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Misdiagnosis of Cushing's Disease
Hello,
This is my first time posting a question on this forum. My dog,Teddy, after blood work and testing was performed, was diagnosed with Cushing's disease today. His symptoms included drinking more water than usual and some panting. He is also overweight but I have to admit I haven't been walking him as much as usual because of the colder weather. He hasn't urinated in the house at all and his coat looks healthy and shiny.
I don't want to sound like I'm in denial but is it possible the Cushing's diagnosis could be incorrect? Could the tests have come back faslse positive? The doctor is recommending medication which is so expensive. I've been reading about the various medications and their side affects. Could someone tell me if their dogs were misdiagnosed with this disease?
This is my first time posting a question on this forum. My dog,Teddy, after blood work and testing was performed, was diagnosed with Cushing's disease today. His symptoms included drinking more water than usual and some panting. He is also overweight but I have to admit I haven't been walking him as much as usual because of the colder weather. He hasn't urinated in the house at all and his coat looks healthy and shiny.
I don't want to sound like I'm in denial but is it possible the Cushing's diagnosis could be incorrect? Could the tests have come back faslse positive? The doctor is recommending medication which is so expensive. I've been reading about the various medications and their side affects. Could someone tell me if their dogs were misdiagnosed with this disease?
Cushings can be ruled out with a urine cortisol creatinine ratio test. If it's negative the dog does not have cushings. If it's positive he might have cushings. The urine has to be stress free and snice a trip to the vet is stressful for the dog the owner needs to get the sample first pee of the day. Take it straight to the vet so its fresh. If you have to let it sit refrigerate it. Also non adrenal illness can cause false positive on LDDS and atch stim. Make sure the dog is stress free before those tests also. If your dog is taking any type of meds that have steroids that could be causing cushings stop the meds
If a dog has all the symptoms of cushing's yet the diagnostic tests (ACTH stimulation test and LDDS) are negative for cushing's, then it is a very good possibility that the dog has atypical cushing's. Typical or naturally occurring cushing's involves excess cortisol whereas atypical cushing's involves excess intermediate/sex hormones. Atypical cushing's can cause the same physical symptoms, same abnormalities on bloodwork and same organ abnormalities seen on imaging. The only facility to test all adrenal steroids is the University of Tennessee Knoxville and Dr. Oliver there is the world's expert on atypical cushing's and adrenal steroids in general. I can't say enough about Dr. Oliver, his amazing expertise and his gracious giving of his time to us pet owners and our vets that have questions. Atypical cushing's is becoming more and more well known; however, most general practitioners are not familiar with it so us pet owners sometimes have to educate them. :-) You can access information on this at http://www.vet.utk.edu/diagnostic/endocrinology/index.php You may want to provide this link to your vet. S/he can contact the university and talk to Dr. Oliver who will explain atypical. He and his staff will also provide instructions on how to ship the blood sample.
If a dog has atypical cushing's, it isn't necessarily being caused by the pituitary so I personally would rule out atypical before spending money on an MRI. By the way, atypical cushing's is a lot easier and cheaper to treat than typical cushing's.
I respectfully disagree that cushing's is easy to diagnose. It is actually one of the most difficult diseases to diagnose because all of the diagnostic tests equally suck, which is why an experienced vet will run more than a few tests before confirming a diagnosis. Because it's the most difficult to diagnose it is also the most misdiagnosed so if your vet makes a diagnosis based simply on an acth stimulation test or just an ldds test, you need to question his experience with the disease.
I'd also like to correct a common misconception. Most dogs with cushing's have polyuria/polydipsia (excessive drinking and urination) because for reasons not fully understood, they are unable to concentrate their urine. Most people think that dogs with PU/PD pee alot because they drink alot but actually the opposite is true. They pee a whole lot because the kidneys have lost their ability to concentrate so they have to drink to stay hydrated. If deprived of water, a dog with PU/PD can dehydrate in a relatively short period of time and they can die.
