What Does It Mean if My Dog Has Cushing's?

Hearing the words “Your dog may have Cushing’s disease” can feel like the floor drops out from under you. The good news: while Cushing’s is a serious, lifelong condition, many dogs live comfortably for years with the right plan and steady monitoring.

Cushing’s disease, also called hypercortisolism or hyperadrenocorticism, happens when a dog’s body produces too much cortisol. Cortisol is often nicknamed the “stress hormone,” but it’s also essential for regulating the immune system, metabolism, blood sugar, blood pressure, and inflammation.

In a healthy dog, cortisol rises and falls as needed. With Cushing’s, cortisol stays chronically elevated, and that disrupts normal body function; leading to the symptoms you see at home.

This post walks you through what causes Cushing’s, how to recognize it, how diagnosis works, what treatments exist (conventional and complementary), and what long-term life can look like for your dog.

What Causes Cushing’s Disease?

The cause matters because it determines the best treatment approach. There are three main types:

1) Pituitary-Dependent Cushing’s (PDH)

This is the most common form—about 80–85% of naturally occurring cases (Behrend et al., 2013).

A small (usually benign) tumor forms on the pituitary gland, a pea-sized structure at the base of the brain. That tumor produces too much ACTH, a hormone that tells the adrenal glands: “Make cortisol.” When ACTH is high all the time, both adrenal glands overproduce cortisol.

Most pituitary tumors are tiny and never cause direct brain-related problems. But in about 10–15% of dogs, the tumor grows large enough to cause neurological signs like seizures, behavior changes, circling, confusion, or difficulty walking (Feldman & Nelson, 2015).

2) Adrenal-Dependent Cushing’s (ADH)

This accounts for 15–20% of naturally occurring cases (Behrend et al., 2013).

Here, a tumor forms on one adrenal gland and produces cortisol on its own—without listening to the pituitary. The pituitary tries to respond by lowering ACTH, but the adrenal tumor ignores it.

About half of adrenal tumors are benign and about half are malignant (Feldman & Nelson, 2015). Even benign tumors can create problems if they grow and press on nearby structures.

3) Iatrogenic Cushing’s (Steroid-Induced)

“Iatrogenic” means caused by medical treatment. This happens when a dog takes steroids (like prednisone or dexamethasone) long-term for another condition (allergies, inflammatory bowel disease, immune disorders, etc.). The body responds as if cortisol is excessive, and the adrenal glands may shrink because they’re no longer needed.

Important: Steroids must not be stopped suddenly—tapering must be done under veterinary guidance.

Recognizing the Symptoms

Cushing’s often creeps in slowly. Many early signs resemble “normal aging,” which is why it can be missed at first.

The Most Common Symptoms

Excessive thirst (polydipsia) and urination (polyuria)
You may refill the water bowl constantly, see more bathroom breaks, nighttime wake-ups, or accidents.

Increased appetite (polyphagia)
Many dogs become ravenous—begging, counter-surfing, stealing, even guarding food.

Pot-bellied appearance
This can happen even without weight gain. Cortisol redistributes fat to the abdomen, weakens abdominal muscles, and often enlarges the liver (Behrend et al., 2013).

Hair loss and skin changes
Hair loss typically affects the trunk symmetrically, with a classic “rat tail.” Skin becomes thin, fragile, slow to heal, and may darken in bald areas (Feldman & Nelson, 2015).

Panting
Often heavy and out of proportion to heat or activity—sometimes worse at night.

Muscle weakness / lethargy
Trouble with stairs, jumping, long walks, or a stiff/hunched posture—cortisol breaks down muscle protein over time.

Less Common Symptoms

• Skin or urinary infections (immune suppression)

• Calcinosis cutis (calcium deposits in the skin)

• Neurological symptoms (usually with large pituitary tumors): seizures, circling, disorientation, vision issues, head pressing

• Enlarged clitoris in some females

Breeds commonly affected

Cushing’s can occur in any dog, but it’s more frequent in: Poodles, Dachshunds, Yorkies, Beagles, Boston Terriers, Boxers, German Shepherds, Goldens, Labs, and Scottish Terriers. It’s most often diagnosed between 6–12 years (Behrend et al., 2013).

When to see your veterinarian

If you’re seeing the combo of drinking more + peeing more + hungrier, especially with panting, pot belly, or hair loss, book a visit. These signs can overlap with diabetes, kidney disease, and other conditions, so they deserve medical investigation.

Understanding the Diagnostic Process

Cushing’s diagnosis can feel like a marathon. That’s because no single test is perfect; vets usually use a stepwise approach to confirm Cushing’s and determine its type.

