Cushing’s Disease in Dogs: Symptoms, Diagnosis and Treatment

Cushings disease in dogs

 

You may have heard the term Cushing’s disease in dogs but aren’t quite sure what it means. In this article we’re going to be looking at what it is, the signs to look out for, how it’s diagnosed and how to help your dog if he does get this diagnosis.

UPDATED October 16, 2018

What is Cushing’s disease in dogs?

The pituitary gland (at the base of the brain) produces a hormone called ACTH

ACTH stimulates the adrenal gland (on top of kidneys) to produce glucocorticoid hormones/corticosteroids (Cortisol)

Something goes wrong in the pituitary or adrenal glands

Too much cortisol is produced by the adrenals

Cushing’s disease develops

Cushing's disease in dogs symptoms diagnosis and treatment

There are two types of Cushing’s

Pituitary-dependent

This means the pituitary gland (pea sized gland at the base of the brain) is overproducing cortisol due to a tumour or enlargement of the gland. It is the most common form, affecting around 80%-85% of dogs.

Adrenal-dependent

A tumour in one or both of the adrenal glands (that sit on top of the kidneys) is responsible for about 15%-20% of cases. About half of these will metastasize (spread).

A third type…

I did say there were two types, but “iatrogenic” Cushing’s disease occurs as a result of high doses of steroids over a long period of time. Once the steroids are discontinued, symptoms should go away.  Anyone taking steroids must be gradually weaned off them over the course of several weeks, because it is too dangerous to stop them abruptly.

What role does cortisol play

  • Helps your dog cope with physical and emotional stress
  • Suppresses inflammation
  • Helps with wound healing
  • Supports muscle and ligament health
  • Controls weight
  • Necessary for proper brain function
  • Maintains bone health
  • Fights infection
  • Maintains normal blood sugar (glucose) levels

 

Signs and Symptoms

Cushing’s comes on very slowly and the first signs you tend to see are your dog having to drink and pee more frequently.

I cannot stress enough the importance of making an appointment with your vet when you notice any changes whether physical or behavioural. Unfortunately they are usually just attributed to the natural aging process, but in most cases they signal a problem. 

Other symptoms to watch out for include

  • Increased hunger
  • Weight gain
  • Hair loss
  • Pot belly/abdominal swelling
  • Thinning skin
  • Tired and inactive
  • Skin infections
  • Muscle loss
  • Fat accumulation on the neck and shoulders
  • Hypertension
  • Housebroken dogs may start to have accidents
  • May bruise easily
  • Bladder or kidney infections
  • Panting
  • Susceptible to blood clots
  • Lack of energy

How is Cushing’s diagnosed?

It can be difficult to diagnose because in many cases the symptoms are quite mild, and especially in the case of senior dogs tend to be attributed to natural aging. In addition, many of the signs are similar to other conditions and there is no ONE definitive test for Cushing’s.   

During your appointment your vet will want to hear your concerns, and what new behaviours you’ve noticed. If you’re going to a new vet he will need a detailed medical history, so you may want to have your dog’s notes emailed over ahead of your appointment.

Once you’ve had a chat your vet will exam your dog then take blood and urine for testing. Think about bringing a urine sample with you to make things easier. Urine should be collected less than 2 hours before your appointment and use a clean container. 

If your vet suspects Cushing’s is a possibility based on the above, there are further tests he can run for confirmation.

Urine cortisol : creatinine ratio

This test measures the cortisol:creatinine ratio in your dog’s urine. If it is high further testing will be needed, because there are other explanations for this result not just Cushing’s.

Low dose Dexamethasone suppression test (LDDST

The next test would be the low dose suppression test and is the most common. It involves taking a blood sample to measure a dog’s baseline cortisol level. A man made version of cortisol called Dexamethasone is injected into your dog, than blood cortisol levels are measured after 4 hours and 8 hours. 

The pituitary gland should mistake it for cortisol and let the adrenal gland know to stop producing it. In a “healthy” dog there would be a significant decrease in blood cortisol levels, but if the levels are high it could mean a pituitary tumour that continues to produce ACTH, or an adrenal tumour that continues to produce cortisol.

