Cushing's - symptoms and diagnosis?

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bfkdiabetic1

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I have been observing for a while but had a troubling visit with my vet on Friday that I could use some help with.

My 9 year old Siamese mix Cassanova was diagnosed as diabetic in May 2010. He also has an inflamed pancreas. He currently gets 5 units of prozinc and a metronidazole pill twice a day. He has been holding pretty steady with his blood tests; we home test periodically and his numbers do not seem to have changed much in the past couple of months.

We went in on Friday for a diabetes check up. We had noticed a scratch on Cassanova's head the night before and assumed it was from his brother. When my vet touched the wound, the skin practically flaked off. He mentioned Cushing's Syndrome and then looked it up in a book, stating that he had only ever seen one cat in his practice with Cushing's before, many years ago. He also consulted an IM who expressed the opinion that, with the good BG numbers, it was unlikely to be Cushing's. So we proceeded with the vet visit as usual, including drawing some blood from Cassanova's rear leg. Later that evening at home, I noticed another bald patch on his back where the skin/fur appears to be peeling away. Then, the wound where the blood had been drawn appeared to reopen; Cassanova came into the living room with blood all over his leg! We wrapped the leg with a bandage so Cassanova could not lick the wound and it appeared to be OK the next morning. He has visited the vet a lot since May and this is the first time that the wound has opened and bled after leaving the vet.

He is always hungry. He had two places on his body shaved in May and the fur has never grown back. His coat is dull and has changed color from a silver grey to a brownish grey over the past year.

I am concerned that it could be Cushing's. Does anyone have any insight into how this is diagnosed and what the prognosis is? The wonderful post on "what am I doing wrong" is right: I do not want to turn my cat into a science experiment based on a hunch! He's still a lap cat with a wonderful loud purr!
 
Cushings will show up on the bloodwork as significantly elevated liver enzymes. (was thinking of the wrong thing) Is the vet currently running a full blood panel? Definitely sounds like something else is going on here.

I don't want to think the worst, but it is good to know what to rule out. Here is a link I found about thinning/fragile skin in cats: http://www.petmd.com/cat/conditions/ski ... y_syndrome
 
My cat had Iatrogenic Cushing's Disease, caused by long term steroid use. We did not undergo any testing or treatment, but the diagnosis was made on the basis of his Cushingoid physical symptoms of thin fragile skin, bald spots and unkempt haircoat, muscle wasting, and pot belly. What you are describing here (bald patches, dull coat, skin peeling away, and poor healing of wounds) sounds quite suspicious for Cushing's disease. You mention good BG numbers, but I think that your dose of 5 units (and I am not at all familiar with your type of insulin, so I will stand corrected if someone else corrects me) sounds high-ish, and could also be consistent with Cushing's. I would suggest that you ask your vet to pursue further tests, which could include blood and urine tests, and ultrasounds to visualize the adrenal glands and/or pituitary. Meanwhile, of course, I would be extremely cautious about any possible injury to his skin.

You mention that he takes Metronidazole. Does he take that for IBD? Is he feeling ill from Pancreatitis? How was the inflamed pancreas diagnosed?

Attached are a couple of links on hyperadrenocorticism:

http://petdiabetes.wikia.com/wiki/Cushing%27s_disease

http://www.vin.com/VINDBPub/SearchPB/Pr ... R00106.htm
 
Thanks for the links. I will check those out right away and let you know what I found out. We are extremely concerned about the thin skin.
 
I agree that it does sound like Cushing's.

While it is usually also associated with insulin resistance (aka high dose needs), Every Cat is Different.

5u PZI BID is an above average dose.

Norton was a High Dose acrocat and only needed 8u BID, or when we changed to TID 5u. (15 u total per day, and some days only 10u - skipped shot)

Cushings is essentially excess cortisol (stress hormone from the adrenal glands)
 
Cassanova has consistently had elevated results on the PLI test. They have been lowered in the past six months; our vet has indicated that Cassanova will be on the Metronidazole indefinitely.
 
Metronidazole is used quite successfully for IBD. It works to reduce inflammation in the GI tract. Since inflammation in the gut can spread to and inflame the pancreas, the Metronidazole may be helping. In my experience, there are no side effects to worry about with that drug.
 
Thanks. I am going to call my vet re: what we found over the weekend. He drew extra blood on Friday and I suspect we can run a panel on it.

And I *always* say prozinc is my insulin when I mean PZI! Cassanova gets 5 units of PZI twice a day.
 
The only downside of metronidazole is that it tastes terrible.

Linda and Bear Man said:
Metronidazole is used quite successfully for IBD. It works to reduce inflammation in the GI tract. Since inflammation in the gut can spread to and inflame the pancreas, the Metronidazole may be helping. In my experience, there are no side effects to worry about with that drug.
 
Cassanova is heading to the vet tomorrow for the full day to do a test of his cortisol levels.

Thanks to everyone for their support and all the information.
 
The results of the test for excess cortisol were negative. Because of the holiday, my vet and I are going to reconnect on Monday to discuss what the next steps should be. Cassanova continues to be himself - sweet, loving and always hungry.
I am wide open for any thoughts! I'll be doing tons of research this weekend to see if anyone out there has seen anything like this!
 
bfkdiabetic1 said:
The results of the test for excess cortisol were negative.

You may not know the details of the testing procedure but what was the exact test that was run?

These tests are not always straight-forward.....no-brainer tests...sorry to say. They can be confusing and up for different interpretations.
 
I understand that it is hard to verify Cushings from testing -- usually when the skin is so very fragile and diabetes is present -- that may be all the "proof" you can get.
 
You may want to ask your vet to peruse VIN if she/he is a member. I am not faulting your vet for the test that was run because it seems like this has never been very clear-cut but here are some excerpts from the VIN consultants with the date of their comments noted:

5/18/10 VIN consultant #1:

The ACTH stim has much lower sensitivity than the LDDS in cats. 60% of cats with hyperadrenocorticism return normal ACTH stim results.

That is, most cats with Cushings will not be picked up by a stim.

(LDDS = low dose dexamethasone suppression test)

6/25/10 VIN consultant #1:

The ACTH stim test is not recommended; it has very low sensitivity for Cushings in cats. The test of choice is a dexamethasone suppression test using the canine high dose.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Other VIN consultants have recommended a UCCR...Urine Cortisol:Creatinine Ratio and while cushings can't be diagnosed simply by an elevation in the UCCR, it can be a useful tool.

The UCCR is a SENSITIVE test for Cushing's (e.g. very few animals with Cushing's would have a negative UCCR), but it is not a SPECIFIC test (e.g. many other diseases will make the UCCR elevate e.g. uncontrolled diabetes could).

So among the screening tests, we usually pick a LDDS to screen cats (using the 'high' dose for a dog DSP).

Adrenal ultrasound is also used since false positives and false negatives can be seen with the LDDS.

So, as you can see, the Dx of cushings is not straight-forward so you should probably keep going with your 'hunt' for answers....IF you and your vet are still concerned about cushings.
 
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