Mastery Pathway: Advanced Canine Cushing's Diagnostics
Go beyond the basics. This structured pathway guides you through the nuances of complex Cushing's cases to build true diagnostic and management confidence.
From Suspicion to Mastery
You've mastered the textbook signs of Cushing's disease, but real-world cases are rarely so clear. This mastery pathway is designed for the curious, growth-oriented clinician ready to tackle the diagnostic gray zones: the atypical presentations, the concurrent illnesses, and the complex monitoring challenges. Follow these modules to build a systematic and confident approach to one of canine medicine's greatest challenges.
The Diagnostic Gray Zone: Beyond Classic Cushing's
Recognizing the Atypical Presentation
Mentor's Note:
Many Cushing's cases don't present with a pot belly and polyuria. This section focuses on identifying subtle biochemical clues and understanding the impact of concurrent non-adrenal illness on your initial workup.
Mastering the Testing Toolkit: LDDST vs. ACTH Stimulation
Choosing Your Screening Test: A Logic Tree
Mentor's Note:
The LDDST is generally more sensitive, but the ACTH Stimulation test is more specific and essential for diagnosing iatrogenic disease. We'll explore a clear decision-making framework for choosing the right initial test for the right patient.
Interpreting Equivocal Results
Mentor's Note:
What do you do with a borderline LDDST result or a mild response to ACTH? This section focuses on building an evidence chain and knowing the logical next step.
The Art of Differentiation: Pituitary vs. Adrenal
Using Endogenous ACTH and High-Dose Dexamethasone Suppression
Mentor's Note:
Once Cushing's is confirmed, the next crucial step is determining if it's pituitary-dependent (PDH) or adrenal-dependent (ADH). This section covers the biochemical tests that provide this vital information.
The Role of Abdominal Imaging
Mentor's Note:
Biochemical tests provide the 'what,' but imaging provides the 'where.' Learn when and how to integrate ultrasound to visualize the adrenal glands, a critical step in confirming an adrenal tumor.
The Confident Monitor: Long-Term Management Protocols
Establishing a Monitoring Protocol
Mentor's Note:
Effective management requires a structured monitoring schedule. We provide a clear protocol for timing follow-up ACTH stimulation tests and chemistry panels to ensure efficacy and avoid iatrogenic Addison's.