Petra's Cushings story (adrenal tumor)

crambywamby

crambywamby

Member Since 2020
Hi everyone,

I've never posted, but I used to lurk last year when I was figuring everything out for my cat Petra. Certain threads even led me to reach out directly to another member whose cat had Cushing's, so I really appreciate this resource. My beautiful tabby was put to rest at 5 1/2 years old, nearly a year after her Cushing's diagnosis. I wanted to help anyone out in the future who may stumble upon this thread. I'd be happy to respond to any questions and offer whatever support I can.

Her Cushing's was the form caused by an adrenal tumor, on the right adrenal gland to be specific. It was around 2cm at the time of her diagnosis, but had grown to 3cm by the time she passed.

We first took her to the vet in January of 2019 because she had rapidly gained weight and was excessively drinking and urinating. After a basic blood test, she was first diagnosed with diabetes. We spent that first month attempting to regulate her blood glucose, shuttling her back and forth to the vet weekly for rechecks. Increasing the dosages of insulin seemed to do nothing and we scheduled her to spend a day at the vet for a BG curve.

Meanwhile, in mid-February I noticed a fresh wound on her upper back that she likely sustained from grooming. It looked like the classic Cushing's skin tear, though when I took her back to the vet they weren't aware of what it might be and considered that she might have burned herself or that it was a reaction to a too-high dose of insulin. A week later, she had another tear on her arm around the same spot. She also had a bout of diarrhea and needed to be cleaned and, not realizing quite yet how thin her skin was, I scruffed her while putting her in the sink. Doing that caused a pretty significant tear in her skin, and it was at that point that I realized that something was really wrong with her.

We were referred to see a specialist in mid-March and they conducted a dexamethasone suppression test to test her cortisol levels, and an ultrasound. They were able to confirm Cushing's due to her adrenal tumor. Her vet and a surgeon discussed the surgery with us and the possible complications and risks involved, especially because of the fact that her tumor was already quite large. The surgery quote was pretty expensive, and we elected to treat her with Trilostane and wait for her insurance period to roll over again the following January while we put some money aside. We knew at this point that Trilostane could possibly not work and that the only cure would be to remove the tumor.

She thankfully responded well to Trilostane 10mg, and her skin wounds, which had been open since she sustained them, quickly began to scab over and heal. Curiously, she never grew hair back in the areas where she was shaved while the vets were treating the wounds, but she DID grow hair in the exact places where the wounds healed.

From April until October, she did quite well. She lived in a onesie and soft cone that we ordered off of Amazon. She had basic bloodwork and repeat dexamethasone suppression test every 3 months, which showed that her cortisol levels were controlled. We tried to control her difficult diabetes as best as we could, but it was difficult to get her any lower than the 200-300 range, because a higher dosage sometimes made her blood sugar TOO low. I think it all depended on how active the tumor was being.

In October she developed a suspected neuropathy in her tail, and she began to attack it. We took her for an ER visit the first time it happened and her bloodwork showed that her potassium and liver values were going bad. She had another ER visit a few weeks later after spending a night unable to eat or drink without vomiting. We started giving her Gabapentin for the tail neuropathy to mixed results. From this point on, it became a delicate balance of keeping her in her small soft cone (for comfort and ability to drink and eat), to switching her to a large hard cone to prevent her from biting herself. She could go weeks at a time without biting herself, and then would suddenly start again.

At this point, we decided to consult the surgeon again and plan to have her surgery in January 2020. She had a CT scan at the beginning of December, which showed that the tumor had not metastasized to any other organs, but that it had grown to about 3cm. It was very close to the vena cava, a major artery that made the surgery particularly risky. Her surgeon said that there was a very significant chance that she would die during surgery, and that if she survived she may have needed to spend a week in recovery. We decided not to go forward with surgery and instead try to make her as comfortable as possible while she was still with us.

I had made a follow-up appointment with her vet for this past weekend (February) to discuss her future and see if any anti-anxiety medications could be useful for the tail issues, since her bouts did seem to be triggered by environmental stressors, being hungry, etc. I had noticed that her skin began to look red and very thin in the areas where she had previously had wounds months ago. Unfortunately, when I took her out of the carrier case, I noticed she had sustained some pretty massive skin tears on her lower back, most likely from handling her and placing her in the case as I had done many times before. It was clear that the Trilostane had suddenly become less effective. We agreed with the vet that the most humane thing to do at this point would be to put her to sleep, and she died peacefully in our arms that evening.

I am always open to discussing anything further or answering any questions to the best of my ability based on my own experiences.

To anyone reading this in the future, I will just say - my heart goes out to you for having to deal with this. It's such an awful rare / under-diagnosed disease to see your cat go through. And you are a great person for taking care of your cat as best as you are able to. As you might have heard others say, this disease, specifically the adrenal type, is very difficult to manage with medicine alone. If you have the means to, and if surgery is viable, definitely look into having that done as early as you can.

EDIT- I had originally put that she had “ACTH suppression test(s)”, but meant to say “dexamethasone suppression test”. This is the gold standard for diagnosing Cushing’s. She did have an ACTH test prior to this.
 
Last edited:
I am sorry for the loss of your sweet kitteh, and at such a young age. It is clear that you cared deeply for her, and you did everything right.

Thank you for posting all the details. Hopefully those details will be helpful to someone as you said.

