#92: Cushing’s: Diagnose like a pro, and treat it like you mean it. With Dr Sue Foster

Who feels like Cushing’s is a nice disease to diagnose and manage? Like, how often do you feel like your hyperadrenocorticism patients are really doing REALLY well? My guess is: not that often. This episode will change that. 

Dr Sue Foster is a registered specialist in Feline Medicine and Senior Lecturer in Small Animal Medicine at Murdoch University in Western Australia. She’s also a medical consultant for Vetnostics and ASAP Laboratory, where a large part of her role is interpreting cortisol test results and supporting veterinarians in their clinical decision-making. In this conversation, Dr Sue challenges the belief that Cushing’s is to some degree a ‘lifestyle’ disease that doesn’t always need to be treated, we discuss the subtle ways that it can present, and of course we take a deep dive into those slippery cortisol tests, which should feel a lot less slippery after this episode. Dr Sue also presents a paradigm shift in how we think about treating these cases.

Topics:

0:00 Understanding the cortisol lab tests. 

4:40 ACTH stim vs LDDT – which is better? 

10:28 The TRUE significance of ALP in diagnosing Cushing’s.

13:30 Fasting triglycerides – your friend in Cushing’s screening? 

16:26 Deciding when to test for Cushings .

18:27 More on triglycerides and lipaemia 

23:52 Why Cushing’s cases don’t all have to have pu/pd. 

26:04 The many different faces of Cushing’s – spotting the sneaky hyperA case .

29:42 Why we should consider treating Cushing’s even if they aren’t textbook cases. 

31:41 Cushing’s and anxiety.

35:40 The dog with the high ALP but no clinical signs of Cushing’s.

39:44 Treatment trials for the ‘undiagnosable’ Cushing’s case.

45:13 Monitoring Cushing’s therapy with ACTH stim testing. 

52:30 The quick and easy ACTH stim test. 

56:20 Treating Cushing’s like a pro. 

This episode is supported by the SVS Pathology Network. 

QML/TML Vetnostics (QLD & Tas): 1300 838 765 vetnostics@qml.com.au

Vetnostics (NSW & ACT): 02 9006 7468 enquiries@vetnostics.com.au

ASAP Laboratory (VIC): 1300 838 522 admin@asaplab.com.au

Vetpath (WA): 08 9317 0777 admin@vetpath.com.au

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