Cushing disease in Dogs

December 16, 2019October 15, 2019 Diane Weinmann Animal Health, animal hospice, healing your pet cushings in dog, dog, dog cushings, dog health, dogs, symptoms of cushings in dogs

Cushing disease in Dogs

By Dr. Karen Becker

Cushing’s disease is most often seen in dogs — especially Terriers, Poodles, Dachshunds and the American Eskimo/Spitz. It rarely occurs in cats.

The medical term for this condition is hyperadrenocorticism. Hyper means too much, adreno refers to the adrenal glands, and corticism refers to a syndrome involving the hormone cortisol. Simply put, hyperadrenocorticism describes a condition in which too much cortisol is released by the adrenal glands.

Overproduction of This Powerful Hormone Can Trigger a Cascade of Health Problems

In a healthy dog’s body, cortisol, known as the fight-or-flight hormone, is released in small amounts by the adrenal glands in response to perceived stress, so the dog can prepare to battle or run for his life. A release of cortisol also triggers a release of glucose from the liver. Glucose provides energy to the cells of the muscles used to fight or take flight.

Cortisol also impacts a number of other important functions in your dog’s body, including blood pressure, electrolyte balance, bone and fat metabolism, and immune function. Cortisol is secreted in response to any type of stress in your pet’s body; physical or emotional, short-term or long-term.

If for some reason your dog’s body up-regulates its demand for cortisol, the adrenal glands begin overproducing the hormone, which can lead to a state of toxicity. In dogs who experience chronic stress in any form, the adrenals release more cortisol than their bodies need.

This situation can result in a number of serious disorders, including elevated blood sugar that can lead to diabetes, elevated blood pressure that can result in heart and kidney disease, extreme hunger in response to lots of excess glucose being burned, thinning of the skin and coat, decreased muscle and bone mass, and increased risk of infection.

If your dog’s body is continuously overproducing cortisol, his immune function is compromised, which opens the door for infections anywhere in the body — especially the gums, eyes, ears, skin and urinary tract. If your dog has recurrent infections or a persistent infection, it’s possible too much cortisol is the cause.

Symptoms of Cushing’s Disease

Most dogs have a few, but not all of the symptoms of the disorder unless diagnosis comes very late in the disease. Symptoms most commonly seen in dogs with early Cushing’s include:

Increased thirst and urination, which can lead to incontinence	Bruising
Increased panting	Hair loss
Abdominal weight gain (pot belly appearance), despite a reduction in calorie intake	Irritability or restlessness
Thinning skin and change of skin color from pink to grey or black, symmetrical flank hair loss	Much less commonly, rear limb weakness and blood clots

These symptoms are so diverse and can affect so many organs because every inch of a dog’s body contains cortisol receptors.

Typical or Atypical Cushing’s?

If your dog is diagnosed with hyperadrenocorticism, it’s important to know which type of Cushing’s she has. Typical Cushing’s is either adrenal dependent or, much more commonly, pituitary dependent. About 85% of affected dogs develop the latter form, in which the pituitary gland sends too much stimulating hormone to the adrenals. The adrenal glands respond by over-secreting cortisol.

The remaining 15% of cases are adrenal dependent, in which a tumor develops in an adrenal gland and triggers an up regulation of cortisol production. It’s not uncommon for veterinarians to unintentionally trigger typical Cushing’s by prescribing a too-high dose of oral prednisone (synthetic cortisone), or a course of prednisone therapy that is too long in duration. If your dog has taken prednisone for any length of time, she’s predisposed to Cushing’s disease.

The atypical form of hyperadrenocorticism occurs when the adrenals overproduce aldosterone, a hormone that balances electrolytes in the body. Atypical Cushing’s can also result from an overproduction of sex hormone (estrogen, progesterone, and rarely, testosterone) precursors.

Diagnosing Hyperadrenocorticism Can Be Challenging

The actual diagnosis of Cushing’s is often complicated. It’s typically done with blood tests like the ACTH stimulation (stim) test and the low-dose dexamethasone suppression test. Both these tests require at least two blood draws to compare cortisol levels for a definitive diagnosis of Cushing’s.

When Cushing’s is confirmed, your veterinarian will want to determine if it’s pituitary or adrenal dependent. In my opinion, the best way to rule out an adrenal gland tumor is with a non-invasive ultrasound test. However, some vets prefer to do a third blood test called a high-dose dexamethasone suppression test.

Whichever method is used, it’s important not only to establish a definitive diagnosis for Cushing’s, but also to determine whether the form of the disease is adrenal or pituitary dependent.

Unfortunately, in the majority of cases, the disease is diagnosed only after it is full-blown and there’s no holding it back. Once a dog has full-blown Cushing’s, she will live with the disease for the rest of her life. It’s a horrible illness that can be managed in many cases, but never cured.

