reader guide
Cushing’s Disease in Dogs: Signs, Testing, and Treatment Choices
A practical, veterinarian-informed guide for dog families who want clear next steps, calmer decisions, and fewer missed warning signs.
| Focus | What to do | Vet cue |
|---|---|---|
| Common signs | Thirst, urination, appetite, panting, belly change | Sudden weakness, vomiting, collapse |
| Testing | Bloodwork, urine, endocrine tests, imaging | Conflicting results or other illness |
| Treatment | Medication, surgery in selected cases, monitoring | Missed follow-up or side effects |
1. What causes Cushing’s disease in dogs?
Most naturally occurring canine Cushing’s disease is pituitary-dependent, meaning a small pituitary tumor signals the adrenal glands to produce too much cortisol. A smaller percentage comes from an adrenal tumor that produces cortisol more directly. Dogs can also develop iatrogenic Cushing’s-like signs from long-term corticosteroid medication. Differentiating these categories matters because treatment options and monitoring differ. The American College of Veterinary Internal Medicine consensus recommendations emphasize using history, exam findings, screening tests, and follow-up diagnostics together rather than relying on a single abnormal lab value (Behrend et al., 2013). Your veterinarian’s job is to decide whether the signs fit the disease strongly enough to test, and then whether the test results fit the dog in front of them.
2. Which signs should owners take seriously?
The classic pattern is drinking more, urinating more, eating intensely, panting at rest, losing muscle, developing a pendulous abdomen, and showing symmetrical hair thinning along the trunk. Skin may bruise easily, heal slowly, or develop recurrent infections. Some dogs have accidents indoors because urine volume increases beyond what their routine can handle. Others become restless at night or less tolerant of exercise. Any one sign can have many causes, but the cluster is important. Measure water intake for a few days, note appetite changes, photograph skin and coat changes, and tell your veterinarian about any steroid tablets, injections, ear medications, or skin creams your dog has received.
3. How do veterinarians test for it?
There is no perfect single screening test. Veterinarians commonly start with a physical exam, urinalysis, blood chemistry, complete blood count, and blood pressure assessment to look for patterns and rule out competing diseases. Specific endocrine tests may include the low-dose dexamethasone suppression test, ACTH stimulation test, or urine cortisol-to-creatinine ratio in selected cases. Imaging such as abdominal ultrasound may help evaluate adrenal glands and screen for other disease. Test interpretation can be tricky because stress, non-adrenal illness, and medications may influence results. That is why a dog with vague signs may need staged testing, while a dog with a strong sign pattern may move more quickly toward endocrine diagnostics.
4. What treatments are available?
Many dogs with pituitary-dependent Cushing’s are managed medically with trilostane, a drug that reduces cortisol production, while some adrenal tumors may be treated with surgery, medication, or palliative plans depending on tumor behavior and the dog’s overall health. Treatment is individualized because reducing cortisol too much can be dangerous. Monitoring is not optional. Dogs on medication need repeat exams, electrolyte
Decision map
5. What happens if Cushing’s is not treated?
Untreated or poorly controlled Cushing’s can worsen skin infections, urinary tract infections, high blood pressure, protein loss in urine, muscle weakness, ligament fragility, and quality-of-life problems. Some dogs are not immediate treatment candidates, especially if signs are mild or another disease is more important, but “watching” should still mean monitoring. Your veterinarian may track water intake, urine concentration, liver enzymes, blood pressure, infection recurrence, weight, and comfort. The decision is not simply disease equals pill. It is whether treatment is likely to improve the dog’s comfort and reduce risk more than it adds monitoring burden or side effects.
6. How can owners support a dog at home?
Home care begins with records. Track water intake, urination accidents, appetite intensity, panting, skin lesions, medications, and energy. Use non-slip flooring and moderate exercise to support muscles without overheating. Keep grooming gentle because thin skin can tear. Do not change steroid medications suddenly unless your veterinarian instructs you, because abrupt withdrawal can be harmful. If your dog is on trilostane or another endocrine medication, give it exactly as directed and keep follow-up appointments. Small day-to-day notes often reveal whether treatment is helping before lab results tell the whole story.
