Cushing’s Disease (Hyperadrenocorticism)

Pebbles, our blog dog, is a female GWP in Seattle, WA originally from Korea, who is ready to be adopted

Adrenal Gland function and Control

A dog’s hypothalamic-pituitary-adrenal axis is a complex set of influences and interactions that provide a balance of positive and negative feedbacks to maintain normal cortisol levels in the dog’s body. When the body is stressed, a positive feedback is sent to the brain to initiate release of cortisol. The anterior pituitary gland in the brain triggers the release of adrenocorticotropic hormone (ACTH) to the adrenal cortex. Within the adrenal cortex, the zona fasciculata releases cortisol. When cortisol levels in the dog’s body are high, they act as negative feedback on the pituitary gland decreasing ACTH and cortisol release.

Causes of Cushing’s Disease

Pituitary-Dependent Hyperadrenocorticism (PDH)

Signs and Symptoms

Regardless of type, clinical signs of Cushing’s disease are essentially the same. Symptoms are often mistaken for common signs of aging. Owners usually notice increased appetite, increased water consumption, and increased urination. Common signs and symptoms are known as “the 7 P’s.” Dogs with Cushing’s disease may also show heat intolerance, lethargy or lack of activity, muscle weakness and atrophy, recurrent urinary tract infections, alopecia (hair loss), thin, fragile skin, bruising, and secondary demodicosis (mange) .

Pyoderma and increased pigmentation in a dog with Cushing’s Disease (Photo credit Katherine Irwin, DVM, Veterinary Dermatologist)
Pot-belly and Pyoderma in dog with Cushing’s disease (Photo credit Katherine Irwin, DVM, Veterinary Dermatologist)


Any patient suspected of Cushing’s disease needs to be assessed through a detailed history and physical examination and preliminary lab work including a complete blood count (CBC), serum chemistry profile, and urinalysis. Findings consistent with canine HAC suggest further endocrine testing is needed to arrive at a specific diagnosis of Cushing’s disease.

  1. The urine cortisol:creatinine ratio (UC:CR) is a very sensitive test and should be performed to rule out HAC. It provides a cortisol measurement over time. A urine sample is collected by the owner at home to avoid stress-related cortisol elevations caused by hospitalization.


Not all dogs with Cushing’s disease need to be treated at the time of diagnosis. The benefits of treatment in dogs without significant clinical signs or complications must be weighed with the potential complications and cost of treatment.


Owners need to be aware of the likelihood of lifelong therapy. Many geriatric dogs with Cushing’s disease die of unrelated causes brought on by aging. Cost of medication and constant veterinary check-ups and testing can be difficult to afford. Survival time, estimated to be two years on average, is probably a direct effect of concurrent diseases and the complications common to HAC patients. Approximately 15–20% of PDH patients exhibit neurological signs due to their pituitary tumor increasing in size over time. Over 80% of untreated HAC patients become hypertensive and 5–10% of dogs additionally have diabetes.


Pebbles, in Korean means “if you bring me home, you will be happy forever” (fictitious, so no reason to Google)

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