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**Kwiggles** · 04-22-2009, 10:47 AM

Re: Harley's visit to the Univ. of Penn.

Hello Lori,

I wanted to stop by and say hi to you and your handsome Harley. My dog Joe is in a similar boat as your Harley- he is positive for Cushings but despite extensive testing we haven't been able to definitively distinguish if it is adrenal or pituitary.

An abdominal ultrasound done on Joe at Cornell Vet Hospital about 4 weeks ago was able to clearly visualize the left adrenal and it appeared normal but slightly enlarged. The right adrenal could not be fully visualized or measured because it was obscured by a loop of bowel.

Not sure what your vet will recommend for Harley, but my vet's advice was to go ahead and put Joe on Lysodren to give him some relief from his symptoms, and at the same time continue to try to get a good visualization of the adrenals, by CAT scan, MRI or re-check ultrasound. So we just completed Lysodren loading on Sunday and I'm awaiting results of his ACTH stim test done yesterday AM.

I wanted also to tell you that I asked the ultrasonographer (her name was Dr Yaeger) about the guideline that 'when there is a tumor on one adrenal gland, the opposite adrenal is atrophied.' She responded that she has found that to be often not the case- that even with a tumor on one adrenal, the other may be normal size or even enlarged. Just thought I'd pass that along for what its worth.

Wishing you success in pinning down Harley's diagnosis and hoping you will get good results on his bloodwork.
Karen & Joe

**Harley PoMMom** · 04-22-2009, 11:45 AM

Re: Harley's visit to the Univ. of Penn.

Hi Karen and Joe,

'when there is a tumor on one adrenal gland, the opposite adrenal is atrophied.' She responded that she has found that to be often not the case- that even with a tumor on one adrenal, the other may be normal size or even enlarged. Just thought I'd pass that along for what its worth.

Hey thanks for the info, will keep that in mind, all info. is welcomed.
This waiting and wondering is awful

but what are you going to do

When I picked Harley up at the vets office he was all smiles, he shows his teeth when he is happy, so I know they are good to him. They said they were just finishing the test (Spinning ??, freezing ??) and were getting the info. to send to UTK. Glad they know what they're doing

as I sure don't feel like I do

They took his blood out of his neck this time b/c they read in the info. pack that I gave to them from the UTK that if the blood samples are grossly hemolyzed they have to be repeated in a week, they said sometimes it's better to take the blood from the dogs neck than the leg, they did say why and I should have written it down, I will when I see them next week.
Poor Harley

he has his neck, belly, right front leg and right rear leg all shaven, he doesn't know what to make of this bare skin

We'll be watching for Joe's test results and crossing all of fingers and paws for good luck and believe me w/ 2 dogs and 2 cats that's alot of paws crossed!!

Talk to you soon, Take care,
Harley and Lori

**Harley PoMMom** · 04-24-2009, 05:49 AM

Re: Harley's visit to the Univ. of Penn.

A Doctor from Univ of Penn. called me yesterday with Harley's Endogenous ACTH results, he said the number's were high and indictive to pituitary cushing.

I also heard from Harley's vet that they sent his adrenal panel out to UTK along with all his results/records related to his cushings. Now the waiting game

I will post the details when I receive them for sure, b/c I know that I am going to need ALOT of advice.

Harley and Lori

**barney's mom** · 04-24-2009, 09:29 AM

Re: Harley's visit to the Univ. of Penn.

Dontcha just hate the waiting game?????????
It seems all my test results are due Friday and are never on time, so I am stuck the entire weekend wondering. Hopefully it goes quick for you!
ps...I passed the Shiloh Veterinary Hospital today and thought of you, haha!
Ironically, me and Barney were coming home from the vets.

Cheryl

**Harley PoMMom** · 04-30-2009, 04:39 AM

Re: Harley's visit to the Univ. of Penn./Endogenous ACTH

Can anyone tell me what these endogenous results mean?

..............4/15/2009 11:09:00.........Reference Range.......Units
Endogenous ACTH.............41.1 (H).......(6.7-25.6)..........pmol/L
Aldosterone, Baseline.........197..............(14-957)...........pmol/L
Aldosterone 1h post ACTH...443.............(197-2103)........pmol/L

Any info would be appreciated,
Thanks,Harley and Lori

**barney's mom** · 04-30-2009, 01:13 PM

Re: Harley's visit to the Univ. of Penn.

