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Cushing’s disease (hyperadrenocorticism) is a disease process in which the adrenal glands are producing too much cortisone in the body. This excess cortisone production results in several symptoms including:
These symptoms often arise gradually and most animals are not overtly sick. However, untreated Cushing’s disease will result in severe consequences and death.
Typically, this disease is seen in middle to older aged animals and is most common in Poodles, Dachshunds, Terriers, German Shepherds, and Labrador Retrievers. However, any breed can be affected.
Cushing’s disease is complicated to diagnose and treat. It requires an owner that is committed to accurate medication of their pet and one that is willing to financially commit to treating the disease.
Diagnosis is based initially on clinical signs (see above). When we have an animal that is exhibiting symptoms compatible with Cushing’s disease we will check a urinalysis, chemistry profile, and CBC (complete blood count). Often these tests will point us in another direction. For instance, dogs that are drinking and urinating excessively can do so for a myriad of other reasons. However, if the blood work supports the probability of Cushing’s disease we will run additional specific tests to confirm the diagnosis. These tests will not only confirm or deny Cushing’s disease, but they will also tell us which of two types we have. These two types are as follows:
Treatment of this disease depends on the type we have (#1 or #2 above):
Pituitary dependant Cushing’s disease: This is the most manageable form of Cushing’s disease and requires lifelong therapy to keep it under control. The drug we commonly use is called Trilostane. It blocks the production of cortisone in the adrenal glands and is typically very effective in controlling the disease. We usually will have you start the drug and then come in for a recheck of adrenal gland function 4 – 6 hours after you have given a dose. We can then determine if we need to adjust the dosage. There are other treatment options for your pet if trilostane causes side effects (rare), but it is the drug of choice at this time for many reasons.
Adrenal gland tumor: The adrenal gland tumor requires surgery. This is the most serious form in that most of these tumors are actually malignant and have spread by the time of diagnosis. Surgery is also tricky as the adrenal gland lies next to many important blood vessels, nerves, and organs. We will usually try and rule out spread before surgery via radiographs and occasionally ultrasound.