A Crash Course in Canine Cushing’s Disease

One of the diseases that struck fear into my heart when I was a newbie vet was hyperadrenocorticism. AKA Cushing’s disease. I barely understood it, could hardly explain it to clients and dreaded diagnosing and treating it.

I’m still not too thrilled about diagnosing and treating it, it’s complicated and messy and requires some diligence, vigilance and more than a little financial output on the part of the clients. However, I have a fairly decent handle on the understanding and explaining of the disease.

I got to thinking about Cushing’s because I had to euthanize a sweet little Chihuahua stricken with it yesterday. She had developed diabetes mellitus as a complication (on top of the Cushing’s). That just opens up a Pandora’s Box of additional requirements for diligence, vigilance, and financial output for this client which proved insurmountable. Euthanasia was the best outcome under these circumstances because her quality of life was poor.

So I haven’t done a particularly educational blog in awhile so I decided to tackle this topic since it’s a bit slow at work today, and who doesn’t like to write about complicated endocrine maladies when they have some free time!

And yes, “Old Broad” (frequent Cone of Uncertainty commenter and confessed crazy cat lady), cats do get Cushing’s disease, but I’ve never seen one so don’t have enough comfort level with the topic to talk about it at the moment 
The major players in Cushing’s disease are the adrenal glands and the pituitary gland. The pituitary is this vaguely testicular looking little gland that sits up in your dog’s brain, nestled in there behind the eyeballs. It is kind of like the remote control gland for all the other glands in the body. It secretes hormones that tell the other glands to secrete their hormones.

In about 90% of the cases, a little benign tumor pops up inside the pituitary gland that shoots out a bunch of ACTH (adrenocorticotropic hormone, for those of you playing along at home). This hormone tells the adrenal glands down by the kidneys to secrete cortisol. And secrete cortisol it does, in huge amounts. Way more than the body needs. (Under normal conditions, you need cortisol to deal with the stresses of every day life. Too much cortisol though, and you have problems.) This is “pituitary dependent hyperadrenocorticism”; I’m throwing in the big words for those who need reassurance that I am, indeed, a medical professional.

Cortisol is a steroid hormone (cortico-steroid not anabolic-steroid. It’s not going to, in the words of Hans and Franz of 90’s SNL fame, “pump you up”). Pretty much the natural version of Prednisone and some of the other anti-inflammatory steroids we use in practice every day. You know, the ones that make your dog pant like crazy, drink tons of water, pee everywhere and want to eat everything in sight.

These steroid side effects, incidentally, are the reasons people bring their dogs to the vet when they develop Cushing’s syndrome. The eating, the panting, the drinking and the peeing.

Especially the peeing.

There are myriad other symptoms, skin issues, hair loss, hypertension, abdominal distention, muscle weakness, etc. But the one that brings them to the vet is usually the peeing.

I imagine I’m losing people here, are you bored?

If you are still with me, I’ll mention that 10% of Cushing’s cases actually don’t have the little pituitary brain tumor, they instead have tumors in the adrenal gland. Symptoms are the same, but if not diagnosed properly (generally via ultrasound) the tumors are malignant will grow and invade things in that region (Like the vena cava, which is this giant vein that carries lots and lots of blood. Things do not go well when this vein gets eaten up by cancer). This is “adrenal dependent hyperadrenocorticism”, best treated with surgery, if caught early enough. I don’t know if any DVM’s read this blog, with different experiences, but in our practice, the dogs that go to surgery for this (and we refer this out to boarded surgeons); have about a 50:50 chance of surviving. Somehow there seems to be a high risk of complications involved with getting these tumors out. Sorry to be all gloom and doom. My “Bible” of endocrinology (Feldman and Nelson’s Canine and Feline Endocrinology and Reproduction) says that “Dogs diagnosed as having ATH have an excellent prognosis…if they survive the first two weeks after surgery”. So there’s that.

I’m not going to go into how we diagnose Cushing’s because it’s boring and painful and confusing and I hate it. Suffice to say that it can be expensive and there are lots of grey areas involved in the testing. There is not usually a really definitive “yes or no” test. It’s more of a “probably” or “probably not” test. Sometimes one expensive test is negative, so then we have to do another expensive test which may test positive. Plus we have to view all these results in light of the patient and his clinical signs. The art of veterinary medicine comes to play quite a bit when dealing with this syndrome. So bear with us, we really are doing our best and we aren’t just after your money.

Not only is diagnosing Cushing’s disease difficult, treating it is also. First and foremost, there is no cure for Cushing’s disease. (Unless your dog has adrenal dependent, and he survives the surgery, and he doesn’t subsequently develop metastasis, or a pituitary mass.)

You just manage the symptoms. The goal is to get them to not act like they’re starving to death, not drinking gallons of water, and most importantly, not peeing all over your carpet. Ultimately they live an average of three years, give or take. They may succumb to complications like diabetes or pulmonary thromboembolism (blood clot in the lungs). Sometimes the little pituitary tumor gets really big and the pet starts to have seizures that we manage with anticonvulsants.

There are several treatment (or symptom management) options. The two more common ones are Lysodren and Trilostane.

Lysodren has been around forever, it’s actually a derivative of the insecticide DDT (which almost wiped out the pelican population in the 70’s, if I remember correctly from my “Ranger Rick” magazines from elementary school). Used VERY carefully, it basically destroys just enough of the adrenal gland to reduce its cortisol secretion. Used not very carefully and it can wipe out the whole gland and cause HYPO adrenal corticism which, if untreated could result in death. This isn’t better than peeing all over the carpet. Usually. Guess it depends on who’s cleaning up all that urine.

