Diagnosis: $500-$1,500. Lifelong Trilostane: $50-$200/month. Cushing's (hyperadrenocorticism) causes excessive cortisol. Signs: excessive drinking/urination, pot-bellied appearance, hair loss. Most common in older dogs but often blamed on aging. Treatment manages but doesn't cure it.
What Causes Cushing's Disease
Two types: pituitary-dependent (85%) - a benign tumor triggers excess cortisol from adrenal glands. Adrenal-dependent (15%) - tumor on the adrenal gland overproduces cortisol. Iatrogenic form occurs from long-term steroid medication. Most common in dogs over 8 years old.
Symptoms What to Watch For
Excessive drinking and urination (most common). Increased appetite. Pot-bellied appearance. Hair loss and thin skin. Recurrent infections. Panting, muscle weakness, lethargy. Many owners dismiss these as normal aging.
Symptoms develop gradually over months.
Diagnosis $500-$1,500
Blood work ($100-$200) shows elevated liver enzymes and cholesterol. ACTH stimulation test ($200-$400) or low-dose dexamethasone suppression test ($200-$400) confirms excess cortisol. Abdominal ultrasound ($200-$400) evaluates adrenal glands for tumors.
Average $500-$1,500.
Treatment $50-$200/month + Monitoring
Trilostane (Vetoryl) is standard: $50-$200/month. Requires ACTH tests at 10 days, 4 weeks, 12 weeks, then every 3-6 months ($200-$400 each). Adrenal tumor surgery: $2,000-$5,000 (risky but potentially curative for adrenal-dependent cases).
Average $50-$200/month.
Total First-Year Cost $2,000-$5,000
Diagnosis, medication, and frequent monitoring. Subsequent years: $1,500-$4,000/year.
Small Breeds Higher Risk
Poodles, Dachshunds, Beagles, and Boxers are most commonly affected. Senior dogs of any breed are susceptible.
Managed Not Cured
Pituitary Cushing's is managed with medication lifelong. Adrenal tumors may be surgically removed if benign.
Prevention
No prevention for naturally occurring Cushing's. Avoid long-term steroid use when possible to prevent iatrogenic form.
The Real Cost
$3,000typical first-year cost
Diagnosis $500-$1,500
Treatment $50-$200/month
Total First-Year Cost $2,000-$5,000
Red flags
Insurance Traps
Cushing's is expensive to diagnose, manage, and monitor. Insurance coverage is critical.
Cushing's Coverage Basics Chronic condition
Most policies cover Cushing's as a standard illness - including diagnostics, Trilostane, and monitoring tests. Standard 14-day illness waiting period applies. Since diagnosis and treatment are costly, insurance saves significantly.
The Slow Onset Problem Pre-existing
Early signs (elevated liver enzymes, excessive thirst, skin issues) are often dismissed as aging. If noted in vet records before enrollment, an insurer could claim pre-existing status. Clean records before enrollment are essential.
Cost vs Deductible Chronic condition
At $2,000-$5,000 first year and $1,500-$4,000/year after, Cushing's is highly expensive. Frequent ACTH tests ($200-$400 each) add up fast. Insurance reliably saves thousands over treatment.
Common Questions
Real answers about costs, treatment, and insurance coverage.
What are the signs of Cushing's disease in dogs?
Excessive drinking and urination (2-3x normal, including overnight). Increased appetite, pot-bellied appearance, bilateral hair loss, thin fragile skin, recurring infections, excessive panting. Many owners mistake these for normal aging.
How much does Cushing's disease treatment cost?
First year: $2,000-$5,000 - diagnostics ($500-$1,500), Trilostane ($50-$200/month), and 4-6 ACTH tests ($200-$400 each). Subsequent years: $1,500-$4,000 with medication and monitoring every 3-6 months. Adrenal surgery: $2,000-$5,000 if needed.
How is Cushing's disease diagnosed?
Blood work shows elevated ALP and cholesterol. ACTH stimulation or low-dose dexamethasone suppression confirms abnormal cortisol. Ultrasound evaluates adrenals - bilateral enlargement suggests pituitary-dependent; single enlarged gland suggests adrenal tumor. Total: $500-$1,500.
Can Cushing's disease be cured?
Pituitary-dependent (85%) cannot be cured - managed with daily Trilostane for life. Adrenal-dependent (15%) may be cured by surgical tumor removal but carries risk. Iatrogenic Cushing's resolves when steroids taper. Managed dogs live well.
What is the life expectancy for a dog with Cushing's disease?
With treatment, pituitary-dependent dogs typically live 2-3 years post-diagnosis, often longer. Since most are 8+ at diagnosis, lifespan isn't dramatically shortened. Untreated, progressive complications significantly reduce quality and length of life.
What is Trilostane and what are the side effects?
Trilostane (Vetoryl) blocks cortisol production in adrenal glands - standard treatment for both types. Side effects: decreased appetite, vomiting, diarrhea, lethargy, weakness. Serious risk: Addisonian crisis (cortisol drops too low, causing collapse or death). Regular ACTH tests are essential.
What breeds are most prone to Cushing's disease?
Poodles (all sizes), Dachshunds, Beagles, Boxers, Boston Terriers, and Yorkies have highest incidence. More common in small to medium breeds. Most affected dogs are over 8 years old. Any senior dog with excessive drinking and pot belly should be tested.
Does pet insurance cover Cushing's disease?
Most policies cover Cushing's as a standard illness. At $2,000-$5,000 year one and $1,500-$4,000/year after, it's highly impactful. Enroll before signs appear in vet records. Once diagnosed, it's pre-existing for any new policy.
My mother-in-law's boxer. Problem. $1,200 in tests, no answers. Another vet solved it with $8 pills. When you're scared, you'll pay anything - and some vets price accordingly. So I built what I couldn't find: real costs, real exclusions, plain language. Not selling policies.
Sources
Research and data used to compile this profile.
- 1 Behrend EN, Kooistra HS, Nelson R, Reusch CE, Scott-Moncrieff JC. Diagnosis of spontaneous canine hyperadrenocorticism: 2012 ACVIM consensus statement (small animal). J Vet Intern Med. 2013;27(6):1292-304.
- 2 Feldman EC, Nelson RW. Canine and Feline Endocrinology and Reproduction. 3rd ed. Saunders, 2004. - Chapter on Hyperadrenocorticism.
- 3 Galac S, Reusch CE, Kooistra HS, Rijnberk A. Adrenals. In: Rijnberk A, Kooistra HS, eds. Clinical Endocrinology of Dogs and Cats. 2nd ed. Schlütersche, 2010.