Laurie's Blogs.

Hi Laurie

I'm seeing a old dog with Cushing's. He's lost a lot of muscular mass and I'm wondering if you have treated a dog with Cushing before and if they can regain muscular mass.

Thank you

Ciao! - G.L.

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Hi G.,

So I actually gave a talk on Red Flags & Concerns (in the Geriatric Dog) in Italy at a conference… and one subtopic is Cushings.  Check out Training Videos 45 & 46  & the Article of the same in the Geriatrics section in the Articles area.)  But to cut and paste from that talk:

Hyperadrenocorticism / Cushing’s disease

Incidence of hyperadrenocorticism (aka Cushing’s disease) generally increases with age (Boari & Aste 2003).  The average age of onset is 10 years.  In 85% of cases, a pituitary tumour secretes corticotrophin (ACTH), whereas adrenal tumours account for the remaining 15% of cases.  In either case, the clinical signs are relatively similar.  A large pituitary tumour can cause neurological signs such as stupor, disorientation, head pressing, pacing, circling, alterations in behaviour, seizures, ataxia and blindness.  Other signs may include polyphagia, polyuria, lethargy / weakness, panting, weight gain (usually accompanied by a large pendulous abdomen), or dermatological abnormalities (including alopecia, comedones, hyperpigmentation, and calcinosis cutis.)

Diagnosis of Cushing’s disease involves routine blood work: a stress leukogram, increased levels of serum alkaline phosphatase (ALP), alaninotransferase (ALT) activities, hypercholesterolaemia, and lipaemia (Boari & Aste 2003).  Further diagnostics may include the urine cortisol:creatinine ratio test, low-dose dexamethasone suppression test, and the corticotrophin stimulation test, as well as a CT, MRI, or abdominal ultrasound to determine whether the cause is pituitary, adrenal or both.  Pharmacologic treatment is usually the course of action.

These dogs may present to rehab for weight management, deconditioning, or as a complicating factor to a primary injury.  Gains in functional abilities can only be made if the dog is medically managed properly.  

The most important line for us as rehab therapists is that essentially, you won't make any gains unless the animal is well controlled medically.

Even as such, they are slow to progress and seem to hit a plateau... however, doing something is better than nothing - even if all you accomplish is Maintenance!!!

(I've had some frustrating post-op TPLO cases... but the owners are happy just to keep them going & keep them active... so we do the exercise therapy to help as best we can!)

I hope this helps... nothing magical I'm afraid!

Cheers! - Laurie