My dog has Cushing's. Can we avoid ACTH stim test on Lysodren?

If Holly is not improving clinically, she might need to be tested again (ACTH stimulation test) to make sure the dose of Vetoryl is the correct one for her. Usually the blood test has to be done 10-14 days after the treatment has started, 4 to 6 hrs after Vetoryl administration. Please post again on the forum if you would like to discuss it further. I hope my answer was helpful.

Vetoryl (trilostane) is the best medication for managing Cushing's disease, but I'm sorry to hear that Lacy has not been tolerating it well. I have anecdotally heard of some vets using a variety of supplements for managing Cushing's disease signs, but these supplements will not ultimately decrease the cortisol production by the adrenal glands and generally seem ineffective. I don't know how long Lacy was receiving Vetoryl, but some dogs can initially become lethargic, vomit, have diarrhea, or a decreased appetite. Fortunately, these signs typically resolve after a few days to a few weeks on the medication. It may be worth discussing a temporary dose adjustment with Lacy's vet to see if she tolerates a lower dose better before gradually increasing to her 30mg dose. Some dogs also benefit from supportive measures (anti nausea medications, bland diets, etc.) in the first few days to weeks of treatment. I hope this helps and that all goes well!

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.

Hello. Yes, as long as the clinical signs of Cushing's are not hindering you or your pets' life. Vetoryl will control most of the symptoms associated with Cushing's by decreasing the influence of cortisol on the body, so as long as your pet seems happy & comfortable, the choice to use this medication is yours. Thanks for using Petco Pet Education Center, formerly Petcoach.

Hi, thanks for using Petco Pet Education Center, formerly Petcoach! Your Vet needs the LDDS first to make the diagnosis that Roxy does actually have Cushings.....and sometimes we can tell from the LDDS if the Cushings is more likely PDH in origin vs tumor (since 70% of patients with PDH suppress plasma cortisol to less than 50% of the pre-treatment value ). If Roxy does not suppress to less than 1/2 of the pre treatment value at 4 hours, then we need the HDDS test which helps us to differentiate Cushings due to adrenal tumor vs PDS. So LDDS first. Then HDDS if the LDDS did not suggest PDH. Other simple things to look at with Roxy: urinary incontinence, trying her on a Proin or DES trial and looking at her vulvar conformation and make sure she doesn't need a vulvoplasty. Good luck!

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

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.