A lack of appetite is a very rare symptom of cushing's whereas a voracious appetite is the norm. A dog may gain a few pounds with cushing's but it's usually the pot belly that makes a pet owner think their dog is fatter. A lot of dogs with cushing's will get a pendulous abdomen because of an enlarged liver, redistribution of fat to the abdominal area and the effects of muscle wasting. There was an actual study done, I believe in Europe, that showed that cushing's is rarely a contributing factor to morbid obesity in dogs.
For those that are looking for support or help and have a desire to learn more about cushing's, please visit ***.**********.***
If a dog has atypical cushing's, it isn't necessarily being caused by the pituitary so I personally would rule out atypical before spending money on an MRI. By the way, atypical cushing's is a lot easier and cheaper to treat than typical cushing's.
I respectfully disagree that cushing's is easy to diagnose. It is actually one of the most difficult diseases to diagnose because all of the diagnostic tests equally suck, which is why an experienced vet will run more than a few tests before confirming a diagnosis. Because it's the most difficult to diagnose it is also the most misdiagnosed so if your vet makes a diagnosis based simply on an acth stimulation test or just an ldds test, you need to question his experience with the disease.
I'd also like to correct a common misconception. Most dogs with cushing's have polyuria/polydipsia (excessive drinking and urination) because for reasons not fully understood, they are unable to concentrate their urine. Most people think that dogs with PU/PD pee alot because they drink alot but actually the opposite is true. They pee a whole lot because the kidneys have lost their ability to concentrate so they have to drink to stay hydrated. If deprived of water, a dog with PU/PD can dehydrate in a relatively short period of time and they can die.
A lack of appetite is a very rare symptom of cushing's whereas a voracious appetite is the norm. A dog may gain a few pounds with cushing's but it's usually the pot belly that makes a pet owner think their dog is fatter. A lot of dogs with cushing's will get a pendulous abdomen because of an enlarged liver, redistribution of fat to the abdominal area and the effects of muscle wasting. There was an actual study done, I believe in Europe, that showed that cushing's is rarely a contributing factor to morbid obesity in dogs.
For those that are looking for support or help and have a desire to learn more about cushing's, please visit ***.**********.***
Our dog has all the Cushings symptoms but the vet says it is NOT cushings and the only way to find out what it is would be an MRI.
I am very confused and do not know what to do. Are there other diseases with the same symptoms?
I am very confused and do not know what to do. Are there other diseases with the same symptoms?
Cushings is not hard to diagnose. It can be detected/suspected through routine blood work (CBC). Dogs who have Cushings will have elevated liver enzymes, alkaline phosphatase, glucose, cholesterol, and red blood cells. BUN and Thyroid are often lower than normal.
To confirm a positive diagnosis vets will run either a Low Dose Dex Test or a ACTH stim.
The common symptoms in dogs that are suffering from Cushings are increased thirst (thus increased urination), hair loss/thinning, lack of appetite (however there is weight gain), discoloration of the skin (blackish color), the stomach can also appear to be 'pot bellied'. Please know not all dogs who are Cushings positive will show all or any of these symptoms!!
If your dog had Cushings the urinalysis would have come back stating they found a low specific gravity. Sometimes we also find high levels of protein, glucose, and infection with dogs who are diagnosed with Cushings.
To confirm a positive diagnosis vets will run either a Low Dose Dex Test or a ACTH stim.
The common symptoms in dogs that are suffering from Cushings are increased thirst (thus increased urination), hair loss/thinning, lack of appetite (however there is weight gain), discoloration of the skin (blackish color), the stomach can also appear to be 'pot bellied'. Please know not all dogs who are Cushings positive will show all or any of these symptoms!!
If your dog had Cushings the urinalysis would have come back stating they found a low specific gravity. Sometimes we also find high levels of protein, glucose, and infection with dogs who are diagnosed with Cushings.
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