How to Diagnose Cushing's?

[Casey Warner]

I believe my 14 y/o cat has Cushing's, if so, the vet and the specialist completely missed it.

She's pot-bellied and the vet does not seem to even notice! She won't give an answer as to what's causing the potbelly. The specialist didn't mention it in her ultrasound report. The only thing I can see in the report that might give that appearance is that both adrenal glands are very large.

I cannot get her diabetes regulated on Lantus. She seems to need more and more and more. The vet knows nothing about insulin and that seems to be a common theme with vets around here.

Brownie has many of the symptoms of Cushing's. I believe she had the pot-bellied appearance for many years, long before she showed any concerning symptoms. Interestingly, I often wondered if her sister had very mild Acromegaly (if that's even possible). This family of cats (there were four) were very sick and malnourished when I found them as kittens. The three that survived ended up with what I guess would be stunted growth. All three started to have health problems in 2017. Two were euthanized last year at 13 due to disease/cancer. Brownie's the last one left.

 

[Wendy&Neko]

Tagging @Tuxedo Mom and @Ana & Frosty (GA) , both members who had Cushings cats. You can search this forum for recent posts by Ana.

What dose is Brownie on now? A pot belly is also a common symptom of acromegaly. What symptoms did Brownie’s sister have?

 

[Tuxedo Mom]

Although many vets consider feline Cushing's to be rare, I believe this is because of under-diagnosing. Cushing's ( which is an excess of cortisol on the body) can be caused by steroid use (Cushing's syndrome) ADH (adrenal tumour) or PDH (pituitary tumour). The 'usual' signs of Cushing's are high glucose (FD),which is very hard to regulate and can have large swings in the levels, excessive hair loss and lack of regrowth on shaved areas, pot-bellied appearance, thin skin progressing over time to skin tears.

The cheapest and least invasive test is the UCCR (Urine cortisol creatinine ratio) test. This is done by collecting a urine sample AT HOME so there is no stress involved and having your vet send it to an outside lab such as IDEXX to test cortisol levels. A borderline or positive test would require additional testing to determine which type of Cushing's it is. It has been almost 4 years since I had the UCCR test done ( in Canada) and the cost was about $100 Cdn, so I don't know what current pricing is.

What results did the U/S you had show? Was the U/S done by a board certified tech or vet? With PDH the pancreas, liver and both adrenal glands are enlarged...with ADH usually only one adrenal gland is enlarged and will show a tumour. Sometimes it can be difficult to visualize both adrenals in kitties because of the size and placement. I had 2 U/S done...in the first only 1 adrenal was able to be visualized but the 2nd one showed both adrenals.

Your spreadsheet is not showing up so I can't comment on the readings. My Tuxie never got higher than 6 units X2 daily (levemir) and Ana's Frosty was not on a high dose either. What I found was that Tuxie's levels could go from extremely high to extremely low to non-responsive all within a few cycles. This is because the excess cortisol production can wax and wane with PDH. PDH appears to be the most common with kitties.

@Ana & Frosty (GA) used trilostane also called vetoryl for her Frosty, which helped with the skin tears. She can give you more information on the medication approach to treating Cushing's.

 

[Ana & Frosty (GA)]

Hey! I am sorry that your baby may have Cushing’s. I’ll try to add to (and not repeat) too much of what Mary Ann already said.

She’s right that Cushing’s is probably not as rare as we think. Besides Mary Ann and I, we have another member here, @Rardito who currently has a kitty with Cushing’s). All of our experiences are very different, but i hope by hearing about all of them it will help you determine what is best for your kitty.
Veterinarians are taught that Cushing’s is extremely rare, and most don’t even see a Cushing’s cat in their lifetime, so it’s hard to blame them for “missing it” per say. General veterinarians are usually just wellness doctors, and should refer out to an internist if they find something complicated. I still can’t believe my luck that an ER vet recognized Frosty’s Cushing’s and sent us to an internal medicine vet for testing and management. If not for her, Frosty’s time with me would have been cut in half.

So my advice is to try to find an Internal Medicine veterinarian. They are way more knowledgeable about feline diabetes, and chances are they have seen at least one cat with Cushing’s. Out IM vet has been in practice for 23 years and has seen 4-5 cats with Cushing’s. She was a wealth of knowledge and very helpful and supportive. I couldn’t have done this without her.

As a workup, Frosty had the abdominal ultrasound and ACTH stimulation test. Once he started Trilostane (brand name is Vetoryl and that’s what I normally refer to it as), his blood sugar, skin, and pot belly significantly improved. Unfortunately, since I got Frosty when he was 8-10 years old and known diabetes, we don’t know how long he had these problems and he passed away likely from long term complications from Cushing’s (cardiomyopathy and pancreatitis ). But I know for a fact that Vetoryl made a huge difference in his life quality and diabetes management. And it gave him an extra 5 months.

Thus, if blood sugar control is an issue, I recommend seeing an IM vet and discussing a full workup for Cushing’s, and Vetoryl as treatment if she does have it.

I hope this helps!

 

[Rardito]

Sorry I'm just now seeing this! I don't seem to get email notifications anymore and my Cushing's kitty is actually in remission, so I hadn't been on the board in a bit. If you have any other questions let me know.