Senior lab with high liver enzymes. Is it Cushing's disease? 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!

I'm sorry to hear about Chi Chi's recent issues. Vomiting and an anal gland abscess/rupture may cause some changes on the blood panel, but not typically ALP. When you have a significantly elevated ALP and normal ALT it is highly suggestive of Cushing's disease. Cushing's can be diagnosed with a few different tests, these tests involve taking blood, injecting a substance then taking blood again to see the body's ability to respond. I think it would be wise to have her checked. If she dies have Cushing's thankfully it is treatable with medication but this will be for life.

Hello and thank you for your interesting question. The first thing I would do is schedule another blood work up appointment to look at the liver enzymes in about two weeks after the first sample was taken. If the liver enzymes, specifically ALT, are still elevated, then there is some evidence that there’s been hepatocellular or liver disease or damage. I understand the veterinarian not wanting to test for Cushing’s disease, especially with the age and the lack of symptoms. But if the enzymes are still elevated, I would ask the vet if it would be worthwhile to start a liver protectant daily medication such as Denamarin. This medication given daily could potential he slow the damage to the liver cells and you may never exhibit clinical signs for the remainder of life and this medication has very little side effects. The other thing that you could possibly do if the liver enzymes are elevated used to start a liver protectant diet which is usually a prescription diet that is dispensed that your veterinary clinic. Again, these are two fairly easy, noninvasive ways to protect your pets liver from whatever is causing the cellular damage. I hope I’ve given you some information that helps. Have a great day.

It's hard to get a full picture of a pets condition without a hands on exam, but the things that concern me with this bloodwork are the glucose level, the ALKP and the elevated WBC count. Unfortunately, in these cases, more veterinary care is the only option. Your pet may have Cushing's disease (adrenal gland disorder), diabetes and an infection somewhere. These cases can get complicated and require follow up testing, likely medications that need to be controlled and adjusted once a diagnosis has been made. There really isn't any way of moving on with your pets care until you have a working diagnosis and these results point to a few possibilities. Perhaps you can see if your vet accepts Care Credit and utilize that for financial assistance.

My biggest concern is that your vet is talking about hyperadrenocorticism also known as Cushing's disease. This is what I think of when you discuss those symptoms, liver enzyme elevations and adrenal issues. Cushings is where they produce too much cortisol in their system. You can do a test to rule this in or out. You can have your vet do a low dose dexamethasone test OR a ACTH stimulation test. If it comes up positive then you can treat with the disease with a daily medicine called trilostane to help the symptoms. But you cannot cure cushings. I hope this helps and will help guide you in a conversation with your vet if this is actually what your vet thinks is going on.

I'm with you, and I don't understand why the ALT would have gone up because of the Cushing's disease. Certainly we expect ALP elevations, but typically not ALT, so it makes me a bit worried that something else is going on. That's fantastic that he's been doing well with Cushing's for 8 years! The milk thistle shouldn't hurt, but I would think about maybe doing an abdominal ultrasound to see if some additional problem is present in the liver now, such as a tumor or infection.

Hi there and thank you for using pet coach to address your concern. The ALP is quite high but this also depends on their reference ranges there. The symptoms you are describing could be consistent with a condition called hyperadrenocorticism (Cushing's disease) which is when there is excessive steroid production in the body due to a pituitary tumor or adrenal gland mass. There is treatment for the disease but it needs to be confirmed first. If you want to know for sure, testing such as an ACTH or low dose dexamethasone test should be performed. You can try using melatonin and flaxseed lignans to treat cushings disease naturally. I have had some cases respond to this treatment but not 100%. Also, I see that cre is 18. If this is creatinine, this is very high. Again, this depends on the machines reference range, calibration and unit of measure. Creatinine elevates typically with renal disease, which could also explain the increased thirst. If you attach a picture and repost to the forum here, it may help us better guide you. I hope this helps! You can visit a website called lignansforlife.net and order the holistic medications that I spoke of earlier. Please let me know if you have any other questions or concerns and I would be more than happy to help you further.