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website:http://www.petplace.com/cats/hyperadrenocorticism-cushing-s-syndrome-in-cats/page1.aspx
tuitary dependent hyperadrenocorticism.
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Diagnosis
Cushing's syndrome is not a diagnosis that should be made solely on the basis of laboratory testing. Both historical information and physical exam findings are equally important in establishing a diagnosis and directing appropriate laboratory testing. Since the majority of cats with Cushing's syndrome are insulin-resistant diabetics – which means they have a poor response to insulin – a poorly regulated diabetic may prompt a clinical suspicion of hyperadrenocorticism. Diagnostic tests include:
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Treatment
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After the removal of both adrenal glands, cats continue on medication for the remainder of their lives. Follow your veterinarian's instructions very carefully when administrating medications.
Diabetic cats almost always have changes in their insulin requirements. Monitor for changes in water consumption and amount of urine produced.
In the immediate postoperative time, frequent blood tests are needed to monitor the cat's blood glucose and electrolytes. Insulin requirements and oral medications need to be adjusted on the basis of laboratory tests. Once stable, cats need to be evaluated at least several times a year.
Observe for any weakness, disorientation, lethargy, vomiting or diarrhea or any changes in your cat's attitude.
Preventative Care
If your cat is a diabetic that is difficult to regulate, Cushing's syndrome (although rare) may be the cause.
Section: Information In-depth
In feline Cushing's disease, elevated cortisol levels are caused by either a pituitary tumor producing increased ACTH orby an adrenocortical tumor directly producing elevations in cortisol. Chronically elevated cortisol levels may predisposea cat to become a diabetic; cause muscle atrophy and weakness; cause skin to be more fragile – even to the extentof bruising or tearing with minor manipulation; cause suppression of the immune system; and changes in the bodyconformation.
Other diseases that might cause similar clinical signs include:
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Section: Veterinary Care In-depth
Diagnosis In-depth
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cats, but this may also be elevated from the concurrent diabetes. Cats lack the specific steroid-induced isoenzymefound in the dog that produces the increase in this enzyme. Other liver enzymes and cholesterol may also beelevated in the cushingoid, diabetic cat.
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Therapy In-depth
Feline hyperadrenocorticism is a very debilitating disease. Stabilizing any secondary complicating diseases should be attempted before treating the Cushing's disease. Concurrent urinary tract infections require antibiotics. Diabetes is often difficult to regulate appropriately, but attempts to stabilize and decrease blood sugar to the safest levels should be attempted. Since feline Cushing's syndrome is so uncommon, only a limited number of cats have been managed. Medical therapy with a variety of drugs has been shown to be of only limited value. The surgical option seems to provide the best long-term prognosis for these cats. Treatment options that have been tried include:
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If pituitary dependent Cushing's disease is confirmed, then both adrenals are removed. Intravenous fluids are given aggressively, as well as intravenous nutrition. In the diabetic patient, the blood sugar needs to be carefully monitored, and fast acting regular insulin is given as needed. Postoperative antibiotics are commonly given, as sepsis (blood infection) is a common complication. Blood electrolytes (specifically potassium, sodium and chloride) need to be monitored closely and medication adjusted to stabilize their levels. Managing the postoperative cat is challenging and usually requires specialized care.
Optimal treatment for your pet requires a combination of home and professional care. Follow-up can be critical,especially if your pet does not rapidly improve. Administer all prescribed medications as directed. Alert yourveterinarian if you are experiencing problems treating your pet.
The surgical treatment of removing both adrenal glands in the cat with Cushing's disease creates another condition,Addison's disease (hypoadrenocorticism), which requires life long medications and very close monitoring.
Glucocorticoid therapy with prednisone will be required since your cat is no longer producing cortisol. It is usuallypossible to decrease the dose of prednisone down eventually to very small maintenance dosages. When decreasingthe dose it is important to monitor for increased lethargy, anorexia or weakness. Notifying your veterinarian andincreasing the prednisone dose usually improves the symptoms if they are being caused by a cortisol deficiency.
Additionally, life long replacement therapy with the mineralocorticoid, fludrocortisone acetate (Florinef) is required.
This drug maintains the normal electrolyte balance of sodium, potassium and chloride. Frequent blood tests areneeded, especially for the first few weeks postoperatively. Adjustments in medication are made on the basis of theelectrolyte results. Florinef is increased if the blood potassium is elevated. If needed, salt may be added to the diet toelevate blood sodium and chloride levels.
Injectable mineralocorticoids (desoxycorticosterone pivalate or DOCP) can be given as a monthly injection instead ofthe daily oral medications.
Since most cats are diabetics, the blood sugar level will need to be closely followed. Once the Cushing's disease iscontrolled, it is common for insulin requirements to decrease dramatically. Watch for changes in drinking, urination andattitude. You will need to work closely with your veterinarian to decrease insulin dosages and to avoid a hypoglycemic(low blood sugar) event. Watch for weakness, disorientation or seizures, as they may indicate a low blood sugar.
