Cushings Disease in Dogs

Cushing’s syndrome happens when your dog’s body makes too much of a hormone called cortisol. This chemical helps him respond to stress, control his weight, fight infections, and keep his blood sugar levels in check. But too much or too little of it can cause problems.

Cushing’s, which is also known as hypercortisolism and hyperadrenocorticism, can be tricky for a vet to diagnose, because it has the same symptoms as other conditions. The key is to let your vet know about anything that’s different about your pet.

The diagnosis of Cushing’s can be done with several blood tests. A general hint of Cushing’s can be obtained by a blood panel. To confirm it, a test known as a low dose dexamethasone test is done. A baseline blood sample is drawn in the morning, an injection of dexamethasone given and a follow-up blood test done 8 hours later. In a normal dog, the dexamethasone should suppress cortisol levels in the blood stream. In Cushing’s disease this effect does not occur. Once the disease is diagnosed, it is possible to differentiate between the adrenal tumors and pituitary gland tumors using a second test, a high dose dexamethasone suppression test. Most dogs with pituitary tumors will have cortisol suppression on this test. There are other tests used, including ACTH response tests and urine cortisol/creatinine ratios to diagnose this disease. X-rays and ultrasonography can help determine if an adrenal gland tumor is present.

If it can be determined that there is an adrenal gland tumor, it can be removed. Many veterinarians prefer to have a specialist attempt this since the surgical risks can be high. Pituitary gland tumors are not usually removed in veterinary medicine. This situation is treated using Lysodren (o’p’-DDD, which is a relative of DDT) or ketaconazole. Some research with Deprenyl for treatment of this is being done, too, I think. Lysodren selectively kills the outer layer of the adrenal gland that produces corticosteroids. By administering it in proper amounts it is possible to kill just enough of the gland off to keep the production of corticosteroids to normal levels. Obviously, close regulation of this using blood testing is necessary since overdoing it can cause severe problems with Addison’s disease – hypoadrenocorticism. Adverse reactions to Lysodren occur at times but it is the standard treatment at this time. Over medication with Lysodren can cause inappetance, vomiting, diarrhea, lethargy and weakness. If any of these signs occur then your veterinarian should be immediately notified.

There are two major types that affect dogs:

Pituitary dependent. This form is the most common, affecting about 80% to 90% of the animals who have Cushing’s. It happens when there’s a tumor in a pea-sized gland at the base of the brain, called the pituitary.
Adrenal dependent: This type comes from a tumor in one of the glands that sit on top of the kidneys, called adrenal glands. About 15% to 20% of diagnosed dogs will have this type.

Another kind, called iatrogenic Cushing’s syndrome, happens after a dog has taken steroids for a long time.

Treatment

Treatment consists of several different options. Depending on the type of disease, surgery can be performed. If an adrenal tumor is identified, then surgical removal may be a viable option. There are several different forms of tumors that can invade the adrenal gland and their treatment will be based on the particular tumor type.

Nonsurgical treatment is the most common treatment for canine Cushing’s disease.

Non surgical treatment is the most often used treatment for most cases of canine Cushing’s disease. About 80% of the cases of Cushing’s disease in the dog are of the pituitary type, and since both the adrenal and the pituitary type will respond effectively to some of the oral treatments, many veterinarians do not perform the diagnostics necessary to distinguish between the two different forms. There are currently several different oral medications being used to treat canine Cushing’s disease.

Lysodren: Until recently, Lysodren (also known as mitotane, and o,p’-DDD) was the only treatment available for pituitary dependent Cushing’s disease. It is convenient to use and is relatively inexpensive and is still probably the most widely used treatment. The downside of this drug is that it can have some serious side effects and regular blood-monitoring needs to be performed. During the initial phases of the therapy, the dog must be very carefully monitored, and there must be close communication between the veterinarian and the owner.