Then there’s Vetoryl (generic name: Trilostane). About, what, 5 or 10 years ago we used to have to buy this stuff on the “grey” market from England and have it shipped over. It all felt very illicit and dicey because the product wasn’t FDA approved in the US, but it was supposed to be fantastic and much safer for managing Cushing’s. It’s available in the US now and we use quite a bit of it. It’s not cheap though. Theoretically it’s safer, but every now and then it randomly can melt down the adrenals and cause death by hypoadrenocorticism (see above). It works by shutting off cortisol production at the molecular level as opposed to randomly killing off adrenal gland cells like Lysodren.

There are many more things I could still tell you about Cushing’s disease, but I’ve got to stop somewhere. If you happen to have a dog (heck, or cat) with the syndrome and want to share your experience, feel free. I’m always open to questions too.


58 thoughts on “A Crash Course in Canine Cushing’s Disease

  1. At one time, my Ivy Elizabeth (yes, a cat) was suspected of having Cushing’s Disease. When I adopted her, she had no hair from the “waist” down. (We later determined that she licked so ferociously she licked herself bald.) Depo Medrol gave her a little relief, but only for about a week. Plus, I really wanted her off the steroid injections.

    Anyway, she had huge bald patches and the vet thought her skin was thin so, on the off chance she had Cushing’s, Ivy was tested. I don’t remember what tests were run (seems like there might have been an ACTH level test), but the vet was almost as happy as I that, after many tests and trials and errors, Ivy was just allergic to most everything.

    So my question is this: Have you found that some dogs you suspect of having Cushing’s end up with just having allergies?

    1. Strangely enough, Cushings actually masks allergy signs in dogs. It’s the excess cortisone, it actually treats any underlying allergy or arthritis issue. Sadly, when you treat their Cushing’s signs, their allergy/arthritis signs get worse.

  2. My “Amber” (dog-mixed breed) has been with me for 11yrs -adopted from the SPCA so maybe she was 2-3 yrs old back then. Now has Cushings for at least 2yrs – drinks lots, pees often, always hungry. Has “licked”/chewed hair from her butt cheeks and back legs so first I used tea tree oil mixed w a little aquafor for those areas but that didn’t really work – back to vet -maybe allergy so put her on zyrtec and a cortisone spray for her hairless areas. Currently give her glucosamine/chrond/MSM tabs, deramaxx 37.5, soloxine, tramadol am & pm. Her wt has dropped from 61lbs to 47.5lbs – her back legs are also very weak – any suggestions

    1. Cushings can cause muscle weakness and hair loss. Cortisone spray won’t help anything (she’s already swimming in cortisone). If you’re not doing anything to treat the Cushing’s I’d start there. The hair should grow back. If she’s losing weight, and you haven’t had her blood checked lately, I would. She may have become diabetic.

  3. Hi, thanks for the article. My dog has cushings (3 years now). He is a 13 year old border collie. He has been treated with vetoryl. Started on 70mg and stable until early this year. Then ACTH tests showed his levels dropping. Each test he dropped so they lowered his meds and said he was reverting and that this is rare. We have just moved to a rural area and in the last two tests his levels fell again (35). The vet dropped him to 10mg but he has begun to pace again through the night. No other symptoms though. She suggested putting him up to 20mg again but I am worried about potential addisonion crisis if we overdose so made her call the lab that do the testing. They said at his levels we should stop completely and test again in a month. I am completely confused about what the right thing to do is so any advice would be welcome. He weighs 18.5kgs and is insured.
    Thank you for a great blog.

    1. So sorry, I wrote a long reply to this a while back, and apparently it never posted. Hope things have leveled off???? The cool thing about Cushings is there isn’t any rush to treat and it’s ok to stop the med when necessary to make sure the dose is ok. Pacing without the drinking/peeing/appetite isn’t a good reason to bump the meds. Again, sorry for the very, very late response.

  4. Thank your for clearing the haze surrounding Cushing’s disease. Our Ginger girl, canine, 15 years, recently went through the testing process and was diagnosed with Cushing’s disease, is now on Vetoryl and Proin. Her symptoms are much improved, for which we are most thankful, but we’re spending more on her medication than our own…which is amazing as my husband and I are in our seventies. We’re obviously on a fixed income and need to find the meds she needs more reasonably priced. I’ve done some searching online, but am unable to find Vetoryl or the generic, Trilostane, any less expensive than our vet’s price. If ANYONE knows of an alternative please share.

    1. That’s a problem with Trilostane. I don’t know of a way to get it cheaper (did you try the human pharmacies? Some carry veterinary drugs at a bit lower cost). The other drug used to treat Cushings, Lysodren is much cheaper, but requires careful administration to avoid side effects. My boss has used Lysodren for 40+ years and is really comfortable with it and considers it an important alternative especially when cost is a concern. Also, I came across this website that lists organizations that help people with their veterinary costs: http://www.warreneckstein.com/g/Groups-Providing-Financial-Assistance-For-Veterinary-Bills/299.html
      Hope that helps…

  5. My old girl, Casey (lab mix rescue) is 15 and has been on Vetroyl for probably two years. She is doing great but still pants and constantly acts like she is starving. We know its the Cushings but at times it drives us crazy. I can afford the meds (she is also on Metacam, Tramadol and one other pill). But wish they would come out with a generic version. I love her to death and will do what I need to keep her pain free and in good shape. As I write this she is licking dirt! Silly girl! Thanks for this. I understand it a little more. Oh and I spent $$$$ on testing for it. But was worth it cos she is doing much better (she developed a pot belly and peed like crazy which got her to the vet and started this).

