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Old 04-21-2009, 07:07 AM
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Lulusmom Lulusmom is offline
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Default Re: Mikey no longer doing well on Trilostane

Hi Dorothy,

I switched both of my cushdogs from Trilostane to Lysodren. They are both Pomeranians (4.5 lbs and 8 lbs) and like your Mikey, they are a breed that is over represented when it comes to adrenal hormone imbalances. They should have never been placed on Trilostane without having a UTK adrenal panel done. After two years of treatment, Lulu's sex hormones had skyrocketed and I took both off of Trilostane immediately.

You are correct in that there is no way for you to tell if the elevation in the other adrenal hormones is due strictly to the Trilostane or if Mikey already had an imbalance and Trilostane has exacerbated the problem. In order for you to have correctly determined this, Mikey should have been taken off the Trilostane for at least 30 days before an adrenal panel. It is also very important that you go through a minimum 30 day washout period when transitioning to Lysodren. In our case, I waited until they were symptomatic again, plus we had acth stim tests done to make sure that cortisol levels were above 22ug/dl before loading with Lysodren.

With Mikey's very high post stim number before starting treatment, I don't believe that it is going to be possible to transition from Trilostane to Lysodren without loading. The two drugs work very, very differently...Trilostane is an enzyme blocker which over time actually enlarges the adrenal glands whereas Lysodren shrinks the adrenals as it erodes the adrenal cortex to a point where they no longer oversecrete cortisol and in most cases, the sex hormones. Maintenance doses of Lysodren given with melatonin and flaxseed can be effective in reducing cortisol in dogs with mild cortisol elevation but Mikey doesn't have mild elevations so I would be very surprised if this treatment regimen is the right one for Mikey.

My Lulu lost 3/4 lb and with a starting weight of under 5.5 lbs, that was pretty significant. I wrote to Dr. Oliver at UTK and asked him if he had experienced this phenomenon with other atypical dogs. He said yes, weight loss can be due to the excess sex hormones. I would very much like to hear how your IM was able to pinpoint the absorption problem with Mikey. Other members have also reported weight loss in their pups while having a very healthy appetite. It is very difficult to watch your dog lose weight and not know why it's happening.

According to the UTK adrenal panel, Mikey's cortisol is being controlled by the Trilostane so like you, I am very confused as to why your IM would suggest increasing the Trilostane.

My IM consulted with Dr. Oliver at UTK to discuss the best approach to Lulu's treatment. It was mutually agreed that Trilostane should be discontinued and treatment with Lysodren be started after an appropriate washout period. Perhaps you might suggest that your IM consult with Dr. Oliver too.

I hope this helps.

Glynda

Last edited by Lulusmom; 04-21-2009 at 07:14 AM.