Dog Cushing’s Disease Treatment Plan: Steps and What to Expect

If your dog has been diagnosed with Cushing’s disease, it may feel a bit overwhelming. The good news is that once your dog’s symptoms are managed, Cushing’s disease in dogs treatment is fairly straightforward for most pets who are diagnosed with this condition. 

If you are just starting out on this journey with a dog that has been newly diagnosed with Cushing’s, or you want to be more informed about what to expect in regards to treatment for Cushing’s disease in dogs, this article will give you the knowledge that you need to make informed decisions for your dog. 

Dog Cushing’s Disease Treatment Plan: What to Expect

Once a dog is diagnosed with Cushing’s disease, their health care depends on the severity of their symptoms, the type of Cushing’s disease they have, the dog’s overall health and condition, and any complicating factors (for example, if they have diabetes mellitus or osteoarthritis).

The most common type of Cushing’s disease diagnosed in dogs is called pituitary-dependent hyperadrenocorticism. This means that a small, usually slow growing tumor in the pituitary gland in the brain causes the adrenal glands to secrete too much cortisol, a steroid hormone. This type of Cushing’s disease in dogs treatment involves long-term daily medication that reduces the level of cortisol in the dog’s body back to normal levels. 

Typically, when a dog is diagnosed with pituitary-dependent Cushing’s disease, their veterinarian will prescribe an initial dosage of daily medication for the dog and ask the pet parent to come back in a few weeks for a recheck examination and blood tests.

The reason for the recheck is to ensure that the medication dosage is appropriate:

• If the dosage is appropriate, then your dog’s blood tests will be normal and their symptoms will be improving (appetite/drinking/urinating return to normal, better energy levels, etc.). If this is the case, your veterinarian will likely tell you to continue on the same dosage and ask you to return for a recheck in 3-6 months, as long as your dog is doing well.
• If the dosage is too low, then your veterinarian will increase the medication dosage and ask you to come back again in a few weeks to repeat the examination and blood test.
• If the dosage is too high, then your veterinarian will decrease the dosage and ask you to come back again in a few weeks to repeat the examination and blood test. 

Dogs can also develop a tumor on their adrenal gland that causes the symptoms of Cushing’s disease. This type of Cushing’s is less common, but still occurs in dogs. If this is the case, then your veterinarian will recommend surgery to remove the tumor. While this type of Cushing’s can also be managed with long-term medication, surgery will cure the condition and is the recommended treatment of Cushing’s disease in dogs that is caused by an adrenal tumor, unless your dog is not a good candidate for surgery. 

If your dog has other disease conditions, that complicates things. Sometimes, dogs can develop multiple hormonal conditions at the same time, which can be challenging to manage. Other times, dogs may have silent skin or joint problems that suddenly become a problem once the Cushing’s is under control. In these situations, it is best to have patience and realize that it will likely take longer to get multiple health conditions under control and will require more veterinary visits. 

Dog Cushing’s Disease Treatment Cost

The cost to manage Cushing’s disease in dogs depends on several things: what type of Cushing’s your dog has, how big your dog is, how easy your dog’s Cushing’s disease is to manage (e.g., how many follow-up visits and blood tests are required), the type of medication prescribed, if surgery is required, and your geographical area. Ballpark estimates are as follows:

• Initial diagnosis: $300-$1,000 (examination, laboratory testing, abdominal ultrasound)
• Follow-up visits: $150-$250 per visit (examination, laboratory testing)
• Medication: Ranges from $50-$150/month, depending on the size of your dog, the type of medication prescribed, and the dosage required to control symptoms
• Surgery: $2,000-$4,000

Cushing’s disease in dogs treatment can be costly. Pet insurance, emergency credit lines, savings accounts, and payment plans can all help with the cost of veterinary bills. 

