Living with A Pituitary Cushing's Disease Beardie

MY JOURNEY WITH PRICE
Written by: Bridget Howell

Editor’s note: Cushing’s syndrome is the name of the human condition more appropriately called hyperadrenocorticism in dogs. It is also sometimes referred to as hypercortisolism, because the body is trying to deal with excessive levels of the adrenal hormone cortisol. The disease can have a number of causes. Iatrogenic disease is caused if a dog receives high levels of steroid drugs for a prolonged period of time. The release of cortisol by the adrenal gland is under feedback control by first the hypothalamus, which monitors blood cortisol levels and if they drop releases corticotropin releasing hormone (CRH), which then goes to the pituitary gland, and causes it in turn to release the hormone adrenocorticotropin (ACTH). This travels in the blood stream to the adrenal glands located just above the kidneys, stimulating them to release cortisol. Most noniatrogenic hyperadrenocorticism is causes by benign tumors (adenomas) of the pituitary gland which causes it to release ACTH and thus cortisol in excess of the body’s needs. In humans this is called Cushing’s Disease. Less commonly hyperadrenocortism is the result of a benign tumor of the adrenal gland itself. In rare cases malignant tumors can metastasize and affect the pituitary or adrenal glands.)

The signs of Cushing's Disease usually appear gradually and, because of the slow onset, these changes are often written off as part of the aging process.  80% of all Cushing's is Pituitary.  My beardie, Price, had pituitary disease, and it is his story I am telling.   The following symptoms are what I observed with Price, but they are typical of all types of Cushing's disease.

Drinking excessively and urinating excessively to the point of incontinence.   The water bowl needs to be filled much more frequently, and some dogs may not be able to hold their urine all night.  Urinary tract infections as well as true urine leaking may be observed.   This was my experience with my Price.  Normally water intake is about 1 cup of water per 10 pounds body weight per day.  The increase in his water intake was progressive.

Weight gain and increased or ravenous appetite.  Eating incessantly if possible or stealing
food (from the garbage, counter or another dog’s plate) may seem a good sign if a Beardie has previously been a finicky eater, but it is not necessarily a sign of good health.  However, I found it to be important to keep track of Price’s consumption of food even before the onset of Cushing's.  He was never one of those beardies who seem to be able to live on air.

Pot-Bellied appearance is another sign of Cushing's disease.  This becomes a symptom in 90% of the cases resulting from re-distribution of body fat – especially into the abdominal cavity and away from the subcutis (under the skin), increased weight of abdominal contents and a decrease in abdominal muscle strength as a result of elevated levels of cortisol.

Skin disease is another classical sign of Cushing's disease. The skin is thin and shows poor healing and susceptibility to infection. It wrinkles easily and blackheads and skin infections – especially along the backbone and on the belly are more common. The skin especially on the flanks and belly tends to darken (hyperpigmentation) and bruises more easily. Dogs are often itchy.

Another common symptom is hair loss on the tail (rat tail) and the main body. The head and legs are spared. If the dog is clipped, it doesn’t grow back. Both conditions are caused by atrophy of the hair follicles. Calcium may be deposited within the skin (Calcinosis Cutis). This results in raised, hard and scaly areas that can become infected.. Also, a perfect 'target' circle/pattern on the trunk may become visible.

Sometimes  excessive  panting  and  shortness of breath, infertility (which Price  was  diagnosed  with  at  an  early stage), extreme muscle stiffness (called  pseudomyotonia - a very rare symptom of Cushing's), and high blood pressure can all be symptomatic.   Price had excessive panting and stiffness but not high blood pressure.

Note: Two of the internal medicine veterinarians I have worked with have told me that, "If  a dog has a low thyroid problem, there more than likely will be another problem or problems in time."  This information will forever stay in my memory, and if I should ever have another Beardie which has hypothyroidism, as Price did, I will be sure to watch them even more carefully than I would otherwise. Hopefully, I won’t have more hypothyroid Beardies.

I have learned a lot as a result of my experience with Price.  If this article helps at least one Beardie on the verge of Cushing's Disease because it helps his owner recognize what’s wrong then I am glad I wrote it.  

The average life expectancy for a dog with Pituitary Cushing's is 30 months. Price lived almost twice that long, and ultimately he succumbed to cancer of the liver and spleen not Cushing's. There is hope with proper treatment and a cooperative, knowledgeable veterinarian making a timely diagnosis.   Cushing's disease can be controlled with monitoring and proper medication, although it cannot be cured.

There are two types of Cushing's Disease: Pituitary (a tumor at the base of the brain) or Adrenal, a tumor on one or both of the adrenal glands.

Cushing's  Disease  cannot  be treated until a positive is attained through *ACTH  testing.   This  can  be  frustrating  to  you but necessary for the welfare  of  your  beardie.   It  took over a year before my boy obtained a positive  result.  We all knew what he had but could not treat it until the ACTH test came back showing positive.  There is also a urine screening test for  Cushing's  disease;  a  positive  test here does not confirm Cushing's syndrome  but a negative test here DOES rule it out.  This test can be done through  your  veterinarian office or you can collect the urine and ship to Dr.  Jean Dodds, D.V.M. (The test is call- T-770 )   This is NOT to be used for  any  treatments until the ACTH test shows a positive diagnosis through your veterinarian and/or veterinarian specialist.

You feel helpless, frustrated and your heart goes out to your Beardie.  You need to  stay focused and determined to help your best friend.  Cushing's can be controlled with monitoring and proper medication.

