Dog Adrenal-Dependent Cushing Management

Adrenal-dependent hyperadrenocorticism in dogs, caused by an adrenal tumour, has different treatment considerations from pituitary Cushing and carries a more variable prognosis.

Key Facts

Approximately 15 to 20 percent of canine Cushing disease is adrenal-dependent
Adrenal tumours may be benign adenomas or malignant carcinomas with different prognoses
CT imaging is recommended to assess tumour size, invasion, and metastatic disease before surgery
Adrenalectomy is curative for benign tumours without metastasis when performed by an experienced surgeon
Medical management with trilostane is an alternative for non-resectable or high-risk surgical candidates
Perioperative mortality for adrenalectomy is significant and requires specialist anaesthetic management

Welfare Considerations

Dogs with adrenal-dependent Cushing experience the same welfare impacts as pituitary Cushing including muscle wasting, skin fragility, and susceptibility to infection. Adrenal carcinoma additionally carries the welfare burden of malignancy including invasion and metastasis. Surgical adrenalectomy for appropriate cases offers the prospect of long-term disease resolution and significantly improved welfare. The perioperative period carries significant risk and requires intensive monitoring. Medical management with trilostane provides welfare improvement for non-surgical cases, though lifelong medication is required.

What You Can Do

Request CT staging of the adrenal gland before any decision about surgical versus medical management
Seek specialist internal medicine and surgical referral for adrenalectomy consideration
Ensure pre-operative trilostane treatment where indicated to improve perioperative safety
Monitor carefully for post-operative hypocortisolism requiring supplementation after adrenalectomy
Support veterinary research into improved perioperative protocols for equine adrenalectomy