English bulldog pants happily in grass
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Your dog has been looking bloated and his once shiny coat is faded and falling out. Plus, he’s constantly panting, drinking water, and starting to have accidents all over your house. Your veterinarian thinks he might have Cushing’s syndrome. This condition will require surgery or lifelong medication, but the good news is your dog can get back to his normal self!
What Is Cushing’s Syndrome in Dogs?
Cushing’s syndrome, also known as hyperadrenocorticism, is when your dog is producing too much cortisol in his body. Cortisol is a steroid hormone that helps your dog’s body respond to stress, control weight, fight infections, and regulate blood-glucose levels. While some cortisol is necessary for a normal, healthy life, too much or too little of it can wreak havoc.
Cortisol production is controlled by two kinds of glands. The pituitary gland, located at the base of the brain, produces adrenocorticotropic hormone (ACTH) in response to stress. The ACTH then stimulates the adrenal glands, located next to each of your dog’s kidneys, to produce cortisol. As cortisol levels in the blood rise, the pituitary gland senses that and stops producing ACTH to prevent the production of too much cortisol. This is called a negative feedback loop. Cushing’s syndrome occurs when a malfunction in this loop causes too much cortisol to be produced and circulated in the body.
Why is hyperadrenocorticism called Cushing’s syndrome? This is a nod to Dr. Harvey Cushing, an American neurosurgeon and the first person to describe this condition.
Are Cushing’s Disease and Cushing’s Syndrome the Same Thing?
Yes and no. Technically, Cushing’s syndrome is the overarching term for hyperadrenocorticism, when there is excess cortisol production. Cushing’s disease is a specific type of hyperadrenocorticism caused by a tumor in the pituitary gland resulting in overproduction of ACTH. It's called pituitary-dependent hyperadrenocorticism (PDH). This is the most common cause of Cushing’s syndrome in dogs, so the term Cushing’s disease is frequently used interchangeably with Cushing’s syndrome. There are actually three primary types of Cushing’s syndrome.
Pituitary-Dependent
This is Cushing’s disease: when a tumor forms in the pituitary gland and causes it to overproduce ACTH, resulting in the overproduction of cortisol. The tumor may be benign or malignant. Most pituitary tumors are small, but large ones may cause neurological symptoms as they grow. According to the American College of Veterinary Internal Medicine (ACVIM), PDH is responsible for 80–85 percent of cases of Cushing’s syndrome in dogs.
Adrenal-Dependent
The remaining 15–20 percent of dogs with Cushing’s syndrome have adrenal-dependent hyperadrenocorticism (ADH). These dogs have a tumor on one or both of the adrenal glands, causing an overproduction of cortisol even though the pituitary gland is functioning normally. These tumors can also be benign or malignant.
Iatrogenic
A third, less common cause of Cushing’s syndrome in dogs is iatrogenic Cushing’s, caused by long-term or high-dose steroid use to treat another health condition.
Signs and Symptoms of Canine Cushing’s Syndrome
The common symptoms of Cushing’s syndrome in dogs include:
- Increased thirst
- Increased urination
- Increased appetite
- Hair loss and thinning of hair, especially on the back and abdomen
- Pot-bellied appearance
- Loss of muscle mass
- Thin, delicate skin
- Decreased activity
- Panting
- Recurring skin issues
- Dark spots of pigment on the skin
- Recurring urinary tract infections
- High blood pressure
“It is a chronic and progressive disease, meaning that the condition begins slowly with mild or subtle symptoms that commonly become more and more obvious with time,” the ACVIM says. Middle-aged and senior dogs are the most commonly affected.
Dog Breeds Prone to Cushing’s Disease
Cushing’s syndrome can affect any dog breed or mix, but it is seen in some breeds more commonly than others. These include:
- Beagles
- Boston terriers
- Boxers
- Dachshunds
- Poodles (particularly miniature poodles)
- Yorkshire terriers
Diagnosing Cushing’s Syndrome in Dogs
As with many diseases, the symptoms of Cushing’s syndrome in dogs overlap with the symptoms of many other conditions. The symptoms are also the same for all three types of Cushing’s syndrome.
The first step to making a diagnosis of Cushing’s syndrome is for you to notice changes in your dog’s behavior and/or appearance and make an appointment with your veterinarian. Make a list of any abnormalities and when you first noticed them to provide your vet with as much information as possible.
To accurately diagnose any of the three types of Cushing's syndrome, your vet will start off with a physical exam and a series of screening tests.
