Cushing’s or Hyperadrenocorticism is a hormonal disease which arises when the adrenal glands produce too much of the steroid hormone cortisol. Whilst the hormone cortisol is needed by every cell in the body, too much cortisol can have harmful effects.
Dogs receiving daily Trilostane medication will need regular check-ups and blood tests with their vet to ensure they are on the correct dose.
With every dose adjustment, your dog will require a check-up and blood test 10-12 days after this.
Once your dog is on the correct dose, the check-ups can be extended to every 3 months
With the right treatment, most dogs will go on to live a normal and healthy life.
As discussed in previous articles, there are two main treatment options for Cushing’s: medication or surgery. The treatment used depends on the type of Cushing’s your dog has. Trilostane medication is the most common treatment for Cushing’s and is used in both adrenal-dependent and pituitary dependent disease. The medication does not provide a cure, with dogs requiring life-long medication. Surgery will provide a cure if the tumour in the adrenal gland or pituitary gland in the brain is removed but as it requires specialist surgery, it is not always an option.
Long term Management of dogs on Trilostane
During the early stages of starting medication, your dog will require regular trips to the vet. This is not only so your vet can ensure your dog is on the correct dose of medication, but also to check it is not showing any signs of receiving too much medication.
Your dog will be started on a low dose of Trilostane, with the dose gradually adjusted according to your dog’s response to the treatment. This will be measured in terms of improvement in their clinical signs and also based on follow-up blood tests.
Monitoring with blood tests
Your vet will usually want to examine your dog 10-14 days after starting Trilostane. At this point they will probably want to take bloods to check their liver, kidneys and electrolytes (salt levels) and also perform an ACTH stimulation test to ensure they are on the correct dose of Trilostane. Your dog will need to be examined and have a blood test after every dose adjustment.
Once your vet is happy that your dog is on the correct dose of medication, the check-ups can be extended to every 3 months.
Monitoring the symptoms
It is not only the blood results which are key to ensuring the correct dose of medication is being given. Monitoring the clinical signs (symptoms) in your dog is also an essential part of this. The Royal Veterinary College, London have developed a ‘quality-of-life’ questionnaire - The CushQoL-pet questionnaire - which is designed to track how your dog is progressing with treatment. It is advised to take this questionnaire regularly, such as just before a vet visit, so that your dog’s progress can be tracked over time. This will help highlight if any adjustments need to be made.
The Cushing’s Quality of Life Questionnaire looks at different aspects of your dog’s life - the symptoms of the disease, your dog’s behaviour, the physical impact of the disease and the impact it is having on you as an owner - so that it can build up an overall picture of how well your dog is progressing.
Although medical treatment will not cure your dog (the tumour in the pituitary or adrenal gland will still be present), the medication will greatly improve your dog’s quality of life and survival time.
You should start to see an improvement in your dog within the first few weeks of starting medication. It can, however, take a good few months before you see an improvement in all of your dog’s symptoms. Cushing’s disease is complicated but with the right treatment, most dogs will go on to live a normal and healthy life.
If the tumour on the adrenal gland or pituitary gland is malignant (cancerous), your dog’s outlook will be less favourable as there is the risk of spread to other organs. In this case, a poor to guarded prognosis will be given.
Cushing’s disease is complicated and all cases are different, so if you wish to discuss management of your dog’s Cushing’s disease, one of our vets will be happy to help!