    1. Sounds like you’re doing a great job! Two years is a long time for a Cushing’s dog. Generic Trilostane would be dreamy. Keep up the good work, it’s a frustrating disease to manage. Keep up the good work 🙂

  6. I have a 4 year old female border collie. About 6 mths ago she started gaining wgt, unable to tolerate exercise like usual, dribbling urine. She has two siblings and now is her littermate. Tests include hypothyroid, X-rays, coronary ultrasound, addtl blood work. My vet has tried to rule out as much as possible before turning us to cardiac doc…because her EKG was normal except for a high vagal tone. The cardiologist said heart working great and we should look at cushings….even though she is only 4. Also, she was hit by a van in her front area and shows signs of spinal changes. My vet just found these on X-rays. Our prior vet kept her in the hospital to monitor and said she was fine. Anyway, would appreciate any ideas, comments,etc…we are stumped and I want my girl to be able to play and be active like before. Also, tested for diabetes(neg). My prior border was an insulin dependent diabetic so I am a little familiar. Thanks.

      1. How did they rule it out? I have an incontinent Westie that I’m seeing and apparently there is a laundry list of exam findings needed to evaluate incontinence. Does she leak in her sleep or while she’s walking around? Does she empty her bladder fully? Is her bladder in the right place within her abdomen? Could there be a bladder stone? Vaginal/vulvar anatomical issue? Ultrasound or contrast x-ray to check bladder/ureter/kidney anatomy? Is she drinking too much? Any other signs of neurological dysfunction? Is she fecally incontinent too? Is the urine culture negative for bacteria? Turns out urinary incontinence is far more complicated than I thought :/ Your GP can rule out some of these things, but she may need an internal med or neuro consult to rule out/assess the rest.

    1. Hi. Has she been tested for Cushing’s? If not then that’s a good starting place to rule in/out that. Urinalysis to follow up on the urine dribbling (does she have a bladder/kidney issue?) Respiratory issues can cause loss of endurance (your chest films should have helped rule that out, were the films read by a radiologist/I assume the cardiologist looked at them). If everything is normal, then sometimes I put the dog on a trial of pain medication to see if something (her back?) is hurting her and she’s modifying her activity in response to that. I usually do about a week or so of an NSAID and maybe Tramodol so I’m confident any pain should be eliminated. Then I have the client monitor to see if the dogs activity level improves on the meds. It’s called a therapeutic trial. If the dog improves, then we need to figure out where she’s hurting (X-Rays, MRI, Neuro consult if indicated) and what we can do long term to help.

  7. Thank you for the information. My black lab is 11, we went through the tests and she has Cushings due to an adrenal tumor. She cannot have surgery because it is too close to her vena cava. She took Lysodren for about 4 months -she lost all of her hair but it grew back in, she had back leg weakness but she was getting her muscle back. She stopped drinking and peeing, she seemed pretty good. But she became lethargic and a blood test revealed her blood O2 was about 11%, she had a transfusion. they took her off the Lysodren. Her drinking and peeing has not come back, i gave her a series of B12 shots, her blood level is finally up to about 30%. The vet told me to give her 6mg melatonin and 50mg plant lignans, this is a new treatment. But her legs are much worse, she was a 60# dog (small lab) but she is in the 40’s now. she can’t get into or out of the car w/o being lifted. She falls down and skins her ‘elbows’ she hits her face, she is not able to get up from most surfaces and she moves her front legs with no results-I wake up through the night and have to help her up and during the day, it is sad to see her struggle. The vet said she has arthritis-she was so active and healthy before the Cushings hit her, now she is so sad. I now take her for cold laser therapy several times a week, I give her glucosamine, and every thing else I can!! she barely eats 1 can of food a day. Everything I read about cushings indicates they live a few more years and get better, this does not seem to be the case for her, I would appreciate your thoughts. I can afford treatment, but I want it for her to feel better-is that truly a possibility. I appreciate any comments you might have. Grateful for your knowledge on this subject.

    1. Well, here’s the difficult thing about Cushings, the ones who have the more common Pituitary form are the ones who can live up to two years. The dogs with the adrenal form, unfortunately don’t share that fate. That terrible tumor is highly malignant and sitting right next to some very important and vascular organs. Eventually the tumor eats its way into something vital and the patients either pass away suddenly at home or have to be euthanized due to decreased quality of life. I wonder if she was bleeding internally from the tumor eating into her vena cava or one of the renal arteries and that’s why she needed the transfusion? Surgery is very often not successful in these cases, I’m afraid. We have managed some adrenal dogs very successfully for a while on Lysodren, but over time, the physical signs from the tumor itself growing impact the dogs quality of life such that euthanasia may be indicated. She sounds like she needs to go to the vet for a quality of life evaluation and to see if her weakness stems from a low blood count/anemia again or if there is evidence of tumor spread. So sorry for your girl. 😦

    1. I believe there is no contra indication for Zyrtec. Best to double check with your vet since I haven’t examined your pet and don’t know what other meds she’s on.

  8. Thanks for the response. She was on a trial of rimadyl which helped with the movement but she was still bottoming out after short periods of activity. The urine problem seems to go hand in hand with the increased activity. I make sure she goes before and after activity…but being a border collie and trying to limit her activity is like trying to put a round peg in a square hole…it won’t go and she won’t stop. I have tried taking her siblings out while my husband distracts her inside and the neighbors thought we had a coyote in the house. She lives for that ball and frisbee and it breaks my heart to see how she struggles to catch her breath after only a few minutes. No urine leaking i her sleep, and no fecal incontinence. The leaking seems to be only after she runs and particularly when she jumps a lot. Radiologist read x-rays and no stones or abnormalities in chest or abdomen. The urinalysis test showed some crystals. Any insight or ideas would be greatly appreciated…

    1. Hard to say without an exam. Maybe it’s something related to the “spinal changes”, the respiratory nerves run through the cervical vertebrae. Maybe a neuro consult/ MRI to look at the spinal cord? Ultrasound to make sure she doesn’t have a hernia secondary to the hit by car incident? (Sometimes diaphragmatic or pericardial hernias become apparent years later). Is there a vet school near you where a team of specialties can take a look at her? Or a referral clinic with multiple disciplines?

