Understanding Cushing’s and Addison’s Disease: A Guide for Veterinary Teams Managing Adrenal Dysfunction
The client describes a dog who’s drinking excessively and losing hair, or a young dog with intermittent vomiting and lethargy that comes and goes without clear explanation. Adrenal dysfunction can be one of the more challenging diagnostic puzzles in general practice, and once confirmed, these cases require careful long-term management. If you’ve ever wondered whether you’re on the right track with a suspected Cushing’s or Addison’s case, you’re not alone.
Cushing’s disease and Addison’s disease represent opposite ends of adrenal dysfunction. Cushing’s produces too much cortisol, while Addison’s produces too little. Both require specific testing to confirm, nuanced treatment decisions, and ongoing monitoring that can stretch practice resources. This is exactly where specialist collaboration makes a difference.
At VESPECON, our network of board-certified internal medicine specialists supports general practice veterinarians through complex endocrine cases from initial suspicion through long-term management. Whether you need help interpreting diagnostics, determining the best treatment approach, or managing a patient who isn’t responding as expected, our partnership model provides on-demand specialist input without the burden of traditional referral. When cases require hands-on specialty care, our specialty hospitals are ready to receive transfers with full case continuity.
How Do the Adrenal Glands Function in Dogs and Cats?
The adrenal glands sit near the kidneys and produce hormones essential for daily function and stress response. Cortisol regulates metabolism, controls inflammation, and helps the body respond to stress. Aldosterone maintains electrolyte balance, particularly sodium and potassium levels, which directly affects cardiovascular function.
When hormone production stays balanced, these processes run smoothly in the background. When production tips too high or too low, the clinical signs can be dramatic or frustratingly vague.
Addison’s disease results from inadequate hormone production, while Cushing’s syndrome stems from excess cortisol. Both conditions benefit significantly from specialist input during diagnosis and treatment planning.
Our diagnostic imaging services include interpretation of abdominal ultrasounds that help differentiate pituitary-dependent from adrenal-dependent Cushing’s disease, guiding your treatment approach from the start.
What Are the Symptoms and Progression of Addison’s Disease?
Addison’s disease, or hypoadrenocorticism, occurs when the adrenal glands fail to produce adequate cortisol and aldosterone. The resulting hormone deficiency affects nearly every body system, but often in subtle, intermittent ways that make early detection challenging.
Early symptoms tend to be vague: decreased appetite, lethargy, occasional vomiting, diarrhea, weight loss, and trembling. These signs may wax and wane, sometimes improving with supportive care only to return weeks later. This pattern earns Addison’s its reputation as “the great pretender”- it mimics gastrointestinal disease, renal issues, and numerous other conditions.
The real danger comes with an Addisonian crisis, when hormone levels drop critically low. Patients present with profound weakness, severe dehydration, bradycardia despite hypovolemia, and cardiovascular collapse. Without rapid intervention, these cases can be fatal.
When you suspect Addison’s or have a patient in crisis, VESPECON’s internal medicine specialists can provide real-time consultation to guide your stabilization protocol and diagnostic approach. Contact us for urgent case support.
How Is Addison’s Disease Diagnosed?
Routine bloodwork raises suspicion but cannot confirm Addison’s disease. The classic electrolyte pattern- low sodium, high potassium, with a sodium:potassium ratio below 27:1- should prompt further investigation, though not all Addisonian patients show these changes.
The ACTH stimulation test remains the gold standard. By measuring cortisol before and after ACTH administration, you can assess whether the adrenal glands are capable of responding to stimulation. A blunted or absent response confirms the diagnosis.
Certain breeds show breed predisposition to Addison’s disease, including Standard Poodles, Portuguese Water Dogs, Bearded Collies, and West Highland White Terriers. In these breeds, a higher index of suspicion is warranted even with nonspecific symptoms.
Knowing when a case constitutes a pet emergency helps guide client communication. Collapse, severe vomiting or diarrhea, extreme weakness, or complete food and water refusal warrant immediate attention.
VESPECON partner practices benefit from specialist guidance on interpreting ACTH stimulation results, especially in atypical presentations. Our clinical advisory services help you confirm diagnoses confidently and develop treatment protocols tailored to each patient.
Can Cats Develop Addison’s Disease?
Yes, though feline hypoadrenocorticism is uncommon. When it does occur, it’s frequently overlooked because the symptoms- lethargy, anorexia, weight loss- are nonspecific and cats are masters at hiding illness.
Complicating matters further, cats more often present with the atypical form of Addison’s, where electrolytes remain normal despite glucocorticoid deficiency. This makes the condition even easier to miss without specific testing.
The good news is that with appropriate hormone replacement, feline Addison’s patients can do very well. Early specialist consultation helps ensure you’re not missing this diagnosis in cats with chronic, unexplained symptoms.
What Causes Cushing’s Disease and What Are the Clinical Signs?
Cushing’s syndrome develops when the body produces excessive cortisol over an extended period. The two primary causes are pituitary tumors (accounting for approximately 85% of canine cases) and adrenal tumors. Understanding which type you’re dealing with significantly impacts treatment decisions.
The clinical signs of Cushing’s syndrome typically develop gradually, which is why many owners initially attribute changes to normal aging. Classic presentations include increased thirst and urination, increased appetite, excessive panting, a pot-bellied appearance from hepatomegaly and muscle wasting, thin skin, and symmetrical hair loss.
Cushing’s disease most commonly affects middle-aged to older dogs. Certain breeds show breed predisposition to Cushing’s disease, including Poodles, Dachshunds, Boston Terriers, Boxers, and Beagles.
Excess cortisol suppresses immune function, leading to secondary complications including recurrent skin infections, urinary tract infections, and occasionally diabetes mellitus. Managing these concurrent issues while addressing the underlying Cushing’s requires a coordinated approach.
