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What Is Cushing Syndrome?
Cushing syndrome or disease is a condition affecting humans and pets wherein there is an overproduction of steroid hormones. This can either be a result of the pituitary gland doing the increased production or the adrenal gland causing the overstimulation and production of the hormone. In the latter case, oftentimes there is a tumor associated with the condition. In layman's terms, Cushing's is too much cortisol being manufactured in the body. Cortisol affects our ability to respond to stress, helps us fight infections, and keeps blood sugar in check. It does the same in our dogs.
Roughly 80% of Cushing's in dogs results from the pituitary variety, and nonsurgical means are used to treat the disease. Since oral treatments can be used to treat the disease, usually more invasive testing is not performed in order to distinguish whether or not the disease is being caused by the adrenal gland versus the pituitary gland.
However, if it is clear that an adrenal tumor is responsible for the symptoms, then surgery may be a viable option. Radiation may also be considered if there is a tumor and it is found. Radiotherapy is used to shrink the size of tumors though, not cure them or destroy them.
Prevalence of Cushing Syndrome in Dogs
- There does not appear to be any correlation of Cushing syndrome amongst certain breeds of dogs.
- The mean age of detection is 6–7 years of age.
- It can be detected as young as 2 years of age and as old as 16 years of age, however.
- Male versus female shows no correlation either. There is no predominance in gender to contracting the disease.
- About 80% of cases are due to a pituitary tumor or overproduction of the pituitary variety of the hormone ACTH.
- About 20% are due to the adrenal gland variety.
Symptoms of Cushing's in Dogs
- Increased water consumption (polydipsia)
- Frequency of urination (polyuria)
- About 80% of animals with the disease have increased appetite (polyphagia)
- Enlargement of the abdomen in 80% of dogs (potbelly appearance)
- Hair loss—between 50% and 90% of dogs usually have this symptom
- Thin skin or slow-to-heal skin—one of the most common presenting symptoms
- Excessive panting
- Fatigue or listlessness
- Recurrent urinary infections
- Loss of reproductive ability
- Acne or pustules
Diagnosing Cushing Syndrome
Just like humans who are suspected of having Cushing syndrome, blood tests are the first line of diagnosis. Usually, tests include a complete blood count (CBC), a urinalysis, and a metabolic or blood chemistry panel.
It should be noted that there is not just one test that is specifically used to diagnose Cushing disease. The diagnosis is usually made on the basis of several tests, and the overall health history and symptomatology the dog is exhibiting.
The three most common screening tests that are used next would include a urine cortisol to creatinine ratio, a low-dose dexamethasone suppression test, and an ultrasound.
The cortisol/creatinine ratio is usually sent out to special labs, and although if abnormal can be diagnostic, other causes can give a result that is not normal.
The dexamethasone suppression test in 90% of dogs with Cushing's will show no decrease in cortisol levels 8 hours after administration while normal dogs will show a marked decrease in cortisol levels.
An abdominal ultrasound shows canine abdominal organs and can detect if one or both adrenal glands are enlarged or if a tumor is present on one side. It can also detect if there are metastases to other organs from a tumor.
An ACTH stimulation test may also be used to distinguish between pituitary-based disease versus adrenal-gland Cushing's. It is also used to assess the efficacy of treatment once begun on a replacement.
Cushing Syndrome Canine Treatments
If a dog has Cushing's syndrome that is determined to be due to a primary tumor of the adrenal gland, surgery might be an option. However, keep in mind that if it is has spread to other organs, it will do relatively little to prolong his or her life and medication might be the best option.
Even if the tumor has not spread to other organs, it is quite possible as well that it can recur so again, mediation of the condition with medication is still a relatively expedient option as well as being more cost-effective. It's always best to consider the age of your dog also, and if the risks of surgery outweigh any potential benefits, medication options would always be better and less stressful to your pet.
The most common drug is trilostane (Vetoryl). Mitotane (Lysodren) is an older drug that vets do not use as much. It causes many side effects, but it may cost less.
Vetoryl was approved by the FDA in 2008. It is the only drug approved to treat both kinds of Cushing's in dogs, pituitary and adrenal-dependent. It works by stopping the production of cortisol in the adrenal glands. It should not be given to a dog that is nursing, has liver or kidney disease, or is being treated for heart disease of some type.
The drug can have side effects of lethargy, diarrhea, vomiting, and lack of appetite. As with any drug, it can have serious and lethal side effects such as total collapse, severe dehydration or depletion of electrolytes, bloody diarrhea, and other fatal consequences.
One other drug, Anipryl (selegiline), is an FDA-approved medication that can treat Cushing syndrome in dogs, but it is only used to treat the uncomplicated, pituitary-dependent variety of Cushing's.
If medications are used, there is constant monitoring required. The dog needs regular checkups and blood tests to make sure that the treatment is working.
Iatrogenic Cushing Syndrome
Another type of Cushing disease is called iatrogenic, which means that it is caused by something else.
Giving a dog high-dose steroids for other conditions such as inflammatory arthritis or other medical conditions can subsequently produce Cushing syndrome. The treatment options in this case usually involve gradually tapering off the steroids to hopefully reduce the Cushing syndrome.
