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Old 04-20-2009, 08:51 PM
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4Mikeydog 4Mikeydog is offline
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Join Date: Apr 2009
Location: New Jersey
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Default Mikey no longer doing well on Trilostane

I am so glad I found you!! My 8 1/2 year old miniature poodle, Mikey was diagnosed with pituitary dependent cushings last March after an ACTH stim test with results:
pre 4.3 and post 39.7 and an ultrasound.
He had most of the classic symptoms; excessive thirst, excessive urinating, ravenous appetite, weak hindquarters, potbelly, and lethargy. He had a dull coat which had gone from a beautiful apricot color to a pale shade of cream, but no visible hair loss...
Mikey was put on Trilostane 30 mg 1x per day and within 2 weeks most of his symptoms started to subside.
All subsequent ACTH tests show effective management of cortisol. Mikey was his old self for quite awhile
However..after 5 months on Trilostane, my sweet guy began to lose hair at the tops of his ears and on his tail. This hair loss has continued.
Trilostane remained at 30mg 1x per day until some adjustments due to trembling and lethargy.
Mikey is presently on Trilostane 10mg BID. He has continued to lose hair, weight and muscle mass. He has an underlying intestinal or absorption problem which is currently being mediated.
His IM specialist ordered the UTK adrenal panel 3/30/09.
The results are as follows:

Cortisol Pre 8.3 ng/ml Post 48.1 ng/ml

Androstenedione Pre 0.90 ng/ml Post 0.70 ng/ml

Estradiol Pre 85.6 pg/ml Post 82.6 ng/ml

Progesterone Pre 1.00 ng/ml Post 1.70 ng/ml

17 OH Progesrerone Pre 4.89 ng/ml Post 6.77 ng/ml

Aldosterone Pre 21.6 pg/ml Post 37.9 pg/ml

Androstenedione, Estradiol, Progesterone, and 17 OH progesterone are all elevated.
I've read enough to know that Trilostane can do this.
Today we met with the IM specialist who is taking over for his original dr who is out on maternity leave..
I am truly confused and upset.
Clinically all signs of urinating, drinking, and appetite are mediated. However Mikey is lethargic, has lost most of his hair and is down to 12 lbs (poor guy)!
The vet initially recommended increasing the Trilostane
I commented that I thought melatonin,
flaxseed oil with lignans and or a maintenance dose of lysodren may be a better choice.
The specialist said we could do that and suggested 5 mg of melatonin BID first with Trilostane as is..
Then if I wanted to introduce the maintenance dose of Lysodren, I should stop Trilostane for 2 weeks and then start a maintenence dose of Lysodren. I'm very alarmed about this because I don't know if the Trilostane will really be out of his system enough to do this safely...
The IM specialist said that if we wait the 30 days without Trilostane we will have to actually load him instead. My questions are as follows:
What is your experience with this concept?
What have you experienced in switching a dog from one treatment to another?
Do you have any recommendations for how to start treatment with melatonin?
Do you think the 5mg melatonin BID is too high a dose for a 12 lb dog?
I am sorry if I am rambling..but I am truly frantic!

Thanks,
Dorothy and Mikey