My Westie has been diagnosed with Cushings Disease. She has a confirmed adrenal tumor, but our veterinarians are saying that all blood tests indicate that the Cushings is ptuitary dependent. She has had an ACTH Stim, endogenous ACTH and LDDS. Her symtoms include, increased thirst and urination, frequent bouts with urinary tract infections and some skin infections.
Abnormal lab values have included increased Alk Phos, increased cholesterol, increased blood sugar and mildly elevated WBCs
Her current course of treatment has been trilostane, starting out at a very low dose of 5mg/BID and closely checking her ACTH levels every 7 days (ACTH STIM TEST). She did not show any improvement until her trilostane dose reached 35mg/BID at which time I am told the ACTH level came into high normal range and the decision was made to increase the dosage to 40mg/BID (maximum dose for her weight of 18 lbs). After 5 days at this dose she developed, lethargy, anorexia, loose stools, vomiting. Electrolyes were normal, pancreatic values increased and her WBCs showed marked elevation. Trilostane was d/c'd temporarily and she is currently having another ACTH STIM done.
My question is: Isn't it very unusual to have an adrenal tumor and a pituitary tumor in the same dog? She definitely has Cushings but can the blood tests misdiagnose the reason for the Cushings?