  9. My Ziggy, who has been a diabetic solidly for one year after a brief remission in 2012. 13 yr. old tuxedo kitty whose fur has been turning reddish brown for a few years. Saw the fur loss on front legs, flanks, now shoulders. Leg/flank fur has had regrowth but not the same as before. Shoulder fur is getting slight regrowth now. It was the last area to go bare. Tummy considered “pot belly”. Insulin resistance now in play since Dec. 2013 – sub 400 BG on 3.5-4 units Lantus each day, now- up from 1.5 each day. He’s had kidney disease without any problems for 7 years and chronic pancreatitis flare-ups (7.6 as of recent test). Kidney test – good. Urine – good. Blood tests are pretty good but high Triglicerides since last year.

    Specialist is soon to, definitively. call it Cushing’s. Ultrasound in mid-Feb. Otherwise, he’s behaving, eating, eliminating and moving normally. That’s a good thing. I’m happy to see this string of communication as I read Cushing’s is rare in cats and shared experiences seem rather scarce. He is a ‘red caution’ kitty so minimizing exposure to tests thus keep stress down will be at play. Doubt surgery will occur for any tumor. He’s a tough guy to deal with in a clinic setting but a tough guy who always beats the odds. But, given the other issues – we suspect that he might fare well with the meds but the reality of the disease(s) combined is being faced. I’ll be reading how everyone else is doing….

    Any insights are welcome. Thanks for taking the time to post. It helps shed light when one is in the dark.

  10. Spiffy my 14 y.o. Jack Russell was diagnosed w/Diabetes 3 months ago. We started on Lantus and there was no change in his symptoms and his glucose remained in the upper 500’s we changed to Humulin for a month and still no change in glucose, I suspected Cushings and did an ultra sound and the blood work and he is indicated for pituitary Cushings. So today I started him on Trilostane. This is my issue. I am moving across country in a month and will do two follow-up blood tests before I go. So much death in my life at the moment as Spiffy’s old Vet and my dear friend recently passed away from Cancer so I am broken hearted and very upset about Spiff and the new Vet said it I can’t get his blood work correct in a month that I should consider what is best for the dog and the stress of moving across country could be fatal. So there is talk of putting him down.

    Will I see changes in Spiffy’s behavior in a month? or hopefully sooner? Having read so ,much I appreciate this site and information posted. Thank you for the time.

    1. So terribly sorry for your loss. I wouldn’t expect Spiff to be perfect in a month, but I would expect some improvement. (Spiff is a great name, by the way. Any relation to Spaceman Spiff of Calvin and Hobbes fame?) I don’t think the stress of moving is going to be fatal. It will be stressful, and I would do everything possible to mitigate that (hopefully you are driving him, or flying him in the cabin with you). Granted, I guess I’m making assumptions here, I don’t know what Spiffy’s current medical condition or overall quality of life is like. For example, I could see myself gently recommending euthanasia if the dog has Cushing’s, kidney disease, a grade 5 heart murmur, terrible arthritis, and uncontrolled diabetes (the stress of the trip could put the dog into overt kidney failure, or congestive heart failure). Your vet could know something I don’t that makes her think the trip may be too much for Spiff (here’s a blog I wrote about euthanasia and determining a pets quality of life ), in the off chance that helps at all.

  11. I have a fourteen year old crossbreed who has had Cushings disease for the past two years, he’s is on vertoryl at the present time and has regular blood tests to check his levels, he is now only on 10mg of vertoryl very other day as his levels went dangerously low just before Christmas. He has lost a lot of weight and has a skeletal appearance, he is still very hungry all the time, he has back leg weakness and is licking his hind quarters. We have visited our vet for blood tests today and the vet agrees that his weight loss and muscle loss is now a problem. Along with his normal blood test today he has taken a liver and kidney function blood test (as he was having bloods taken anyway), my vet has said he may need some steroids for his weight loss and muscle loss but he did say this is going to be difficult due to his Cushings. I have come home and read about steroids and really not keen on my old boy having these as I don’t see how they can help, I also have a 3 years old cavalier King Charles and a 15 year old ginger tom cat and on top of all the side effects from steroids it also states they can change the dogs temperament and they may become snappy, I can not afford this to happen due to other animals living in the home. Any adivce welcome and I will be speaking to my vet anyway tomorrow when he rings with the blood test results. Sorry for the long response.

  12. Hi..read your article with interest. my dog was finally diagnosed WIth Cushings after a couple of misdiagnosi. She showed all the classic signs, such as massive thirst, peeing, hair loss and muscle weakness. I resorted to 30 mg a day of Vetoryl, however, sadly, on the second day of her treatment, she became overly affectionate, then started acting drunk, seemed to be blind as she walked into corners and stared vacantly. She then started to defecate uncontrollably and fell into what seemed like total paralysis. After four hours( this was at 3am on a saturday), in which she seemed to be breathing normally, I rushed her to an emergency clinic but she died on the way. Could her death have been an adverse reaction to Vetoryl? Your reply would be massively appreciated as I am asking myself so many painful questions.