The use of Lysodren is somewhat like chemotherapy. It works by destroying cells of the adrenal gland that produce the corticosteroid hormones. As the number of corticosteroid-producing cells is reduced, even though the pituitary gland continues to produce excess ACTH, the adrenal gland is less able to respond, so the amount of glucocorticoid being produced is reduced. The problems arise when too much of the adrenal cortex is killed off. The animals may then need to be placed on prednisone, either short or long term. The Lysodren is initially given daily while the animal is being monitored for a decrease in the symptoms (water consumption, appetite). On the 8th or 9th day of the initial therapy, the dog needs to be examined and an ACTH stimulation test is performed to determine if the drug is working. If the goal is achieved, maintenance therapy is started. If the goal has not been reached, then the dog generally remains on the daily medication for 3 to 7 additional days and is rechecked until the proper results are achieved. If the dog becomes lethargic, vomits, or has diarrhea, or if the treatment does not work by 30 days, then the treatment plan is reevaluated. If treatment is successful, then symptoms should resolve within 4 to 6 months. A certain percentage of dogs will relapse and need to undergo the daily therapy again at some point in their lives. If a dog ever becomes ill while on Lysodren, the Lysodren should be stopped immediately and the dog should be examined by a veterinarian. If the therapy is successful, the dog will need to be on Lysodren for the rest of his life.

Trilostane: Trilostane is a newer treatment that is used to treat some dogs with Cushing’s disease. It is more expensive, but may be an alternative treatment for dogs with adrenal tumors. As with Lysodren, the dog is reexamined repeatedly during the initial phase of treatment, and ACTH stimulation tests are performed. In many cases, after several months of therapy the dose needs to be increased.

Ketoconazole: Ketoconazole is an oral antifungal agent that has been used extensively since the mid 80s. One of the side effects of ketoconazole is that it interferes with the synthesis of steroid hormones. It therefore gained some popularity as a treatment for Cushing’s disease. However, it is rarely used today.

L-deprenyl (Anipryl): L-deprenyl (Anipryl) has been advocated for the treatment of Cushing’s disease in dogs, but its effectiveness has come into question.

Adrenal Harmony Gold for Dog Cushings from Pet Wellbeing

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Fresh Ashwagandha root (Withania somniferum): A primary adaptogen in this formula, Ashwagandha assists the adrenal glands directly to respond normally and produce healthy amounts of cortisol. This is a well-known herb for helping the body’s stress levels and supporting normal, restful sleep.
Holy Basil leaf (Ocimum sanctum): Also called Tulsi, Holy Basil is a gentle adaptogen for supporting the adrenal glands. Of key importance, adaptogens will neither cause the body to relax nor become stimulated, necessarily. Rather, their action is to assist the body to adapt as needed and bring it back into balance. For that reason, adaptogens are used for a variety of reasons when normal adrenal function is desired.
Fresh Turmeric rhizome (Curcuma longa): One of the best antioxidant herbs available, Turmeric also supports liver health. Turmeric can be difficult for the body to absorb. Our extraction method using fresh, organic Turmeric is an extremely potent liquid extract, much stronger than a simple glycerin extraction and captures all of the useful constituents of this herb, including curcumin and other curcuminoids.
Bacopa herb (Bacopa monnieri): Bacopa exhibits uses both as an adaptogen and as an antioxidant. It has also been used for stress and is said to generally contribute to healthy moods and cognitive function.
Sarsaparilla root (Smilax officinalis): A traditional herb of the south western United States, Sarsaparilla has a long-standing use for helping the body to normally excrete excess toxic materials through the lymphatic system. It has also been used to support liver function and healthy blood pressure levels.
Astragalus root (Astragalus membranaceous): Another popular “adaptogen”, Astragalus helps the body’s normal ability to adapt to stress. It also contains polysaccharides, constituents that assist the body’s normal immune response to fight off bacteria and viruses.
Milk Thistle seed (Silybum marianum): A gentle and effective herb for normal liver function, Milk Thistle supports the liver’s metabolization of drugs and toxins for excretion. Another function of the liver is to denature (take apart) circulating hormones, thereby helping to keep the balance of hormones in the body.
Blessed Thistle flower (Cnicus benedictus): Blessed or Holy Thistle has similar uses as Milk Thislte for liver support. Additionally, it has been shown to exhibit support for the immune system and digestion.
Chaste Tree berry (Vitex agnus-castus): Used for its gentle, tonic action on the anterior pituitary, Vitex is an amphoteric herb, meaning it will help maintain normal hormonal levels, rather than cause them to go higher or lower. Vitex is included in this formula for its affect on the pituitary’s action in adrenal hormone regulation.
Prickly Ash bark (Zanthoxylum americanum): Used by many First Nations communities at one time, the bark of the Prickly Ash tree has been termed an “alterative”, meaning that it will help support normal flow of lymphatic circulation. It also helps maintain normal arterial and capillary circulation.