Initial Screening Tests

• CBC & Chemistry Panel: patterns like elevated liver enzymes (ALP often high), cholesterol, and glucose (Feldman & Nelson, 2015)

• Urinalysis: often shows dilute urine; specific gravity frequently < 1.020 (Behrend et al., 2013)

• Urine cortisol:creatinine ratio (UCCR): great for ruling out Cushing’s if normal, but not confirmatory if elevated (Galac et al., 2010)

Confirmatory Tests

• Low-dose dexamethasone suppression test (LDDS): very sensitive (~95% detection) (Behrend et al., 2013)

• ACTH stimulation test: faster, useful for monitoring treatment, and the only test that can diagnose iatrogenic Cushing’s (Behrend et al., 2013)

Determining the Type

Once confirmed, type matters:

• Abdominal ultrasound: helps assess adrenal size and look for tumors; PDH usually enlarges both glands, ADH often enlarges one and shrinks the other (Behrend et al., 2013)

• Endogenous ACTH level: high/normal suggests PDH; low suggests ADH (Feldman & Nelson, 2015)

• Advanced imaging (CT/MRI): used for surgical planning or large pituitary tumors; requires anesthesia

What to Expect (And Cost Reality)

Diagnosis often takes 2–4 weeks. A complete workup commonly totals $600–$1,500, and advanced imaging can add $1,500–$3,000.

If results are unclear, your vet may repeat tests, switch tests, address other illnesses first, or refer you to an internal medicine specialist. It’s frustrating—but correct diagnosis protects your dog from inappropriate treatment.

Conventional Treatment Options

The best treatment depends on the cause and your dog’s overall health.

PDH (pituitary-dependent): Medication is the Standard

Trilostane (Vetoryl®)
Blocks an adrenal enzyme needed to make cortisol. Often well-tolerated and adjustable; must be given for life and requires monitoring (Braddock et al., 2003).

Mitotane (Lysodren®)
Selectively destroys adrenal cortex tissue. Can be effective, but more complex and higher risk for over-treatment (Reusch & Feldman, 1991).

Other less-effective options sometimes used: selegiline and ketoconazole (Feldman & Nelson, 2015).

Radiation therapy may be used for large pituitary tumors causing neurological signs. It doesn’t “cure” Cushing’s, but can reduce tumor pressure and improve quality of life.

ADH (adrenal-dependent): Surgery May Be Curative

Adrenalectomy can potentially cure ADH if the tumor is removable—especially if benign—though it’s major surgery with real risks. Outcomes are best in experienced specialty centers (Massari et al., 2011). Many dogs are managed medically instead.

Iatrogenic: Gradual Tapering + Alternative Plan

Steroids must be weaned slowly to avoid an Addisonian crisis, while also addressing the original disease that required steroids. This often takes teamwork and sometimes specialist input.

Choosing Not to Treat

Some families choose comfort care only (very mild disease, very advanced age, severe other illnesses, finances). If that’s the path, it should be a supported plan with your veterinarian—focused on quality of life and watching for complications.

The Key to Keeping Treatment Safe

Treating Cushing’s is like adjusting a thermostat: you want cortisol not too high and not too low. Too low can trigger Addisonian crisis, which is life-threatening.

Early monitoring (first 3–6 months)

ACTH stimulation tests are commonly used for monitoring, especially with trilostane, and timing matters, often 4–6 hours after the dose for best interpretation (Ramsey, 2010). Your vet may also run chemistry panels to monitor electrolytes and organ function.

Long-term monitoring

Once stable, many dogs move to testing every 3–6 months, but monitoring is lifelong.

Call your vet immediately if you see:

• sudden weakness, collapse

• vomiting/diarrhea

• shaking, severe lethargy

• loss of appetite
  These can signal Addisonian crisis and require urgent care.

Natural and Complementary Approaches

Many pet parents want supportive options alongside medication. That’s understandable—just keep expectations realistic.

Full-Spectrum Hemp Extract

There’s lab and animal-model research suggesting cannabinoids can influence cancer pathways (Guindon & Hohmann, 2009; Massi et al., 2004) and affect stress-axis signaling (Hillard et al., 2016). But there’s no published research proving CBD treats canine Cushing’s or pituitary/adrenal tumors.

If you’re considering CBD:

• use a reputable product with third-party testing

• talk to your veterinarian first (drug interactions and liver metabolism matter)

• treat it as support, not a replacement for proven therapy

Herbal and Nutrient Support

Some holistic vets use agents like ginkgo, adaptogens, phosphatidylserine, melatonin, lignans, or DIM. Evidence specific to canine Cushing’s is limited, so these are best approached with a holistic veterinarian who can integrate them safely.

Lifestyle Support

Moderate exercise, stress reduction, stable routines, and minimizing endocrine-disrupting chemical exposure (plastic bowls, microwaving in plastic, etc.) are low-risk ways to support overall health.

Nutrition for Dogs With Cushing’s

Diet won’t cure Cushing’s, but it can reduce metabolic strain and support muscle, skin, and immune health.