Hi Lori,
Unfortunately, about the only one I can decipher is the endogenous ACTH, which you already know is high and would indicate PDH.
I am sure some of our members more experienced with a full adrenal panel can help you with your other numbers will be along this evening.

Cheryl

**Harley PoMMom** · 04-30-2009, 02:14 PM

Re: Harley's visit to the Univ. of Penn.

These other numbers were with the endogenous results, I haven't got the adrenal panel results back yet, still anxiously waiting

I was just wondering if these results should be emailed to Dr. Oliver (UTK).

Harley and Lori

**Buffaloe** · 04-30-2009, 02:28 PM

Re: Harley's visit to the Univ. of Penn.

Hi Lori,

I personally think the endogenous ACTH test is probably the best of the blood tests to differentiate between pituitary/adrenal cushing's. We never had that one done on Shiloh and I don't know how to interperet the numbers. But, they said it indicated PDH. I would think that is a positive because pituitary tumors are much easier to treat with medication than adrenal.

I also think it is really good that Harley's aldosterone is within the normal range. Shiloh's aldosterone was significantly elevated and she had the big adrenal tumor. All of her other intermediate hormones were within the normal range. I'm just saying, Harley having normal levels of aldosterone is a heck of a lot better than if they were elevated.

It sounds like your vet treats Harley very well. I know my vet and his assistants treat Shi really well because she gives my vet kisses...and Shi is pretty darn stingy with her kisses.

Lori, we were typing at the same time...if it were me I'd wait until I had all of the results from Tennessee before contacting Dr. Oliver. Hopefully in just a few more days.

Ken

**Harley PoMMom** · 04-30-2009, 02:58 PM

Re: Harley's visit to the Univ. of Penn.

Ken and Cheryl, you are both right, from what I am reading the high number for the endogenous ACTH test does indicate pituitary cushings for Harley

I'm on pins and needles until the full adrenal panel results from Dr. Oliver gets back.

Then I don't know what will be worse-- this waiting game-- or the treatment phase-- will I do it right

I'll be a mess

Hopefully, you'll all be here to help me thru it

Harley and Lori

**barney's mom** · 04-30-2009, 06:43 PM

Re: Harley's visit to the Univ. of Penn.

The waiting game is WAY worse than the treatments.

I still hate the waiting game. (waiting on stim test results now, lol)
We are right here with you! Hoping you get your panel back soon.
It's been over a year since Barney's diagnosis, and every single test he had came back consistent with cushings' but we couldn't differentiate the kind of cushings until his ultrasounds.
Sounds to me like Harley is PDH, and you are awaiting information to rule out that he is atypical also?

If this is solely PDH, have you given any thought to treatment?

Ps.....it was chilly today

**Harley PoMMom** · 05-01-2009, 04:37 AM

Re: Harley's visit to the Univ. of Penn.

Cheryl, Yes I am waiting to make sure Harley is not atypical also.

As far as treatment, I was hoping Dr Oliver would suggest something, if not, then I'll probably go with Lysodren, or what Harley's vet and I feel most comfortable giving to him. I really like Harley's new vet, and Harley does too.
When I get the adrenal panel results back, I will post them and hopefully I will get advice here as well. I DO NOT WANT TO MAKE THE WRONG CHOICE for Harley, so I am asking everyone and anyone to help me when this time arrives. It seems Harley's LDDS test was indictive to adrenal cushings and now his endogenous test points to pituitary, so WHAT DO YOU DO???

Harley's U/S really showed nothing but a small nodule on one of his adrenal glands and enlarged liver, so this tells me nothing.

I've read trilo. is for both adrenal and pituitary cushings, but one can only treat a cushpup w/trilo as long as the cushpup is not atypical.
So, if I never really can pinpoint Harley's cushings, how can I really treat him properly?

Harley and Lori

**Harley PoMMom** · 05-06-2009, 04:26 PM

Re: Harley's results from UTK

Here's Harley's results from the UTK.

