Cushing’s disease is a challenging diagnosis for many dog owners. The condition causes the adrenal glands to produce too much cortisol, leading to imbalances in the body, sometimes-frustrating symptoms, and long-term health issues. 

Although Cushing’s is manageable in many dogs, it can sometimes create quality-of-life concerns for pet owners. This Lap of Love guide to Cushing’s disease in dogs, including diagnosis, long-term care, and when to euthanize a dog with Cushing’s, can help you know what to expect and how to handle difficult decisions that come with the disease.

What is Cushing’s disease in dogs?

Classic Cushing’s disease develops when a dog’s adrenal glands produce too much cortisol, a hormone that helps their body respond to stress, maintain regular blood sugar, regulate metabolism, and support the immune system. We know that chronic stress causes chronic health problems. Since cortisol is typically released when a dog is stressed, Cushing’s disease is an amplified version of this. 

In atypical Cushing’s disease, symptoms are similar, but cortisol is often normal. Other adrenal hormones, such as testosterone, progesterone, or estrogen, are elevated instead.

There are three main types of Cushing’s disease in dogs:

* Pituitary-dependent Cushing’s disease – A small tumor on the pituitary gland in the brain tells the adrenal glands to produce excess cortisol. This is the most common type.

* Adrenal-dependent Cushing’s disease – A tumor on one of the adrenal glands causes excess hormone production directly from the source.

* Latrogenic Cushing’s disease – Dogs given high doses of corticosteroid medications (e.g., prednisone) or who are given steroids for a long time can develop symptoms of Cushing’s disease.

While the condition is most often seen in middle-aged and senior dogs, it can affect dogs of any breed or size.

How do you know if a dog has Cushing’s disease?

Common symptoms of Cushing’s disease in dogs overlap with other hormonal conditions. They may include:

* Increased thirst

* Frequent urination and accidents

* Increased appetite 

* Panting for no reason

* Hair loss

* Fragile, thin skin

* Slow wound healing

* Patches of hardened skin

* Darkly pigmented skin

* Frequent infections

* Pot-bellied appearance

* Muscle loss and weakness

* Low energy

* High blood pressure

* High blood sugar or diabetes

Some affected dogs develop a characteristic Cushing’s “look” with multiple symptoms, while others show only one or two changes. If you notice your pet’s habits or appearance changing, schedule a visit with your vet. 

The art of diagnosing Cushing’s disease in dogs

Cushing’s disease can be a diagnostic challenge. Your vet might notice abnormalities on routine lab work, such as elevated liver enzymes or dilute urine. However, an official diagnosis requires special, multi-step blood tests.

The two most common diagnostic tests for Cushing’s are:

* ACTH stimulation test – This test measures baseline cortisol levels, then rechecks them after the veterinary team gives an injection of a hormone that stimulates the adrenal glands. Dogs with Cushing’s have an exaggerated response.

* Low-dose dexamethasone suppression test (LDDS) – This test measures baseline cortisol levels, then rechecks them after administering a steroid that should suppress adrenal cortisol secretion. In dogs with Cushing’s, cortisol levels stay high.

Other tests include abdominal ultrasound imaging and, occasionally, a full hormone panel. Getting a precise diagnosis is crucial because it guides treatment and helps rule out other conditions that can resemble Cushing’s disease in dogs. 

Treatment and management of Cushing’s disease in dogs

The goal of treating Cushing’s disease in dogs is to normalize cortisol and other hormone levels. Options include:

* Medication – Drugs that block cortisol production (e.g., trilostane) or partially destroy the adrenal gland (e.g., mitotane) are options for medical management of Cushing’s.

* Surgery – Removing an adrenal tumor may cure some dogs with Cushing’s disease. Because the adrenal glands are very close to large blood vessels and the kidneys, this surgery can be risky and requires a specialist.

* Alternative medicine – In milder cases or when pet owners choose not to pursue other treatments, natural supplements containing melatonin and plant lignans may help.

Dogs under treatment need regular check-ups and repeated blood and urine tests to ensure the treatment is working and that cortisol levels don’t become too low. Your vet may adjust medications as your pet’s body and needs change over time and address complications as they arise.

Quality of life in dogs with Cushing’s disease

Every dog is different, so the quality of life in dogs with Cushing’s disease depends on how well the condition is managed, whether you pursue treatment, and how your dog responds. Some dogs do well for a long time; others may not.

Sometimes treating Cushing’s disease is impractical or unaffordable. Owners of dogs with many other health problems, geriatric dogs, or dogs with manageable symptoms may choose to offer supportive care, such as a healthy diet and gentle exercise, and monitor for changes in quality of life.

Some aspects of quality of life to consider in general include:

* Pain

* Hygeine

* Mobility

* Appetite and thirst

* Behavior

Some dogs with Cushing’s disease experience intense hunger and thirst, have accidents in the house, or deal with recurrent painful infections. Muscle loss can lead to mobility issues, and some dogs may develop behavioral problems due to hormone level changes. 

The pet family’s quality of life matters, too. You’ll need to consider whether you have the time, energy, finances, and emotional reserves to handle accidents, frequent baths and laundry, multiple trips outside, medication administration, numerous vet visits, and possibly specialist care.

Every pet with Cushing’s disease is different. You may find it helpful to keep a daily or weekly journal of your dog’s symptoms and mood, or mark on a calendar whether the day was good or bad for your pet, and discuss your concerns with your primary or hospice care veterinary provider.

When to euthanize a dog with Cushing’s

Signs that you are approaching the end-of-life stage of a dog with Cushing’s disease may include:

* Severe muscle loss or weakness

* Vomiting, diarrhea, or appetite loss

* Chronic skin or urinary infections

* Pain or discomfort despite medications 

* Incontinence or frequent accidents

* Extreme fatigue

* Lack of interest in usual activities

End-stage Cushing’s, usually a result of chronic organ damage, can be hard to differentiate from overtreatment. Too little cortisol (i.e., Addison’s disease) can be easily treated, while end-stage Cushing’s cannot. A discussion with your vet and a few medication adjustments will help determine if it’s time to euthanize your dog.

There’s no single sign or test that can tell you it’s time; this is a personal decision based on your dog’s unique experience and your family’s values. A hospice care provider from Lap of Love can help you decide if and when in-home euthanasia is right for your pet. 

Support for a Cushing’s diagnosis in dogs

Cushing’s disease is one of many conditions that can impact an older dog’s quality of life. When treatments no longer work, your pet’s condition declines, or your senior dog’s health becomes unmanageable, saying goodbye may be the right choice.

At Lap of Love, we offer compassionate, convenient hospice care, quality-of-life assessments, telehospice visits, in-home euthanasia, and pet loss support services. You can call our support center at 855-933-5683 for guidance.