May your sweet kitteh fly free, and land softly at the Bridge.:bighug::bighug::bighug:
 
I'm so very sorry for your loss. Cushing's is an unpleasant thing, and the adrenal-dependent form is fairly rare in cats so diagnosis isn't always straightforward either. We actually did do the surgery for Roxi, although her tumor was also pretty close to her vena cava by the time it was discovered. She did make it through, although her recovery was far from easy - the surgeon was very skilled and the adrenalectomy itself went very well, but her remaining adrenal never recovered. We almost lost her a month later to an Addison's crisis. And she's since been diagnosed with pancreatitis and SIBO, although both thankfully seem to be better under control now. However, the situation we do have is that she's still diabetic - Addison's and diabetes is meant to be an impossible combination, but she's managed it. I will say that, in all, with the 3 hospitalizations she's needed since the surgery, the total cost to date has been about 3-4x what we paid for the surgery itself (and as you know that isn't cheap and carries significant risks). We sort of hit the point where we'd spent so much already that you kind of have to keep going...but I do think if we'd known how tough her recovery would be, we might have opted not to do the surgery and to give her the best we could without it as you did.
 
@manxcat419

I’m glad to hear that Roxi’s adrenalectomy was ultimately a success. And I’m sorry to hear of the additional obstacles she had along the way, but glad that things seem to be going better now. You’ve certainly taken great care of her!

Do you know how large the tumor ended up being? Was it malignant?

Also, did her overall skin condition improve? I’m curious because in the time leading up to us considering surgery, I wondered if Petra’s skin would ever actually thicken again to how it was when she was healthy, if her missing fur would grow back, and if she’d be able to live again without wearing a protective onesie (though after a year I’d almost forgotten what she’d looked like without one, and I’d almost miss it since it had become her ‘style’ in a way, haha).
 
crambywamby said:
Do you know how large the tumor ended up being? Was it malignant?
Click to expand...
I would have to check her records for the exact size - I'll try to do that for you tomorrow. I do know they said it was about as big as it could get without involving the vena cava. And she's part Maine Coon, so is a pretty big cat all over. The tumor was malignant, and there was initial concern that there was a chance it would grow back even with the adrenal removed. Thankfully, her follow up ultrasounds have been clear, and they now feel the risk of that is very minimal.

Her skin condition has improved, although her coat is still very dry and prone to matting. That may at least partly be the Addison's of course. I can't say for sure if her skin is exactly as it was before the Cushing's as we've since realized that she must have already had Cushing's when we adopted her - she had never had more than peach fuzz fur on her belly from the time we'd known her, where she now does have a full coat of fur. So I'm pretty sure her skin was already showing signs of damage, although not enough to tear until shortly before her diagnosis. We'd had her to and from the vet so many times because of her high dose of insulin, which would control some of the time but she would also crash horribly into the 20s at times. And she'd had almost every test going. The tumor was found by accident - she was having a urinalysis done under ultrasound for a UTI and the vet thought they saw something on the adrenal. So off we went for a specialist ultrasound. But the tumor had clearly been there for some time.
 
manxcat419 said:
she had never had more than peach fuzz fur on her belly from the time we'd known her, where she now does have a full coat of fur.
Click to expand...

Petra was the same way with the peach fuzz belly fur. We’d had her since birth, but didn’t get her spayed until she was about a year old. I feel like it was around that time afterwards that we noticed that she had minimal hair on her belly, and that her fat pad was a lot looser there. I think we attributed that to a result of the spay and recovery at the time, but looking back this was probably the earliest sign we had of the Cushing’s process. This would have been over 3 years before her diagnosis.
 
Hi, nice to meet you.
I don't know if my cat has cushing.

I'll write in spanish, because my English is very bad.

Mi gato tiene toda la sintomatología, pero le hicieron un test de orina que dio negativo, donde dice que el cortisol en orina estaba normal. Es posible esto?
En el caso de él, la ecografía y doppler, no mostraba nada, por lo cual si hubiera algo, podría ser de hipófisis. A él lo encontraron el 22 de noviembre de 2019 muy grave, no sabemos sobre su vida. Sí que es adulto, de apariencia viejo, pero no su edad real ni todo por lo que ha tenido que pasar.

Agradeceré me puedas confirmar si podría dar aún en orina falso negativo y ser positivo (sé que es muy raro que pase eso, por lo general lo usual es que de falsos positivos, más con su glucemia sin controlar).

Gracias!
 
Just using Google translate on this:
My cat has all the symptoms, but they did a negative urine test, which says that the cortisol in urine was normal. Is this possible?
In his case, the ultrasound and Doppler showed nothing, so if there was something, it could be from the pituitary.
They found him on November 22, 2019 very serious, we do not know about his life.
Yes he is an adult, looking old, but not his real age or everything he has had to go through.
I will be grateful if you can confirm if I could still give false negative urine and be positive (I know that it is very rare for that to happen, usually the usual thing is that of false positives, more with uncontrolled blood glucose).

