Could my dog have Cushings Disease?

Does your dog drink a lot of water? Sometimes that is the only clue to a disease that is developing. Drinking excessive amounts of water (known as polydipsia) can be a sign of a serious disease process. The most common causes include diabetes, kidney or liver disease and Cushings disease. It is easy to have your dogs urine tested for diabetes and a blood test to check for kidney or liver disease, but picking up Cushings Disease is a lot trickier. So what is Cushings Disease? Cushings Disease, known officially as hyperadrenocorticism, is the bodys overproduction of a hormone called CORTISOL. In normal healthy amounts, cortisol plays an important role in the bodys metabolism. These include activating anti-stress and anti-inflammatory pathways and the production of glucose. The adrenal glands produce cortisol and each of these glands is located near the kidneys. These glands are in turn controlled by a gland in the brain called the pituitary gland. Cushings Disease occurs when the adrenal glands start producing too much cortisol hormone. This can either be caused by an adrenal gland tumour (10% of cases) or due to a (usually) benign enlargement of the brains pituitary gland which over stimulates the adrenal glands (85% of cases). It is more common in middle-aged to older dogs and while the disease can occur in any breed of dog, in particular Maltese Terriers, Poodles and Dachshunds are especially prone. What are the symptoms? An oversupply of cortisol hormone can cause detrimental effects on the body over long periods (months to years). For example, the body becomes susceptible to infections, high blood pressure, weakness (cortisol breaks down muscle over time), pot-belly, hair loss or coat thinning, urinary incontinence and excessive water intake. It is important to note that sometimes the only symptom is drinking a lot of water or just one of the other symptoms. Overall, it causes the appearance that your dog is prematurely ageing. Eventually it starts to greatly affect the dogs quality of life, particularly if the dog eventually becomes too weak to walk properly or develops dangerously high blood pressure. So if you suspect your dog may have Cushings Disease, ask your vet to test for it. How is Cushings Disease tested for? A urine test is a good start. There is a screening test called a urine cortisol to creatinine ratio can be run alongside a urine dipstick and urine specific gravity test (USG) to check for abnormalities. If your dogs urine is normal with this screening test then it is unlikely your dog has Cushings. However, it is also advised that a general health screen blood test be carried out in older dogs periodically to check for underlying diseases. A general health screen blood test can pick up other problems too. If your dogs blood test comes back with an elevation in ALP (alkaline phosphatase, a liver enzyme), then it is possible that your dog has Cushings and further testing is required. This is because cortisol

has an effect on this enzyme directly. Other things can also cause an elevation in ALP so a diagnosis cannot be made from this change alone. The next stage is adrenal function testing. There are two tests that can be done for this part of the diagnostic work up: 1) ACTH stimulation test 2) Low dose dexamethasone suppression test (LDDST) Both tests involve about a half day stay at the vet hospital and blood collection before and after a hormone is administered. I usually run the ACTH stimulation test in suspected cases, but if it is negative and I am still suspicious of Cushings Disease, then I will run the LDDST to be sure I havent missed a diagnosis. However, your vet may have a preferred testing method. If a test comes back positive, it is a good idea to have an abdominal ultrasound to ensure there is no adrenal tumour causing the disease (15% of cases). The ultrasound should be carried out preferably by a specialist or a vet who is very experienced and has extra training in ultrasound with a good quality machine, as ultrasonography is very much an operator dependent diagnostic tool. How is Cushings Disease treated? Once confirmed, Cushings Disease is treated with a daily medication in the form of an oral capsule. The drug is called trilostane. It is not always easy to get the right dose and several blood tests may be required to adjust the dose to what is appropriate for your dog. There can also be side effects to trilostane if the dose is too high, so usually your vet will start your dog on a conservative dose initially and increase it slowly in the early stages of treatment. The use of trilostane to treat Cushings Disease has recently superseded its predecessor, mitotane, due to its reduced side effects. However, it is not neccessary to switch a dog that has been wellcontrolled on mitotane to trilostane. Some vets who are experienced in using mitotane may still prefer to manage their animal patients on this drug. I usually use trilostane as it is registered for use in dogs for this purpose. If your dog has an adrenal gland tumour then this tumour should be removed. This is a difficult operation and should be carried out preferably by a veterinarian who specialises in surgery at a facility with overnight monitoring facilities. Some people decide not to go ahead with surgery due to the expense and risks involved. This decision should be discussed with your veterinarian. Dogs with adrenal tumours can still be successfully managed medically with either trilostane or mitotane in some cases. My dog is not doing well on the treatment for Cushings Disease what should I do? For cases that are not responding well to Cushings Disease treatment, it is possible there is another disease going on. For example, Diabetes and Cushings Disease can occur together. It can take months before the hair coat grows back, even with well-managed cases. So you should be patient.

If your dog goes off food during treatment, this is cause for alarm and your vet should be contacted immediately. Its possible that the drug is causing side effects or that there is another problem present. Sometimes your vet will have given you some prednisolone pills as anti-dotes. A prednisolone tablet can be given in cases where it is suspected that the dose of trilostane is too high. If so, your dog should feel better and start eating after the anti-dote is given. Then the dose can be re-evaluated. Speak to your vet about this first though. I will always offer the option of referral to a veterinary specialist if treatment is not going according to plan. There are specialists available at www.sashvets.com or www.northshorespecialist.com.au and you have the option of making an appointment with an internal medicine specialist and asking your vet to send the history to the specialist vet.