.......................................result..... ..Normal.....RESULT(post.....Normal
....................................(baseline).... RANGE**.....ACTH)...........Range**
CORTISOL ng/ml.................61.6*....2.0-56.5.........129.8..........70.6-151.2
ANDROSTENEDIONE ng/ml.....0.43*...0.05-0.36.......1.67............0.24-2.90
ESTRADIOL pg/ml...............129.4*..23.1-65.1.......132.2*.........23.3-69.4
PROGESTERONE ng/ml.........0.66*....0.03-0.17.......1.15............0.22-1.45
17 OH PROGESTERONE ng/ml.0.30*...0.08-0.22........0.91...........0.25-2.63
ALDOSTERONE pg/ml ***......32.5.....11-139.9.........81.9...........72.9-398.5

(*Above or below reference range.)
(**Mean normal range values for neutered male dogs (N=37)),
(*** Normal range values for male and female dogs (N=72, baseline, N=23 post-ACTH).)

These results indicate presence of increased adrenal activity.(Mild)
Comments: Elevated estradiol may be coming from the adrenal glands or may be coming from peripheral tissues such as adipose which can synthesize estrogens.

For elevated estadiol, some veternarians consider items 2 or 3 and 4 of attached sheet. Various treatment option considerations are attached. More estradiol information is on our website under Treatment Considerations.

I understand giving Harley Melatonin (regular, NOT rapid release) but for the flaxseed oil with lignans, the website they direct you to is confusing me-www.FLAXHULLS.COM, THIS WEBSITE is now selling pressed flaxhulls that they say are just for Atypical canine cushing's and the dosage is the same. I'm not so sure, does anyone know about this????

Any comments, advice, anything is appreciated on Harley's results, treatment, just talk to me please

Harley and Lori

**AlisonandMia** · 05-06-2009, 04:33 PM

Re: Harley's visit to the Univ. of Penn.

I understand giving Harley Melatonin (regular, NOT rapid release) but for the flaxseed oil with lignans, the website they direct you to is confusing me-www.FLAXHULLS.COM, THIS WEBSITE is now selling pressed flaxhulls that they say are just for Atypical canine cushing's and the dosage is the same. I'm not so sure, does anyone know about this????

I personally don't know a lot about this (the whole flaxseed oil/hulls etc issue) - but don't worry others do! On the old board (cc.net) there was a lot of discussion about this so there is a quite a bit of knowledge here on the subject. Someone should be along with some useful input for you soon.

Alison

**Buffaloe** · 05-06-2009, 08:54 PM

Re: Harley's visit to the Univ. of Penn.

Hi Lori,

I can't help you with the flaxseed, etc. at all, we never dealt with atypical cushing's.

I've heard that Dr. Oliver may be on vacation but should return in a few days. Alison has all of his contact information, particularly his e-mail address. In my opinion, when you communicate with him, you should ask him if the U.T. test results give any indication that Harley may have an adrenal tumor. We had similar testing done and after going back and forth with Dr. O a couple of times, he eventually told me he thought Shiloh had a primary adrenal tumor....based on the test results. I'm just saying, I think it would be worth asking him about it in light of Harley's LDDST results and his ultrasound. Harley's post ACTH cortisol level was in the normal range which is often seen with adrenal tumors. That may also be common with atypical cushing's, I don't know. I'm strictly a layman but Dr. Oliver is THE expert. I think you should pick his brain a little when you get the chance...get all the information from him that you can. He is the best!

I think someone will be by soon to help you with the atypical treatment. I hope I didn't confuse you or worry you needlessly. I think after you converse with Dr. O everything (diagnosis, treatment) will be crystal clear.

Ken

**Squirt's Mom** · 05-07-2009, 11:21 AM

Re: Harley's visit to the Univ. of Penn.

Hi Lori,

I know how hard it is to relax when the diagnostic phase seems to go on and on, but I was like you and wanted to know all I could about Squirt's hormone functions that could effect treatment choices.