ACTH Stimulation Test
This is a blood test that can confirm if your dog has Cushing’s syndrome by evaluating his response to adrenocorticotropic hormone (ACTH), which is the hormone that regulates cortisol levels.
Urine Cortisol: Creatinine Ratio (UCCR)
This test requires a urine sample from your dog. Creatinine is produced at a constant rate, while cortisol levels in the urine increase if the dog has Cushing’s syndrome and is producing excess cortisol.
Low-Dose Dexamethasone Suppression Test (LDDS)
This blood test evaluates your dog’s response to increased cortisol levels. Your vet will draw a blood sample and then give an injection of dexamethasone (synthetic cortisol). Dogs with PDH typically still have some response to elevated cortisol levels and the pituitary gland will slow down ACTH production to control cortisol levels (but not as much as in a dog with a totally normal pituitary gland). Dogs with ADH won’t show any decrease in cortisol levels because the diseased adrenal glands have gone rogue.
High-Dose Dexamethasone Suppression Test (HDDS)
The procedure for this test is the same as the LDDS, but a higher dose of the dexamethasone is given. The higher dose can trigger the negative feedback loop in PDH, causing a depression of cortisol levels. If the test results still show no depression of cortisol, it can confirm that the dog has ADH.
Endogenous ACTH Levels
This blood test checks the levels of ACTH in the blood. If the dog has a pituitary tumor, he should have abnormally high ACTH levels. Unfortunately the ranges for normal ACTH levels, ADH, and PDH can overlap, so the results of this test do not always give a clear-cut answer.
Abdominal Ultrasound and Other Imaging
An ultrasound can be done to look for tumors on the adrenal glands. In some cases, an MRI or CT scan may be recommended to look for pituitary gland tumors or to confirm the presence of an adrenal gland tumor.
While this series of tests typically confirms a Cushing’s syndrome diagnosis, they do not determine the cause of the disease.
Expect that getting to the final diagnosis of pituitary-dependent or adrenal-dependent hyperadrenocorticism will take at least two rounds of testing, possibly three. It can be frustrating to get inconclusive results, but rest assured that each test allows your veterinarian to narrow down your dog’s diagnosis and make sure that you are making the right treatment choices.
Treatment for Cushing’s Syndrome in Dogs
Treatment for this disease depends on the type of Cushing’s syndrome that your dog has. The most common treatment options across the spectrum include:
- Surgery
- Medications
- Radiation therapy
- Gradually stopping corticosteroid use (if applicable)
Pituitary-dependent Cushing’s can be cured by surgically removing the tumor from the pituitary gland. Brain surgery is not to be undertaken lightly, however, and will require a visit to a specialist, along with the travel and cost associated with that.
More commonly, PDH is treated with medications to either block cortisol production or kill the cells that produce it. No medications cure Cushing’s, so your dog will be on them for the rest of his life. He may need dosage changes, so it is important to follow your veterinarian’s protocols for recheck blood work.
Adrenal-dependent Cushing’s can often be treated by surgically removing the tumor from the adrenal gland(s). If the tumor is benign, removal can provide a full cure. If the tumor is cancerous, the prognosis will depend if the cancer has already spread or not. Malignant tumors are also more likely to grow back.
Radiation therapy is also an option for treating the tumors that cause Cushing’s syndrome, and it can be done in conjunction with other therapies if warranted.
For iatrogenic Cushing’s, in which the symptoms were caused by corticosteroid therapy to treat a different condition, weaning off the steroids will usually resolve the Cushing’s. Never stop corticosteroids abruptly, as this can do further damage to your dog’s metabolism. If the adrenal glands have been harmed, it may be necessary to supplement some of the hormones that they produce to keep your dog’s body working properly. This may only be temporary or might be needed long term. It is also important to note that stopping the steroid therapy will likely cause your dog’s original health condition to return, so a new treatment plan for that may be needed.
Life Expectancy with Canine Cushing’s Syndrome
The American College of Veterinary Internal Medicine says that most dogs treated for Cushing’s respond extremely well. Dogs can live healthy, normal lives once they have been treated with surgery or are on a stable medication schedule.
It is important to follow medication instructions closely to ensure your dog is getting his meds at the right times. He will also need to go to the vet regularly for blood work to make sure the treatment is still effective at the current dose. The ACTH stimulation test is frequently used to monitor response to treatment, and may be done monthly at first while your vet is determining the ideal medication dosage and then dropped back to once or twice a year when your dog is stable.
