Dog Cushing Disease Trilostane Management and Monitoring

Cushing disease is a complex hormonal condition in dogs that requires careful medical management and regular monitoring to prevent both under- and over-treatment.

Key Facts

Cushing disease (hyperadrenocorticism) is caused by excess cortisol, most commonly from a pituitary tumor (PDH) in 85% of cases
Poodles, Dachshunds, and Boxers are among the most frequently affected breeds
Clinical signs include pot-bellied appearance, increased thirst and urination, hair loss, and skin thinning
Trilostane inhibits cortisol synthesis and is the most widely used treatment in the UK and increasingly in the US
Mitotane (o,p-DDD) destroys adrenal cortex cells and requires careful monitoring to avoid adrenal insufficiency
Over-treatment with trilostane causes an Addison-like crisis - a life-threatening emergency
ACTH stimulation tests performed 4 weeks after starting treatment and then every 3-6 months guide dose adjustments

Welfare Considerations

Untreated Cushing disease causes chronic discomfort - dogs are constantly thirsty, develop skin problems, and lose muscle mass. The pot-bellied appearance reflects muscle wasting and fat redistribution driven by excess cortisol. Proper medical management dramatically improves coat quality, activity level, and overall wellbeing, but requires owner vigilance for signs of over-treatment.

What You Can Do

Keep all scheduled monitoring appointments - Cushing management requires regular ACTH stimulation testing
Know the signs of Addisonian crisis from over-treatment: lethargy, vomiting, collapse, and weakness
Carry a record of your dog Cushing diagnosis and medication for any emergency vet visit
Monitor water intake daily - a sudden decrease may indicate over-treatment
Work with an internal medicine specialist for complex or poorly controlled cases