Dog Cushing's Disease Monitoring and Adjustment

Managing Cushing's disease in dogs requires careful monitoring to maintain cortisol in the ideal range while avoiding dangerous under-suppression.

Key Facts

Trilostane monitoring uses ACTH stimulation test performed 4-6 hours post-pill on the day of treatment
Target post-stimulation cortisol of 40-150 nmol/L provides good control without over-suppression
Signs of over-treatment include lethargy, anorexia, and electrolyte changes indicating adrenal crisis
Rechecks are needed every 4 weeks for the first 3 months then every 3-6 months when stable
Monitoring also includes assessment for urinary tract infections, hypertension, and clotting disorders
Dogs on treatment with controlled Cushing's have significantly improved quality of life and coat condition
Mitotane requires different monitoring using basal cortisol and has higher risk of adrenal destruction

Welfare Considerations

Undertreated Cushing's allows continued effects of excess cortisol - weight gain, muscle wasting, immune suppression, and secondary infections. Overtreated Cushing's causes adrenal insufficiency - a potentially life-threatening crisis. The narrow therapeutic window requires regular monitoring to maintain welfare-optimal cortisol levels. Dogs with well-controlled Cushing's show dramatic behavioral improvement and often owners report their dog 'becoming themselves again.'

What You Can Do

Follow prescribed monitoring schedules - ACTH stimulation tests at the right timing are essential
Know the signs of under-treatment (continued pot belly, excessive thirst) and over-treatment (lethargy, vomiting)
Contact your veterinarian immediately if your dog on Cushing's treatment shows sudden lethargy or vomiting
Never adjust Cushing's medication dose without veterinary guidance - the margin for error is narrow
Monitor for secondary conditions including hypertension and UTI that commonly accompany Cushing's disease
Keep a daily log of your dog's water intake and activity level to track treatment response