The presence of other health conditions can affect the prognosis for a dog with Cushing’s syndrome. Diabetes mellitus is one of the most common diseases for dogs to have in addition to Cushing’s, but senior dogs can fall victim to a variety of conditions. Additional illnesses can have an effect on your dog’s response to treatment. Discuss all of your dog’s medications with your vet to ensure that there won’t be any adverse interactions.
If your dog has just been diagnosed with Cushing’s disease, expect that it may take a few months to get him completely stable on a medication schedule that works for him and controls his symptoms. Be patient during this process and stay in contact with your veterinarian. But if after several months and dosage changes your dog is still not stabilized and doing well, it may be time to consider his quality of life. Many dogs with Cushing’s syndrome do well once they have been diagnosed with the disease and are started on a treatment plan, and although it is an extremely difficult decision, euthanasia is an option you can discuss with your vet if your dog is suffering or has a poor quality of life.
FAQs
Is it worth it to treat Cushing's disease in dogs? ›
Statistically, treatment for Cushing's disease may help decrease the incidence of gall bladder disease in 26.6% of patients. Hypertension and proteinuria improved in 47% with treatment, and 60-80% in other references. All other comorbidity improvement is anecdotal or not likely to help with treatment.
How long do dogs usually live with Cushing's disease? ›According to the American Kennel Club the average survival time for a dog with Cushing's is about two years, with only 10 percent living beyond the four-year mark. That said, it's important to remember that most cases of Cushing's disease are diagnosed in elderly dogs.
Can a dog live a normal life with Cushing's disease? ›Generally, if the activity of the adrenal gland can be controlled, many dogs with this form of Cushing's disease can live normal lives for many years, as long as they take their medication and stay under close medical supervision.
How fast does Cushing's disease progress in dogs? ›Because it takes time — at least one year — for these symptoms to develop, and because the symptoms are often mistaken for common signs of aging, many dogs have the advanced form of CD before the owner even recognizes a problem exists.
Do dogs suffer when they have Cushing's disease? ›While not inherently painful, Cushing's d isease in dogs (especially if uncontrolled) can be associated with: High blood pressure. Kidney infections. Bladder stones.
Do dogs with Cushings suffer? ›Most dogs with Cushing's are not in any pain and their symptoms can be easily managed through medication. Dogs that have developed the condition due to a tumor on the adrenal gland may require the tumor to be surgically removed as these tumors are aggressive.
What kills a dog with Cushings disease? ›Cushing's itself does not kill dogs, but complications related to Cushing's can lead to kidney failure, serious infection and can even be fatal.
When should a dog with Cushings be put down? ›Dog's diagnosed with it tend to have an average lifespan of 2-3 years. If your dog's condition has been diagnosed at a later stage, is not improving despite medication, is in constant pain, or has started having a neurological impact on its health, it is time to make that tough decision to euthanize them.
What triggers Cushing's disease in dogs? ›Most canine Cushing's disease occurs naturally and is either pituitary-dependent or adrenal-dependent. About 80–85 percent of Cushing's is pituitary-dependent, meaning it's triggered by a tumor on the pituitary, a pea-sized gland at the base of the brain.
Is Cushing's terminal for dogs? ›Cushing's disease (hyperadrenocorticism) is a serious health condition in dogs that occurs when the adrenal glands overproduce cortisol (cortisone) in the animal's body. Excess cortisol can put a dog at risk of several serious conditions and illnesses, from kidney damage to diabetes, and can be life-threatening.
How expensive is it to treat a dog with Cushings? ›
Veterinary Cost
$500 to $1,500 is considered typical for a complete diagnosis (though the low end of this estimate would not include an ultrasound). Medical treatment can be as low as $50 a month or as high as $200, depending on the dog's response to treatment and the drug selected.
If Cushing's disease is left untreated, dogs tend to become progressively lethargic and weak. They have an increased susceptibility to contracting infections (particularly urinary infections) and the skin is slow to heal after any injury. Osteoporosis has been reported.
What are the stages of Cushings disease? ›These three Cushing's disease signs are known as the three P's—polydipsia, polyuria, and polyphagia.
Should you withhold water from a dog with Cushings? ›You must continually monitor your dog's food and water intake. Both should return to a normal level. Water intake should be less than 1 ounce per pound (66 ml per kilogram) of body weight per day, but do not limit the water if your dog needs to drink more.
Do dogs with Cushing's have anxiety? ›The symptoms of Cushing's disease in dogs are similar to some of the side effects human patients experience when taking steroids. Symptoms of Cushing's disease in dogs may include: Restlessness, which may include senior dog anxiety at night.
