Dog Cushings Treatment Monitoring and Welfare

Monitoring the response to Cushing's treatment is essential for ensuring both efficacy and safety, as the margin between adequate and dangerous cortisol suppression can be narrow.

Key Facts

Trilostane works by blocking cortisol synthesis — over-suppression causes an acute cortisol crisis that can be fatal
ACTH stimulation testing is the primary monitoring tool, measuring the adrenal response to stimulation
Initial monitoring occurs at 10-14 days and 30 days after starting treatment, then at 3-month intervals
Signs of over-suppression include weakness, collapse, vomiting, and loss of appetite — a veterinary emergency
Some dogs require dose adjustment multiple times before adequate control is achieved
Mitotane (lysodren) destroys adrenal cortex tissue — requires very different monitoring protocols from trilostane

Welfare Considerations

Cushing's treatment monitoring is a welfare necessity because the narrow therapeutic window means both under-treatment (continued disease symptoms) and over-treatment (acute cortisol crisis) cause significant welfare harm. A dog receiving adequate treatment experiences the welfare benefit of normalizing cortisol levels — restored energy, healthier skin, normal water intake, and weight stabilization. A dog in acute cortisol deficiency crisis from over-treatment is in a life-threatening emergency. The monitoring visits that seem routine are the welfare checkpoints that keep the dog in the beneficial therapeutic range.

What You Can Do

Schedule all recommended ACTH stimulation testing appointments — do not skip monitoring visits when the dog appears well
Know the signs of over-suppression: sudden weakness, collapse, vomiting, or extreme lethargy following treatment
Stop trilostane and seek emergency veterinary care immediately if over-suppression signs develop
Never adjust trilostane dose without veterinary guidance — small changes have significant hormonal effects
Monitor water intake at home as both under-treatment (high intake) and over-treatment (low intake) provide useful information
Carry the treating vet's emergency contact and know the closest emergency facility in case of acute cortisol crisis