Cushing's disease, or hyperadrenocorticism

Cushing's disease, or hyperadrenocorticism, is caused by an excess of cortisol in the body. It is relatively rare in people, affecting between 10 and 15 of every million people each year. The problem occurs more commonly in the dog than in the cat.

A thorough patient work-up is needed to reach a diagnosis."Cushing's disease commonly affects middle-aged to older dogs, It is most commonly seen in poodles, dachshunds, terriers, German shepherds, and golden retrievers.

These animals typically present with symmetrical hair loss; excessive eating, drinking, and urination; lethargy; and a distended abdomen. They commonly have other skin abnormalities and secondary urinary tract infections as well.

There are three types of Cushing's disease: adrenal cortical tumor, pituitary tumor, and iatrogenic (veterinarian-induced).

An adrenal cortical tumor--a tumor of the cortisol-producing cells of the adrenal gland--causes excess production of cortisol. Although there are two adrenal glands, these tumors generally develop in one gland and will lead to one abnormally large adrenal gland and one abnormally small gland.

Blood tests are necessary for proper diagnosis of Cushings Disease.Pituitary-dependent hyperadrenocorticism is due to microtumors in the pituitary gland in the brain that produce excessive amounts of a hormone that causes the adrenal glands to produce cortisol. In this form, both adrenal glands are enlarged.

Iatrogenic Cushing's is produced by an excess of cortisol being given to a pet by a veterinarian, for example, to treat a skin disorder. The excess cortisol in the body signals the adrenal glands to decrease their normal production of cortisol, leading to a decrease in the size of the adrenal glands.

Cushing's disease is first suspected with clinical signs, physical exam abnormalities, and blood tests that are suggestive of this disease. A definitive diagnosis is made using three-stage testing of adrenal challenge gland function.

The treatment for an adrenal tumor is surgical removal and supplementation of cortisol until the shrunken adrenal gland returns to normal function, It is uncommon for these tumors to recur on the remaining adrenal gland.

The treatment for pituitary-dependent Cushing's is generally Mitotane? (O,P'-DDD), a chemical derivative of the pesticide DDT. This drug destroys the zones of the adrenal cortex that produce cortisol. The drug is administered until a reasonable level of cortisol production is achieved and the pet is then maintained on the drug at that level for life, with periodic rechecks to adjust the dose.

The treatment for iatrogenic Cushing's is slow withdrawal from the external source of cortisol. It is extremely important that changes in the medication are not made without first consulting your veterinarian. Quickly withdrawing the source of cortisol before the adrenal glands can recover can lead to dramatic consequences, such as vomiting, diarrhea, vascular collapse, and death.

The prognosis for this disease varies depending on the type. Surgery can cure an adrenal cortical tumor that has not spread to other areas of the body. However, about half the adrenal tumors are malignant and therefore may have already spread, in which case, there is a much poorer prognosis. Pituitary-dependent Cushing's has a good short-term prognosis, as the microtumors do not generally cause other problems. Long-term, however, pets with Cushing's disease are predisposed to other diseases, such as diabetes mellitus, urinary tract infections, kidney disease, hypertension, and pancreatitis. Iatrogenic Cushing's disease has a good prognosis, if proper withdrawal times are maintained.

It is important to remember two things about this disease. First, two of the most common signs of this disease are excessive drinking and urination. Excessive drinking and urination are also the most common signs of other serious diseases, such as kidney failure, diabetes, and hyperthyroidism (in cats), which need to be investigated prior to testing the adrenal glands. Second, other conditions, such as arthritis and itchy skin, may be masked by the excess cortisol production. These conditions are coincidental but may surface as the Cushing's disease is treated and may require other forms of treatment.

If you would like further information about this condition, contact your local veterinarian.