Cushing’s disease in dogs can be really easy to spot sometimes, we’ve all seen it: the scruffy looking, pot-bellied, panting and incessantly drinking dog. Or so we think. In the members’ webinar last week, we looked at “Difficult cases of Cushings” with Ian Ramsey BVSc PhD DSAM DipECVIM-CA FHEA FRCVS.
I will say that I’m biased here, I was a student of Dr. Ramsey in my University career but this webinar is really quite wonderful. I love to have resources available for when a patient doesn’t quite fit in with any specific disease process. It keeps me prepared and helps me get out of a rut. so this webinar was promptly bookmarked in my internet browser!
The general plan of the webinar is as follows:
– Unusual clinical signs
– Test results not matching with appearance
– Adrenal tumours
– Pituitary macroadenomas
– Concurrent conditions
There are a few polls through the webinar as well, although we don’t get to see the results. It’s quite useful to do self-tests with the questions as the answers are talked through right after.
Who knew that Cushings’ can cause neurological effects?
As a new graduate, Cushing’s disease sounded like it always presented with alopecia but as Dr. Ramsey states: only 30-50% of Cushingoid dogs have dermatological change. That’s a whole 50+% that don’t. We go over the unusual clinical signs in the first part of the webinar. Particularly haemostatic, reproductive, neurological and diabetes among others. These are further specified in the webinar but if I just stated them, that would be no fun!
What you see is not always what you get.
We also get walked through the confusing times when the testing doesn’t match up with what we’re seeing. We covered this in another webinar about lymphoma. Of course further testing is advantageous but as the clinician, you’re the one with the hands on the animal. You decide whether what the tests say fit with what you’re seeing. There’s a reason there are reference ranges rather than reference values!
Dr. Ramsay also reviews the importance of ruling out concurrent diseases that may be confounding results. Simple in-house tests such as urinalysis, biochemistry, and haematology can rule out processes such as diabetes or UTI’s that can cause confusion. Radiography can very easily expose concurrent conditions that we may have missed if we jump straight to the trilostane.
Seeing things clearly.
It’s also important that we differentiate between the causes of Cushings’. We can do this through the ACTH assay (high dose dexamethasone suppression test is reducing in popularity) and diagnostic imaging. This can include radiography, ultrasound and if you have access, CT and MRI. The importance is because it can affect treatment and in the case of pituitary macroadenomas, can cause further issues if not identified.
Lurking in the shadows
There are so often things going on in the body that we don’t realise until we do some digging. If you even think of cryptorchidism, I’ve heard of folk missing out on a diagnosis because they forget to palpate both testes. It seems obvious but we’re all human, and if we’re focusing on one diagnosis we may miss another. It’s particularly essential that we notice and diagnose these concurrent issues as some may be steroid responsive. We learn that heart, renal, and liver/biliary tract disease can all be affected when we start fiddling with the steroid levels – like in treatment for Cushing’s disease!
To wrap it up
I loved this webinar and I’ll be keeping it in my back pocket. It’s another great reminder not to hyper-focus on one thing or another in the clinical exam and instead to keep an open mind. If you’d like to have a watch of the webinar, you can find it here.
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