    1. I don’t think it was a Vetoryl reaction. Sounds like a thrombotic event, due to a blood clot, which Cushings patients are susceptible to (regardless of whether or not they are on medication).

    2. I know this is a late response, but perhaps it will help someone else. Our dog has been on Trilostane for 4 years now. 3 times he has exhibited symptoms like you described after his dose was increased. In each case he recovered after a few days off the medicine. Our vets insist there is no medical reason for this to happen, and his blood tests don’t indicate anything amiss. Trilostane works well for him overall. We’ve been incredibly fortunate in that he is healthy and happy at 14, after having been diagnosed over 4 years ago. I recommend being extremely cautious when increasing the dose however, and temporarily stop treatment if your dog’s behavior alters after an increase. In all 3 cases, mine became almost catatonic.

  13. My Jack Russell Terrier was diagnosed with cushings almost 3 years ago. We noticed a major weight gain, 12lb to 17lbs at the time- now almost 3 years later he is 23lbs. eek! But we chalked it up to just having a baby and maybe thought he was depressed, what brought us to the vet was the fact that he was peeing EVERYWHERE and we were refilling his water dish 9x a day. He seemed better with lysodren for quite a while, but now he is peeing everywhere again. We try to watch the water intake, but that deems pretty much impossible – how can you not give a thirsty dog water? He’s also been struggling over the last few weeks with stairs- he can do them, but a lot of times he stumbles. Might have to do with his large belly?
    I’m at a loss right now and don’t know what to do. He is 11 years old and otherwise seems decently happy- definitely “not himself” and looks at me with sad eyes after he has an accident. He typicalliy only has accidents when he’s up and moving. I don’t know if we should try to move our family dog out to live in the garage or what is best? All I know is, we can’t continue having him pee all over the house or my husband my just leave me (kidding, he won’t… but he’s having a much harder time accepting this is part of having a pet) Suggestions? Is there anything I can do to stop the peeing? My husband and I differ on the topic of putting him down. Any help is greatly appreciated. Thank you, thank you, thank you!

    1. He may have become diabetic, he may need a Lysodren dose adjustment, or he may have a urinary tract infarction/stone/etc. Have you been back to your vet for evaluation?

  14. jrtlover, it is not uncommon for dogs to relapse on Lysodren and you are lucky if you’ve managed to control cortisol so well for three years without a reload or adjustment in maintenance dose. I suspect that your boy’s adrenal tissue has regenerated and cortisol is once again flowing unabated. I’ve treated three dogs with Lysodren so I know the drill only too well. The longest we ever went without an acth stimulation test was six months. All of mine relapsed in the first and second year, two requiring increase in maintenance dose, which was effective, and one requiring a reload.

  15. This may seem strange but is Cushing’s catchy? Our 14 year old dachschund was diagnosed in December and now our 12 year old rottie mix likely has it now. We let our dachschund go because the treatment was beyond our financial means and the vet said it would be very hard on her body. I am afraid we’re facing the same thing with our other baby. Could there be environmental things contributing? Is it painful or miserable? If we were to not treat would she suffer?

    1. Cushing’s isn’t contagious. Nobody has been able to isolate an environmental factor that I know of, but who knows. I don’t think Cushings is too miserable, although getting in trouble all the time for peeing in the house might be. Feeling super thirsty all the time might not be fun. Eventually untreated, Cushings patients could become diabetic or suffer such profound muscle weakness that they just can’t move around and may need euthanasia at that time. Other effects may be detrimental as well…off the top of my head: immunosuppression, hypertension, recurrent skin infections, etc. I’d say that if you choose not to treat, then have a good enough relationship with your vet so that together you can determine when it’s “time” for humane euthanasia when your dogs quality of life is poor.

      1. Our girls didn’t get in trouble for pottying. It wasn’t their faults. We did say goodbye to our rottie mix last Sunday. It was her overall quality of life that made us know it was time. It’s such a difficult thing to do. We got her when she was a week old. Her litter had been dumped. We bottle fed her. Thank you so much for the information.

      2. You’re welcome and I’m sorry for your loss. The one thing we can do for our pets is to not let them suffer, so you did the right thing for your pup. Take care.

  16. I don’t even know where to start. Molly is a 9 year old dachshund. When we rescued her at 2 she had heart worms and seizures. We had her treated for heart worms and she was cured. The seizures continued. They kept increasing phenobarbital and no improvement. We changed vets at age 4. Molly was diagnosed with diabetes, Cushings, hypothyroid and epilepsy. Four the last 5 years we have juggled these issues. She takes insulin twice a day, thyroxin, phenobarbital and flourdicort . For about 2 years she was on Samee and milk thistle as well. The diabetes has caused her to go blind. Believe it or not most days she is fine. Her weight and glucose are stable. Ok…now…periodically she gets tired of her food. I have even cooked food. That is fine except when she decides not to eat for a day or so I have to cut back insulin. I am a people medical professional…nurse with advanced degree…but I am at a loss here. No seizures. No extreme lethargy…etc. tired of going for expensive tests and nothing new. Change her food and she is ok? Any ideas?

    1. Unfortunately Molly has a slew of complicated medical issues that require those expensive tests to manage. Diabetes, hypothyroidism, and Cushing’s can all precipitate seizures. Sometimes the Cushings dogs seizure from the mere physical presence of the little tumor in the Pituitary gland, over time they get bigger and make the seizures worse. Are you monitoring the blood glucose levels at home diabetes-wise? Over time that helps save a little money, there are all kinds of resources on line to help teach this. Petdiabetes.com is a good starting place. The best you can do is to continue to manage all of these conditions, no matter what, they will progress. What are you using to treat the Cushings? You won’t get good control of the diabetes until the Cushing’s is managed. Also, I am unfamiliar with flourdicort, just looked it up on VIN and nothing comes up. What’s that for?

