Adrenalectomy

[chiquito]

Hi

I would like to know if anyone in the forum has gone through an adrenalectomy and how was the experience.

Our little guy is 13.5 yo maltese cross and was diagnosed with a functional adrenal tumour / nodule which causes cushings after blood and urine tests, ACTH and ultrasound.

Then we went to a specialist in North Ryde that check him up and explained details of the surgery. We scheduled the surgery for the 11th of Nov.

Now after reading some experiences in other forums we've been having second thoughts if going with the procedure is the right thing to do. He has mild clinical signs: doesn't drink more water than normal but he eats a bit more than before. He urinates a bit more. Doesn't have a round belly but lost a small area of hair on his side that quickly recovered after using malaseb (at that point we didn't know he could have cushings) and now has full normal coat. There is some weakness in the muscles as I notice he takes stairs with care - one step at a time - instead of running up and down as he used to. Some days he's a bit lethargic but normally he's active and enjoys his walks.

We'll be grateful if we could read experiences in Australia about this procedure (most of the ones we had read are in USA).

Thank you

[blacklabrador]

Sorry to hear that your little dog is having problems. I would think very seriously about major surgery on a dog that age, particularly if he is essentially a well dog. I would seek a second opinion from a vet that you trust.

[Poodle wrangler]

Some vets are much more interventionist than others.

> 13 is a nice age.

If he can have a good quality of life without surgery for another couple of years, why do it?

Have good talk with your vet, so you can make an informed decision.

S/he is the best one to talk to as they know your dog's condition.

[Loraine]

I would think hard about surgery at your wee dog's age. Adrenal Cushing's can be easily treated with either Trilostone or Lysodren. These can be in pill or liquid form. If you have an adrenalectomy done you still end up having to medicate the dog daily with cortisone drugs to replace what the adrenals would normally produce.

I think I would be more worried about the effects of anasthetic on a dog of 13, as it is a big operation followed by lots of testing to get the cortisol, potassium and elctrloyte levels right.

[Kelly_Louise]

I agree with Loraine... at 13.5 years of age I would be considering medication to treat the symptoms over surgery. Will give him good quality of life. Once on medication the symptoms should resolve very quickly (the coat may take a bit longer to recover).

My girl has pituitary dependant Cushings, has been on meds for 2 years now and when on the correct dosage she is a happy and well dog.

But regardless of which way you go, I would definitely treat. The symptoms will get worse over time and put pressure on other organs - eventually over time becoming fatal, in the meantime the pet is uncomfortable.

Discuss the alternatives and your concerns about surgery with your vet, medications etc... there may be a reason that the surgery was thought the best treatment? Otherwise, they have some great specialists at The Animal Referral Hospital in Strathfield - they look after my baby and do a fabulous job... I trust them 100% with her life and care.

[Cavalier]

A large percentage of adrenal tumours are malignant and can grow very quickly (therefore clinical signs will worsen) and spread to other areas of the body.

Adrenal Cushings does not respond as well as pituitary cushings to trilostane/mitotane therapy.

IMHO, to give your dog the best chance, especially if he is in otherwise good health, I would go ahead with the surgery. I would if it was my dog.

[chiquito]

Thank you so much for your replies.

As Cavalier pointed out and as we've been told by the vets the drug treatment for adrenal based cushing's needs to be much more aggresive than the pituitary based cushing's. That makes it a lot riskier and does not necessarily improves the quality of life. That's why the vets we saw thought that the best alternative was the surgery. Our vet actually said that they have never treated with drugs an adrenal based cushing's. But I've read in other forums that many people has done this and successfully treated the symptoms for a few months, even over a year.

The tumour is in the left gland which is more accessible than the right gland. And the statistics are not that bad either with an approx 70% post operative survival. However, most of the accounts we have read in other forums are very very dim. It also seems to be a procedure that is not perfomed often. That's why we wanted to know about experiences here in Australia.

We will get a second opinion, most likely we will try to go to the ARH in Strathfield as Kelly Louise advised - as it's also close to home. But still we'd like to hear about others that have gone through this procedure.

Thank you again for your advise and care.

[chiquito]

Hi again!

Just wanted to update and share the experience as it may help someone in a similar situation.

We decided to do some more tests and consult an specialist before the operation. We did a new ultrasound (first one was done mid september) and new blood tests, urinanalysis, x rays and a ACTH supression test which is done with three blood samples four hours apart. The idea was to assess our Chiquito's general health (ie liver, lungs, if tumour had grown, etc) before putting him through the procedure. Luckily (a miracle i would add here) everything came back clear: there is no growth of the tumour, even more, it appears to have shrinked. The ACTH came back negative, that is his cortisol levels are within normal range. His lungs are fine (we were concerned that if it was cancer it would've spread to his lungs). The liver seemed OK however enzymes were high but as high as before, not worse. All this meant that for the time being there is no need to do the adrenalectomy and not even for medication. All these tests were done before going to the specialist so when we called her she said that we should re do tests in 3 months and see where we are at then. Because as it went away it also may come back. For now, however, we couldn't be happier because we thought there was a real chance of losing him right after the operation.

I'm not sure what happened. Perhaps the first tests were false positives or perhaps this disease can enter in remission. Our vet is also very surprised with the outcome.

The only thing that changed during the six weeks between the first ACTH and the second was his diet from commercial dry and meat rolls to home cooked and raw, plus some hills i/d dry and RC sensitivity control.

The change in diet came along because he wasn't tolerating his food any more and was having explosive diarrhoea.

Our vet thinks that diet may play a powerful role in some cases of cushing's disease.

Now we have the next three months to forget about tests and the waiting game and hope the disease doesn't come back.