Sorry for the wall below - vet student so I have a lot of questions.

Species: Dog

Age: almost 8

Sex/Neuter status: Female/spayed

Breed: Beagle

Body weight: 19lbs

History: History is LONG so i'll try to keep it short (owned dog past 1.5 years) - currently doctors suspect Cushing's syndrome and we are testing on Monday.

• History of pruritis/presumed atopy - on a food trial currently
• 8/20/15 episodes of intermittent vomiting so we did the full workup of CBC/Chem/UA/Radiographs/Ultrasound and she was ruled as normal for the most part with presumed bilious vomiting syndrome - adrenal was small, all liver and renal values were normal, only thing was 2 proteinuria and enlarged spleen.
• She started her food trial (Z/D) and a dose of prednisone at a tapering dose for 2 weeks (2.5 mg BID for 3 days, 2.5 mg SID for 3 days, 2.5 mg every other day until the recheck appointment)
• 9/3/2015 refilled prednisone for another 2 week course (same regimen as above) so she finished the drugs about September 19, 2015
• 10/1/2015 UTI visit where USG was 1.013, 3 proteinuria, finely granular casts, urine culture showed E. coli; resolved with Amoxicillin
• 10/26 recheck UTI recheck - USG 1.023, 2 proteinuria, UPC 0.88 - concerns of kidney damage from UTI at this point. Recheck in a month to see if her kidneys have healed.
• 11/7/2015 - she ate a raisin bagel :( but wasn't noticed until 11/9 so we went for bloodwork on 11/10. Chemistry panel showed BUN 8 (low), ALP 389 (high) and otherwise WNL; UA showed USG 1.023 otherwise WNL
• 12/1/2015 recheck appointment. Not looking so hot. ALP 307 (high), Cholesterol 325 (high), BUN 8 (low). USG 1.025, 3 proteinuria, no bacteria cultured from urine. So that's kind of where we are at right now. Doctor's said that there is strong clinical suspicion of cushing's based on the ALP, cholesterol, low BUN, low USG, proteinuria, history of UTI.
• Low dose dex suppression will be done on Monday to hopefully rule in Cushing's

Clinical signs: I was asked if I saw any clinical signs of her being Cushinoid. I don't think so. She may be a bit PU/PD but nothing excessive and she is certainly always hungry, but I've always chalked that up to her being a beagle. She gets the shakes when she knows she's about to be fed and I always assumed that was normal for her. Definitely no pot belly. She is actually quite skinny with great BCS 5/9. It's hard for me to assess if she is lethargic because she's a pretty sedentary dog and always has been ever since I owned her. Doesn't like to run around a lot. Just chills out.

Duration: uh....liver chemistry derangements were past month. Proteinuria seems like that's been since August.

Your general location: Georgia

• Originally, the doctors wanted to do an ACTH-Stim but I argued with them that I didn't want to do that since it would provide less information than a LDDS. They were insistent that they wanted to rule out iatrogenic Cushing's but that didn't make too much sense to me since her last dose of steroids was basically 2 months ago and she was appropriately titrated down. Is it likely that it could be iatrogenic in origin even though it's been two months?
• Okay, let's assume she tests positive for Cushing's on Monday. :/ what drug is going to be best? Mitotane or Vetoryl? I'm not a fan of Vetoryl especially since she has liver/kidney derangements. I'm not so sure about how mitotane is metabolized though. Kind of bummed since neither of these drugs are benign and I don't want to mess up her liver and kidney more.
• I know surgery is common treatment for adrenal tumors. What about pituitary tumors? I realize it can be done but is uncommon or treated by radiation but has it been successful??
• With treatment of Cushing's would we see improvement in her liver/kidney problems?? I'm just not too clear on how excessive steroids causes liver necrosis and renal disease (physiology was a while ago :/)