Can anyone tell me about Cushing's disease?

[celestialsquirrelnuts]

Oh dear. Took my 9.5 yo standard poodle to the vet as she had suddenly got fat and slowed down a lot and had lost a lot of hair from her back - you can see her skin and she was always so thick-coated. Vet checked thyroid levels - normal. Now says that she is thinking it may be Cushings.

The test she would like to do is ACTH stimulating test - but apparently the drugs needed are not being supplied for a manufacturing reason. So we are in limbo until they are available - could be months apparently.

Can anyone tell me what it means for her health and life expectancy if she does have Cushings? Is it genetic ie should I tell her breeder if and when she gets a diagnosis? And it is treatable?

Poor old girl.

Thanks in advance.

Anyone?

Synacthen may be available from some human pharmacies - your vet could write a prescription. It's also possible to use smaller doses than the formulary lists and to store spare in the freezer, so it might be thatthey test her after all.

If not there are other tests which are less reliable but in combination may be enough to confirm diagnosis - UCCR, LDDST and probably betahydroxyprogesterone. A medicine specialist would be able to advise.

Cushing's isn't painful and can be successfully treated, although it is a costly medication. If untreated she will be prone to infections and may be lethargic and pee a lot. These things cause some animals more problems than others.

Is she thirsty just now? Has your very also checked her TSH?

*vet

Only heard of Cushing's in horses. Didn't realise other animals could suffer from it as well.

Our last standard poodle was diagnosed with cushings at 9 years old, she lived in pretty good health until she was 12 years old. I told her breeder but she was the only one out of a litter of eight that got it, none of her parents on mother's side had it. She lived a happy life. Once on medication she stopped the drinking and slimmed down to her previous weight, wasn't ravenous about food any longer. She had quarterly veterinary checkups and insurance covered it all.

Her mother and grand mother lived until between 12 and 13 so I don't think it shortened her life at all. If I could put my finger on anything towards the end I thought she was a little depressed but not sure if that was the medication, the disease or simply old age.

If it is cushings the medication will reverse the problems of weight, hair loss now and hopefully she will return to her previous form :)

That's really good to hear red priest, thanks so much for that reassuring story.
Cashew the vet tested tag, t3 and t4 all comfortably in normal ranges.
Vet said that there was another test which could be done but it was unreliable - produced false positives at a rate of 50% - which I think is hardly worth doing, unless I misunderstood her. What do you think I should do? I don't want to keep her in limbo, undiagnosed and untreated, if she does have Cushings...

Not tag, tsh!

Has she had a blood profile done or just a T4 (thyroid) test? There are normally abnormalities on a profile with Cushings (elevated ALKP and cholesterol and changes in the white cells) that are suggestive. You didn't mention drinking and peeing excessively which is nearly always present.
I disagree that you'll be able to get synacthen on prescription, it has been reserved for human hospital use only until the current manufacturing problem is resolved. The other tests mentioned (low dose dex suppression and urine cortisol:creatinine) may be useful if a basic blood profile supports the suspicion of cushings. The main problem has been that ACTH tests are recommended frequently to monitor the cushings treatment vetoryl, and without synacthen you can't perform ACTH test.
It tends to be gradual onset and it's usually the owner's quality of life affected by the peeing more than the dog's, so don't worry too much about delay in diagnosis/treatment, but if the other tests haven't been done rule out the other stuff first.

Well i would have a go at getting hold of synacthen. We are getting ours from the chemist down the road!

Crikey baking, sounds like the local pharmacist is on thin ice

There is now a world wide shortage of synacthen and from a discussion I had the other day is not going to be resolved for the foreseeable future (predictions are it could be off for several years). As Bakingtins said it is being reserved for diagnosing Addisions disease in humans.
We are investigating our potential cushings case with low dose dexamethasone suppression test and then monitoring with urea, cortisol and electrolyte readings. The manufacturers of the drug to treat cushings have provided comprehensive information to support the diagnosis and treatment until synacthen is avaliable again.

That's so interesting everybody. So it sounds like there is no point waiting for a month to see if synthacen becomes available, we should go straight into other diagnostics. That's v helpful, thank you.
The vet I saw for bloods and spoke to today was not the one I usually see - this one was much younger and I felt not entirely sure of her ground - perhaps I should try and talk to the more experienced one.

We just had tsh t3 and free t4 done not a full profile. I will get that done.

Is ultrasound useful for assisting with a diagnosis? Or does one MRI the pituitary? (Can one MRI a dog?!)

She has been drinking a lot. I'm not sure about peeing because she is in and out of a v large fenced garden all day pretty much at will. She hasn't had any problems staying dry at night - she usually has 6-7 hours between being let out last thing at night and again first thing in the morning (I go to bed v late and DH gets up v early!)

My old boy has cushings and has had it for years now (cant remember how long) He has an ACTH test every 6 months to check his medication is at the right level. I wasn't aware of a shortage of synthacen and it hasn't been mentioned by my vet.
I would try and get diagnosed some other way if that's possible. The only real symptom my old boy was drinking loads, I was recording how much water I was putting down and as soon as he was on Vetoryl for the cushings the huge water consumption stopped really quickly. He has had his meds adjusted a couple of times and to look at him you wouldn't know there was anything wrong with him, and he's now 15
Hope you sort out your girls diagnosis soon

That's so good to hear, thanks very much daisy!

Sometimes blood test results can be used to differentiate between adrenal and pituitary forms but you often rely on ACTH stim for this. Abdominal xray may show calcification of the adrenal glands, and ultrasound can be helpful to examine the adrenals although it's quite a tricky area to scan so it depends on your vet's level of confidence. MRI could be used in theory but it's very expensive so I'd only use it in cases with neurological signs.

Definitely start with full bloods - I had assumed they'd already been done. As has already been mentioned they are often enough to give me a very strong suspicion when taken in context with the clinical signs. Thirst is the cardinal sign so if in doubt measure her water intake because if it is normal that effectively rules out Cushing's.

Good luck :)

Thanks so much cashew. I'll keep you posted if I may!

My vet told me it's a disease of old age and there was a time when lots of dogs died with it but not of it, if that makes sense. One symptom we did notice was her head became very boney and protruding, but she had gained weight in other regions.