Shishi unable to regulate BG, skin lesion pics, need advice

[will and shishi]

Hello All on the Health forum.

I am linking a post I have mode in the lantus tight regulation forum for additional exposure and input regarding regulation and skin lesion issue.

She has a new onset of symptoms which involve hair loss and skin lesions, extremely thin skin and lots of thirst for water and peeing lots, even more than she was unregulated. I am rather convinced that it could be cushings, but the vet suggest that it is so rare, and testing for it is not 100%. I will upload pictures for your opinions, they are not the best quality photos but should tell the story.

viewtopic.php?f=9&t=58110

 

[Dale]

Re: Shishi unable to regulate BG, skin lesion pics, need adv

If you suspect Cushings but the vet poo-poo's you, send her Dr. Lisa's research on Cushings which I've pasted below. My friends vet said it couldn't be cushings until she followed Dr. Lisa's advise and did further testing. Definitely Cushings. Taking the med for it (trilostan) and the cat is doing so much better and growing hair and diabetes more regulated. From the pics you sent, that looks to me more like itching caused by an allergy (fleas, food) rather than the tearing of skin due to cushings. But if she has the pot belly and fragile skin with tearing so bad that it peels away from the body, then I'd ask the vet to do the other tests Dr. Lisa lists. FWIW.

Re: Cushing's - symptoms and diagnosis?
by Lisa dvm » Fri Dec 24, 2010 10:03 pm

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.
Lisa Pierson, dvm