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Old 05-19-2009, 07:11 AM
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labblab labblab is offline
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Default Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Originally Posted by AlisonandMia View Post
I believe Dechra says somewhere (and I'd dig it out but won't be able to because I've got a v-e-e-e-e-ry slow connection at the moment - need that "frustration" emoticon, too!) that with Trilostane treatment the way to discriminate between cortisol withdrawal and absolutely-low cortisol is to take a look at the electrolytes - I'm pretty sure it's in the latest US product info if you want to be look it up for yourself (see Trilo FAQ's). This is because, with Trilostane, if the cortisol really is too low then the aldosterone (the adrenal hormone that balances the electrolytes) will also be too low and this will show up as an electrolyte abnormality.

I think with Angelina trying to sort whether you are seeing cortisol withdrawal or low cortisol might really help you work out what dose suits her best.

John, I think these are the Dechra excerpts that Alison is talking about (taken from:

A small percentage of dogs may develop corticosteroid withdrawal syndrome within 10 days of starting treatment. This phenomenon results from acute withdrawal of circulating glucocorticoids; clinical signs include weakness, lethargy, anorexia, and weight loss.1 These clinical signs should be differentiated from an early hypoadrenocortical crisis by measurement of serum electrolyte concentrations and performance of an ACTH stimulation test. Corticosteroid withdrawal syndrome should respond to cessation of VETORYL Capsules (duration of discontinuation based on the severity of the clinical signs) and restarting at a lower dose.
and also:

If the ACTH stimulation test is <1.45 μg/dL (<40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.