Cushing's
Syndrome LettersCushing's
Syndrome Letters| CyberScots:
Cushing's Syndrome is a collection of symptoms caused by an excess of a hormone called cortisol. There are three main causes of Cushing's Syndrome: a tumor on the pituitary gland; a tumor on the adrenal gland; or veterinarians who over-prescribe corticosteroids to treat itching skin. It is, as yet, unknown whether there is an inherited predisposition to Cushing's Syndrome in Scottish Terriers. Your Scottie should be checked for Cushing's
if:
Cushing's Syndrome is usually treated successfully with a drug called Lysodren. Surgery is rarely recommended and radiation therapy, used in humans, is very expensive and rarely available for dogs. In my opinion, many Scotties are misdiagnosed with Cushings because of elevated SGPT without the other symptoms. It is important NOT to treat until you are positive you are dealing with Cushing's. Lysodren is still the drug of choice according to the three endocrinology experts I consulted (especially Dr. Knockreiner [sp?] at MSU). Some vets are jumping on the bandwagon to use Anapryl but our guest speaker at Montgomery a couple of years ago was VERY negative about using it. The trouble with Lysodren is that it is difficult to get the dosage right. The only way to do it is to measure the dog's water intake every day. Once you have the dosage established, then you only need to change it when there is a change in the dog's water intake. This can be a problem in multiple dog households. Again, let me emphasize that just because a Scottie has an elevated SGPT doesn't mean it has Cushing's. My vet has been trying for six years to tell me that Tempest has Cushing's because of her SGPT and liver enzymes. I've had REAL Cushing's dogs and they were always incontinent. She can hold in for EVER even though she seems to drink a lot of water. Good luck Cindy Cooke
PS The oldest Scottie of my friend, 10 years old, has Cushings. ++++++++++++++++++++++++++++++++ Cindy: As much as I agree with 90% of what you have written, I think it is most misleading to state Lysodren as the *only or even preferred drug therapy for Cushings. Although it has a long standing pharmacological reputation as being efficacious, there are medical/veterinary critics who argue in favor of Anipryl over the older drug modality, Lysodren. Each present with their own list of precautions. It's just my personal opinion, but speaking as a retired pharma rep, today more than ever, there are *choices, what may be appropriate for one patient may or may not be for another. My Kugel being a perfect case study of tolerating Anipryl for nearly 6 years, for which I am eternally grateful. I agree most, with your statement to get a clear and definitive diagnosis with a qualified specialist before beginning any drug therapy. Second opinions are worth their weight in gold in our experiences with Kugel. Advanced, scientific technology coupled with extensive research has allowed us the privilege to exceed yesterday with improved tomorrow's. Debbie of ~ TRADITIONS ~ Handcrafted Dog Tiles ~ +++++++++++++++++++++++++++++++++ Hi CyberScots, Each of these drugs works via a different
mechanism. Anapryl works on the pituatary gland to suppress the hormone
that causes the adrenal gland to produce excessive steriods. Lysodren
actually destroys the adrenal cortex that is producing the steroids.
If the cause of Cushings is a pituatary tumor (causing the excess production
of hormone), both drugs can work.
However, if the cause of the Cushings is an adrenal tumor, the *only* real cure is surgery. :Lysodren may help in the short term, but it will not destroy a tumor. This is why it is so important to get a differential diagnosis from your vet to determine the underlying cause of the Cushings. What are the tests available to differentiate between pituitary and adrenal dependent Cushings in a dog? The high dose or ultra high dose dexamethasone suppression test or an endogenous ACTH level. About 75% of dogs can be differentiated using the high dose dexamethasone suppression. If the dog suppresses, the diagnosis is pituitary-dependent. If there is no suppression, then the dog could still have either form of Cushings and an endogenous ACTH level should be submitted. In other words, the results of the high dose dexamethasone suppression test can only identify dogs with pituitary-dependent Cushings. If cortisol levels are not suppressed by a high dose of dexamethasone in a dog with confirmed Cushings, the odds of pituitary-dependent versus adrenal-dependent Cushings are 50:50. Jane Morley +++++++++++++++++++++++++++++++++++ Cindy: As much as I agree with 90% of what you have written, I think it is most misleading to state Lysodren as the *only or even preferred drug therapy for Cushings. Although it has a long standing pharmacological reputation as being efficacious, there are medical/veterinary critics who argue in favor of Anipryl over the older drug modality, Lysodren. Each present with their own list of precautions. It's just my personal opinion, but speaking
as a retired pharma rep, today more than ever, there are *choices, what
may be appropriate for one patient may or may not be for another.
I agree most, with your statement to get
a clear and definitive diagnosis with a qualified specialist before beginning
any drug therapy.
Advanced, scientific technology coupled
with extensive research has allowed us the privilege to exceed yesterday
with improved tomorrow's.
Kiwi & Kugel Debbie of ~ TRADITIONS
~ Handcrafted Dog Tiles ~
|