My limited response from Google translate:
Las almohadillas de tumores pituitarios son mucho más comunes. (Cushings from pituitary tumours is much more common)
¿Qué síntomas tiene tu gato? (What symptoms does your cat have)
 
Thanks for your answer.
Regarding the symptoms, it has:
* Alopecia, especially the back
* A big belly (although he is depressed) and his little veins are noticeable there many times.
* Recurrent skin problems, it scratches and hurts and its skin looks very thin, without fat under it (like caught, when you want to stretch, like on the belly you can't grab fur like in a normal cat -no elasticity? - ).
* The pads of their feet are very dry and peel, leaving dry skin.
* Your nails grow misshapen, become ugly and fall off (onychomadesis, onychodystrophy).
* He is diabetic (he drank a lot of water, urinated a lot, eats a lot, but this seems to be more associated with diabetes, because by lowering his very high values, he improved a lot, although in general his hunger persists). And you can't regulate your blood sugar well.
* Has recurrent relapses (starts with skin problems, has diarrhea and then begins to heal the skin and starts with something respiratory. It improves. Relapses and repeats the cycle.
* Your nose has squamous cell carcinoma.
* You have chronic bronchitis and a cough that looks like asthma that you will have once or twice a day or every other day.
* He has feline acne and inflammation of his chin (which led to an abscess - but the suppuration was not due to infection, but due to inflammation), -
* When I found him he had mouth sores and he was treated with penicillins, which improved. And that adds to the fact that he has a fang to remove and chronic gingivitis.
* There is a little eye (the right one, which always tears more than normal) and I don't know if I saw a gray male in his eyes or is it just the reflection.

____________________

Gracias por tu respuesta.

Respecto a los síntomas tiene:

* Alopecia, sobre todo el lomo

* Una panza grande (si bien está denustrido él) y se notan sus venitas ahí muchs veces.

* Problemas recurrentes de piel, se rasca y lastima y su piel se ve commo fina, sin grasa bajo la misma (como agarrada, cuando querés estirar, como que en la panza no podés agarrar pellejo como en un gato normal -sin elasticidad?-).

* Las almohadillas de sus patas están muy resecas y se pela, saliendo la piel reseca.

* Sus uñas crecen deformes, se ponen feas y se desprenden (onicomadesis, onicodistrofia).

* Es diabético (tomaba mucha agua, orina mucho, come mucho, pero esto parece estar más asociado a la diabetes, porque bajando sus valores altísimos, mejoró mucho, si bien por lo general su hambre persiste). Y no logra regular bien su glucemia.

* Tiene recaídas recurrentes (arranca con problemas de piel, tiene diarrea y luego comienza a curar la piel y arranca con algo respiratorio. Mejora. Recae y repite el ciclo.

* Tiene su naríz con carcinoma de células escamosas.

* Tiene bronquitis crónica y una tos que parece asma que la tendrá una vez o 2 al día o día por medio.

* Tiene acné felino e inflamación de su mentón (que llegó a hacerle un abceso -pero la supuración no era por infección, sino por inflamación),-

* Cuando lo encontré tenía llagas en la boca y se trató con penicilinas, con lo cual mejoró. Y eso se le suma que tiene un colmillo como para sacar y gingivitis crónica.

* Hay un ojito (el derecho, que siempre le lagrimea más de lo normal) y no sé si le vi una machita gris en sus ojos o es sólo el reflejo.
 
