how they monitor their patients, so not all of us will recommend the exact same plan for every patient. I hope this helps guide you in the right direction. Please let me know if you have any further questions or concerns and I would be more than happy to help you further.

Cushing's or Hyperadrenocorticism is a fairly common endocrine disease in dogs. It can be caused by a bit of overactive tissue in the brain (in the pituitary gland, which is the master ruler of hormone secretion in the body) or a mass in an adrenal gland (sits by the kidneys, secretes hormones as directed by the pituitary gland). Basically what happens is an excess of a hormone in the body, usually a steroid called cortisol, if it is traditional Cushing's. This then causes some symptoms in the pet, blood work changes, and sometimes other changes like high blood pressure. I suspect based on the value that you report that this was a liver enzyme elevation call ALP. This very commonly occurs in pets that have Cushings, but is not specific for Cushing's and elevation can be caused by other disease processes. This value does not correlate with severity of disease as many dogs have a high value. It sounds like your vet is on the right track by recommending an ultrasound to look at the adrenal glands and also the rest of the abdominal organs to rule out other disease processes. Ultimately Cushing's Disease has to be diagnosed by some sort of endocrine testing which your vet may recommend as well. Treatment if then based on what type of Cushing's disease is present. I hope this helps and thank you for using Petco Pet Education Center, formerly Petcoach!

An enlarged liver is unfortunately one of the common side effects of Cushing's disease so it is not unusual that Ginger's liver appeared enlarged. Her urine concentration is very low (normal for a dog is 1.040) but again, this can be attributed to her Cushing's disease as well (because she is probably drinking more water and therefore causing her urine to be more dilute). In Ginger's case I would be worried about Diabetes and possibly cancer as well. I know it can be frustrating (and expensive) to keep doing more tests, especially when you aren't getting clear answers as to what is going on. I would recommend talking to your vet about costs/additional testing versus palliative care/keeping her comfortable for the time being. It may also be worth beginning treatment for her Cushing's disease because it could help allieviate some of her symptoms. Good luck. Please let us know if you have more questions/concerns.

Diabetes and Cushing's disease are caused by two different things, and both need to be treated. While you can see an increase in blood sugar when a dog has Cushing's, it's not as high as the blood sugar levels of diabetic patients. Gabe will need to be treated for both.

Poor Nemesis. Sometimes pets will need the medication adjusted. I recommend to call your veterinarian and ask if another test is needed to evaluate the blood levels in his body. The test is called an ACTH stimulation test. It has been found that 50% of dogs with Cushing’s disease will also have a urinary tract infection that can only be detected with a urine culture. I recommend to have this test done as well as this will cause constant drinking and urination. Other conditions such as thyroid disease, diabetes or kidney disease can also cause these signs. You must start ruling them out. Best of luck.