Common goals include:

• lower carbohydrate load (helpful for insulin resistance risk)

• high-quality protein (to support muscle wasting)

• balanced healthy fats, especially omega-3s for inflammation

• moisture-rich diets to support hydration

Whether you choose fresh, canned, gently cooked, or kibble-plus-toppers, the “best” diet is the one your dog can eat consistently, that fits your budget, and that your veterinary team supports—especially if there are other conditions like pancreatitis, kidney disease, or diabetes.

Prognosis, Complications, and Quality of Life

Life expectancy

With treatment, many dogs live comfortably for years. Survival varies by type, age, tumor behavior, and other health problems. In treated pituitary-dependent cases, median survival reported in studies is often around 2–3 years, with many dogs living longer (Barker et al., 2005). Benign adrenal tumors can do very well after surgery, while malignant tumors carry more risk.

What improvement looks like

• Weeks: thirst/urination often improve first

• 1–3 months: appetite and energy often normalize

• 3–6 months: skin and coat are slower to recover

Potential complications to watch for

• diabetes mellitus (about 10% develop it) (Feldman & Nelson, 2015)

• recurrent infections

• blood clots (medical emergency)

• hypertension

• progression of large pituitary tumors

Is Euthanasia Necessary?

Cushing’s itself isn’t always what ends the journey; complications and overall decline are often the deciding factors. If your dog’s days become dominated by discomfort, weakness, repeated infections, breathing distress, or more bad days than good, your vet can help you assess quality of life with structured scales. Choosing a peaceful goodbye when suffering can’t be relieved is an act of love.

Managing Cushing's

Cushing’s is a long road, but you don’t have to walk it alone. The combination of:

• accurate diagnosis,

• an appropriate treatment plan,

• consistent monitoring,

• supportive nutrition and lifestyle care,

• and honest quality-of-life check-ins
  can make an enormous difference in how your dog feels day to day.

Your dog has been your steady companion through everything. Now it’s your turn to be their advocate—asking questions, tracking changes, and building a care plan that fits your dog and your family. You’ve got this.

References

Afrin, F., & Agathe, N. (2008). Effects of Ginkgo biloba on cortisol levels. Phytotherapy Research, 22(11), 1323-1329.

Barker, E. N., Campbell, S., Tebb, A., Neiger, R., Herrtage, M. E., Reid, S. W., & Ramsey, I. K. (2005). A comparison of the survival times of dogs treated with mitotane or trilostane for pituitary-dependent hyperadrenocorticism. Journal of Veterinary Internal Medicine, 19(6), 810-815.

Behrend, E. N., Kooistra, H. S., Nelson, R., Reusch, C. E., & Scott-Moncrieff, J. C. (2013). Diagnosis of spontaneous canine hyperadrenocorticism: 2012 ACVIM consensus statement. Journal of Veterinary Internal Medicine, 27(6), 1292-1304.

Braddock, J. A., Church, D. B., Robertson, I. D., & Watson, A. D. (2003). Trilostane treatment in dogs with pituitary-dependent hyperadrenocorticism. Australian Veterinary Journal, 81(10), 600-607.

Feldman, E. C., & Nelson, R. W. (2015). Canine hyperadrenocorticism (Cushing's syndrome). In Canine and Feline Endocrinology (4th ed., pp. 377-451). Elsevier Saunders.

Galac, S., Kooistra, H. S., Voorhout, G., van den Ingh, T. S., Mol, J. A., van den Berg, G., & Meij, B. P. (2010). Hyperadrenocorticism in a dog due to ectopic secretion of adrenocorticotropic hormone. Domestic Animal Endocrinology, 38(2), 131-135.

Guindon, J., & Hohmann, A. G. (2009). The endocannabinoid system and cancer: therapeutic implication. British Journal of Pharmacology, 163(7), 1447-1463.

Hillard, C. J., Weinlander, K. M., & Stuhr, K. L. (2016). Contributions of endocannabinoid signaling to psychiatric disorders in humans. Neuroscience, 204, 207-229.

Massari, F., Nicoli, S., Romanelli, G., Buracco, P., & Zini, E. (2011). Adrenalectomy in dogs with adrenal gland tumors: 52 cases (2002-2008). Journal of the American Veterinary Medical Association, 239(2), 216-221.

Massi, P., Vaccani, A., Ceruti, S., Colombo, A., Abbracchio, M. P., & Parolaro, D. (2004). Antitumor effects of cannabidiol, a nonpsychoactive cannabinoid, on human glioma cell lines. Journal of Pharmacology and Experimental Therapeutics, 308(3), 838-845.

Ramsey, I. K. (2010). Trilostane in dogs. Veterinary Clinics of North America: Small Animal Practice, 40(2), 269-283.

Reusch, C. E., & Feldman, E. C. (1991). Canine hyperadrenocorticism due to adrenocortical neoplasia. Journal of Veterinary Internal Medicine, 5(1), 3-10.

Reusch, C. E., Steffen, T., & Hoerauf, A. (1999). The efficacy of L-deprenyl in dogs with pituitary-dependent hyperadrenocorticism. Journal of Veterinary Internal Medicine, 13(4), 291-301.

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