In addition, I found him in November 2019, I only know that he is an adult cat, apparently already long-lived. He was very thin, injured, with skin infections that are difficult to heal, and hairless, in much of the body.
I have been doing studies since that date, until now:
1) Echocardiogram and electrocardiogram, with a cardiologist specialist:
A murmur and enlargement of the left ventricle were detected, he does not need medication at that time.
2) Ultrasound of the abdomen and reproductive system:
A concave mass was detected in the liver, and a puncture was made but it did not yield accurate results either (it could be a cyst, tumor, abscess). Its center has fluid and changes in size (from ultrasound to puncture it had shrunk at that time).
Hepatomegaly was also detected, inflamed intestines, the kidney slightly past its size (indicates that there is some renal failure). Rest of organs looked ok.
3) Complete blood test:
It was the first and with that diabetes was confirmed. In the first analysis, there were also some high neutrophils and the most striking were the very low albumin and very high globulins. The rest of the analyzes improved somewhat in the second. In the third, low hematocrits, high neutrophils, had emerged. When the hematocrits dropped, he was given amoxycycline in case he had mycoplasma.
4) VIF / VILEF viral test:
Rapid test and PCR were done, both negative.
5) Mycoplasma (hemobartella) test taken from the ear:
Negative.
6) IGF-1 blood test:
Normal. There is no evidence of acromegaly.
7) Thyroid analysis (T4 and free T):
Normal.
8) Urinalysis cortisol:
Normal cortisol.
9) Scrapings of skin, samples of suppuration of wounds with pus, samples of wax from your ears and scabs:
All tested negative for mites, bacteria and the pus was due to an inflammatory reaction and not an infection.
But, in the last sample, hair and 2 nails that were shedding were removed. In the hairs, the parasite demodex gatoi was found (I know that they happen with immune-mediated diseases, vif / villef, diabetes, Cushing, and other endocrine diseases, but in general their bodies keep this parasite at bay).
10) X-rays of the thorax and legs (due to the problem of his nails):
No tumor was found in the lung.
Chronic bronchitis and osteodystrophy were detected (this was marked on their legs).
11) Calcium and phosphorus analysis (to diagnose parathyroids):
Normal values. If he had failed, he would do a vitamin D and PTH test, but it was not done because the other one gave normal. This analysis was based on the results of the X-rays to see why the osteodrystrophy.
12) Internal deworming several times with suspension and with a pipette (without doing stool analysis):
Despite covering a wide variety of parasites and he being isolated, for some reason a few days ago he eliminated ascaris (toxocara cati) and dead parasites, having visible poor digestion in his fecal matter, almost the texture and color of his wet food. This is also associated with diseases such as those that favor demodex in cats.
13) External deworming with pipettes:
He is now wearing the common Bravecto, because it works against demodex gatoi, but my cat is still scratching (he has hurt his entire leg, the back along it now, and his entire belly and inner thigh).
14) Nose swabs to test for carcinoma and Papanicolau cells from the sample:
3 samples of common scraping were made, all without finding. The last Pap smear with the fourth sample gave a result consistent with squamous cell carcinoma.
15) Between each relapse he had, he was medicated with different things at different times:
• For the skin: cephalexin, chlorehexidine in the first wounds, antihistamic ceterizine, with its allergic outbreaks (at first he had his skin wounds on his head, and they seemed vascular). They wanted to give him corticosteroids because he became very strong as he injured himself, but he avoided giving.
• For respiratory problems: Amoxicillin with clavulonic acid.
With the last outbreak he had very big congestion and I did steam baths and nebulizations with only physiological solution and it seemed to do him well.
• For recurrent drops of hematrocrits: Doxycycline.
• For your feet: ketoconazole cream on the nails (believed to be fungi), cephalexin, feet soaked in water solution with povidone iodine, chlorehexine spray.
• To improve the use of their fat, they gave him a paste that was L-cartinine and then for his liver, liver protector, when he was seriously hospitalized (this happened because the cat was weak, they gave me metformin for his diabetes when due to the symptoms he was not It was treatable with that and it was bad for the liver, they made me change the balance to Royal Canin diabetic and give him only the indicated dose; with which this was insufficient, he did not get to nourish himself, he drank jars of water, urinated in a while all his Sandbox, he was hungry with those doses, until he began to be lethargic, wobbly, in days he lost the little weight that he had improved, he had diarrhea and I ran to an emergency vet and he was dehydrated, glycemia through the roof, fat in the blood -almost makes a ketoacidosis and hepatic lipidosis- (All this was before starting with insulin with another go).
• Before that he also took when I found him antibiotics, vitamin B, interferon (in case he had vif / or vilef).
• Now they gave me 3 homeopathic medicines, but I don't know what they are for (one for carcinoma I think, another for defenses and another I have no idea).
• Follow with insulin is with Lantus glargine. It started without responding well almost reaching 7 units every 12 hours and began to fall from there. And when I gave wet without cereals, flours or sugars - although it is of poor quality - it fell much more suddenly daily and now we are looking for the right dose in units of around 1.75 every 12 hours. The problem is that his skin we do not know if it also has an effect with this food or not, but at the time he managed to gain more weight and improve his hair, until it sprouted very badly from one day to the next, leaving his skin almost raw paw scratching.

___________________________________


Además, a él lo encontré en noviembre de 2019, sólo sé que es un gato adulto, aparentemente ya longevo. Estaba muy delgado, lastimado, con infecciones piel que se dificulta que cure, y sin pelo, en gran parte del cuerpo.

Vengo haciendo estudios desde esa fecha, hasta el momento:

1) Ecocardiograma y electro, con especialista cardiólogo:

Se detectó soplo y agrandamiento del ventrículo izquierda, no necesita medicación en ese momento.

2) Ecografía de abdomen y aparato reproductor:

Se detectó masa cóncava en hígado, y se hizo una punción pero tampoco arrojó resultados certeros (podría ser quiste, tumor, abceso). Su centro tiene líquido y cambia de tamaño (de la ecografía a la punción se había reducido en ese momento).

También se detectó hepatomegalia, intestinos inflamados, el riñón pasado un poco de su tamaño (indica que hay cierta insuficiencia renal). Resto de órganos se veían ok.

3) Análisis de sangre completo:

Fue lo primero y con eso se confirmó la diabetes. En el primer análisis había además algunos neutrófilos altos y lo más llamativo era la albúmina muy baja y las globulinas muy altas. El resto de los análisis, mejoró algo en el segundo. En el tercero había surgido hematocritos bajos, neutrófilos altos. Cuando bajaron los hematocritos se le dio amoxiciclina por si tuviera micoplasma.

4) Test de virales VIF / VILEF:

Se hizo test rápido y PCR, ambos negativos.

5) Test de micoplasma (hemobartella) tomado de oreja:

Negativo.

6) Análisis de sangre IGF-1:

Normal. No hay indicios de acromegalia.

7) Análisis de tiroides (T4 y T libre):

Normal.

8) Análisis de orina cortisol:

Cortisol normal.

9) Raspados de piel, muestras de la supuración de heridas con pus, muestras de cera de sus orejas y costras:

Todas dieron negativas a ácaros, bacterias y el pus era por reacción inflamatoria y no por infección.

Pero, en la última muestra, se extrajo pelo y 2 uñas que estaban desprendiéndose. En los pelos se logró hallar el parásito demodex gatoi (sé que pasan con enfermedades inmunomediadas, vif/villef, diabetes, Cushing, y otras enfermedades endócrinas, sino por lo general sus cuerpos mismos mantienen a raya este parásito).

10) Radigrafías de torax y patas (por el problema de sus uñas):

No se halló tumor en pulmón.

