What are the symptoms of Cushing's disease in dogs?

Common symptoms include: increased thirst and urination (most common), increased appetite, pot-bellied appearance, hair loss (especially on the body, not head/legs), thin skin, muscle weakness, panting, recurrent skin or urinary infections, and lethargy. Symptoms develop gradually over months.

What bloodwork changes indicate Cushing's disease?

Cushing's typically causes: very high ALP (often 5-10x normal), mildly elevated ALT, elevated cholesterol, elevated blood glucose (sometimes diabetic range), dilute urine (low specific gravity), and a stress leukogram on CBC. High ALP in an older dog with classic symptoms strongly suggests Cushing's.

How is Cushing's disease diagnosed in dogs?

Diagnosis requires specific hormone tests: Low-Dose Dexamethasone Suppression (LDDS) test is most common — cortisol should suppress after dexamethasone but doesn't in Cushing's. ACTH stimulation test measures cortisol response. Urine cortisol:creatinine ratio is a screening test. Abdominal ultrasound checks for adrenal tumors.

What causes high ALP in Cushing's disease?

Excess cortisol induces a specific liver enzyme called corticosteroid-induced ALP (C-ALP). This can cause ALP levels 5-10x or higher above normal. In fact, very high ALP in a middle-aged or senior dog is one of the most common reasons vets suspect Cushing's disease.

How is Cushing's disease treated in dogs?

Treatment depends on the cause. Pituitary-dependent Cushing's (85% of cases) is treated with trilostane (Vetoryl) or mitotane to reduce cortisol production. Adrenal tumors may be surgically removed if benign and operable. Treatment is lifelong and requires regular monitoring with ACTH stimulation tests.

Can Cushing's disease be cured in dogs?

Pituitary-dependent Cushing's (most common) cannot be cured but can be well-managed with medication. Adrenal tumors can potentially be cured with surgical removal if benign and caught early. Most dogs require lifelong treatment and monitoring.

Cushing's Disease in Dogs: Symptoms, Bloodwork & Treatment Guide

Q: What is Cushing's disease in dogs?

Cushing's disease (hyperadrenocorticism) is a condition where the body produces too much cortisol. It's usually caused by a pituitary tumor (85% of cases) or an adrenal tumor (15%). It primarily affects middle-aged to older dogs and causes symptoms like increased thirst, urination, appetite, pot belly, and hair loss.

Q: What is the life expectancy of a dog with Cushing's disease?

With proper treatment, many dogs with pituitary-dependent Cushing's live 2-3+ years with good quality of life. Prognosis for adrenal tumors depends on whether benign or malignant. Without treatment, complications like diabetes, infections, and blood clots can significantly shorten lifespan.

Q: Is Cushing's disease painful for dogs?

Cushing's disease itself isn't typically painful, but it causes discomfort. Dogs may feel constantly hungry and thirsty, have muscle weakness making movement difficult, develop skin infections that are uncomfortable, and experience breathing difficulties from a pot belly pressing on the diaphragm.

Q: What breeds are prone to Cushing's disease?

Breeds with higher risk include: Poodles, Dachshunds, Boxers, Boston Terriers, Beagles, and terrier breeds in general. However, any breed can develop Cushing's. It's most common in middle-aged to older dogs (8+ years).

Cushing's Disease Quick Facts

Cushing's (hyperadrenocorticism) = too much cortisol. Classic signs: excessive thirst/urination, pot belly, hair loss, and very high ALP. Most cases (85%) are caused by a pituitary tumor and managed with medication.

ALP Elevation

5-10x

above normal

Pituitary Cause

85%

of cases

Typical Age

8+ yrs

middle-aged to senior

Treatment

Trilostane

daily medication

If your vet mentioned Cushing's disease after seeing your dog's bloodwork, you're probably wondering what it means and what comes next. This guide explains the condition, how it's diagnosed, and what treatment looks like.

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What Is Cushing's Disease?

Cushing's disease, medically called hyperadrenocorticism, occurs when a dog's body produces too much cortisol (the "stress hormone"). Cortisol affects nearly every organ system, which is why Cushing's causes such wide-ranging symptoms.

Two Types of Cushing's Disease

Pituitary-Dependent (85%)

A tumor in the pituitary gland (brain) produces too much ACTH, which tells the adrenal glands to make cortisol.