7. What should you ask at the diagnosis visit?
Ask which type of Cushing’s is most likely, what tests support the diagnosis, what conditions were ruled out, and what the treatment goal is for your dog. Ask how soon you should expect thirst, urination, appetite, panting, or skin signs to improve. Ask what side effects require urgent care and how medication monitoring will be scheduled. If surgery or advanced imaging is discussed, ask about referral to an internal medicine or surgical specialist. A good plan explains both the medical logic and the practical home responsibilities.
8. Can dogs with Cushing’s still have good lives?
Yes. Many dogs do well when the diagnosis is accurate, treatment is monitored, infections are addressed, and owners understand warning signs. Cushing’s is usually a long-term management condition rather than a quick fix. Improvement may be gradual: fewer water bowl refills, fewer accidents, less panting, healthier skin, and better stamina. Celebrate those changes, but keep perspective. Older dogs often have arthritis, dental disease, kidney changes, or other conditions at the same time. The best care plan treats the whole dog, not just the cortisol number.
Owners should also ask how other diseases will be handled alongside Cushing’s. A senior dog may have arthritis, dental disease, kidney changes, heart disease, or cognitive decline at the same time. Treating cortisol alone will not solve pain from bad knees or confusion at night. A whole-dog review helps the family decide which problems affect comfort most and which monitoring schedule is realistic. That conversation is especially important when medication costs, frequent testing, or travel to specialty care may strain the household.
Owners should also ask how other diseases will be handled alongside Cushing’s. A senior dog may have arthritis, dental disease, kidney changes, heart disease, or cognitive decline at the same time. Treating cortisol alone will not solve pain from bad knees or confusion at night. A whole-dog review helps the family decide which problems affect comfort most and which monitoring schedule is realistic. That conversation is especially important when medication costs, frequent testing, or travel to specialty care may strain the household.
Owners should also ask how other diseases will be handled alongside Cushing’s. A senior dog may have arthritis, dental disease, kidney changes, heart disease, or cognitive decline at the same time. Treating cortisol alone will not solve pain from bad knees or confusion at night. A whole-dog review helps the family decide which problems affect comfort most and which monitoring schedule is realistic. That conversation is especially important when medication costs, frequent testing, or travel to specialty care may strain the household.
Owners should also ask how other diseases will be handled alongside Cushing’s. A senior dog may have arthritis, dental disease, kidney changes, heart disease, or cognitive decline at the same time. Treating cortisol alone will not solve pain from bad knees or confusion at night. A whole-dog review helps the family decide which problems affect comfort most and which monitoring schedule is realistic. That conversation is especially important when medication costs, frequent testing, or travel to specialty care may strain the household.
Owners should also ask how other diseases will be handled alongside Cushing’s. A senior dog may have arthritis, dental disease, kidney changes, heart disease, or cognitive decline at the same time. Treating cortisol alone will not solve pain from bad knees or confusion at night. A whole-dog review helps the family decide which problems affect comfort most and which monitoring schedule is realistic. That conversation is especially important when medication costs, frequent testing, or travel to specialty care may strain the household.
Owners should also ask how other diseases will be handled alongside Cushing’s. A senior dog may have arthritis, dental disease, kidney changes, heart disease, or cognitive decline at the same time. Treating cortisol alone will not solve pain from bad knees or confusion at night. A whole-dog review helps the family decide which problems affect comfort most and which monitoring schedule is realistic. That conversation is especially important when medication costs, frequent testing, or travel to specialty care may strain the household.
References
- Behrend, E. N., et al. (2013). Diagnosis of spontaneous canine hyperadrenocorticism: ACVIM consensus statement. Journal of Veterinary Internal Medicine, 27(6), 1292-1304.
- Merck Veterinary Manual. (2024). Hyperadrenocorticism in dogs.
- American Animal Hospital Association. (2022). AAHA canine life stage guidelines.