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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 23848
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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My dog has been diagnosed with Cushing's Disease and her

Customer Question

my dog has been diagnosed with Cushing's Disease and her albumin level is low. The vet wants to treat her w/Trilostane (sp). They told us her platelets were elevated, and her cortisol was high normal. She was spilling protein in her urine, and that was 20 (the normal was .5). They gave her a shot of something and tested her blood at 4 hours and then at 8 hours, and she was positive for Cushings. She has been taking Incurin (sp) for incontinence for a couple of years. She has always peed multiple times, but for the last couple of months I noticed she has been excessively thirsty and peeing more often. Her tummy always looked a little bloated, but now, it's insanely bloated. Not fat, bloated, like an over-filled balloon. She licks the floor for food...she started that a couple of weeks ago. The vet said this is because of an adrenal tumor, she thinks, so I wonder why we aren't looking at surgery versus the medication. The vet said the tummy isn't filled w/fluid, but she thinks her liver is inflamed, which could be causing the stomach to swell. Her BP is good. She also now has a heart murmur that was not present in February, when she had her dental. It's graded a 3 by the one vet and 4 by another. I honestly don't know what to think. I want her to have an ultrasound NOW to see if this is an adrenal tumor. The vet wants to wait to see if the albumin level improves, because that is significant. I think her prognosis may not be good if that number does not improve.
Submitted: 2 months ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 2 months ago.

I'm sorry to hear of this with your dog. How old and which breed is she, please? I'll address your concerns as you presented them...

Hypoalbuminemia (low serum albumin level) secondary to proteinuria (loss of protein in the urine) is common in cushingoid dogs. Her urine protein:urine creatinine ratio should be assessed in order to determine just how proteinuric she is. Much of the proteinuria may have resulted from bacterial urinary tract infection found in the majority of cushingoid dogs and so it's important to perform a bacterial culture and sensitivity on urine obtained by cystocentesis (percutaneous aspiration of her bladder through her abdominal wall) - the most sterile manner in which to obtain urine. We can't depend upon a urinalysis to tell us if infection is present in very dilute urine...which I expect is the case in your dog.

Polydipsia (increased thirst) and polyuria (increased volume of urine) are hallmarks of Cushing's.

Abdominal "bloating" (pot belly) results from muscular weakness due to the excess cortisol (a steroid) of Cushing's.

The low dose dexamethasone suppression test can be used to differentiate pituitary dependent (PDH) from adrenal dependent (AT) Cushing's. When the 8-hour post-dexamethasone cortisol value supports Cushing's, the 4-hour post-dexamethasone serum cortisol value may be useful in distinguishing between PDH and AT. I suspect that her vet believes that the 4-hour value supports AT and in that case, ultrasound is indicated. In fact, ultrasound may well be the best diagnostic for identifying the presence of Cushing's in dogs. There's no reason to delay having it performed. Unilateral adrenalectomy is the treatment of choice for adrenal neoplasia in dogs. It's best performed by a specialist veterinary surgeon.

Please respond with further questions or concerns if you wish. I have to leave my computer for a few hours but promise to reply as soon as I return if need be.

Expert:  Dr. Michael Salkin replied 2 months ago.

I'm just following up on our conversation about your pet. How is everything going?

Dr. Michael Salkin