Update on Jack - Cushing's and Diabetes

Jack had his ultrasound yesterday. They did not see a tumor on the adrenal glands, there wouldn't have been concern of cancer, they're just narrowing down the reasons for high cortisol levels. After the ultrasound they completed a cortisol blood test, which did confirm the Cushing's diagnosis. His blood sugars during fasting were 565. We're going to increase his insulin from 5 units twice a day to 8 units twice a day. We are going to start on a medication called Mitotane. This is the scary part. The Mitotane will help reduce his cortisol levels by destroying parts of the adrenal glands. But it can be life threatening if it gets too low. And the symptoms of that are pretty much the same as his Pancreatitis episodes. It's all so overwhelming.

Below is some info that I found on the Mitotane research I've done so far. I don't have all of the answers yet, but I'm compiling a list of questions to discuss next week with the Dr. My comments are in italic.

Mitotane and trilostane therapy are effective and relatively safe in dogs with adrenal-dependent hyperadrenocorticism. Dogs with adrenal tumors however, tend to be more resistant to mitotane and trilostane than dogs with pituitary-dependent hyperadrenocorticism. This is why we didn't want a tumor!

Dogs with Cushing's disease have elevated levels of cortisol, which increases triglycerides and cholesterol. To help combat these increases, a food that's lower in fat (less than 12 percent on a dry matter basis, or DM) and moderate in crude fiber (8-17 percent DM) is reasonable. But as you'll see below, it's preferred that you give the Mitotane with a food that is high in fat.

The basis for increased panting in dog's with Cushing's disease is multifactorial. First, Cushing's disease results in increased fat deposits in the abdominal cavity and around the chest. This might explain the fatty deposits he began getting a few years back. I'll have to reach out to his prior vet and request his records.

Second, an increase in liver size impedes the diaphragm from being able to expand with ease. Mitotane, also known as o,p’-DDD (brand names: Lysodren®, Lisodren®) is an anticancer medication that is toxic to the adrenal gland cells and is used to treat hyperadrenocorticism (Cushing’s disease) or adrenal gland carcinoma. Its use in dogs and ferrets to treat adrenal disorders is ‘off label’ or ‘extra label’. Many drugs are commonly prescribed for off label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions very carefully as their directions may be significantly different from those on the label.

Mitotane is given by mouth in the form of a tablet. It should be given with food, preferably one high in fat. Your veterinarian may provide you with a high fat pet food, or you can give the medication with a little corn oil, butter, or cheese. Wear gloves when administering this medication and do not allow the medication to come into contact with your skin, eyes, or mouth. Wear gloves when handling your pet’s urine, feces, or vomit, as the drug may be present.

The following medications should be used with caution when given with mitotane: central nervous system (CNS) depressant drugs, fentanyl, insulin, midazolam, phenobarbital, selegiline, spironolactone, or warfarin. Your veterinarian will monitor your pet to be sure that the medication is working by monitoring clinical effects and performing regular ACTH response tests. Your veterinarian may also monitor liver and kidney values, blood cell counts, blood sugar levels, and blood electrolytes. Regular monitoring at home for adverse/serious side effects is very important in addition to regular monitoring by your veterinarian.


Recommended Facebook Groups: Support group for owners of dogs with Cushing’s disease Dogs with Cushing’s support and information Canine diabetes support and information