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Old Dog Resources
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College of Veterinary Medicine
Louisiana State University
DERMATOLOGY SERVICE
Dr.Sandra Merchant, DVM Dr. Carol S. Foil, DVM
Diplomate A.C.V.D. Diplomate
A.C.V.D.
HYPERADRENOCORTICISM - CUSHING'S DISEASE
Healthy skin and a normal hair coat are the result of many factors, both
external and internal. There are several glands in the body responsible for the
production of hormones that are vital for the regulation of other body functions
as well as a normal skin surface and hair coat.
Cushing's disease results from an overproduction of the hormone cortisol.
Cortisol is produced by the adrenal glands (located next to the kidneys) and
stimulated to produce cortisol by the pituitary gland (at the base of the
brain). Disease may be due to overproduction in the adrenal glands by
themselves or overstimulation of the adrenal glands by the pituitary gland.
Signs associated with Cushing's disease may include increased thirst and
urination, a voracious appetite, an enlarged sagging belly, hair loss,
lethargy/weakness, panting and sometimes recurrent infections. Without
treatment most dogs will die within one or two years. With treatment your pet's
life can be prolonged, at times to a normal life-span. Treatment consists of
medication to control the overproduction of cortisol by the adrenal gland or
surgery to remove the abnormal adrenal gland. Which treatment is best depends
upon where the problem is in the dog's body (pituitary or adrenal)
DIAGNOSIS: Cushing's disease can be difficult to diagnose, especially in early cases.
Tests which may be needed may include; complete blood count, chemistry panel,
urinalysis, ACTH stimulation test (a 1 or 2 hour test), low dose dexamethasone
suppression test (an 8 hour test), a high dose dexamethasone suppression test
(an 8 hour test), an ACTH assay, radiographs or CT scan and possibly other
tests!
MEDICAL TREATMENT:
INDUCTION: For the first __ days tablet(s) of Lysodren®
will be given twice daily to decrease the size of the enlarged adrenal glands.
Feed your dog before each pill to be sure the appetite is normal, and if your
dog does not eat, do not give the pill, but call us the next morning. We will
set up a follow-up ACTH stimulation test on your dog after 7 - 10 days, or
sooner if he looses appetite or becomes ill as discussed below. Please schedule
the first follow-up ACTH stimulation test (8 am drop-off appointment) on
_________(day) , ____________(date). Your dog’s medication will be altered on
the basis of the test results as needed. PLEASE note: Prednisone given within
24-hours of the recheck blood test will make the test invalid, so check your
veterinarian if you have any questions.
Some dogs are very sensitive to Lysodren, while other dogs are very resistant.
Although excess cortisol is causing many of the dog's problems, a low level of
cortisol is needed to sustain life. If the cortisol falls below normal,
weakness, decreased appetite, vomiting, diarrhea or, rarely, collapse can be
seen. Another drug, Prednisone, can be used to substitute for the
needed cortisol in your dog's body.
Please either: 1) Give tablets of prednisone
times daily while giving the Lysodren or, 2) _____Keep the prednisone
tablet prescribed to you on hand in case they are needed.
If your dog becomes weak, refuses to eat or vomits while on the Lysodren, please
take the following steps:
1. Discontinue the Lysodren.
2. Give
tablets of Prednisone times a day. This drug can
be thought of as an antidote to the Lysodren. The signs should abate in a few hours. Please call your veterinarian if this happens.
3. If vomiting or illness continues in spite of prednisone administration or your pet collapse you
must seek veterinary attention immediately. Treatment by the veterinarian will consist of replacement glucocorticoids (steroids) either orally or by injection,
depending on the severity of the signs. Intravenous fluids may also be needed if collapse is a problem.
MAINTENANCE: After the initial treatment period, if the ACTH stimulation test
shows satisfactory reduction in cortisol production, a maintenance protocol
with Lysodren will be instituted. Usually the maintenance Lysodren will be
given 1-2 times weekly. Although the prednisone is usually not necessary during
this time always keep this "antidote" on hand if any of the above mentioned side
effects occur. Give your pet ______ tabs Lysodren on and
on . Schedule a recheck examination/ACTH stimulation
test in months.
Every few months, a recheck and re-evaluation will be necessary since most dogs will require adjustments in their medication dosages. Remember
we are controlling a disease, not curing it. Therefore cooperation and faithful re-evaluation is in the best interest of your pet.
Reprinted with permission from Louisiana State University School of Veterinary Medicine |
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