VESPECON’s dermatology specialists can assist with complicated skin cases secondary to Cushing’s, while our internal medicine team guides overall disease management.
How Does Cushing’s Disease Present in Cats?
Feline hyperadrenocorticism is rare but serious when it occurs. Cats present differently than dogs, with extremely fragile skin being the most striking and characteristic sign. The skin may tear with minimal handling, creating significant management challenges.
Other feline symptoms include pot-bellied appearance, muscle wasting, poor coat quality, increased thirst and urination, and lethargy. Perhaps most significantly, Cushing’s in cats is strongly linked to difficult-to-control diabetes mellitus. When a diabetic cat requires escalating insulin doses without achieving regulation, Cushing’s should be on your differential list.
Diagnosis and treatment in cats can be complex, making specialist consultation particularly valuable for these cases.
How Is Cushing’s Disease Diagnosed and Managed?
Routine bloodwork often reveals elevated liver enzymes (particularly ALP), high cholesterol, and dilute urine with low specific gravity. These findings raise suspicion but don’t confirm the diagnosis.
The low-dose dexamethasone suppression test is typically the first-line confirmatory test, measuring whether administered dexamethasone appropriately suppresses cortisol production. Abdominal ultrasound plays a crucial role in differentiating pituitary-dependent disease (bilateral adrenal enlargement) from adrenal tumors (unilateral enlargement with possible contralateral atrophy), directly guiding treatment decisions.
Our diagnostic imaging interpretation services provide timely, specialist-level ultrasound reads that help you determine disease type and plan appropriate treatment.
Treating Cushing’s disease typically involves trilostane for pituitary-dependent cases, starting conservatively and adjusting based on ACTH stimulation testing and clinical response. The decision of whether and when to treat requires careful consideration of treatment decisions for Cushing’s syndrome, weighing the patient’s age, symptom severity, and overall health status.
VESPECON’s internal medicine specialists can help you navigate these gray areas, providing guidance on when treatment benefits outweigh risks and how to optimize medication protocols for individual patients.
What Does Long-Term Management of Adrenal Disease Look Like?
Both conditions are manageable with appropriate treatment and monitoring, though the approach differs significantly.
Addison’s patients typically do very well once stabilized on hormone replacement therapy. Most receive monthly DOCP injections for mineralocorticoid replacement and daily prednisone for glucocorticoid support. With consistent medication and monitoring, these patients often return to completely normal lives. The key is recognizing that stressful situations- boarding, surgery, illness- may require temporary glucocorticoid dose adjustments.
Cushing’s management tends to be more dynamic. Trilostane dosing requires regular reassessment through ACTH stimulation testing, typically at 10 days, 4 weeks, and 12 weeks after starting or adjusting medication, then every 3 to 6 months once stable. Clinical improvement- reduced drinking, improved energy, better coat quality- often precedes normalized test results.
Early detection through routine wellness bloodwork is invaluable, especially for older patients and at-risk breeds. Catching these conditions before they become critical improves outcomes and simplifies management.
VESPECON partner practices benefit from ongoing specialist support throughout the management process. Our team helps interpret monitoring results, troubleshoot cases that aren’t responding as expected, and adjust protocols as needed- all without requiring formal referral for every question.
Frequently Asked Questions
Can general practitioners distinguish between Addison’s and Cushing’s based on clinical signs alone?
Clinical signs provide important clues, but definitive diagnosis requires specific testing. Cushing’s patients typically show increased thirst, appetite, and urination with a pot-bellied appearance and skin changes. Addison’s patients more often present with intermittent lethargy, vomiting, and weakness. However, overlap exists, and confirmatory testing is essential for both conditions.
Are Cushing’s and Addison’s disease curable?
Neither condition is typically curable, but both are manageable. Addison’s patients require lifelong hormone replacement but often live normal, healthy lives. Cushing’s management focuses on controlling cortisol production through medication, with regular monitoring and dose adjustments. Some adrenal tumors causing Cushing’s may be surgically resectable, potentially offering cure in select cases.
When should I contact VESPECON for case support?
Reach out when you’re uncertain about diagnostic interpretation, need help developing a treatment protocol, have a patient not responding as expected, or want guidance on complex cases involving concurrent conditions. Our specialists are available for consultation throughout the case lifecycle. Contact us to discuss how we can support your practice.
Is lifelong monitoring truly necessary for these patients?
Yes. Addison’s patients need periodic electrolyte monitoring and medication adjustments, particularly around stressful events. Cushing’s patients require regular ACTH stimulation testing to ensure appropriate medication dosing. Consistent monitoring prevents complications and optimizes quality of life.
How VESPECON Supports Your Practice in Managing Endocrine Cases
Complex endocrine cases don’t have to strain your practice resources or require you to refer every patient out of your hospital. VESPECON’s network of board-certified specialists provides the support you need to manage these cases confidently in-house, with seamless transfer options when hands-on specialty care is warranted.
Our internal medicine specialists offer consultation on diagnostic interpretation, treatment planning, and ongoing case management. Our diagnostic imaging services provide timely ultrasound and radiograph interpretation to guide your clinical decisions. And when cases need more intensive intervention, our specialty hospitals receive transfers with complete case continuity.
This is what we mean by concierge-style collaboration- active partnership through the entire case lifecycle, with workflows and support as polished as the specialty care itself.
If you’re managing a challenging Cushing’s or Addison’s case, or if you want to discuss how VESPECON partnership can elevate your practice’s approach to complex endocrine patients, we’d love to hear from you. Contact our team to start the conversation, or explore our partnership options to learn how we can support, empower, and educate your practice with timely, trustworthy specialist input.
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