Understanding Cushing\u2019s Disease<\/span><\/span>\u00a0<\/span><\/h2>\nIn a healthy dog, <\/span>steroid hormones (cortisol) are produced by adrenal glands that sit above each kidney. The adrenal glands are stimulated by ACTH, a hormone released by the pituitary gland <\/span>that\u2019s<\/span> located<\/span> below the brain. The release of cortisol is tightly controlled to meet the exact needs of the body, including the ability to respond to stress and <\/span>maintain<\/span> normal homeostasis<\/span>.\u00a0<\/span>\u00a0<\/span><\/span>\u00a0<\/span><\/p>\nThere are several forms of Cushing\u2019s disease in dogs, including:<\/span><\/span>\u00a0<\/span><\/p>\n\n- The most <\/span>common form<\/span> (~85% of cases) results from <\/span><\/span>a small tumor in the pituitary gland<\/span><\/span><\/strong>. This is called pituitary-dependent hyperadrenocorticism (PDH)<\/span>.<\/span><\/span>\u00a0<\/span>\n
\n- In dogs with PDH, these tumors are most often small and not associated with any neurologic symptoms<\/span>.\u00a0\u00a0<\/span><\/span>\u00a0<\/span><\/li>\n
- For a smaller percentage of dogs with PDH, the tumor is larger <\/span><\/span> (macroadenoma) and results in a combination of symptoms of Cushing’s and primary neurologic disease<\/span>.\u00a0\u00a0<\/span>\u00a0<\/span><\/span>\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n
- In ~ 15% of cases, Cushing’s disease is caused <\/span><\/span>by a tumor in one of the adrenal glands<\/strong>.<\/span><\/span>\u00a0<\/span>\n
\n- Tumors in the adrenal gland can either be benign or malignant (cancerous).<\/span><\/span>\u00a0<\/span><\/li>\n
- Most dogs with adrenal tumors will have no symptoms other than the symptoms o<\/span>f<\/span> their Cushing’s <\/span>disease<\/span>,<\/span> particularly in the early stages<\/span>.<\/span>\u00a0\u00a0<\/span><\/span>\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n
- Dogs can also develop symptoms of Cushing\u2019s disease when they <\/span>have been taking steroids for a long time<\/span>.<\/span><\/span>\u00a0<\/span><\/strong>\n
\n- Most commonly<\/span>, these steroids are<\/span> <\/span>prednisone or prednisolone<\/span><\/span><\/strong>.\u00a0\u00a0<\/span><\/span><\/li>\n
- This is called <\/span><\/span>iatrogenic <\/span>Cushing’s<\/span><\/span><\/strong> and symptoms are expected to improve\/resolve when t<\/span>he steroids<\/span> are <\/span>discontinued<\/span>.<\/span><\/span>\u00a0<\/span>\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
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<\/h2>\nDiagnosis<\/span><\/span>\u00a0<\/span><\/h2>\nTypically, pet parents <\/span>observe<\/span> signs of Cushing\u2019s disease at home that prompt a visit to their family veterinarian, who then <\/span>also notices<\/span> changes<\/span> during the dog\u2019s <\/span>physical <\/span>examination and routine lab work.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\nA formal diagnosis of Cushing\u2019s disease <\/span>requires<\/span> additional<\/span> blood <\/span>work<\/span>. Often, your family veterinarian will perform more specific diagnostic<\/span>s<\/span> to evaluate adrenal function, including an ACTH stimulation test or a low-dose dexamethasone suppression test<\/span>.\u00a0\u00a0<\/span>\u00a0<\/span><\/span>\u00a0<\/span><\/p>\nIf your dog is diagnosed with Cushing’s disease, <\/span>your pet may <\/span>require<\/span> advanced diagnostics, such as:\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n\n- An abdominal ultrasound can<\/span> identify<\/span> if your dog has a pituitary-dependent or adrenal-dependent form of the disease. This information can <\/span>help <\/span>determine<\/span> the best treatment options for your dog\u2019s specific case.\u00a0<\/span><\/span>\u00a0<\/span><\/li>\n
- Advanced imaging <\/span>(<\/span>CT scan or MRI<\/span>)<\/span> is<\/span> rarely <\/span>needed but<\/span> may be recommended if there is concern for a large pituitary mass<\/span>.\u00a0\u00a0<\/span><\/span>\u00a0<\/span><\/li>\n<\/ul>\n
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<\/h2>\nTreatment<\/span><\/span>\u00a0<\/span><\/h2>\nMost dogs with Cushing\u2019s disease are treated with oral medications that work by reducing the production of cortisol from the adrenal gland. <\/span>Medical management for Cushing’s disease requires life-long medications and routine monitoring with a veterinarian. <\/span>Note that t<\/span>he<\/span>se medications<\/span> can reduce symptoms of Cushing\u2019s disease, but do not treat the underlying cause of the disease.<\/span><\/span>\u00a0<\/span><\/p>\n\n- The most common and successful medications prescribed are <\/span>trilostane<\/span> (<\/span>Vetoryl<\/span>) or mitotane (<\/span>Lysodren<\/span>).<\/span><\/span>\u00a0<\/span>\n
\n- It\u2019s<\/span> important to know that these medications have risks including the potential to:<\/span><\/span>\u00a0<\/span>\n
\n- Suppress cortisol production too much<\/span><\/span>\u00a0<\/span><\/li>\n
- Damag<\/span>
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