Just a reminder of what ACTH is – Adrenocorticotropic hormone produced in the pituitary gland in the brain that regulates cortisol levels. 

High Dose Dexamethasone Suppression Test

Same as the low dose test except more Dexamethasone is given.

ACTH stimulation test

Blood is drawn before and after a shot of ACTH to see how the hormone affects your dog.

Abdominal Ultrasound

An abdominal ultrasound will allow your vet to see the adrenal glands and whether or not a tumour is present.

 

Who is at risk of developing Cushing’s?

I had a Maltese who had Cushing’s when we adopted him, and since I was writing about this disease I was curious to learn if there were any breeds that were more susceptible to developing it than others, and at what age it typically happens.

I have read reports that say it doesn’t discriminate based on sex or breed, and others that say breeds like Beagles, Boston Terriers, Dachshunds, Yorkies, Poodles and Boxers are more prone, and females slightly more than males. I’ve also read it tends to happen around 6 years of age or 8. 

Please don’t start panicking if you have one of the breeds mentioned, because it in no way means your dog will develop Cushing’s. Carry on caring for him as you do, and like I mentioned above, see your vet if you notice any changes. 

Treatment 

If your dog has iatrogenic Cushing’s we know it is caused by steroid use, so the obvious way to reverse the condition is by stopping their use. Your vet will help you do that with a withdrawal schedule. Since there is a strong possibility the original condition that was being treated will come back, be sure to speak to your vet about alternative treatments.  

If your dog has Adrenal Dependent Cushing’s the tumour could, technically, be removed by surgery. However it/they are often impossible to see, may have already spread, the operation is tricky and post op complications a big enough concern that it is not commonly done.

The following information about treatment options was taken from the FDA website

“Vetoryl (trilostane), approved by the FDA in 2008 is the only drug approved to treat both pituitary- and adrenal-dependent Cushing’s in dogs. This prescription drug works by stopping the production of cortisol in the adrenal glands. Vetoryl should not be given to a dog that

  • has kidney or liver disease
  • takes certain medications used to treat heart disease
  • is pregnant

The drug’s most common side effects are poor or reduced appetite, vomiting, lack of energy, diarrhea, and weakness. Occasionally, more serious side effects, including bloody diarrhea, collapse, severe sodium/potassium imbalance, and destruction of the adrenal gland may occur, and may result in death. In 2014, with input from CVM, the manufacturer updated the information about patient monitoring and side effects on the package insert. Although not proven to be caused by Vetoryl, some additional side effects reported to CVM and now included on the package insert are adrenal insufficiency, shaking, elevated liver enzymes and elevated kidney tests.

Only one other drug, Anipryl (selegiline), is FDA-approved to treat Cushing’s disease in dogs, but only to treat uncomplicated, pituitary-dependent Cushing’s.

Veterinarians have often used a human chemotherapy drug, Lysodren (mitotane), “off-label” to treat Cushing’s in dogs. Lysodren destroys the layers of the adrenal gland that produce cortisol. It requires careful monitoring and can have severe side effects.

“Off-label,” or “extra-label,” means veterinarians can legally prescribe human drugs to animals for uses not listed on the label, or for other species or at different dosage levels from those listed on the label. But because dogs may react unpredictably to human drugs, says Stohlman, it’s beneficial to have treatments available that have been studied in dogs and approved specifically for them.”

If you’re interested in alternative treatments there are options for you to explore, so I have included links to articles you may find interesting. Having said that, please do not stop the treatment your vet has recommended without first having a conversation with him or her. There may be a way to integrate the two, or if he is completely opposed find a holistic vet and make an appointment for a consultation to discuss alternatives.

Natural Remedies For Cushing’s Disease In Dogs 

Holistic and Natural Treatment for Cushings Disease in Dogs

 

 

Prognosis

This is a conversation you’re going to want to have with your vet, since the answer will depend on many factors such as –

Your dog’s overall health

The type of Cushing’s he has

His response to the treatment 

Has the tumour spread and is causing other issues

Life with Cushing’s

  • Follow your dog’s treatment plan to the letter
  • Regular vet checks and testing
  • Keep a close watch on behaviour and symptoms
  • Good nutrition
  • Low stress, quiet life
  • Watch for any reactions to medications like lethargy, loss of appetite, vomiting, diarrhea… and call your vet immediately.

