The adrenal gland disorder known as Cushing's disease was first described in humans in 1910 by Harvey Williams Cushing, after whom it was named. It involves increased stimulation of the adrenal cortex, resulting in excessive cortisol production (hyperadrenocorticism). The resulting symptoms are referred to as Cushing's syndrome. Unlike Addison's disease (adrenal insufficiency), Cushing's disease is not life-threatening. It mostly affects older, small dogs and breeds such as boxers, poodles, and dachshunds.
In most cases (80-85%), the cause is a small benign tumor of the pituitary gland (=secondary or PDH Cushing's syndrome). This leads to excessive secretion of the hormone ACTH, which causes increased cortisol production in the adrenal glands. As a result, the adrenal glands enlarge and permanently produce too much cortisol.
Less commonly (15-20%), a tumor develops in one of the adrenal glands, which produces and releases cortisol independently (primary or AT Cushing's syndrome).
In addition, Cushing's syndrome can occur with excessive doses of corticosteroids, such as those used to treat allergies (= iatrogenic Cushing's syndrome).
The first signs of Cushing's disease are usually increased drinking and urination, a pot belly, and changes in the coat. Since cortisol influences many metabolic processes, a wide range of symptoms can occur.
The following symptoms may occur:
If you notice one or more of the symptoms described above in your dog, please contact your veterinarian. Since the symptoms can also have other causes in older dogs, diagnosis is not always easy. If Cushing's disease is suspected, a comprehensive blood test will first be performed on your dog. In addition, an ultrasound examination of the abdominal cavity and a urine test are generally performed. However, as cortisol levels in the blood fluctuate greatly throughout the day, special urine and blood tests must be carried out to confirm the diagnosis – usually several in combination.
The urine cortisol-creatinine ratio (UCCR) is a kind of screening test: if it is abnormal, Cushing's disease is likely and further tests will follow. The low-dose dexamethasone suppression test (LDDS) helps to distinguish between PDH and AT Cushing's syndrome. In addition, the ACTH stimulation test is performed to monitor the success of any treatment. Your vet will discuss the exact procedure with you if your dog is suspected of having Cushing's disease.
Before treating Cushing's disease itself, any accompanying conditions such as urinary tract infections or diabetes mellitus should be treated.
The actual treatment then varies depending on the cause of Cushing's syndrome. In the case of a drug-induced excess of cortisol (iatrogenic Cushing's syndrome), the dose of the drug must be readjusted.
In the case of a pituitary tumor, a medication containing the active ingredient trilostane can be used to inhibit cortisol production in the adrenal gland. At the beginning of therapy, the dosage must be closely monitored using an ACTH stimulation test, as the required dose varies greatly from dog to dog. Even once the dog is well adjusted, regular checks of the dosage must be carried out throughout its life. Highly specialized veterinary practices also offer removal of the pituitary gland. However, this is a very demanding surgical procedure. After the operation, the body's own hormones may need to be replaced artificially, as the pituitary gland has a strong influence on the hormone balance of the entire body. It is also possible to irradiate tumors of the pituitary gland.
In the case of a tumor of the adrenal gland (Cushing's syndrome), surgical removal of the adrenal gland (adrenalectomy) is possible. This procedure is also surgically demanding and should be performed by a specialized veterinary practice. In addition, it must first be determined whether the tumor can be removed easily and whether it has already spread (metastasized). CT or MRI scans are used to determine this.
Your veterinary practice will discuss the exact procedure for your dog with you.
If Cushing's syndrome is diagnosed and treated early, the prognosis is good, even if a cure is not always possible. After starting the appropriate treatment, dogs should be monitored closely to check their hormone levels and adjust the dose of medication if necessary. A feared complication of treatment is Addison's disease (see corresponding article), which is caused by a lack of cortisol. Dogs with Cushing's disease should undergo check-ups every three to six months for the rest of their lives, as relapses (recurrence of the disease) and periods of medication overdose are common.
Regular check-ups at your vet's, combined with blood and urine tests, provide an opportunity to assess your dog's general health. This also allows Cushing's disease to be detected at an early stage. For older dogs, especially those of affected breeds, an ultrasound scan of the abdomen may also be recommended as part of preventive care.
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