After the first several weeks postoperatively, the long-term prognosis is good.
·
Diagnosis
Cushing's syndrome is not a diagnosis that should be made solely on the basis of laboratory testing. Both historical information and physical exam findings are equally important in establishing a diagnosis and directing appropriate laboratory testing. Since the majority of cats with Cushing's syndrome are insulin-resistant diabetics – which means they have a poor response to insulin – a poorly regulated diabetic may prompt a clinical suspicion of hyperadrenocorticism. Diagnostic tests include:
·
·
·
·
·
·
·
·
Treatment
·
·
After the removal of both adrenal glands, cats continue on medication for the remainder of their lives. Follow your veterinarian's instructions very carefully when administrating medications.
Diabetic cats almost always have changes in their insulin requirements. Monitor for changes in water consumption and amount of urine produced.
In the immediate postoperative time, frequent blood tests are needed to monitor the cat's blood glucose and electrolytes. Insulin requirements and oral medications need to be adjusted on the basis of laboratory tests. Once stable, cats need to be evaluated at least several times a year.
Observe for any weakness, disorientation, lethargy, vomiting or diarrhea or any changes in your cat's attitude.
Preventative Care
If your cat is a diabetic that is difficult to regulate, Cushing's syndrome (although rare) may be the cause.
Section: Information In-depth
In feline Cushing's disease, elevated cortisol levels are caused by either a pituitary tumor producing increased ACTH orby an adrenocortical tumor directly producing elevations in cortisol. Chronically elevated cortisol levels may predisposea cat to become a diabetic; cause muscle atrophy and weakness; cause skin to be more fragile – even to the extentof bruising or tearing with minor manipulation; cause suppression of the immune system; and changes in the bodyconformation.
Other diseases that might cause similar clinical signs include:
·
·
Section: Veterinary Care In-depth
Diagnosis In-depth
·
cats, but this may also be elevated from the concurrent diabetes. Cats lack the specific steroid-induced isoenzymefound in the dog that produces the increase in this enzyme. Other liver enzymes and cholesterol may also beelevated in the cushingoid, diabetic cat.
·
·
·
·
·
·
Therapy In-depth
Feline hyperadrenocorticism is a very debilitating disease. Stabilizing any secondary complicating diseases should be attempted before treating the Cushing's disease. Concurrent urinary tract infections require antibiotics. Diabetes is often difficult to regulate appropriately, but attempts to stabilize and decrease blood sugar to the safest levels should be attempted. Since feline Cushing's syndrome is so uncommon, only a limited number of cats have been managed. Medical therapy with a variety of drugs has been shown to be of only limited value. The surgical option seems to provide the best long-term prognosis for these cats. Treatment options that have been tried include:
·
·
·
·
If pituitary dependent Cushing's disease is confirmed, then both adrenals are removed. Intravenous fluids are given aggressively, as well as intravenous nutrition. In the diabetic patient, the blood sugar needs to be carefully monitored, and fast acting regular insulin is given as needed. Postoperative antibiotics are commonly given, as sepsis (blood infection) is a common complication. Blood electrolytes (specifically potassium, sodium and chloride) need to be monitored closely and medication adjusted to stabilize their levels. Managing the postoperative cat is challenging and usually requires specialized care.
Optimal treatment for your pet requires a combination of home and professional care. Follow-up can be critical,especially if your pet does not rapidly improve. Administer all prescribed medications as directed. Alert yourveterinarian if you are experiencing problems treating your pet.
The surgical treatment of removing both adrenal glands in the cat with Cushing's disease creates another condition,Addison's disease (hypoadrenocorticism), which requires life long medications and very close monitoring.
Glucocorticoid therapy with prednisone will be required since your cat is no longer producing cortisol. It is usuallypossible to decrease the dose of prednisone down eventually to very small maintenance dosages. When decreasingthe dose it is important to monitor for increased lethargy, anorexia or weakness. Notifying your veterinarian andincreasing the prednisone dose usually improves the symptoms if they are being caused by a cortisol deficiency.
Additionally, life long replacement therapy with the mineralocorticoid, fludrocortisone acetate (Florinef) is required.
This drug maintains the normal electrolyte balance of sodium, potassium and chloride. Frequent blood tests areneeded, especially for the first few weeks postoperatively. Adjustments in medication are made on the basis of theelectrolyte results. Florinef is increased if the blood potassium is elevated. If needed, salt may be added to the diet toelevate blood sodium and chloride levels.
Injectable mineralocorticoids (desoxycorticosterone pivalate or DOCP) can be given as a monthly injection instead ofthe daily oral medications.
Since most cats are diabetics, the blood sugar level will need to be closely followed. Once the Cushing's disease iscontrolled, it is common for insulin requirements to decrease dramatically. Watch for changes in drinking, urination andattitude. You will need to work closely with your veterinarian to decrease insulin dosages and to avoid a hypoglycemic(low blood sugar) event. Watch for weakness, disorientation or seizures, as they may indicate a low blood sugar.
After the first several weeks postoperatively, the long-term prognosis is good.