What If I Don't Treat My Dog's Cushing Syndrome?
About 100,000 dogs per year are diagnosed with Cushing's. Generally speaking, a dog with Cushing syndrome will live about as long as he or she will if not treated for the disease. It usually does not prolong the dog's lifespan.
However, dependent upon the symptoms of course, it may be preferable to treat the dog if the symptoms are severe enough, such as constant urinary accidents, extreme hair loss, fatigue, etc.
As in all pet diseases, we as their human caretakers have to decide if the treatment far outweighs the benefit to our beloved pets and if it is financially feasible for us to try and prolong their life or relieve their symptoms. Sometimes the treatments can also produce more problems than merely accepting the outcome of our pet's medical condition and allowing them to live out their remaining time without complications.
Two Sides of the Coin
The polar opposite of Cushing syndrome is Addison disease. This occurs when there is hypoadrenocorticism rather than hyperadrenocorticism. There is not enough corticosteroid secretion from the adrenal gland, and there can be similar symptoms to Cushing's with the exception that the symptoms are usually much worse.
Symptoms can also include vomiting, diarrhea, weight loss, shaking, low temperature, weakness, dehydration, bloody feces, and pain in the abdomen. Kodi (the beautiful fellow at the beginning of this article) suffered from this disease and was diagnosed with it at 5 years of age when he went into near collapse just out of the blue.
He was treated with high-dose steroids by injection and in pill form and had to be constantly monitored. We were told that he would most likely respond if he was going to and do very well, but he would experience a very quick decline once his body could no longer absorb the steroids that we were replacing for him.
He lived another 5 years, so in his case, I think the treatment was worth it. However, he did literally tank overnight and went into total collapse, which was very painful to live through for us.
Diets for Cushing's in Dogs
Some of the recommended dietary approaches for a dog with Cushing's include:
- Low-fat diet—staying away from high-fat fish products, etc. as the dogs usually have increased appetite anyway and may have extra fluid retention
- Diets rich in potassium-containing foods
- Low-fiber diets as it is harder for these dogs to digest foods - shredding vegetables and fruits is a good way to give them fiber but keep it at a low level
- Natural foods—keep to as natural a diet as you can afford or even make your own food for your pet—the less additives and preservatives the better
- Raw diets—some vets and breeders recommend a raw diet as these keep sodium, fiber and carbohydrate levels low
It is interesting to note that Cushing syndrome is on the rise in dogs.
Cushing Syndrome in Other Animals
You will find some incidence of Cushing syndrome in the following animals:
- Guinea pigs
- Humans—more common!
In cats, it is fairly rare and in horses as well. Any animal that has adrenal glands could develop Cushing syndrome, though it is again, highly more common in dogs it seems than other animal species.
Questions & Answers
Question: I do not have the money to get a diagnosis from my vet. My dog is showing all the symptoms of Cushing's, except the hair loss. They sell Holistic medicines for dogs for adrenals. Would this be a feasible route?
Answer: I don't think it could hurt. If your dog shows improvement, you will know that it was worthwhile.
Question: Will taking away water for next morning surgery hurt a dog with Cushing's?
Answer: I'm not sure on that one. I would imagine that midnight was the cut-off for next day surgery. I would ask the vet though as they drink a lot of water and would not want them to be dehydrated. They might advise cutting off water at say 6:00 a.m. instead - but always pays to ask a professional.
Question: My dog consumes tons of water without retention. She actually looks like she is dehydrated. Is this dangerous?
Answer: I'm actually not sure about that. Some dogs do drink a lot of water though. I would ask your vet just to be sure. One of my malamutes drinks a ton of water but she has a thyroid condition so I am assuming that is why from what my vet has told us and what I have researched. It is always better to check if you are concerned about it.
© 2017 Audrey Kirchner
Audrey Kirchner (author) from Washington on April 16, 2018:
It sometimes can be hard to know which food is 'best' because every dog with this syndrome is going to be different. For me, I just kept trying different formulas slowly over time until I found the one that helped Kodi most with his Addison disease and then stuck with that. In times of flare of his disease, I also did natural cooking for him with chicken and rice for example. I would ask my vet as well as many will recommend a certain type of diet. Hope that helps!
Sandy on April 16, 2018:
What food should I feed my dog he has Cushing
Is Cushing’s Disease Painful For Dogs?
Cushing’s Disease in Dogs
Symptoms of Cushings Disease in dogs
The symptoms of Cushing’s Disease can vary between dogs. The symptoms also can mean something else and not always mean the dog has Cushing’s Disease. It will require more than noticing symptoms to determine if your dog has Cushing’s Disease other diagnostic tests will be required. Some of the symptoms to look for in the meantime, if you are concerned, are increased thirst and urination, urinating at night or having frequent accidents, increased hunger, panting more than normal, pot-bellied abdomen, obesity, loss of hair, lack of energy, infertility, dark areas in the skin, bruises, muscle weakness, and white scaly patches on the skin. It is important to know that Cushing’s Disease is mostly found in older dogs, so a puppy will most likely not have this disease.
