decreased mobility

[dodopuffy]

My dog (pekingese) has had two spinal surgeries due to ruptured discs (c 4, 5) and now shows decreased mobility on his right side. The neurosurgeon who did the surgeries before said that my dog has a "cyst" around the injured nerve and there is nothing he can do about it. He then said that my dog's symptoms could be from hyperfunction of its adrenal. Then he ordered ACTH stimulation test. But his resident called back with the result of being "insignificant" then recommended abd ultrasound. His resident said that my dog's cortisol level pre-ACTH injection was lower than normal but it went too high post ACTH injection. So she thinks that my dog still has cushing's and she would like to see if my dog has a tumor in its adrenal by using abd ultrasound. My questions are:
1. Clinical manifestations of Cushing's include decreased mobility? I thought hypofunction of adrenals may cause sluggishness ...
2. Wouldn't it be hypofunction if serum cortisols is low to begin with? Then after ACTH and cortisols increasing showing possible secondary adrenal insufficiency (problem at the pituitary)?
3. My dog is doing better with Metacam. Should I continue using it?

Please help me ...

[dodopuffy]

Thanks for your help. Your opinion really eased lots of my anxiety. You are right. I will not want to put my lovely puffy through a brain surgery. Maybe an ultrasound will help to rule in/out of something.

[Arnold L Goldman, D.V.M.]

Hi,

1. Clinical manifestations of Cushing's include decreased mobility? I thought hypofunction of adrenals may cause sluggishness ...

Typical signs of hyperadrenocorticism (Cushings disease and syndrome) are increased thirst, urination, appetite, skin disease, and sometimes hyperactivity.
Typical signs of hypoadrenocorticism (Addison's disease, opposite of Cushings)
are sluggishness, slow heart rate, weakness, vomiting and a variety of other signs, often very nonspecific. Diagnosis of Cushing's disease may involve a Low Dose Dexamethasone Suppression Test, an ACTH stimulation test and others. Diagnosis of Addison's disease typically involves an ACTH stimulation test.

2. Wouldn't it be hypofunction if serum cortisols is low to begin with? Then after ACTH and cortisols increasing showing possible secondary adrenal insufficiency (problem at the pituitary)?

Not necessarily. Addision's disease (hypo function) is diagnosed not by a low resting cortisol, but rather by the inadequate increase after ACTH induced stimulation. Treatment of the inadequate adrenal function is by supplementing one or both major hormonal components of the adrenal: glucocorticoids if cortisol inadequate, mineralocorticoids if aldosterone inadequate (regulates electrolyte balance)

Most cases of Cushing's disease are related to pituutary hyperactivity and the adrenal hypersecreation is secondary. Since getting at the pituitary is difficult and  risky, management of adrenal hypersecretion is targeted at the adrenal instead. Many fewer cases of hyperadrenocorticism are related to an adrenal tumor hypersecreting cortisol and often other steroid hormone intermediaries, many of which may be biologically active in a variety of ways in their own right.

3. My dog is doing better with Metacam. Should I continue using it?

If your doctor feels an NSAID is necessary, we cannot speculate otherwise here. Your dog's comfort may depend on continued use. It will not affect the endocrine system.


Abdominal ultrasound allows visualization of the adrenals and an enlarged adrenal, if assymetric with the opposite side may indicate an adrenal tumr. If he/she is recommending it, I would follow through and do it.

Good luck.

Sincerely,

Arnold L> Goldman DVM, MS
MedHelp & PDOC