Se detectó bronquitis crónica y osteodistrofia (esto estaba marcado en sus patas).

11) Análisis de calcio y fósforo (para diagnosticar paratiroides):

Valores normales. Si hubiera dado mal se iba a hacer análisis de vitamina D y PTH, pero no se hizo porque el otro dio normal. Este análisis fue a raíz del resultado de las radiografías para ver el por qué de la osteodristrofia.

12) Desparasitaciones internas varias veces con suspensión y con pipeta (sin hacerle análisis de materia fecal):

A pesar de cubrir amplia variedad de parásitos y él estar aislado, por algún motivo hace unos días eliminó parásitos áscaris (toxocara cati) y muertos, teniendo mala digestión visible en su materia fecal casi textura y color de su comida húmeda. Esto también se asocian a enfermedad como las que favorecen demodex en gato.

13) Desparasitaciones externas con pipetas:

Ahora tiene puesta la Bravecto común, porque actúa contra demodex gatoi, pero mi gato sigue rascándose (se lastimó toda la pata, la parte trasera a lo largo de la misma ahora y todo su mientre y muslo interno).

14) Raspados de nariz para analizar si había células de carcinoma y Papanicolau de la muestra:

Se hicieron 3 muestras de raspado común, todas sin hallazgo. El Papanicolau último con la cuarta muestra dio un resultado compatible con carcinoma de células escamosas.

15) Entre cada recaída que tuvo se lo fue medicando con distintas cosas en distintos momentos:

· Para la piel: cefalexina, clorehexidina en las primeras heridas, antihistámico ceterizina, con sus brotes alérgicos (al principio tuvo en la cabeza, y parecían vasculares sus heridas de piel). Se le quizo dar corticoides porque llegó a ser muy fuerte como se lastimó, pero se evitó dar.

· Para el problema respiratorio: Amoxicilina con ácido clavulónico.

Con el último brote tuvo congestión muy grande y le hice baños de vapor y nebulizaciones sólo con solución fisiológica y parecía hacerle bien.

· Para las bajas recurrentes de hematrocritos: Doxiciclina.

· Para sus patas: ketoconazol en crema en las uñas (se creía que eran hongos), cefalexina, patas en remojo en solución de agua con iodopovidona, spry de clorehexina.

· Para mejorar el uso de sus grasa le daban una pasta que era L-cartinina y luego por su hígado, protector hepático, cuando estuvo internado grave (esto pasó porque el gato estaba débil, me dieron metformina para su diabetes cuando por los vlaores no era tratable con eso y le hacía mal al hígado, me hicieron cambiar el balanceado a Royal Canin diabetic y darle sólo la dosis indicaba; con lo cual esto era insuficiente, no llegaba a nutrirse, tomaba tarros de agua, orinaba en un rato todo su arenero, pasaba hambre con esas dosis, hasta que empezó a estar letárgico, tambalaneante, en días bajó el poco peso que había mejorado, hizo diarrea y corrí de emergencia a una veterinario y él estaba deshidratado, glucemia por las nubes, grasa en la sangre -casi hace una cetoacidosis y lipidosis hepática- (Todo esto fue antes de arrancar con insulina con otro vete).

· Antes de eso también tomó cuando lo encontré antibióticos, vitamina B, interferón (por si tenía vif/ o vilef).

· Ahora me dieron 3 medicamentos homeopáticos, pero no sé para qué son (una para el carcinoma creo, otro para las defensas y otra ya ni idea).

Sigue con insulina está con glargina Lantus. Arrancó sin responder bien casi llegando a 7 unidades cada 12 horas y empezó a caer de ahí. Y cuando di húmedo sin cereales, harinas ni azúcares -si bien es de mala calidad- bajó mucho más de golpe diariamente y ahora estamos buscando la dosis justa en unidades de alrededor de 1.75 cada 12 horas. El problema es que lo de su piel no sabemos si tiene incidencia también con esta comida o no, pero en su momento logró engordar algo más y a mejorar el pelo, hasta que se brotó muy mal de un día al otro dejando casi en carne viva su pata de rascarse.
 
Sorry about your kitty Petra. I'm glad you posted and that's what I'm doing in case I can help another person. We are at the beginning of our journey with Pantera. Diagnosed with diabetes oct 2023, insulin won't regulate with Lantus. Lots of curves done at the vet, and 2 seperate blood tests that showed nothing unusual. Switched to Vetsulin Dec 2023. We then started testing at home with the Alpha Trek 3 meter. (were using ReliOn meter which we liked, but she apparently didn't trust it). We have posted results on the chart.
That wasn't working so went to a specialist in Feb 2024.
Ultrasound found an enlarged adrenal gland. She doesn't know if there's a tumor or not. Did the dexamethasone Suppression test Friday March 1st 2024 and waiting on the results. Cushings is suspected and I believe she mentioned liquid Trilostane to start.
Thankfully, our cat does not have the skin tearing issue.

I see that your post was in 2020. I know that surgery is still very expensive. I hear some people have been successful with just the adrenal removed. Not a common specialist to find tho if there is tumor on the pituitary. I believe now they have radiation pills that have had some success also.
I didn't know you could have Cushings and Addisons. Are new conditions and diagnosis going to continue to be discovered on her, in addition to Diabetes and Cushings? She is very thin and starting to walk a little wobbly, but still has an appetite and carries a shoe around the house.
 