 

Does your dog have Cushing’s? What symptoms did you start to see that had you concerned? What tests did your vet carry out in order to arrive at this diagnosis? What treatment is your dog on and how is he doing? Sharing helps others so please leave your comments below.

 

**I would like to invite you to join Senior Dog Care Club, my Facebook group for senior dog parents. It is a wonderful community where you will find lots of helpful tips and advice, a place to ask questions and share experiences. I look forward to welcoming you.**

 

 

40 Comments

  1. Nam

    Hi Hindy,

    Great information about taking care of older dogs. Dogs is a man best friend and a lojal companion. It’s really incredible that you have this website and so much information about caring for senior dogs.

    Well written about cushing and how to take care of it. I have friends that have dogs and I will recommend this site to them.

    Have a nice day and keep up the good work 🙂

    Nam

    Reply
    1. Hindy Pearson (Post author)

      Hello Nam, thank you very much for your comment, and I’m so glad you like the information on my site. My goal is to provide as many resources as I can, to help people caring for older dogs. I’m very happy if you want to recommend this site to people you know who have dogs. I can help with dogs of any age, so please be sure to let them know if they have any questions, to contact me.

      Reply
  2. The Simple Retiree

    Great explanation of this disease. I think one of the main problems with pet owners is they don’t want to spend the money on their pets so don’t go to the vet regularly. My vet said in this current economy he’s seen a dramatic drop off in annual visits. It’s one of the first things people cut back on when money’s tight. So, the pet suffers, shame really!
    Great post, thoroughly enjoyed it!

    Reply
    1. Hindy Pearson (Post author)

      Hi Peter, thanks very much for taking the time to comment, and so glad you enjoyed the post. I agree, pets definitely suffer when we don’t take them to the vet as often as we should. Sadly it feels like you have to be rich to afford to share your life with a pet these days. My senior dog Red is costing us thousands and thousands, with no break, ever, from the vet. I recently started researching some of her medications in order to buy online, and the difference in price really is staggering. When a vet would rather put down an animal that could be treated, than allow the client to spread out payments, there’s something very wrong.

      Reply
  3. Kim Haug

    I’m interested in knowing the side effects of the medications for Cushings.
    Thank you.

    Reply
    1. Hindy Pearson (Post author)

      Hello Kim and thanks for your comment. I’m afraid I can’t answer that question. There are various medications and treatments available, and I have no idea what your vet will recommend. One he/she decides on the best treatment plan for your dog, he will discuss any possible side effects.

      Reply
  4. Linda Cox

    My 13 yo staffy just died of Cushings! Such a ugly disease. When will research discover a cure?? I understand Cushings is becoming more prevalent. This is unacceptable!! My sweet girl suffered very much!

    Reply
    1. Hindy Pearson (Post author)

      I’m very sorry to hear that Linda, I know how tough it is to say goodbye.

      Reply
  5. Kelly

    Thank you for this information. I have heard of Cushings in dogs before but never quite understood what it was, the causes or symptom to look out for – and apparently there are many.

    Reply
    1. Hindy Pearson (Post author)

      I think it’s a bit misunderstood and can go undiagnosed, particularly because it shares symptoms with other conditions. Hopefully by highlighting this disease senior dog parents won’t allow themselves to be dismissed when general tests come back negative, and they will think to ask about Cushing’s.

      Reply
  6. Ruth Epstein

    Hindy thanks so much for this great information as with Layla aging I am keeping a closer eye on her although at this moment TG she is a healthy 11 year old and want to keep it that way.

    Reply
    1. Hindy Pearson (Post author)

      Layla is so lucky to have such a fantastic dog mom Ruth. She’s doing so well and it’s thanks to your wonderful love and care.

