Probable cushing’s

Jaxie

Jaxie

New Member
Hello I’m still new to the forum and still trying to get my feet under me after the last couple of weeks. My cat may have cushing’s and I’m looking for questions that I should be asking the internist that I see next week as well as anyone’s experiences with cushing’s in their cats (and any commiserations are welcome, diabetes felt isolating enough, now an even rarer thing to deal with!)

A bit about my kitty, whose name is Cat (named after the cat from Breakfast at Tiffany’s):
Since 2021, he’s had a couple of cysts in his back that have become infected and exploded (health issue one). About a month and a half ago, he had a tear in his side that healed very well. Two weeks ago he had the same tear (I’m starting to suspect it was from a brush that would pull his already thin skin) so my vet started sent blood work and a thin skin biopsy. The blood work showed elevated levels of glucose in his blood and HIGH (55 mmol) glucose in his urine. It also showed a UTI (that seems to have cleared). The Cushing’s test came back negative and I was so relieved. The thin skin test showed he did have thin skin but it wasn’t cancer. Based on the elevated glucose, my vet prescribed 2 units of caninsulin twice a day. He got the evening dose that night and only 1 unit in the morning because I was terrified that he would go hypo since he’s not a cat that eats large meals. My vet and the tech dismissed the concerns and just told me to have maple syrup around. That day he became lethargic and wasn’t responding very much and he could barely keep his eyes open. I stuff as much sugar and carbs into him as I could and when I thought he was more stable I took him to the emergency vet to confirm for the night (my monitor wasn’t coming for another two days). After that we moved to see if we could control it with diet alone. I had already decided to get a second opinion so I managed to find another vet close-ish to me that had a 4.9 rating on a bunch of reviews on google and their sister clinic was aaha accredited even if they weren’t. The vet took a look at him and then consulted with an internist. The internist said that they would not give insulin to him as he was never consistently above 17 mmol (he averages around 13/14, and has only been 17 and 17.7 twice). The second vet said that she had never seen a diabetic cat with such bad skin. The internist said that this looked like cushing’s to them and that the urine test that my vet had done is just a moment in time snapshot and usually unreliable, especially in cats. They suggested I see an internist. This was yesterday. I somehow lucked out and was able to book an appointment with an internist for next Friday.

Has anyone had experiences with cushing’s in their cats? What did treatment look like? I know there are two kinds. Did/do you kitties lead happy lives with treatment? I’m looking for any experiences at all. I’m a wreck about this because he’s been my baby for the last 13 years and holds a very strong connection to my mom who passed away. I just want to make sure he’s okay and happy and healthy.
 
Hello and welcome. Waving from the west coast of BC. :) We don't have too many currently active members with Cushing's kitties or experience with one, but will tag one @manxcat419

Jaxie said:
The Cushing’s test came back negative
Click to expand...
Can you tell me the name of the test that was done?

The more common form of Cushings is caused by a pituitary tumour. A pituitary tumour can also cause acromegaly, like my girl had, but it's a different condition and symptoms, other than the diabetes. Does you kitty have any hair loss or pot belly? Those two seem to be common symptoms in Cushings kitties. The pituitary tumour type of Cushings can be treated with Vetoryl. Here is a paper describing one such case: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5912277/pdf/10.1177_2055116918767708.pdf

Regarding the diabetes. First, Caninsulin is not a great insulin for cats. Note the word "Canin" for "canine". Great insulin for dogs. Lantus, Prozinc, or Levemir are all much better cat insulin and last much longer. 2 units is also too high a starting dose for Caninsulin. Seems that vet is a little rusty in their cat diabetes knowledge. Sadly that's not uncommon, vets have to know so many different conditions for different species.

What type of monitor have you ordered? Most of us just use human blood glucose meters. The Freestyle Lite being one such monitor. You want one that just needs a small blood drop and hopefully cheaper test trips.
 
Wendy&Neko said:
Hello and welcome. Waving from the west coast of BC. :) We don't have too many currently active members with Cushing's kitties or experience with one, but will tag one @manxcat419


Can you tell me the name of the test that was done?