Pantera said:
Sorry about your kitty Petra. I'm glad you posted and that's what I'm doing in case I can help another person. We are at the beginning of our journey with Pantera. Diagnosed with diabetes oct 2023, insulin won't regulate with Lantus. Lots of curves done at the vet, and 2 seperate blood tests that showed nothing unusual. Switched to Vetsulin Dec 2023. We then started testing at home with the Alpha Trek 3 meter. (were using ReliOn meter which we liked, but she apparently didn't trust it). We have posted results on the chart.
That wasn't working so went to a specialist in Feb 2024.
Ultrasound found an enlarged adrenal gland. She doesn't know if there's a tumor or not. Did the dexamethasone Suppression test Friday March 1st 2024 and waiting on the results. Cushings is suspected and I believe she mentioned liquid Trilostane to start.
Thankfully, our cat does not have the skin tearing issue.

I see that your post was in 2020. I know that surgery is still very expensive. I hear some people have been successful with just the adrenal removed. Not a common specialist to find tho if there is tumor on the pituitary. I believe now they have radiation pills that have had some success also.
I didn't know you could have Cushings and Addisons. Are new conditions and diagnosis going to continue to be discovered on her, in addition to Diabetes and Cushings? She is very thin and starting to walk a little wobbly, but still has an appetite and carries a shoe around the house.
Click to expand...

I’m so sorry about Pantera. they *say* adrenal tumors in cats are rare. I think it’s because people *rarely* check …they say “oh he’s old so he’s putting on weight” or “she’s old so she’s weak” or “his kidney tests and electrolytes are a bit off but he’s old and old cats get kidney disease” etc. I say this because I now have my *second* cat with an adrenal tumor.
I’m sure you’ve checked her potassium (K) recently but if not, check it as low K can make her weak/wobbly.
My first adrenal tumor cat, Erik, was first diagnosed with DM (decades ago), treated with insulin that never controlled him, finally his adrenal tumor was found and sadly I lost him during surgery (which has vastly improved since then). In retrospect it made sense: his bad coat, his pot belly, the DM.
Fast forward 20 years. My tall/long but always thin cat Methos (DNA says part Maine Coon, part Siberian, part Norwegian) began to have a bad coat and no longer needed to be begged to eat. I checked his thyroid (normal). I kept mentioning his coat and eventually his putting on weight but his labs looked fine. He became more aggressive at the vet when he’d always been so easy going. I pushed down my fear because adrenal tumors are rare and his blood sugar was fine. Then he lost his appetite, and stopped jumping onto bar stools. My world collapsed when the radiologist told me he had an adrenal tumor. He was 17 and I couldn’t shake my memory of handing Erik over for his surgery. Perhaps I made the wrong decision but I decided against it.
His first test for Cushing’s was borderline. A few months later another was positive-ish (ish bc tests are geared mostly to dogs). He improved on Vetoryl. Then his symptoms increased again. Tests showed initial improvement then worse control. His dose was increased. His K continued to drop despite improving dex suppression tests. His main symptoms were muscle weakness/wasting…flexed head. He was tested for hyperaldosteronism and was positive (apparently his tumor makes both). His K improved on spironolactone. Then he began drinking more again. Yes…diabetes. We’ve just added bexacat and I’m trying to get blood out of an 18 yo huge polydactyl who’s always hated me touching his ears.
re Cushing’s and Addisons: if adrenal tumor is removed and the other adrenal doesn’t “wake up” and take over (having been suppressed by the tumor) then the cat will have Addisons. Can also cause it by too much vetoryl but that’s more reversible.
TLDR: might consider repeating her test for Cushing’s at some point. Test for hyperaldosteronism since that may induce DM (at least in humans, I’m an MD not a vet…as some vets have reminded me). Adrenal tumors may secrete more than one hormone. I also had Methos tested for a pheochrocytoma since his initial symptoms were vomiting and diarrhea. (Thank God negative). I think suspicion should increase for adrenal tumors (and the conditions they cause) for cats with weakness, uncontrolled DM, or slightly declining kidney function.
EDIT: when I say “they” I mean in general, NOT vets (even though they also may say adrenal tumors are rare). This is not saying vets don’t pay enough attention but that it’s normal for ppl to write off a cat who doesn’t jump and puts on weight. After Erik I got Methos and Muz. Muz is fat. It’s been a lifelong struggle since he also ate Methos’ food. I now k ow what a “fat” cat looks like and it’s different than the weight put on by Erik and Methos. I thank God daily for the kind vet caring for Methos who lets me call/text after hours.
 
Last edited:
crambywamby said:
Hi everyone,

I've never posted, but I used to lurk last year when I was figuring everything out for my cat Petra. Certain threads even led me to reach out directly to another member whose cat had Cushing's, so I really appreciate this resource. My beautiful tabby was put to rest at 5 1/2 years old, nearly a year after her Cushing's diagnosis. I wanted to help anyone out in the future who may stumble upon this thread. I'd be happy to respond to any questions and offer whatever support I can.

Her Cushing's was the form caused by an adrenal tumor, on the right adrenal gland to be specific. It was around 2cm at the time of her diagnosis, but had grown to 3cm by the time she passed.