      Reply
  7. Michelle & The Paw Pack

    Great post. I know what you mean about people associating a lot of issues with a dog being old when really it could be a symptom of something being wrong. I’m the opposite – now that my first dog is a bit older I feel like I’m running to the vet for every little thing, lol. I don’t even want to think about how much money I’ve spent just for the vet to tell me that something I’m worried about is normal for a dog his age. He’s my first senior dog so he’s teaching me a lot. On the plus side, at least if it ever was anything more I’d hopefully get it treated asap.

    Reply
    1. Hindy Pearson (Post author)

      Thank you Michelle, and I can relate to the expense!! I was such a regular the staff recognised my phone number and would answer the phone “hello Mrs. Pearson.” Now that’s often! It’s better to go when you have a concern than wait until it’s too complicated or late to treat. It is absolutely a learning curve having an older dog, but you’re obviously doing great.

      Reply
  8. Talent Hounds

    So interesting and a bit scary (Kilo is 6 now and so many things can go wrong). I always thought of Cortisol as the stress hormone in humans and associated it with inflammation- lots of benefits as well I see but not when too much. I guess it is all about balance which is why it is so important to know what is normal for your dog and go to the vet if anything changes. We just signed Kilo up with a new vet I just love – he is a difficult patient so it is a big relief. Sorry we did not get to see you in person in Toronto. Next time.

    Reply
    1. Hindy Pearson (Post author)

      I always encourage every senior dog parent (although of course this applies to animals of any age) to contact their vet if they see any changes in behaviour, no matter how slight. Things can go downhill quickly in an old dog, so the sooner they’re looked at the greater the chances of successful treatment or at least maintenance. Glad you found such a great vet, I’m afraid there aren’t enough of them around. I’ll be back in Toronto sooner rather than later hopefully.

      Reply
  9. Holly

    Having older pets is a challenge isn’t it? It seems like a lot of the same issues that affect people are affecting pets. Or at least research is bringing it to light as our pets live longer.

    Reply
    1. Hindy Pearson (Post author)

      It can definitely be challenging, although I must admit I have a soft spot for the old animals…I just love them!! It’s true, just like humans tend to develop issues as they age so do our pets.

      Reply
  10. Kamira

    Wow I’ve head of Cushings disease in humans but had no idea this impacts dogs too! This is a great wealth of information and advice for pet parents. I love Dr. Karen Becker’s videos. She’s really knowledgeable and practical too. Sharing!

    Reply
    1. Hindy Pearson (Post author)

      It’s funny because I had only heard of it in relation to dogs, never people and I just heard one of my neighbours has it!! I think she’s amazing, I really enjoy learning from her, she presents such a different perspective.

      Reply
  11. Dorothy "FiveSibesMom"

    Excellent information on Cushing’s Hindy. I shared on my Pinterest board. Having a senior gal, I always keep an eye out for this as she does have some, but not all of the symptoms. As you said, it can be so many things especially with aging dogs, but so important to keep an eye out and bring it to vet’s attention just to be safe.

    Reply
    1. Hindy Pearson (Post author)

      Thanks, and thanks for pinning Dorothy. There are quite a few illnesses that share symptoms, and sometimes it can be challenging identifying which one our pets are suffering from. I agree, used to watch Red like a hawk and the slightest thing that seemed “off” I was on the phone. I called so often they would recognise my number and answer the phone “hello Mrs. Pearson!!”

      Reply
  12. Tenacious Little Terrier

    Mr. N is one of the breeds prone to it apparently. Not that I don’t watch him like a hawk but I’ll definitely keep a watch out for any beginning symptoms!

    Reply
    1. Hindy Pearson (Post author)

      I must admit I don’t pay too much attention to which breeds are susceptible to what. I just see them as a dog and contact my vet if I see something that doesn’t seem right.

      Reply
  13. Beth

    I’ve heard of Cushings Disease but never knew what it was. All of my dogs are over 8 years old, and technically seniors, so I am trying to observe them more carefully now.

    Reply
    1. Hindy Pearson (Post author)

      You’re right to do that Beth. Unfortunately too many senior dog parents, and vets, attribute changes to the natural process of aging when in fact it is often a sign something is going on.