The most important thing on her results and treatment options was the suggestion from Dr O to have an ultrasound done. She had already had one four months earlier but I took his advise and had a second one. This is when I was told about a tumor on her spleen. To make a long story short, once the surgery was over and she had completely recovered, her cortisol level came back the lowest its been since 3/08 when she was diagnosed. Her signs are gone, she is doing very well tho she has not been tested again. Without his suggestion, that tumor would probably have ruptured, which is life-threatening. When I saw the comment about the nodule on Harley's adrenal, my antennae went up. Did the docs make any comment about that? I can't help but wonder if it could be the source of the hyper-adrenal activity.

I have included a portion of the treatment sheet from UTK showing the numbers Dr O listed and put the dosing info in bold. Many have not seen this sheet so don't really know what we are talking about when we mention it.

Anyway....the FSO (Flax Seed Oil) w/ Lignans was the standard approach at 1000 mg until the purified lignans in a capsule came on the scene. The purified lignans have a consistent dose of 40 mg/cap. Many dogs cannot handle the amount of oil in the FSO's so the caps helped them. Now, there are the crushed hulls. They serve the same purpose as the FSO w/lignans and the capsules. I use the purified lignans so I can't offer any first hand experience with the hulls, but it seems like Glynda was looking into it for her little ones. And on the old site, one, or more perhaps, of our members had opted to use them with apparent good results. It's is my opinion that if Dr O approves, then they have to be alright.

The post numbers all look good to me except for the estradiol, which makes me wonder about that nodule again. I'm not sure what the pre numbers indicate but there are those here who do!

What Dr O is saying here, "Elevated estradiol may be coming from the adrenal glands or may be coming from peripheral tissues such as adipose which can synthesize estrogens." is that the hormone estradiol can be produced (synthesized) in areas of the body other than the adrenal glands (where the other intermediate/sex hormones are produced) such as fat (Adipose cells/tissue). This is why Lysodren may not be effective on estradiol; Lyso works on the adrenal cortex only so since estradiol may be coming from fat tissue, the combination of melatonin and lignans are used as they will be effective outside the adrenal glands. Estradiol is one of the more difficult hormones to get control of because of this, but the bright side is that treatment for Atypical is much easier than for true Cushing's.

You will do just fine with all this, Lori, I know you will. And we will be here with you all the way.

Hugs,
Leslie and the girls

Treatment Option Considerations Steroid Profiles in the Diagnosis of Atypical Cushing�s Disease Clinical Endocrinology Service/College of Veterinary Medicine/University of Tennessee

"2) Melatonin. Often used as a first treatment, especially if alopecia is present, since it is cheap, has few side effects and is available in health food stores or via nutrient suppliers on the Internet. Typically, a total dose of 3 mg is given q12hrs (BID) for dogs <30 lbs; a total dose of 6 mg is given q12hrs (BID) for dogs > 30 lbs. Regular melatonin is usually used rather than rapid release or extended release products. Melatonin has anti-gonadotropic activity (effective for ferret adrenal disease), and it inhibits aromatase enzyme (decreases androstenedione and testosterone conversion into estradiol) and 21-hydroxylase enzyme (effectively lowers cortisol level). Monitor treatment effectiveness by improvement in clinical signs, biochemistries or by repeat of steroid profile.

3) Melatonin Implants. Available for dogs and ferrets. (WWW.MELATEK.NET). Sizes are 8, 12 and 18 mg for <25, 25-50 and >50 lb dogs, respectively. Effects last 3-4 months.

NOTE: Melatonin and flaxseed oil with lignans are used together when estradiol is increased.

4) Flaxseed oil (FSO) with lignans. The lignans in FSO have phytoestrogenic activity, and may compete with estradiol for tissue estrogen receptors with less biological effect. Lignans also inhibit aromatase enzyme (lowers estradiol) and 3-beta HSD enzyme (lowers cortisol). The oil may have low level of lignan, so a flax hull product may be preferable. E.g., WWW.FLAXHULLS.COM (standardized product with high content of lignan). Give SID on food: 1/2 tsp for dogs <30 lbs; 1 tsp for dogs >30 lbs. Also, WWW.VITACOST.COM/NSIFLAXSEEDLIGNANS. Standardized, lower concentration lignan product (40 mg capsules). Give SID: 1 capsule for dogs <30 lbs; 2 capsules for dogs > 30 lbs."