Cushing's Disease in Dogs

Treatment for Cushing's Disease in Dogs


Treatment for Cushing’s disease that develops due to corticosteroid medication overuse is fairly straightforward. Dogs should be slowly weaned off of these medications while under a veterinarian’s care. Removing these medications too quickly can lead to a life-threatening condition called an Addisonian crisis.


Dogs with mild symptoms associated with pituitary-dependent Cushing’s disease may not need immediate treatment but should be closely monitored to determine when it would be beneficial. In general, treatment should start when a dog develops symptoms that are potentially dangerous and/or troublesome to the pet or owner. These might include high blood pressure, an increased urine protein:creatinine ratio (evidence of kidney damage), recurrent infections, a noticeable increase in drinking and urinating, urinary accidents, having to get up in the middle of the night to urinate, exercise intolerance, and excessive panting.


Once the decision to treat a dog’s pituitary-dependent Cushing’s disease has been reached, a veterinarian will likely prescribe one of two drugs:  mitotane (Lysodren) or trilostane (Vetoryl). These drugs can have serious side effects, so dogs taking them should be closely monitored. Other medications (ketoconazole, selegiline or cabergoline) may also be used under certain circumstances.


When a patient is diagnosed with an adrenal tumor, chest radiographs and possibly a CT scan or MRI should be taken to examine the body for any possible metastatic spread of the disease. If no metastases are seen, the dog is often given a medication (trilostane) for a few months to shrink the tumor, followed by surgery to remove it.


Living with and Managing Cushing's Disease


If your dog is being treated with trilostane or mitotane for Cushing’s disease, you need to be prepared to continue treatment for the life of your pet. You will need to be observant for any adverse reactions to these powerful medications. Typical signs of an adverse reaction are lack of energy, weakness, lack of appetite, vomiting, diarrhea, and sometimes difficulty walking. If any of these side effects do occur, you should discontinue the medication and contact your veterinarian immediately. He or she may have given you the medication prednisone to give to your dog under circumstances like these (or during times of stress). Follow your veterinarian’s directions with regard to prednisone use in your dog.  


Your veterinarian will schedule regular follow-up visits to monitor for the adverse effects of mitotane or trilostane and make sure that your dog continues to receive an appropriate dose. Schedules vary, but you should be prepared to see your veterinarian several times a year once the maintenance phase of therapy has been reached.


Successful removal of a benign adrenal tumor that was responsible for a dog’s Cushing’s disease should be curative, but if the tumor was malignant the prognosis is more guarded.


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