Flynn - Possible Cushing's Disease Diagnosis

[Morgan & Flynn]

Link to previous thread: https://www.felinediabetes.com/FDMB/threads/flynn-pmps-589-help.249098/#post-2812847

Flynn had an abdominal ultrasound done last week and they took a sample from his small intestine and an enlarged lymph node, we are still waiting for those results unfortunately. However this is what the vet says they see from the ultrasound itself "Flynn's ultrasound showed a thickening of his small intestines (a sample was taken), somewhat large and cystic lymph nodes (a sample was taken), a gall bladder with a small amount of sediment in it, somewhat irregularly shaped kidneys, a pancreas with benign nodules (no evidence of neoplasia/cancer), and enlarged adrenal glands. The adrenal glands are the most interesting thing (at least until the cytology returns) as this implies Flynn might have Cushing's Disease. Cushing's is extremely rare in cats and tends to be only discovered if they develop something like diabetes that is then difficult to regulate prompting further testing, which sounds very familiar. In dogs Cushings is generally manageable with good success. For cats I'm reading that it's a little more complicated and the prognosis can be guarded, though I suspect this is due to the diabetes complication. Flynn likely had Cushing's before he was diabetic, and we've only found evidence of it now because he hasn't been easy to regulate."
I guess my question is if anyone has felt with Cushing's? What was their quality of life like? How did their diabetes react once you started treating the Cushing's? Any other info you have to share with me is also welcome!!
I'm so so lost once again!

 

[Bron and Sheba (GA)]

I’m sorry you have this probable diagnosis.
We have had a couple of cats here with Cushings. I know of two but their user names escape me at the moment. I’ll tag @Wendy&Neko as she has a good memory for user names.

 

[Wendy&Neko]

Sorry to hear about this next challenge with Flynn. Are you seeing an internal medicine vet now?

None of the people who had Cushing's kitties are actively posting here - but you'll see their posts over in this forum:
Acromegaly / IAA / Cushings Cats

The type of treatment depends on what is causing the Cushings. The most common kind is caused by a benign pituitary gland tumour. Adrenal Cushings is less common. April @manxcat419 is sometimes on, and she had a kitty with adrenal Cushings. Here is a post that talks about treatments.

 

[manxcat419]

Our Roxi did have adrenal Cushings. I don't know whether the diabetes or the Cushings was present first - we adopted her already diabetic. And, while I felt she showed signs of Cushings from fairly early on, our vet wasn't convinced and thought she was just a high-dose cat. Hers was also discovered pretty much by accident - they were using an ultrasound to get a cystocentesis on her and spotted something "not right" with her right adrenal. We then did a more in-depth ultrasound to double check and the ultrasonographer confirmed that the right adrenal was abnormal.

Hers was treated by removing her right adrenal altogether. Adrenal-based Cushings generally involved a tumor on the adrenal. And while those tumors don't metastasize, they do spread and infiltrate locally. So removal before it infiltrates the artery is important. We did have a specialist surgeon on her case for the removal as her tumor was fairly big.

Roxi's recovery was excellent in terms of the surgery itself. However, she did develop pancreatitis during recovery and had a few wobbles from that. She also developed Addison's disease - it's likely that her left adrenal had simply shut down because of the excess steroids being produced from the tumor. And it never fully resumed steroid production. She's on a monthly shot of Zycortal for that. However, although Addison's shouldn't go along with diabetes, she is still diabetic. These days, she takes just a fairly normal 1-2 units of insulin though instead of the 10+ units she was on.

If your vet feels adrenal-based Cushings is in the mix here, you do need to manage the diabetes with some caution until you decide on a plan. When Roxi was on a big insulin dose, she would do OK for a while (never fully regulated), but then she would crash and run in the 20s for most of a day. The reason this can happen is that the tumor tends to pulse steroid production. So when it's not producing, you suddenly have a cat who probably only needs a couple of units...but you've just given 10 because you have no way of knowing that they don't need the higher dose that day.

If you have other questions, please go ahead and ask. I work some pretty long hours most of the week, but I will get you answers as soon as I have a chance.