Medication for Cushing’s Disease in Dogs

Medication controls the symptoms of Cushing’s disease in dogs by suppressing the production of cortisol from the adrenal glands. When dosed appropriately, medication normalizes the levels of cortisol in the body and symptoms of Cushing’s resolve. While Cushing’s medications are very effective, they can also be dangerous, causing abnormally low levels of cortisol that can be fatal, if the dosage is too high. That is why it is very important for pet parents to closely monitor their dogs while on Cushing’s medications and to return to the veterinarian for scheduled rechecks, especially at the beginning of treatment. 

If you notice any of the following symptoms in your dog while they are on Cushing’s medications, stop the medication and call your veterinarian immediately:

• Loss of appetite (misses a meal)
• Excessive lethargy, shaking, or weakness
• Vomiting
• Diarrhea 

Most veterinarians will counsel pet parents thoroughly on this risk associated with Cushing’s medications, and most veterinarians will also send you home with a few prednisone tablets with instructions to give them if the symptoms of low cortisol are ever noticed while on medication. 

Trilostane (trade name Vetoryl), is the most widely prescribed FDA approved medication for dog Cushing’s disease treatment. This medication works by suppressing the production of cortisol in a dog’s body, and is very effective in controlling the symptoms of Cushing’s disease in dogs. This drug is either given once or twice daily and is well tolerated in most dogs. Anecdotally, Cushing’s dogs that are treated with trilostane often need less after a year or two of treatment, and some dogs go into remission completely, no longer requiring medication. 

Mitotane, otherwise known as Lysodren, is the other main drug used to treat Cushing’s disease. It works by selectively destroying cells in the adrenal gland that secrete cortisol. It may also be used in dogs for adrenal tumors that aren’t good surgical candidates since it may destroy tumor cells as well as control symptoms. This medication is usually given once a day.

Other drugs that may be prescribed for Cushing’s disease in dogs include ketoconazole and selegiline hydrochloride.

Diet for Dogs with Cushing’s Disease

Dogs who are being treated for Cushing’s disease usually do not require a diet change; a regular maintenance diet is appropriate for most dogs unless they are also diagnosed with diabetes mellitus. If the dog is overweight, your veterinarian may recommend a short-term change to a weight loss diet to facilitate weight loss. 

Keeping Dogs with Cushing’s Disease Comfortable

Cushing’s disease in and of itself is not a painful condition. Dogs with Cushing’s can have a hard time regulating their body temperature and breathing, however, so make sure they have a cool place to rest and don’t force exercise, especially in the heat. The best thing you can do for a dog with Cushing’s is get the condition treated appropriately, which will resolve symptoms.

Excessive cortisol secreted in Cushing’s disease, however, can mask painful inflammatory conditions, like joint pain from osteoarthritis. It can also mask skin allergies because cortisol works the same way steroids do. If you notice that your dog starts limping, is having a hard time getting around, or starts excessively scratching their skin while they are under treatment for Cushing’s, speak to your veterinarian about how to keep your pet comfortable. 

If your dog has surgery to remove an adrenal tumor, then they will need to ‘stay quiet’ for 2 weeks to allow their incision to heal. This includes no running, jumping, or long walks. For the first 48 hours, your dog will likely just want to sleep, eat a little, and drink water. Make sure they have a warm, soft place to recover, prevent them from licking or biting at the surgery site, and monitor their incision daily for any signs of infection (heat, swelling, redness, discharge), gaping, or loose sutures. 

Dog Cushing’s Disease Treatment: Tips and Advice

Once your dog’s cortisol levels are controlled, you can expect to see rapid resolution of symptoms associated with Cushing’s. This includes resolution of:

• Excessive drinking and urinating
• Excessive eating
• Excessive panting
• Anxiety
• Hair loss
• Skin and urinary tract infections
• Weakness and trembling
• Pot belly

As stated above, if you notice signs of low cortisol, stop medication and call your veterinarian immediately. 

Cushing’s, in general, is fairly easy and rewarding to treat. Most dogs can live for years with a good quality of life, and most pet parents are very pleased with how their dogs respond to therapy. Just be patient, remain vigilant for the signs of adverse drug reactions or low cortisol, communicate regularly with your vet, take it one day at a time, and you will likely be successful in helping your dog feel much, much better.