The more common form of Cushings is caused by a pituitary tumour. A pituitary tumour can also cause acromegaly, like my girl had, but it's a different condition and symptoms, other than the diabetes. Does you kitty have any hair loss or pot belly? Those two seem to be common symptoms in Cushings kitties. The pituitary tumour type of Cushings can be treated with Vetoryl. Here is a paper describing one such case: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5912277/pdf/10.1177_2055116918767708.pdf

Regarding the diabetes. First, Caninsulin is not a great insulin for cats. Note the word "Canin" for "canine". Great insulin for dogs. Lantus, Prozinc, or Levemir are all much better cat insulin and last much longer. 2 units is also too high a starting dose for Caninsulin. Seems that vet is a little rusty in their cat diabetes knowledge. Sadly that's not uncommon, vets have to know so many different conditions for different species.

What type of monitor have you ordered? Most of us just use human blood glucose meters. The Freestyle Lite being one such monitor. You want one that just needs a small blood drop and hopefully cheaper test trips.
Click to expand...

Thank you so much for your reply, hello from Toronto! The urine test done for cushing’s was the URCc - Cortisol/Creatinine ratio test and it came back 16.10 x 10^(-6). The range for the test was 2 x… to 36 x…

I’m really hoping the (possible) cushing’s is relatively straight forward and when that calms down the diabetes/above normal pancreas will calm down as well. He doesn’t really have a pot belly. I’ve been trying to feed him more than usual as he is technically unregulated diabetic even if it’s at the lower end, so he’s starting to fill out a decent bit. He has lost a lot of muscle though so his legs look so skinny.

I’m hoping he’ll be able to take medication for all this, since he’s 13 and I don’t know how safe it would be for them to operate on him. Do you know what the options are for the adrenal gland type of cushing’s?

I was using the Pet Test monitor by advocate as I found a coupon for it through one of the feline diabetes groups on Facebook. If the internist puts him on insulin and I have to continue testing him more regularly, I’ll probably get the ContourNext monitor.

And yes this vet was definitely rusty with his feline care. I don’t want to disparage them too much because they weren’t awful, just good for run of the mill stuff, especially if you have a young dog. One of the techs was amazing and what you hole every tech will be. But the other one basically said tough my cat had to learn to eat every twelve hours. And I was like lady he’s on antibiotics, has a uti, and a hole in his side. I’m already struggling to give him his antibiotics, what do you want from a 13 year old cat?? So glad I went for that second opinion.
 
I would request an ACTH stimulation test - that's going to be far more accurate than the urine testing you've had done.

My Roxi had adrenal-based Cushings. It's very rare in cats - more common in dogs - but is almost always caused by a tumor on one of the adrenal glands. The treatment is to remove the tumor and the affected adrenal. The tumor should be visible on ultrasound, although you'll probably need to have the ultrasound done by a specialist as the adrenals themselves are very small and can be difficult to image by a regular DVM. Our regular DVM was able to see "something not right" but couldn't confirm what it was or where it was...and for a cat adrenal tumor, Roxi's was huge and was close to impacting the artery. This type of tumor is generally malignant, but doesn't usually metastasize. It can grow locally, of course, and the major risk is that it starts to involve the artery that runs to the kidney, which of course becomes fatal in very short order.

The specialist who did Roxi's surgery (over 3 years ago now) explained to us that they can do the surgery even in a cat with fragile skin because the tumor causing the fragile skin is removed, so the cortisol level drops immediately post-surgery, making healing possible. Roxi had suffered several skin tears pre-surgery, but healed fine from her incision. Overall, if you do the surgery, the adrenal form of Cushings is easier to resolve fully because you can remove the tumor completely, which resolves the Cushings in one hit. There is a risk that your cat would be left with Addisons (Roxi is now an Addisons cat), but that is easy to treat. Roxi actually doesn't need prednisolone, although all the specialists she's seen are stumped as to how that can be. However she does get a mineralocorticoid shot (desoxycorticosterone pivalate, always abbreviated to DOCP even among veterinary professionals) once a month. That shot can be given at home subcutaneously.

Although I wouldn't say Roxi is healthy as such, that is because of other conditions. Her Addisons is well controlled and easy to control. However, she also has chronic pancreatitis with flare ups, is still diabetic despite being Addisonian (that should be impossible, but she's a cat and they tend to do the unexpected), has SIBO, probable early CKD (that can be difficult to determine fully with an Addisons cat as their kidney values do fluctuate depending on when you draw the blood compared to when their DOCP shot was last given), and also has either IBD or SCL which we are not going to do surgery to determine as the treatment is the same either way.
 
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