      Reply
  14. Cathy Armato

    Thanks for sharing this information Hindy. Not having a firm test for Cushings makes it harder to diagnose for sure but I’m glad there are other tests that can help narrow it down and that there is treatment.
    Love & Biscuits,
    Dogs Luv Us and We Luv Them

    Reply
    1. Hindy Pearson (Post author)

      Just like there is no test for dementia whose symptoms are similar to others, it can make it harder to narrow down. Another reason to keep after your vet when searching for answers, and to not accept “your dog is old” as a diagnosis.

      Reply
  15. Sweet Purrfections

    I’d always heard of Cushing’s Disease, but didn’t quite know what it was. Thank you for the informative post!

    Reply
    1. Hindy Pearson (Post author)

      Glad you found it so helpful!

      Reply
  16. Jana Rade

    Nice overview. It seems this disease still often goes undiagnosed.

    Reply
    1. Hindy Pearson (Post author)

      Thanks and yes it does seem to be often overlooked.

      Reply
  17. Wanda

    I just lost a dog with Cushing disease, June 3 will mark 2 years. She drank like she couldn’t get enough, you could not feed her enough, she was constantly hungry, she wasn’t just tired, she was flat…we took her to two separate facilities… told them what we saw at home, they never once checked her for this disease. My dog suffered, which is what I tried to prevent…im still so sad, my girl is gone…she was a papillion..she is missed beyond measure.

    Reply
    1. Hindy Pearson (Post author)

      I’m so terribly sorry to hear that Wanda, I’m sure she really is terribly missed. It’s shocking you went to two different practices and no one thought to test for Cushing’s. Surely they would have wanted a diagnosis. I had two different vet practices responsible for the deaths of two of my dogs, it was absolutely shocking. I’ve learned to stay on top of everything and demand explanations and if I can’t get them in one place I have no problem finding another.

      Reply
  18. Wanda

    Yep, we are looking for a new doctor..what really made us sad is that our girl had to have specialists..that is why we were going 2 places..they worked with my dr…she had other health issues but the Cushing’s just threw her into the worst case scenario. I still miss her and had a dream about her last week…i woke up thinking she was here…only to remember that she was gone. Miss my girl terribly. We thought we were on top…we did question everything…but they are the doctors…its so sad to lose a best friend.

    Reply
    1. Hindy Pearson (Post author)

      I’m very sorry for your loss, I know how tough it is. We can only do the best we can do, and I think it’s important to question and stay on top of our pets’ care, but at the end of the day the vets are the experts and we have to rely on them for treatment. Sometimes we don’t know they weren’t much use until after the fact, and sadly I have had that experience more than once.

      Reply
      1. Wanda

        Yes, what you say is true…i just wish they would have listened to my husband and i…because she would not have suffered as she did…thats the one thing we both tried to eliminate…and it didn’t work.Have a great day…

        Reply
        1. Hindy Pearson (Post author)

          It’s tough because we rely on our vets to help us take the best possible care of our animals, sadly not every vet is a good one. I have had too much experience in that arena. I learned painful lessons but now there is no such thing as a vet not listening to my concerns. If that would ever be the case I would be out of there like a shot and researching the next vet. One day I actually had them unhook my dog from an IV because I was petrified of what they might do. I immediately took her to another vet I trusted.

          Reply
  19. Wanda

    We all try to be the best doggie parents we can be….and yes we get let down by the ones we depend on the most…we are currently looking for new doctors for our new girls..i won’t go back. It just makes you nervous when your dog gets sick and you’re not sure who to trust. We had a very good vet…my girls loved her, she left the practice to move out of state to marry!!! How could she!!! Lol…she was a great doctor. Happy holidays to you and your family..

    Reply
    1. Hindy Pearson (Post author)

      I hope you manage to find a new vet you like and trust. I also know from experience how scary it is when your dog is sick and you don’t have anyone to turn to for help. I used to panic every time my vet would go on vacation or be out of the office for a day or two. I agree, how selfish to move just to get married!! I want a great vet available for me 24 hours a day!! Happy holidays to you and yours as well.

      Reply

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