Many veterinarians tend to ignore repeated and progressive elevations in serum Alkaline Phosphatase (ALP), one of the commonly elevated enzymes found on routine bloodwork, until several Cushing’s symptoms are present, or a pet parent becomes concerned that their dog is suddenly urinating in the house or losing her hair.

The better, proactive approach is to try to prevent the disease from taking hold. That’s why I recommend getting a copy of your pet’s yearly bloodwork results. Your pet should age with picture-perfect bloodwork, or there’s work to be done.

Never let a veterinarian tell you your pet’s abnormal bloodwork is “normal for their age,” as this means disease is taking place without anyone addressing it. If your dog’s ALP is two to three times higher than normal, ask your vet if your dog could be in the early stages hyperadrenocorticism.

The Importance of Catching This Disease Early

Most of the drugs currently available to treat Cushing’s disease have many undesirable side effects. It’s extremely important to discuss your concerns about possible side effects with your veterinarian. I recommend you do your own research as well.

I try to avoid using Lysodren and other potent Cushing’s drugs because in my opinion, the side effects are often worse than the symptoms the animal is dealing with. If Cushing’s drugs must be used, I prefer to use Trilostane, which has fewer side effects. Obviously, the goal is to catch the disease before high drug doses are required.

If, however, your dog requires drugs to manage full-blown Cushing’s, I recommend starting with the lowest possible effective dose, and using it in conjunction with a natural protocol to reduce potential side effects. Identifying pre-Cushing’s syndrome as early as possible and reducing your pet’s risk for full-blown disease is the approach I always recommend. Dogs don’t suddenly wake up with this disease — it happens over time.

Unfortunately, many conventional veterinarians ignore the early signs of adrenal dysfunction because they don’t know what to do about it until a dog fails the ACTH stim test. The problem with this approach is it takes months and sometimes years for an animal to be officially diagnosed with Cushing’s.

Waiting this long to take action often means waiting too long. I consider a dog to have pre-Cushing’s syndrome when he exhibits classic symptoms but is still able to pass the stim test. Often there are minor changes in bloodwork, for example, the UCC (urine cortisol:creatinine ratio) is slightly elevated, there are elevated cholesterol levels, and/or the elevation in ALP has been proven to be cortisol induced (your vet can check what fraction of ALP is coming from cortisol vs. other sources).

I’m able to reverse many pre-Cushing’s patients with nutraceuticals, Chinese herbs, homeopathics, nutritional therapy, and lifestyle management (reducing biologic and metabolic stress).

My advice is to be proactive by having your pet’s ALP level checked annually, which should be a part of a basic “wellness blood test,” along with a physical exam that evaluates muscle mass, coat condition, and an environmental stress assessment. Ask your veterinarian to establish baseline blood levels and address any elevation from the baseline through a screening test like the UCC or CiALP to determine if your dog’s body is over-secreting cortisol.

Never accept steroids prescribed for your pet unless they’re required to dramatically (and temporarily) improve quality of life (e.g., if your pet has acute head trauma and steroids are needed to control brain inflammation, etc.).

Having this information will help you better manage a pre-Cushing’s situation before it develops to full-blown disease. And don’t ignore symptoms. If your pet has consistent Cushing’s-type symptoms, no matter how minor, they are absolutely worth investigating for a possible endocrine or adrenal disorder.

It’s during the development of Cushing’s disease that many dogs are also over-prescribed aggressive traditional drug protocols for full-blown Cushing’s disease, often with disastrous results.

When these potent drugs are prescribed for mild adrenal dysfunction, the result is often an acute Addisonian crisis in which there are insufficient adrenal hormones necessary for normal physiologic function. A natural protocol to manage pre-Cushing’s is essential to avoid drug-induced hypoadrenocorticism (Addison’s).

Prevention Tips

There are some common-sense steps you can take to reduce your dog’s risk of developing hyperadrenocorticism, including:

Feed a moisture rich, nutritionally optimal, species-appropriate anti-inflammatory diet to reduce biologic stress; this means eliminating all grains and carbohydrates from the diet, since carbs trigger insulin release and insulin triggers cortisol release

Exercise your dog daily to help combat stress and promote the release of endorphins

Instead of spaying or neutering, consider a sterilization procedure that leaves your dog’s testicles or ovaries in place; if that’s not possible, wait until your pet has reached his or her full adult size, and in the case of females, after the first and preferably two estrus cycles

Minimize your pet’s exposure to xenoestrogens

Investigate adaptogenic herbs and adrenal-supportive natural substances like magnolia (rhodiola), ashwagandha, and phosphatidylserine

Address abnormal hormone levels early on with natural support, such as melatonin, DIM, glandular therapies and high lignan flax hulls

Cushings Disease in Dogs

January 23, 2017December 19, 2016 Diane Weinmann Animal Health cushings in dog, dog cushings

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.