  17. I have an 11-12 year old lab that was recently diagnosed with cushings and was told he does not have a tumor. They put him on Vetoryl and he has been taking for over 2 weeks. They did a follow up ACTH test and said the medicine is working. I have not seen any improvement at all in his wanting to constantly drink water and his constant urination. How long does it take for this medicine to take effect? He has lost a lot of weight and now seems to be more interested in water than eating. This is very confusing, he seems miserable. Any advice would be wonderful.

    1. That’s weird. If the ACTH Stim test says his levels are normal, then he shouldn’t be drinking that much still. I’d discuss this with your vet, and if you don’t get resolution, then consider a second opinion or an internal medicine referral.

  18. I’m really getting confused after reading all these. My now 13 pound Miniature Schnauzer, who was around 15 pounds or slightly under, was diagnosed with Cushings after the Creatinine test with results on Tuesday slightly over the gray area. She previously had Calcium Oxalate stone surgery a year and a half ago with no signs of crystals thus far. Her PH never goes above 6 though, on any food. She was on Royal Canin SO and began to lose weight and go down hill. Her weight prior to surgery was perfect. She was eating By Nature Chicken kibble at that time. I started her on a quality home cooked diet, which took her from 12 pounds to just over 13 pounds. I also ordered mineral free water for the stone situation. Her symptoms are only low body weight, boney back bone, some slight panting usually in bed at night, but it’s usually controlled,(maybe once a weak) no excessive drinking, no fat belly,no hair loss, no peeing anywhere but where she is supposed to ever, she’s always peed quite often, but holds it through the night fine and will even roll over for a belly rub in the morning before going outside to pee, no excessive drinking. She also tires a bit more after a run than the other dogs, but she is age 9 and doesn’t get a lot of exercise, due to my medical condition, but always had good body tone. She’s a bit of a high strung dog, true to breed. Runs around here like she has plenty of energy, never lazes around…so why would I want to start her on drugs that may make all this much worse? I feel torn between a rock and a hard place. I read about Cushex drops online and they sound like a good place to start, but truthfully, I am wondering if this diagnosis is wrong. I have called the vets twice to set up an ultrasound, and they are usually good, but have not called me back either time yet. I guess they have a tech come in to do them. My vet seems to have limited knowledge on testing, symptoms, and treatments. He says Vetoral and that’s it. She has VPI pet insurance with a cancer rider. (double cancer coverage) They cover the ultrasound and some of the Cushing’s testing, but if it’s on her Adrenal gland and can be operated on or is malignant, it matters as to how she’s covered. They pay a lot more of the cost if it is. They also cover for an MRI if needed, and surgery if needed. I care, because I want her to have the best treatment I can afford, and also want to know exactly where this tumor lies…so I can try to access time I have left with her. She’s the love of my life. I’m worried sick, and at the same time trying to help her. Advice? Thank you so much for reading. Kristyl

    1. <<>> I am not familiar with this test to diagnose Cushings. I wouldn’t treat for Cushings if there are no symptoms present. Never heard of Cushex drops. If your vet isn’t returning calls, I would consider getting a second opinion, or ask for a referral to a veterinary internist.

  19. My retiredguidedog of 11 years …he’s 14…has been diagnosed with cushing’s through the blood test and ultrasound. They found an adrenal tumor and another mass in his abdomen which is explained as nondescript and which the vet believes is scar tissue from a surgery that took place three years ago after he chewed off the top part of a Kong and ripped his intestines to shreds. Never a chewer, he was retired shortly thereafter, his lymph node to the right of the adrenal shows nodal metastasis. He has been my loyal guide and I do not want him to suffer in any way. My question refers to knowing when he is. He pants most of the time. I can still walk him for a block or two. He is famished all the time, drinks a lot of water, has back end weakness,,his legs splay in the rear, he sees very little and is now deaf. He gets carpofen twice a day, famotidine once a day, and tramadol and diazepam at night to sleep. Sometimes his breathing and panting is so labored that I don’t know if he is in pain or not. His weight is 95 lbs and he is a lab and I love him so dearly. His tail wags at times and he has difficulty getting up from the wood floor but still goes upstairs a few times a day if prompted with a treat. He is also losing control of bladder function and dribbles on his way in the house and out. He also has accidents at times. When to know the time to euthanize is a difficult decision. The chronic breathing issues in and of themselves are for us, as humans, difficult and uncomfortable. Pain is not the only way that I can judge whether it’s time to let him go. He doesn’t play at all and is very lethargic until someone brings food out. Then, he is at attention. What are my parameters for determining quality of life and when I must let him go? I have entrusted my life to him as a blind woman and, although it breaks my heart for him to leave, I must show him the same loyalty and love he has shown to me for so many years. Thank you.

    1. I think you’re getting pretty close. Labs are notorious for being eternal optimists in the face of adversity. I’ve seen labs who can’t even walk and can barely lift their head, but will still wag their tails and eat readily. Here’s a blog I posted on the topic, if you want, scroll down to the “Quality of life scale”. It’s a nice way to assess whether or not your pet is suffering. IF they can’t keep urine/feces off themselves, if they are having more bad days than good, if they aren’t getting much joy out of life, if they just want to be left alone, these are all signs that maybe it’s close to time to let go.

  20. My standard poodle Casey was just diagnosed with Cushing. He will be turning 4 next week. He was diagnosed using the three blood test as well as his symptom. He has not had the ultrasound done. From reading this I am wondering if his best chances are three years of quality life before more compilations start. The vet is starting him on Lysodren . This is all still new to me and Casey is staying at my daughters because she works for our vet and she can monitor Casey. I live in a remote area. If a ultrasound sound is done and surgery is possible would Casey have a better chance of a quality longer life? He is still very young.