We first took her to the vet in January of 2019 because she had rapidly gained weight and was excessively drinking and urinating. After a basic blood test, she was first diagnosed with diabetes. We spent that first month attempting to regulate her blood glucose, shuttling her back and forth to the vet weekly for rechecks. Increasing the dosages of insulin seemed to do nothing and we scheduled her to spend a day at the vet for a BG curve.

Meanwhile, in mid-February I noticed a fresh wound on her upper back that she likely sustained from grooming. It looked like the classic Cushing's skin tear, though when I took her back to the vet they weren't aware of what it might be and considered that she might have burned herself or that it was a reaction to a too-high dose of insulin. A week later, she had another tear on her arm around the same spot. She also had a bout of diarrhea and needed to be cleaned and, not realizing quite yet how thin her skin was, I scruffed her while putting her in the sink. Doing that caused a pretty significant tear in her skin, and it was at that point that I realized that something was really wrong with her.

We were referred to see a specialist in mid-March and they conducted a dexamethasone suppression test to test her cortisol levels, and an ultrasound. They were able to confirm Cushing's due to her adrenal tumor. Her vet and a surgeon discussed the surgery with us and the possible complications and risks involved, especially because of the fact that her tumor was already quite large. The surgery quote was pretty expensive, and we elected to treat her with Trilostane and wait for her insurance period to roll over again the following January while we put some money aside. We knew at this point that Trilostane could possibly not work and that the only cure would be to remove the tumor.

She thankfully responded well to Trilostane 10mg, and her skin wounds, which had been open since she sustained them, quickly began to scab over and heal. Curiously, she never grew hair back in the areas where she was shaved while the vets were treating the wounds, but she DID grow hair in the exact places where the wounds healed.

From April until October, she did quite well. She lived in a onesie and soft cone that we ordered off of Amazon. She had basic bloodwork and repeat dexamethasone suppression test every 3 months, which showed that her cortisol levels were controlled. We tried to control her difficult diabetes as best as we could, but it was difficult to get her any lower than the 200-300 range, because a higher dosage sometimes made her blood sugar TOO low. I think it all depended on how active the tumor was being.

In October she developed a suspected neuropathy in her tail, and she began to attack it. We took her for an ER visit the first time it happened and her bloodwork showed that her potassium and liver values were going bad. She had another ER visit a few weeks later after spending a night unable to eat or drink without vomiting. We started giving her Gabapentin for the tail neuropathy to mixed results. From this point on, it became a delicate balance of keeping her in her small soft cone (for comfort and ability to drink and eat), to switching her to a large hard cone to prevent her from biting herself. She could go weeks at a time without biting herself, and then would suddenly start again.

At this point, we decided to consult the surgeon again and plan to have her surgery in January 2020. She had a CT scan at the beginning of December, which showed that the tumor had not metastasized to any other organs, but that it had grown to about 3cm. It was very close to the vena cava, a major artery that made the surgery particularly risky. Her surgeon said that there was a very significant chance that she would die during surgery, and that if she survived she may have needed to spend a week in recovery. We decided not to go forward with surgery and instead try to make her as comfortable as possible while she was still with us.

I had made a follow-up appointment with her vet for this past weekend (February) to discuss her future and see if any anti-anxiety medications could be useful for the tail issues, since her bouts did seem to be triggered by environmental stressors, being hungry, etc. I had noticed that her skin began to look red and very thin in the areas where she had previously had wounds months ago. Unfortunately, when I took her out of the carrier case, I noticed she had sustained some pretty massive skin tears on her lower back, most likely from handling her and placing her in the case as I had done many times before. It was clear that the Trilostane had suddenly become less effective. We agreed with the vet that the most humane thing to do at this point would be to put her to sleep, and she died peacefully in our arms that evening.

I am always open to discussing anything further or answering any questions to the best of my ability based on my own experiences.

To anyone reading this in the future, I will just say - my heart goes out to you for having to deal with this. It's such an awful rare / under-diagnosed disease to see your cat go through. And you are a great person for taking care of your cat as best as you are able to. As you might have heard others say, this disease, specifically the adrenal type, is very difficult to manage with medicine alone. If you have the means to, and if surgery is viable, definitely look into having that done as early as you can.

EDIT- I had originally put that she had “ACTH suppression test(s)”, but meant to say “dexamethasone suppression test”. This is the gold standard for diagnosing Cushing’s. She did have an ACTH test prior to this.
Click to expand...
This sounds so similar to my story with Frosty. The meds worked for a few months, until they didn’t. We dealt with skin tears, and by the end of his life they were so bad that there was no way they could have healed. Unfortunately I waited too long to put him down and he died in my arms at the vet before they could give him the drugs. You did the right thing. Thank you for sharing your story, and I’m so sorry for your loss and what you went through. :bighug:
 
crambywamby said:
Hi everyone,

I've never posted, but I used to lurk last year when I was figuring everything out for my cat Petra. Certain threads even led me to reach out directly to another member whose cat had Cushing's, so I really appreciate this resource. My beautiful tabby was put to rest at 5 1/2 years old, nearly a year after her Cushing's diagnosis. I wanted to help anyone out in the future who may stumble upon this thread. I'd be happy to respond to any questions and offer whatever support I can.

Her Cushing's was the form caused by an adrenal tumor, on the right adrenal gland to be specific. It was around 2cm at the time of her diagnosis, but had grown to 3cm by the time she passed.

