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Question. My goldendoodle (75% poodle; 25% golden) who is a…

Hi,question. My goldendoodle (75% poodle...
Hi,question. My goldendoodle (75% poodle; 25% golden) who is a little over 9 years old was diagnosed with ITP over the summer. It was determined that this was caused by the injectable antibiotic Covenia. She was put on steroids and responded immediately. She had some issues with weaning her off (her platelets kept dropping every time we weaned her) but after about 3 months of a slow wean, her platelets stabilized. At the onsite of her sickness, she dropped from her normal weight of 53 too 45 pounds. She eventually put the weight back on. She has been off all steroids for approximately 3 months. At the beginning of December, she was at the vet for a tech appointment and her weight again as down to 45 pds. We didn't worry about it though as she seemed to be eating and acting normal. Well about two weeks ago, I was petting her and realized she felt super thin. This week she had a vet appointment and her weight is 47 pds but the vet agreed she felt way too thing. He ordered a full comprehensive blood profile, resting cortisol level, SDMA Idexx, heartworm, parasite, Urinanalyis and Urine culture. The urine culture and urinalysis came back fine. Today, he called me with her blood work and her liver and kidney levels are fine as are her electrolytes but her protein levels are off and her platelets are low again (60,000) and her resting cortisol level was a bit low at 1.6. She is going on this afternoon for the ACTH stimulation test.My question is, can a low cortisol level be causes by anything else besides Addison's disease? Could the ITP have caused or is causing Addison's? Can she have this diagnose but her electrolytes be normal? I thought with Addison's her electrolytes would be off.I'm super worried and hoping Addison's is the cause bc we can treat that. The vet and I are both worried it could be cancer lurking somewhere.
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Customer reply replied 1 month ago
Sorry, I should add, she stopped showing interest in her food, which is what triggered me to take her to the vet this week. We have switched her to human food and she has been eating that. Also, playing and acting normal for the most part although at times she seems almost depressed. Also, I have noticed back in the summer, once we weaned her off the steroids, that she seemed to be peeing more on walks. Almost like marking with a male dog.
Answered in 22 minutes by:
1/5/2018
Scott Perry
Scott Perry, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 2,057
Experience: DVM
Verified

Hello. My name is***** and I am a veterinarian that can answer your question. I understand your goldendoodle has a recent history of ITP that was treated with steroids and resolved after about 3 months. She was off steroids for 3 months. This is when you noticed her urinating more on walks. In December, she was noticed to have weight loss again. Last week she was noticed to have a lack of appetite and diagnostics showed a drop in platelet numbers, low cortisol level, and the protein levels were out of range. I hope I got that summary correct. Did I miss anything?

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Customer reply replied 1 month ago
Yep.
Customer reply replied 1 month ago
You have the summary correct. I'm extremely worried.

I see your questions regarding the low cortisol level. I can answer this by saying there are no other differentials for a low cortisol level. It is possible for a lower than normal level to be normal because dogs will fluctuate between low and normal throughout the day, but this will typically stay above 2.0. Since her number is ***** I would also be concerned about Addison's Disease. Whipworm is a parasite that can also mimic Addison's Disease in various ways, so it would be advisable to give a prophylactic dose of Panacur, a dewormer. Otherwise, I agree with the next step of the ACTH stimulation test.

Potassium is usually elevated with Addison's Disease, but it is not always reliable. There is also a form of Addison's that does not affect electrolytes at all, called "atypical Addison's."

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Customer reply replied 1 month ago
would Addison's caused by ITP be a cause of what would be referred to a "atypical"? Especially with her platelets low again?
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 32,318
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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Did you mean to opt out Dr. Perry? I'll clarify his information for you. The causes of hypocortisolemia include improper storage of the sample, iatrogenic hyperadrenocorticism (causing Cushing's disease by the administration of glucocorticoids (steroids) such as prednisone), a progesterone-secreting adrenal tumor (but you would see signs of Cushing's, not Addison's), primary hypoadrenocorticism caused by destruction of the adrenal zona glomerulosa and zona fasciculata, secondary hypoadrenocorticism (i.e., pituitary insufficiency), and atypical hypoadrenocorticism (a selective deficiency of glucocorticoid secretion which may result from inadquate ACTH secretion as a result of pituitary disease or primary loss of function of the zona fasciculata). Acute critical illness can also result in hypoadrenocorticism.

To answer you directly, then, ITP (an acute critical illness) can cause Addison's but it wouldn't be considered "atypical" which has the criteria I posted above. Make sure her platelet count is done by hand. Machines too often report falsely low blood platelet counts due to platelet size and clumping. Please continue our conversation if you wish.

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 32,318
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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Customer reply replied 1 month ago
I did opt out as I requested and paid for in-depth information and didn't feel I got it from him. Thank you for your response. We are planning on repeating the platelet count at the internal medicine doctor who does a platelet count by hand. Is it unusual to have a normal electrolyte level but have Addison's? Her level was only 1.6 which isn't that far below normal.

No, atypical Addison's (which will have a normal serum potassium and sodium) isn't nearly as common as primary Addison's but needs to be kept in mind in dogs with the nonspecific signs of Addison's yet normal electrolytes. Atypical Addisonian dogs are typically older than primary Addisonian dogs at time of diagnosis. Atypical Addisonian dogs may exhibit a lack of a "stress" response in their complete blood count (CBC) - in other words, the lymphocyte count remains in the normal range and eosinophils remain in the normal range which is expected in primary Addisonian dogs. Please continue our conversation if you wish. Thank you for your kind accept. I appreciate it.

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Customer reply replied 1 month ago
Hi,As a follow-up my dog tested negative for Addision's on the ACTH stem test. We had an abdominal ultrasound performed and nothing showed up really besides a moderately enlarged spleen. We performed a needle aspiration of the spleen and the pathologist got back to us yesterday that the enlarged spleen was benign. We are now going to perform a GI function test. Any ideas of what could possibly be causing her weight loss and lack of appetite. The intestines looked fine on ultrasound and the internal medicine doctor said her lymph nodes were not enlarged. Not sure where to go from here.

Thank you for the update. I, too, would check for maldigestion and malabsorption (the "GI function test") although I would expect a polyphagic (increased hunger) rather than inappetent dog in those cases. I must defer to the specialist internist who knows Leila far better than I do. I would, however, like to review the results of that testing, please.

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Customer reply replied 1 month ago
thank you. I will send them your way once I have them. Question- is cancer still a very big possibility? In speaking with the internal medicine doctor, he said he's lower on his diagnosis than it once was since the abdominal ultrasound was essentially normal. Just trying to prepare myself.

I don't see any evidence of cancer. What does ..."he's lower on his diagnosis" imply, please?

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