Once  you have a positive for Cushing's Disease through ACTH testing, there are  treatments  that  can  produce good results.  This will entail regular visits  to  your  internal  medicine veterinarian or your veterinarian  for monitoring  and more ACTH testing done to make sure the medicine is working at the proper dosage over time.
Note:  Cushing's  Disease  is the opposite of Addison Disease. Addison's is the  result  from  a  deficiency  of cortisone where Cushing's is excessive cortisone.

Pituitary treatments: (there are other brand names not listed below)

Lysodren;  which  is relatively inexpensive. This does not work on all dogs as  was  the  case with "Price" due to it being given along with prednisone tablets. "Price" would collapse anytime he was given prednisone.

Anipryl (L-Deprenyl); if Addison's is not a concern or only light Cushing's symptoms  this  may  work.  About one in five dogs may improve according to claims  by the manufacturer.  The cost is more than Lysodren. This also did not work on "Price."

Trilostane (also known as Vetoryl): Sold in the U.K. Enzyme involved in the production  of  several  steroids  including cortisol. Inhibiting an enzyme called 3-beta-hydroxysteroid dehydrogenase (this inhibits the production of cortisol). a 90 day supply is expensive.

Trilostane  is  not  available  in  the  U.S.  however;  it can be obtained through your  veterinarian  (with  approval  from  the FDA) by prescription and the medicine  can  be mailed to you or your veterinarian.  This medication also needs  to  be monitored closely.  There can be Addisonian reactions as some have been reported but less possibility than using Lysodren.

I  was  fortunate  that this worked with Price.  He stabilized and within 5 months his hair began slowly to grow back, his positive attitude started to return,  his scaly & leather-like skin condition began to improve and water reverted went back to normal. As  with  any  drugs,  there may be reactions.  Call your vet if any of the following signs of adverse reactions are observed with treatment:

• Diarrhea or vomiting
• Appetite  loss  (this  may be subtle as less enthusiasm towards  eating when the food is served, not running to the bowl)
• Decrease  in  water  consumption  (during the induction period)
• Lethargy or listlessness
• ACTH test: Ideally this test is run in the morning The dog needs to fast
  overnight  and  the test is best performed between 8:00 AM and 10:00 AM.  A
  blood  sample  is  drawn. Then a dose of ACTH is given. A second drawing of
  blood  2  hours  later is done. If a larger than expected, rise in cortisol
  levels  is  measured  in  2 hours a diagnosis' of Cushing's syndrome may be
  achieved.   There  is a stimulatory 'message' sent from the pituitary gland
  to  the  adrenal  glands.   This  message  consists  of  a  hormone  called
  adrenocorticotrophic hormone or ACTH.

There is another test Low Dose Dexamethasone Suppression test.  This is the only  test  that can be used if the iatrogenic form of Cushing's disease is suspected.   This  is  also  a  test  crucial  in  monitoring patients with Cushing's disease, depending on which medications are used.

During  the  time  frame (of almost a year) not having a diagnoses was very frustrating  to  both  "Price" and myself.  He 'looked' terrible having the full  'appearance' of Cushing's but not the diagnostic. I would look in his eyes  and see the determination which kept me going.  Many that saw Price's appearance  felt I was 'hanging on' and should let him go but I knew it was not the time. He would go outside with his ball in his mouth.  He would bark and chase squirrels if they were in HIS backyard.  "Yard patrol" was  priority  with  him.  Price wore jacket's to keep him warm in the cold months  and  light  cotton  ones in the summer to protect his skin from the sun.   He  was  a  proud  boy wearing his various jackets made by a devoted admirer. It  is  important  to protect your Beardie from the elements as they do not
have the double coat to protect them.


Pituitary  Cushing's (tumor) cannot be seen by x-ray as the Pituitary is at the  base  of  the brain.  With Adrenal Cushing's an x-ray or an ultrasound usually  can  pick up a tumor before diagnosis.  If I knew then what I know now  when  we  just started to suspect Cushing's  I would have not done the x-ray  and  done  instead the ultrasound of the adrenal glands to eliminate the  possibility  of  a tumor even though it meant shaving what was left of
"Price's"  back  hair.   There  are times when an x-ray cannot pick a small adrenal tumor when an ultrasound can.

Maintenance Therapy for Cushing's disease:

1. Once  an  adequate control is reached then your dog will be maintained
   with medication determined by your veterinarian.  Some need  to be administered        once a day, twice a day or once a week.
2. An ACTH stimulation test will be needed in 1 to 3 months after start of maintenance therapy and generally every 3 to 6 months after that,
3. It  is common for clinical signs to reoccur during maintenance therapy due to the dose becoming inadequate.  If you notice these signs returning see your veterinarian so the dose can be adjusted accordingly.

Adrenal Cushing's:

The  average  life expectancy for dogs with adrenal HAC is 36 months. Treat your  dog if you can because that is three years that you could be together and enjoy each other.

Kidneys and electrolytes should be checked regularly for both Pituitary and Adrenal Cushing's disease.

The on-set of Cushing's symptoms is generally seen about the age of 7 years or older.

From  my  experience  with  Price,  I  am  having full blood (CBC) and full thyroid  panels  done  yearly on my Beardies.  By keeping on top of what is going  on inside..it will help them (and me) in the coming years to stay on top  of  any  potential  problems.   Just as humans get a complete physical yearly  or  every two years to make sure everything is running smoothly, so should our beloved companions.

Bridget Howell (and "Price" - always in my heart)


The  above  dissertation  is  the result of my personal experiences with my Beardie  "Price"  and  is  intended  for  informational purposes only. This should not be construed as medical advise or as a substitute for the normal care and consultation of your licensed veterinarian.