Usually a small, benign tumor. Treated with medication.

Adrenal-Dependent (15%)

A tumor in the adrenal gland itself produces excess cortisol, ignoring normal signals.

Can be benign or malignant. May be treated surgically or medically.

Symptoms of Cushing's Disease

Symptoms develop gradually over months, which is why many owners initially think their dog is "just getting old." Classic signs include:

Most Common Symptoms

Increased thirst & urination (PU/PD): Often the first sign noticed. Dogs may have accidents in the house or need to go out at night.
Increased appetite: Acting hungry constantly, begging, getting into food.
Pot-bellied appearance: Muscle wasting + fat redistribution + enlarged liver creates a sagging belly.
Hair loss (alopecia): Typically symmetrical, on the body (trunk), sparing head and legs. Skin may darken.
Thin, fragile skin: May bruise easily, wounds heal slowly.
Panting: Even when not hot or exercising.
Muscle weakness: Difficulty jumping, climbing stairs, general weakness.
Recurrent infections: Skin infections, urinary tract infections — cortisol suppresses immune function.
Lethargy: Less energy, sleeping more.

Bloodwork Changes in Cushing's Disease

Routine bloodwork can't diagnose Cushing's, but certain patterns raise strong suspicion:

ALP (Alkaline Phosphatase)

Very high — often 5-10x normal or higher. Cortisol induces a specific form called corticosteroid-induced ALP. This is the most consistent finding.

ALT

Mildly elevated — usually 1.5-3x normal. Less dramatic than ALP.

Cholesterol

Elevated — cortisol affects fat metabolism.

Blood Glucose

High-normal to elevated — some dogs develop diabetes secondary to Cushing's.

Urine Specific Gravity

Dilute (low) — kidneys can't concentrate urine properly due to excess cortisol.

CBC (Complete Blood Count)

"Stress leukogram" — high neutrophils, low lymphocytes, low eosinophils. Classic cortisol pattern.

Test	Finding in Cushing's	Why
ALP	Very high (5-10x+ normal)	Cortisol induces corticosteroid-ALP in liver
ALT	Mildly elevated (1.5-3x)	Secondary liver effects
Cholesterol	Elevated	Cortisol affects fat metabolism
Glucose	High-normal to elevated	Cortisol raises blood sugar
Urine SG	Dilute (<1.020)	Excess cortisol impairs concentration
CBC	Stress leukogram	High neutrophils, low lymphocytes

Pro Tip

Key Point: High ALP

Very high ALP (especially in a middle-aged or senior dog with increased thirst/urination) is one of the most common reasons vets suspect Cushing's disease. If your dog has ALP 5-10x normal, Cushing's testing is often recommended. See our ALP guide for more details.

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How Is Cushing's Disease Diagnosed?

Routine bloodwork raises suspicion, but specific hormone tests are required to confirm Cushing's:

Diagnostic Tests

Low-Dose Dexamethasone Suppression Test (LDDS): Most common test. A synthetic steroid (dexamethasone) is given, and cortisol is measured at 0, 4, and 8 hours. In healthy dogs, cortisol suppresses. In Cushing's, it doesn't. Can also help differentiate pituitary vs adrenal.
ACTH Stimulation Test: ACTH hormone is given and cortisol response is measured. Useful for diagnosis and for monitoring dogs on treatment. Takes about 1-2 hours.
Urine Cortisol:Creatinine Ratio (UCCR): Screening test done on morning urine. A normal result makes Cushing's unlikely. An elevated result needs follow-up with LDDS or ACTH stim.
Abdominal Ultrasound: Visualizes the adrenal glands. Can detect adrenal tumors and measure adrenal size. Both glands enlarged = pituitary-dependent. One gland enlarged, one small = adrenal tumor.
Advanced Imaging (MRI/CT): May be recommended to visualize pituitary tumors if neurological signs are present.

Treatment Options

For Pituitary-Dependent Cushing's (Most Common)

Trilostane (Vetoryl): First-line treatment. Blocks cortisol production. Given once or twice daily with food. Requires regular ACTH stimulation tests to monitor and adjust dose. Most dogs respond well within weeks.
Mitotane (Lysodren): Older medication that destroys part of the adrenal gland. Effective but requires careful monitoring due to higher risk of side effects. Used when trilostane isn't effective.
Radiation therapy: For large pituitary tumors causing neurological signs. Not commonly available.