    1. I’ve never seen a dog develop Cushing’s that young. I would consider the ultrasound, in the off chance that there might be a surgical cure (?) to the problem.

  21. My little girl Schatzi, a white miniture schnauzer, is gone. She was diagnosed with off-the-charts Cushings (had to do the test twice to confirm) in the summer of 2010 when she was 12-years old and put on Vetoryl. She handled it well but when I look back now, she developed an insatiable appetite and started to gradually lose weight. In the summer of 2012 she became very lethagic and started vomiting, had diarrhea, wouldn’t eat and slept on the cool dirt in my courtyard. I tried everything working with our veterinarian until she finally had to go on an IV of fluids and was in the dog hospital for 5 days. I came so close to losing her but somehow my little Lazarus pulled through and came home with a whole new diet of only Royal Canin Gastrointestinal food. Problem solved. But she was hungry all the time and lost all of her muscle tone and grew a large belly. My veterinarian suggested I double her food intake but her little system couldn’t handle it so the vomiting and diarrhea would start again. So I stayed on the one can a day program which she begged for but otherwise seemed content. But I was losing her. She went from 25 pounds in 2010 to 15 pounds in January of this year. For the last four months, she slept all the time and just looked sad. Eventually she had trouble walking and last week I had to let her go. She was with me her entire 15-1/2 years and I miss her so very much and the tears keep coming. I wonder if it would have been better for her to not have survived the 2012 episode. I feel as if I may have starved her and I didn’t see it. It’s killing me to think I may have caused her pain day-in-and-day-out as she scoured for food. My veterinarian showed me a photo of her in her happier days. I forgot what that looked like.

  22. My 7 year old Australian was just diagnosed with Cushings after numerous tests that came up negative. I kept taking him back and insisting that something wasn’t right. He has been on Vetoryl for 5 days now and we’ve seen immediate improvement. He was drinking water all the time and that has stopped and his appetite has returned to normal. Prior to the drug he acted as if he hadn’t eaten in weeks. My kids say he smells better too. 🙂 my concern is the tests that I believe the vet will insist that he take for the rest of his life. The meds by themselves are $135 per month.. if you add the expensive tests quarterly it could get up to $250 per month. My question is an ethical one. At what point do you stop prescribing a drug because the patient’s owner refuses to pay to have all the expensive tests done, despite the obvious visible improvements in the condition of the canine? Some of these tests give marginal results at best. Why not give the dog an examine and if he’s looking better and the owner reports that he’s behaving normally or more normally, continue to prescribe the dose that is giving that result? hell if it wasn’t for my insistence that he had a problem he wouldn’t be treated in the first place.. . The vet figured it was just a thyroid problem.. I realize it’s tough to diagnose but it’s certainly not hard to see that the drug is working and that the dog is better than he was,. Having said that is it better to take him off the drug because the owner can’t afford $250 per month in drugs and tests? ( I’m assuming a $300 ACTH stimulation test quarterly on top of the drug).

    1. In a perfect world, quarterly ACTH testing is the best way to monitor the level of cortisol in the dog. If it gets too low, that could be a potentially fatal consequence. In some patients, Vetoryl works better over time and the dose must be lowered. If you don’t catch this, you can end up in a crisis. I repeat: a potentially fatal one. There is no law that says we have to do this though. There is a law that says we have to examine the pet at least once a year in order to refill prescriptions. Twice yearly ACTH stim testing on a stable dog would be pretty good, I’d be happy with that. No ACTH testing would be very scary and I’d probably be inclined to have the client sign something to the effect that they realize that they are going against medical advice and there could be adverse events associated with non compliance. I’d be hard pressed to discontinue the drug altogether unless there isn’t an annual exam, BUT I would make darn sure the client understands the ramifications. But that is just me, and another vet might (and maybe should) be unwilling to take that chance.

  23. My 8-year old cocker spaniel has been tentatively diagnosed with cushings, based on bloodwork, ultrasound and xrays. We have not yet done the ACTH test that the vet is recommending to confirm. If the ACTH test confirms cushings, the doctor would like her to start trilostane. She does not show any symptoms (no changes in appetite/eating/drinking/potty habits or skin, etc), but a senior blood panel showed elevated ALT, ALP, GGT and Triglycerides, decreased creatinine and normal TT4/FT4. She also is presenting with bradycardia (the vet said her heart rate was 60) which is suspected to be secondary to high vagal tone as the ECG showed no other evidence of cardiac disease. The ultrasound did not show any tumors, but one of her adrenal glands in normal size and the other is somewhat enlarged, which my vet said suggests an adrenal tumor. If the ACTH test confirms cushings, should she be treated while she is asymptomatic or should I wait to put her on trilostane after she starts showing symptoms? And does the high vagal tone have anything to do with cushings and how would the trilostane impact that?