Why do dogs with Cushing's Lick? ›Your dog may have Cushing's disease or Hyperadrenocorticism, in which his adrenal gland produces excessive glutocortisoid which can harm or affect many organs in the body such as the kidney and liver. It is also known to cause the excessive floor licking. Liver failure also causes this weird licking habit.
Does Cushing's affect dogs eyes? ›Cushing's disease in dogs is associated with a number of ophthalmologic abnormalities, including corneal abnormalities (such as corneal degeneration and ulceration), keratoconjunctivitis sicca, lipemia of the aqueous humor and/or retina, and hypertensive chorioretinopathy.
What is the best natural treatment for Cushing's disease in dogs? ›A combination of Melatonin and Lignans offer an excellent natural treatment for both Cushing's and Atypical Cushing's disease in dogs. In fact, supplementing with melatonin and lignans helps your dog's system return to normal.
What are the first signs of Cushing's disease in dogs? ›Some common symptoms of Cushing's disease include hair loss primarily on body, unusually thin skin, propensity for bruising, hard calcified lumps on skin, lethargy, swollen belly, increased appetite, thirst, and urination.
Should you treat Cushing's in older dogs? ›Usually treatment for Cushing's is not even recommended unless the dog has clinical signs because treatment does not necessarily change their overall life span - it just keeps them from being polyuric (urinating a lot), polydypsic (drinking a lot), losing their hair, etc.
How do you reduce cortisol in dogs? ›
Studies show that another supplement, Phosphatidylserine, derived from lecithin, may support hypothalamo‐pituitary‐adrenal function and help reduce cortisol levels naturally. Ask your holistic vet about giving this to your dog.
Do dogs with Cushings pee a lot? ›Many of the Cushing's syndrome dogs urinate more frequently and for long time period due to excess urine volume. House broken pets may begin to urinate in the house, or begin to have leakage. Excessive thirst is commonly observed in Cushing's syndrome dogs. Loss of hair is common along the back, tail and rear legs.
Does Cushing's in dogs cause leg weakness? ›In addition to the common telltale signs noted above, the excess cortisol production of Cushing's syndrome can also affect your pet's muscular strength. This muscle weakness is actually the cause of the pot belly your dog may develop. It can also make a noticeable impact on the hind legs.
What happens if I don't treat my dogs Cushings disease? ›If Cushing's disease is left untreated, dogs tend to become progressively lethargic and weak. They have an increased susceptibility to contracting infections (particularly urinary infections) and the skin is slow to heal after any injury.
Is Cushing's disease terminal in dogs? ›Cushing's disease (hyperadrenocorticism) is a serious health condition in which the adrenal glands overproduce cortisol (cortisone) in the body. Excess cortisol can put a dog at risk of several serious conditions and illnesses, from kidney damage to diabetes, and can be life-threatening.
Does Cushings need to be treated? ›Untreated Cushing syndrome can be life-threatening. Fortunately, most people with the syndrome are treated and cured.
How long can a senior dog live with Cushings? ›How long does a dog live with Cushing's Disease? The ultimate age for a dog to survive with Cushing's is approximately three years. However, in some cases there is a survival rate of two years. Dogs with the disease can have a good quality of life if they're closely monitored by a vet.
Should you treat an old dog with Cushing's disease? ›Although Cushing's is typically a lifelong condition, the disease usually can be managed with medications. "It's important for a veterinarian to see the dog regularly and do blood tests," Stohlman says.
How does a dog act with Cushing's disease? ›Aggression, increased pursuance of food and water, exercise intolerance, lethargy, and difficulty moving around in their day-to-day environments (navigating stairs, going up onto elevated surfaces, etc.) are some of the behavior changes commonly seen in dogs afflicted by Cushing's disease.
What do you feed a dog with Cushings disease? ›Low in Fat With Moderate Fiber
Dogs with Cushing's disease have elevated levels of cortisol, which increases triglycerides and cholesterol. To help combat these increases, a food that's lower in fat (less than 12 percent on a dry matter basis, or DM) and moderate in crude fiber (8-17 percent DM) is reasonable.
How do you improve Cushing's disease? ›
Medications to control excessive production of cortisol at the adrenal gland include ketoconazole, mitotane (Lysodren) and metyrapone (Metopirone). Mifepristone (Korlym, Mifeprex) is approved for people with Cushing syndrome who have type 2 diabetes or glucose intolerance.
Is Cushing a terminal? ›Today, virtually all people with Cushing's syndrome can be treated effectively, and many can be cured. Because Cushing's syndrome is potentially fatal if untreated, people with this condition should have regular medical care and follow their treatment plan closely.