The Cost Of Cushings

The Financial Burden of Your Dog’s Cushings Disease

Cushing’s disease, while not necessarily a death sentence for your dog, is a complex disorder that affects many normal biologic processes. A definitive diagnosis is paramount because the treatment can be dangerous if your pet doesn’t need it. However, if the disease goes untreated, it could be detrimental to your dog. What about the costs? Here we go over potential expenses of diagnosing Cushing’s disease and subsequently treating it.

What is Cushings Disease?

Several species can become affected by Cushing’s disease. Also known as hyperadrenocorticism or hypercortisolism, it occurs when the body produces too many glucocorticoids or natural steroids.

Signs of hyperadrenocorticism are increased thirst, increased urination, and increased hunger. Your dog can also show more frequency of infections, thinning skin, bruising, loss of fur in classic patterns, excessive panting, distended belly, and reduced activity levels.

The pituitary gland at the base of your dog’s brain tells the adrenal glands to produce corticosteroids or cortisol. Cortisol produces sugars by breaking down macronutrients (fats, carbohydrates, and fats) to deal with stress, mainly, along with other biological processes. There are three reasons it could go wrong.

  • Pituitary gland tumor
  • Adrenal gland tumor – there is an adrenal gland above each kidney
  • Iatrogenic – this means it was medically induced by treatment with steroids for common problems like allergies; it may be reversible once the medication is stopped.

How is Cushing’s disease in dogs diagnosed?

A definitive diagnosis of Cushing’s disease in your dog can be challenging. Tests are neither 100 percent specific (a positive test doesn’t distinguish between the disease and excessive stress sometimes) nor 100 percent sensitive (tests do not pick up every case). Sometimes multiple tests must be performed. Thus starts the expenses.

Physical examination

Your veterinarian should perform a thorough check-up on any suspicion of hyperadrenocorticism. During the exam, your vet will also get an in-depth history from you. The typical costs for a medical exam range from 50 to 150 dollars.


Your vet will start with some basic bloodwork and a urinalysis to try to reach an initial assessment of your pet’s health. Blood tests evaluate liver, kidney, and pancreatic function, blood sugar levels, and some important elemental values like calcium, sodium, cholesterol, and lipids. Also included in this screening is a complete blood count which will tell your veterinarian what the red and white blood cells are doing. Cushinoid dogs may show classic changes in their blood profiles.

  • Elevate liver enzyme S-ALP
  • Urinary bladder infection – common with Cushings.
  • Diabetes – blood glucose is already elevated in hyperadrenocorticism, but some dogs have concurrent diabetes.
  • Increased urine cortisol/creatinine – highly indicative of Cushings when combined with a positive dexamethasone suppression test.
  • Increased blood lipid and cholesterol

Bloodwork and a urinalysis cost 125 to 200 dollars for the bloodwork and another 30 to 75 dollars to test the urine. If your veterinarian needs to catheterize your pet for the urine or insert a needle into the bladder, the costs could be 25 to 50 dollars additional.

If your medical professional strongly suspects Cushings from the initial results, he or she will perform more advanced diagnostic tests. There are several different tests, and occasionally your dog will need more than one.

The Cost of a Dexamethasone suppression test for dogs with Cushings disease

This test requires minimal stress, so your dog likely need to stay at the clinic for its duration. Multiple samples of blood are taken over eight hours. An initial sample is drawn upon arrival for baseline cortisol. A tiny amount of Dexamethasone is injected and then blood is redrawn at subsequent intervals. This measures the response of the adrenal glands. If they are working properly, their production of cortisol will be “suppressed” by the Dexamethasone. The average cost of Cushings disease test is 110 to 150 dollars, and there may be a day hospital charge of 25 to 50 dollars. It detects 90 to 95 percent of cases.

The Cost of an Acth stimulation test for dogs with Cushings disease

Similar to the low dose dex suppression test, this test involves drawing a baseline blood sample then drawing a second sample after administering an ACTH hormone. Extreme spikes in ACTH support a potential diagnosis of Cushings. This test is size-dependent because ACTH can be expensive. Small dogs can range from 140 to 160 dollars for the test, while large dogs cost 200 to 500 dollars. This test is often more helpful for diagnosing the opposite problem of too little cortisol production (Addison’s disease). It only picks up 60 to 90 percent of Cushing’s cases. However, it is useful for assessing your treatment of Cushing’s. It is also the test of choice to diagnose iatrogenic hyperadrenocorticism.

High dose dexamethasone suppression test for dogs for dogs with cushings disease

This test is the gold standard for differentiating between a pituitary tumor and a primary adrenal tumor. It is an eight-hour test. It is only necessary if the low dose dex suppression test fails to distinguish between the two types of Cushing’s. Adrenal tumors are resistant to both high and low levels of dexamethasone, while pituitary tumors are only partially resistant. Usually, pituitary levels will suppress a small amount after low dose administration of dexamethasone. It will cost about 150 to 175 dollars, marginally more than the low dose test.


Abdominal ultrasound may be useful to detect adrenal tumors. Usually, it requires the skill of a specialist. It generally costs between 400 and 600 dollars.


How expensive is Cushing disease treatment for dogs?

Traditional therapy

Medications to treat Cushing’s require regular ACTH-stimulation tests which cost at least 95 dollars at two weeks, 30 days, 90 days, then every three months. Dogs treated with Lysodren or Vetoryl can convert to Addison’s disease. Hypoadrenocorticism, or Addison’s disease, is fatal if ignored.

Mitotane (Lysodren)

– A classic therapy that suppresses cortisol production, it must undergo a loading phase of about seven days. This initial therapy is about 50 dollars for a twenty-two-pound dog. Monthly maintenance costs approximately 20 dollars a month. Side effects can range from digestive upset like vomiting and diarrhea to lethargy and weakness.

Trilostane (Vetoryl)

– Vetoryl also suppresses cortisol production. The average cost of Vetoryl for dogs is 85 dollars per month. It can work effectively against pituitary or adrenal tumors but is much better against the former. Side effects are lack of appetite, lethargy, vomiting, diarrhea, and kidney problems.

Ketoconazole (Nizoral)

– Actually an antifungal, Ketoconazole block cortisol production in the adrenal glands. It can cause abdominal pain, itching, vomiting, loss of appetite, liver damage, and bleeding disorders. It costs about 12 dollars a month to maintain a Cushinoid dog. It is less effective than Lysodren.


– This is the treatment of choice for dogs with operable adrenal tumors. It is a complicated surgery ordinarily performed by board-certified surgeons and costs 3,000 to 5,000 dollars. It may be the cheapest option if it cures your dog, and there are no complications.


– This drug has the fewest side effect of medications used to treat Cushings in dogs, but its efficacy is the most questionable. It cost about 65 dollars a month.

Alternative Treatments For Cushings Disease In Dogs

Due to the high costs of treatment as well as side effects associated with these treatments, many people try alternative treatments for cushings disease in dogs.

Herbal Treatment for Cushings

Because of expense and harmful side effects, many people and veterinarians are turning to alternative medications and a more holistic approach to the disease. This may include dietary changes and the use of dandelion, lignans, and melatonin among other herbal supplements.

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