Dog Cushing's Disease Long-term Management

Hyperadrenocorticism (Cushing's disease) in dogs requires lifelong management but significantly improves quality of life when well-controlled.

Key Facts

Cushing's disease affects approximately 100,000 dogs per year in the US alone.
It is caused by excess cortisol production, most commonly from a pituitary tumour (85% of cases).
Signs include pot belly, increased thirst and urination, hair loss, muscle weakness, and recurrent infections.
Trilostane is the primary treatment, given daily to suppress adrenal cortisol synthesis.
Regular monitoring of ACTH stimulation tests is required to maintain appropriate cortisol control.

Welfare Considerations

Dogs with uncontrolled Cushing's disease experience significant welfare compromise: the osmotic effects of polyuria and polydipsia disrupt routine; muscle weakness impairs mobility; the pot belly from fat redistribution and muscle loss is uncomfortable; recurrent skin and urinary infections cause pain. Once treatment with trilostane is initiated and stabilised, most dogs show dramatic improvement in energy, coat condition, and appetite regulation. However, the risk of over-suppression (Addisonian crisis) is a management concern. Owners must be educated about the signs of both under- and over-treatment. Regular monitoring is non-negotiable for safe management.

What You Can Do

Begin ACTH stimulation testing 10 days after starting or changing trilostane doses.
Have emergency dexamethasone available if your dog is on trilostane, for use if adrenal crisis occurs.
Monitor water intake as a practical indicator of treatment adequacy at home.
Report any sudden lethargy, vomiting, or weakness in a trilostane-treated dog as an emergency.