Is Cushing’s Disease Painful for Dogs?
If your dog has been diagnosed with Cushing’s Disease, it is normal to wonder, “Is my dog in pain with Cushing s disease?” Cushing’s Disease can come with a great deal of pain and discomfort, or the dog may not have much pain at all. It can vary between dogs, and there are medication options to help if pain does occur. It is crucial to remember to provide pain relief to your pet regardless if your pet has Cushing’s Disease or not. Cushing’s Disease can lead to other health complications that can cause pain as well. You should educate yourself about this disease and treatment options before you ever suspect your dog may ever have it.
Natural treatment for Cushings Disease in dogs
If you wish to provide your dog with a natural treatment instead of medication, there are several beneficial options of natural treatment for your dog with Cushing’s Disease. You may give your dog Kelp, Nettle, Rosehips, Cliver, Warmwood, Burdock, Milk Thistle, Clover, Garlic, and Apple Cider Vinegar. Also, Homeopathic Pituitary is a great remedy made from the posterior lobe of the pituitary gland and helps balances the gland. This will work well if your dog is diagnosed in the early stages. It is given in low doses over a long period of time. Additionally, it is worth noting that you should take your dog to a holistic veterinarian that has experience with Cushing’s Disease if you are choosing a more natural treatment. You should begin with eliminating stress, foremost. Since Cushing’s Disease is a disease caused by a hormone that helps with stress, it is important to minimize stress in your dog’s life.
CBD for Dogs With Cushings Disease
If you are looking for a safe and affordable way to treat Cushing’s Disease, CBD may be a great option for your dog. CBD is not a cure for Cushing’s Disease, but it is an optimal choice to help with soothing your dog’s pain and will be a benefit to your dog’s overall health. If you are asking yourself, “Is my dog in pain with Cushing s Disease,” you should give CBD a try to see if it helps your dog. Your dog will not experience a “high” feeling, and you are in control of the doses given. You may notice your dog being happier and more active, which usually means the CBD is helping with its pain. It is also a fully natural solution. There are a few different CBD options to give your pet. CBD oil is a fully organic option tested and proven to be safe for pets. It will help them with joint and digestion issues as well as anxiety and stress. It is also a supplement, able to be given to your dog even if it is healthy. CBD treats are tasty treats that will provide health benefits for your dog. These treats are natural and organic as well, which makes them safe for your dog. You will not have any trouble getting your dog to eat these treats, and you will have the peace of mind that your pet is benefitting from them.
Dog Cushings Disease Untreated
If you decide to not treat your dog’s Cushing’s Disease diagnosis, it will most likely develop more side effects and worsen overtime. Treating does not usually help your dog’s lifespan, but it does help with the symptoms that comes with the disease. Cushing’s Disease usually accompanies other health conditions that may lead to an earlier death. There is currently no cure for this disease but being diagnosed early can help find the best treatment possible. It is preferred to provide your dog with some kind of treatment to give them the chance of a happy and better quality of life. If your dog has other health conditions, Cushing’s Disease can have a negative impact on the conditions and make them worse. It is important to always monitor your dog for any and all symptoms present. If you are questioning, “Is Cushing’s Disease painful for dogs?” The answer is it can be, and it is recommended to provide your dog with CBD or medications to soothe any pain your dog may be in.
Basics of Classification
As with all central nervous system tumors, the Tumor–Node–Metastasis system used by the World Health Organization does not apply. Current classification systems for PAs in veterinary patients are based primarily on secretory characteristics of the tumor. However, in humans, PAs are currently classified based upon:
- Tumor size and degree of invasiveness (Table 1) 1
- Tumor endocrine activity (hormone secretion), or functional classification based on immunohistologic findings, such as ACTH and thyroid- and follicle-stimulating hormones.
In both humans and dogs, pituitary corticotroph adenomas that are responsible for Cushing’s disease (ie, PDH in dogs) are classified as functional ACTH-secreting PAs (ACTH-PAs).
The World Health Organization classification system for PAs in humans has been refined to include designations for benign adenoma, atypical adenoma, and pituitary carcinoma on the basis of proliferation indices (p53 immunoreactivity, MIB-I Index, mitotic activity) and the absence/presence of metastases. 2
More comprehensive molecular classification systems based on relevant gene expression have not been systematically used to further characterize pituitary tumors. Similar work to classify canine pituitary tumors both morphologically and functionally is currently underway.
Cushing's Disease in Dogs: Understanding, Diagnosing, and Treating
Has your dog been drinking their water more quickly than usual even with extra refills? Or maybe your housetrained pooch had an accident or been requesting extra night time potty breaks? Perhaps you’ve also noticed your pup devouring every meal with even more than their typical enthusiasm. All of these indicators may be clinical signs pointing to the possibility of Cushing's syndrome in your dog.
Cushing's Disease, scientifically called hyperadrenocorticism, usually happens in middle aged or senior dogs when their bodies create too much of the stress hormone cortisol. Cortisol is a very useful and necessary hormone that helps with stress response, metabolism, and many other important bodily functions. However, excess cortisol impairs the immune system and often leads to infection, inflammation, and other health maladies like cushing’s disease.