We first took her to the vet in January of 2019 because she had rapidly gained weight and was excessively drinking and urinating. After a basic blood test, she was first diagnosed with diabetes. We spent that first month attempting to regulate her blood glucose, shuttling her back and forth to the vet weekly for rechecks. Increasing the dosages of insulin seemed to do nothing and we scheduled her to spend a day at the vet for a BG curve.

Meanwhile, in mid-February I noticed a fresh wound on her upper back that she likely sustained from grooming. It looked like the classic Cushing's skin tear, though when I took her back to the vet they weren't aware of what it might be and considered that she might have burned herself or that it was a reaction to a too-high dose of insulin. A week later, she had another tear on her arm around the same spot. She also had a bout of diarrhea and needed to be cleaned and, not realizing quite yet how thin her skin was, I scruffed her while putting her in the sink. Doing that caused a pretty significant tear in her skin, and it was at that point that I realized that something was really wrong with her.

We were referred to see a specialist in mid-March and they conducted a dexamethasone suppression test to test her cortisol levels, and an ultrasound. They were able to confirm Cushing's due to her adrenal tumor. Her vet and a surgeon discussed the surgery with us and the possible complications and risks involved, especially because of the fact that her tumor was already quite large. The surgery quote was pretty expensive, and we elected to treat her with Trilostane and wait for her insurance period to roll over again the following January while we put some money aside. We knew at this point that Trilostane could possibly not work and that the only cure would be to remove the tumor.

She thankfully responded well to Trilostane 10mg, and her skin wounds, which had been open since she sustained them, quickly began to scab over and heal. Curiously, she never grew hair back in the areas where she was shaved while the vets were treating the wounds, but she DID grow hair in the exact places where the wounds healed.

From April until October, she did quite well. She lived in a onesie and soft cone that we ordered off of Amazon. She had basic bloodwork and repeat dexamethasone suppression test every 3 months, which showed that her cortisol levels were controlled. We tried to control her difficult diabetes as best as we could, but it was difficult to get her any lower than the 200-300 range, because a higher dosage sometimes made her blood sugar TOO low. I think it all depended on how active the tumor was being.

In October she developed a suspected neuropathy in her tail, and she began to attack it. We took her for an ER visit the first time it happened and her bloodwork showed that her potassium and liver values were going bad. She had another ER visit a few weeks later after spending a night unable to eat or drink without vomiting. We started giving her Gabapentin for the tail neuropathy to mixed results. From this point on, it became a delicate balance of keeping her in her small soft cone (for comfort and ability to drink and eat), to switching her to a large hard cone to prevent her from biting herself. She could go weeks at a time without biting herself, and then would suddenly start again.

At this point, we decided to consult the surgeon again and plan to have her surgery in January 2020. She had a CT scan at the beginning of December, which showed that the tumor had not metastasized to any other organs, but that it had grown to about 3cm. It was very close to the vena cava, a major artery that made the surgery particularly risky. Her surgeon said that there was a very significant chance that she would die during surgery, and that if she survived she may have needed to spend a week in recovery. We decided not to go forward with surgery and instead try to make her as comfortable as possible while she was still with us.

I had made a follow-up appointment with her vet for this past weekend (February) to discuss her future and see if any anti-anxiety medications could be useful for the tail issues, since her bouts did seem to be triggered by environmental stressors, being hungry, etc. I had noticed that her skin began to look red and very thin in the areas where she had previously had wounds months ago. Unfortunately, when I took her out of the carrier case, I noticed she had sustained some pretty massive skin tears on her lower back, most likely from handling her and placing her in the case as I had done many times before. It was clear that the Trilostane had suddenly become less effective. We agreed with the vet that the most humane thing to do at this point would be to put her to sleep, and she died peacefully in our arms that evening.

I am always open to discussing anything further or answering any questions to the best of my ability based on my own experiences.

To anyone reading this in the future, I will just say - my heart goes out to you for having to deal with this. It's such an awful rare / under-diagnosed disease to see your cat go through. And you are a great person for taking care of your cat as best as you are able to. As you might have heard others say, this disease, specifically the adrenal type, is very difficult to manage with medicine alone. If you have the means to, and if surgery is viable, definitely look into having that done as early as you can.

EDIT- I had originally put that she had “ACTH suppression test(s)”, but meant to say “dexamethasone suppression test”. This is the gold standard for diagnosing Cushing’s. She did have an ACTH test prior to this.
Click to expand...

Thank you for all of your information and I am so sorry about the trauma and loss of your Petra. I am dealing with an old cat with possible Addison's, which is kind of the opposite of Cushing's. She had the ACTH test that was suggestive but not definitive but we are treating her for it as well as her long term DM. It seemed to help for a while but she is failing again and we are grasping at straws. The help on this website has been tremendous and I am very grateful. It is generally believed that these adrenal conditions are rare in cats but testing is rare, so maybe it is not as rare as they believe. Your sharing was very helpful for me with Lulu and I hope better diagnosis and treatment will be available in the future.
 
Oh I am so very sorry about your loss of adorable Petra. That is such a difficult and sad story to read, although the love I perceive in the story of Petra is beautiful. I can see how much you loved her. It is so difficult when we fight so hard to win against a disease for our beloved cats; it takes a lot out of us when they pass away. Take care of yourself.

Thank you for sharing Petra’s story here because I think you will really help other cats and their caregivers.
 
You must log in or register to reply here.
Back
Top