Great news
!
With that high-normal LDDS - I'd absolutely be sending his bloods to U of Tennessee for that next ACTH - bc it could be very likely he has Atypical Cushings - and your vet
cannot test for that - it can
only be done at U of Tenn. If you do the ACTH and it comes back "borderline" just like the LDDS - you'll have paid your normal vet for that ACTH test, and then you'll have to pay all over again for the specialized ACTH & Atypical testing at the U of Tenn. And in the end, you would already have all this info had your vet sent the bloods to the U of Tenn in the very first place. I honestly would not be having any vet diagnose Cushings in my dog (an extremely complex disease) if they didn't even know about U of Tenn in the first place (world-renowned, known about by any / every vet who knows anything about Cushings bc it's the only place that has the advanced endocrinology diagnostics). If the vet has never heard of Dr. Jack Oliver from U of Tenn and what he did for the diagnosis of Cushings and Atypical Cushings, again, the vet would not be touching my dog in regards to Cushings. It'd be like giving a bow and arrow to a soldier who only used guns, and expecting them to be successful (?!).
Here is
the link again. If you scroll to middle area - you can click on those pdf's and read about how U of Tenn doesn't just test for ONE steroid (cortisol) like your vet is - they can test for ALL the other Cushings related intermediate steroids - which ALSO cause Cushings. Your vet
cannot test for the intermediate steroids (17-hydroxyprogesterone, androstenedione, estradiol etc).
Your baby can actually have a *normal* ACTH and LDDS -- and
*STILL* have Atypical Cushings (caused by
intermediate steroids, not cortisol steroid) - but you will never, ever be able to know unless the blood is sent to U of Tenn bc your vet can only test for cortisol - and that's all.
Also: "Dr. Jack Oliver, the former Director of the Clinical Endocrinology Service at the University of Tennessee Veterinary Medical College, developed the adrenal panel as another screening test for hyperadrenocorticism however this test evaluates
6 adrenal steroids versus just 1 as in the ACTH stimulation test and dexamethasone suppression test."