- 10 year old FS Boston Terrier that belongs to a veterinarian.
- In July of 2017. she started showing signs of cushings disease (pu/pd, accidents in house, thinning hair, distended abdomen, ravenously hungry).
- She had a mildly elevated alkp and sg of 1.020 and no other abnormalities.
- Abdominal ultrasound performed by a general practitioner was unremarkable. LDDST was not able to differentiate between adrenal vs. pituitary.
- 10 year old FS Boston Terrier that belongs to a veterinarian.
- In July of 2017. she started showing signs of cushings disease (pu/pd, accidents in house, thinning hair, distended abdomen, ravenously hungry).
- She had a mildly elevated alkp and sg of 1.020 and no other abnormalities.
- Abdominal ultrasound performed by a general practitioner was unremarkable. LDDST was not able to differentiate between adrenal vs. pituitary.
- She was started on 10mg of vetoryl bid. Initially, her pu/pd resolved, her belly looked less distended and her hair started growing back. Her stim since then have been where we want them.
- After moving to MN in June of 2018, her PU/PD returned dramatically, her hair is thinning out again and she has a markedly distended abdomen. ACTH stim done 7-17-18 shows a pre cortisol level of 3.8 mcg/dL and a post level of 4.8mcg/dL. U/a wnl. Treated with cephalexin for mild skin infection at that time. Pu/pd improved slightly. Side note she had a ventral slot done July 2016 and no pituitary tumor present at that time on MRI.
- Ultrasound exam performed today shows a normal size left adrenal gland, and a plump, right adrenal gland with slight enlargement at the caudal pole. The liver shows slight enlargement and increased echogenicity. Ultrasound guided cystocentesis was performed and U/A and culture are pending.
- I am still thinking uncontrolled PDH but don’t want to ignore any other potential causes for the PU/PD. Not sure what to make of the ACTH stim results in light of the patient’s clinical signs of distended abdomen, ventral alopecia, and PU/PD.
- Would you increase this dog’s Vetoryl dose? FNA or core biopsy the liver? Bile acid testing?
Comments
No tumor here. The views are
No tumor here. The views are oblique but as long as false + isnt an issue it would be pdh.
Other pupd causes include occult uti +.- adh recepto inhibition by bacteria, emerging renal disease, psychogenic pd…
Im sure remo has more to add on this
Thanks Eric. Any thoughts on
Thanks Eric. Any thoughts on her ACTH stim? Since all of her Cushing’s signs are returing (PU/PD, alopecia, pot-belly), would it be appropriate to increase the trilostane even though her ACTH post is in the 4.0 range?
Based on the clinical signs
Based on the clinical signs would go for incontrolled Cushing’s despite the ACTH stim results and would trickle the trilostane dose upwards. DDx that Eric mentions are spot-on but would not account for the clinical signs. Occult UTI may, howver, be contibuting.