My dog has Cushing's: Do we need so many costly blood tests?

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!

Unfortunately, that's just the nature of some diagnostic tests - they don't always give a clear answer, just like in humans. So repeated testing over the course of a few months, or retesting with a different type of test, may be needed to get a diagnosis. Cushing's disease is notoriously hard to diagonse in many dogs, because the testing is often borderline or inconclusive.

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.

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.

Hi there, Yes, this sounds similar to a typical test for Cushing's disease. The most common test is blood drawn prior to injection, as well as samples taken four and eight hours later. Sometimes, the eight hour sample may not be necessary depending on test results. Here is a link to more information about diagnosing hyperadrenocorticism: https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4951504 Thanks for using PetCoach. Best of luck to you and Miss Dixie.

Cushings is an extremely complicated condition to both diagnose and treat but with such a high reading on an acth stimulation test is is extremely likely in this case. There are additional confirmatory tests such as a urine cortisol:creatinine ratio and dex suppression tests which can be used to further investigate. If she has no symptoms at all then it may be an option to withold treatment and monitor very closely, keeping a symptom diary to track any changes. In some dogs, the abnormal excess cortisol can actually provide antiinflammatory effects improving quality of life and treatment can actually allow other symptoms to emerge. You should be aware that untreated cushings may indeed shorten life expectancy

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!