For Adrenal-Dependent Cushing's

Surgery (adrenalectomy): Removal of the affected adrenal gland. Can be curative if the tumor is benign and hasn't spread. Major surgery with risks, but potentially curative.
Medical management: Trilostane or mitotane if surgery isn't possible. Controls symptoms but doesn't remove the tumor.

Monitoring During Treatment

Dogs on Cushing's medication require regular monitoring:

• ACTH stimulation tests: Initially every 2-4 weeks until stable, then every 3-6 months
• Clinical signs: Watch for improvement in drinking, urination, appetite, energy
• Watch for over-treatment: Signs include weakness, vomiting, diarrhea, loss of appetite — this means cortisol is too low (Addisonian crisis)
• Routine bloodwork: Monitor liver values, electrolytes

Emergency

Warning Signs of Over-Treatment

Contact your vet immediately if a dog on Cushing's medication shows:

•Vomiting or diarrhea
•Loss of appetite
•Severe weakness or collapse
•Shaking or trembling

These can indicate an Addisonian crisis (too little cortisol) — a medical emergency.

Prognosis and Life Expectancy

• Pituitary-dependent (with treatment): Most dogs live 2-3+ years with good quality of life. Some live much longer.
• Adrenal tumor (benign, surgically removed): Potentially curative with good long-term prognosis.
• Adrenal tumor (malignant): Prognosis depends on spread; medical management helps but is not curative.
• Without treatment: Cushing's causes progressive complications including diabetes, infections, blood clots, and significantly reduced quality of life.

Breeds at Higher Risk

While any dog can develop Cushing's, these breeds have higher rates:

• Poodles (all sizes)
• Dachshunds
• Boxers
• Boston Terriers
• Beagles
• Yorkshire Terriers
• Staffordshire Bull Terriers

Most cases occur in dogs 8 years or older.

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Frequently Asked Questions

What is Cushing's disease in dogs?

Cushing's disease (hyperadrenocorticism) is when the body produces too much cortisol. It's usually caused by a pituitary tumor (85%) or adrenal tumor (15%). Common in middle-aged to older dogs.

What are the main symptoms of Cushing's disease?

Increased thirst/urination, increased appetite, pot belly, hair loss (on body, not head/legs), thin skin, panting, muscle weakness, recurrent infections, and lethargy. Symptoms develop gradually over months.

What bloodwork changes indicate Cushing's?

Very high ALP (often 5-10x normal) is the most consistent finding. Also: mildly elevated ALT, high cholesterol, elevated glucose, dilute urine, and stress leukogram on CBC.

How is Cushing's disease diagnosed?

Specific hormone tests are required: Low-Dose Dexamethasone Suppression (LDDS) test or ACTH stimulation test. Urine cortisol:creatinine ratio is a screening test. Ultrasound evaluates the adrenal glands.

Why does Cushing's cause such high ALP?

Excess cortisol induces a liver enzyme called corticosteroid-induced ALP. This can cause ALP levels 5-10x or higher above normal — it's one of the most dramatic bloodwork changes in Cushing's.

How is Cushing's disease treated?

Pituitary-dependent Cushing's is treated with trilostane (Vetoryl) or mitotane. Adrenal tumors may be surgically removed. Treatment is typically lifelong and requires regular monitoring.

What is the life expectancy with Cushing's disease?

With proper treatment, many dogs live 2-3+ years with good quality of life. Prognosis for adrenal tumors depends on whether benign or malignant. Without treatment, complications significantly shorten lifespan.

Is Cushing's disease painful for dogs?

Not typically painful, but it causes discomfort: constant hunger/thirst, muscle weakness, skin infections, and breathing difficulties from the pot belly pressing on the diaphragm.

What breeds are prone to Cushing's disease?

Poodles, Dachshunds, Boxers, Boston Terriers, Beagles, and terrier breeds have higher risk. Most cases occur in dogs 8 years or older.

Can Cushing's disease be cured?

Pituitary-dependent Cushing's (most common) can be managed but not cured. Adrenal tumors can potentially be cured with surgery if benign and caught early. Most dogs need lifelong management.