  24. My 8 year old rescue dog Kodiak who was purported to be 100% German Shepherd but looks like a Husky may have been involved is ill. This dog was drastically abused before we rescued him. He has never been food or animal aggressive. He trembles when climbing the two steps into our kitchen from the garage then walks backwards through the house till well away from the door he entered through. He walks normally after that unless he returns to that door then he walks backwards again.He is rigidly opposed to more than 2 steps and will jump off the kitchen level to avoid the stairs. He can only be bathed outdoors as he will fight any effort to lure him into the tub for a bath. Kodi is a tense animal. hyper vigilant and rarely relaxes. He never once would lie down inside our home for the first two years we owned him. He still rarely will lie down in the house. He paces unless he is kept distracted with fetching a ball or toy. He will sometimes lie down at the top of the stairs to the basement if I go down the basement and catch a thrown ball that thrown from the basement up to him. He will mouth it for a bit then place it on the floor and roll it off the step with his nose and watch it bounce back to me. That one game is the only time he seems relaxed and a bit serene. He will only tolerate being inside for maybe one hour or so then demands to go to the garage. He prefers to be outdoors in his the kennel during the daylight hours. As soon as it gets dusk for the past 8 years since the first day he lived with us, he has barked and fussed till he was brought indoors.The Vet thought he may have low vision that makes it more difficult for him to see after dusk.. I read Huskys sometime have eye issues. He would yelp and bark loudly if he was not brought in at dark We have air conditioned the garage for him. .He has been hypothyroid for years and has been on meds 2 x a day for control. About 10 weeks ago he began panting excessively at rest. His rate is aprrox 100 breaths per min. His tongue is not enlarges as if he is overheated. He does not drool. Even during sleep he is breathing rapidly.He is obsessed with food and weighs 122 Lbs. He has muscle wasting of his hindquarters. He has two soft palpable tumors on his trunk. We have noted personality changes.. He is not listening as well. For several days he was barking in a vicious tone at the new neighbors when he would see them outside. They built a large fence ! He has drank 4 1/2 gallons of water between 10 PM and 6 AM of late and is obsessed with food. He was near the food container in the garage the other night when I was taking him outside for one of his 4-5 trips during the night when he saw the food scoop and lunged for it nearly knocking me down. He barks on and off all night long.every 2 to 3 hours wanting more water or asking to go outside. He has looked at me as if he does not know me or cannot see well. I asked the vet if his eyes are ok and he said they were.
    Sometimes he asks to go out then just stands panting. For the first time ever in the 8+ years he has been with us he refused to remain indoors and wanted to go to his outdoor kennel during the night. He did not fuss or bark and remained out there all night. The following night he wanted back inside..tonight he wanted outside again. He has two circular areas of baldness near his spine the skin is dark where the hair is lost.He seems miserable. He has no peace. No real rest.
    The first trip to the vet weeks ago, they said he had back pain. One hip was dirty and they thought he had fallen and hurt himself. His right hip looks lower then the left and mild pressure will cause him to drop so that seemed reasonable. He was in pain and that was causing his panting. He was given injectable steroids and Oral Prednisone they gave tramadol for the “pain” but it all gave no relief.Still breathing 100 x a min. Labs were ok I was told. his heart and lungs seemed fine. After 3 weeks the meds were completed and I took him back in as he was still breathing fast and did not seem himself. More Labs were done Liver enzymes high, WBCs > 30.000 No anemia, Thyroid level was not good and they increased his dose by 0 .2 mg each dose.He was started on an antibiotic x 10 days Possible infection vs steroid effect. We were told to give Benadryl in increasing doses to calm him When we hit 75mg he was up all night agitated. We have tried Valarian. Sleep Essentials an herbal blend. with no improvement. We have to wait to test for Cushings testing because of the recent steroids. We watch him standing , panting, fretting for food nothing seems to comfort him, He cannot chase his beloved toys because of his elevated rate the vet says keep him quiet. We feel his quality of life is gone. The treatments listed seems as bad or worse than the disease. With the personality changes and his size we are considering euthanasia because he seems so miserable day to day.We know there is a possibility he may have a brain tumor but with his age and current status do not feel doing an MRI and being certain would change anything. That is hard because he is not totally failing and yet the future looks so grim in everything I am reading.. What will the long term effects of this respiratory rate be. Don’t dogs develop complications from breathing 100 x a minute nearly 24-7 ? Wont he get respiratory and metabolic alkylosis? We need Doggy Hospice !

  25. My boxer has cushings and I have not put her on the medicine yet. I ‘m terrified I could make her worse than she is.. She does pee and drink lots of water- seems she doesn’t drink as much when I’m not home (like she knows she will pee 100x) but once I get home she drinks a ton, then licks people’s legs, arms whatever she can’t reach– I just don’t know if I could worsen her health by giving her the Vetoryl

  26. I have a 175 lb. bull mastiff who was diagnosed with atypical Cushings at age 2. He is now almost 6. He had weak hind quarters, loss of hair, pot belly, allergies, arthritus and everything that comes with it. His cushings is now managed with a special diet and a combination of melatonin, flax seed lignan extract and benadryl. This is all over the counter and far better for him than the prescription drugs that he started with. It is labor intensive but worth it. We still have skin issues and infections but all in all he is stable and happy.

  27. Does anyone know if the application of glucosamine supplements or the anti-inflammatory drug piroxicam can have adverse effects on a dog with cushings?
    Our 14 year old mix breed is suffering most of cushing’s symptoms now.

  28. I am in the same situation as the last comment. My Beagle at 12+ years was diagnosed with Cushing’s Disease in June of 2014. She was put on Vetoryl 60mg and then rechecked at 10 days. Her levels had dropped but were not low enough for the vet. He wanted to increase her dose to 90 mg which would mean 2 prescriptions. We couldn’t afford this so we kept her at the 60mg. Now we are faced with retesting and are trying to be financially sound in our decision to continue down this path. It’s frustrating because she drastically improved, though she is not perfect, on the 60mg, but now we have to stop. And, in reality, that means that we are faced with the end-of-life decision. What can we expect from stopping the Vetoryl cold turkey? How long do you think we’d have before symptoms return, debilitating her again? Just frustrating, though I understand the dangers, when something is working and you have to stop. 😦

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