Cushing's Disease

Cushing's Disease Holistic Protocol for Dogs and Cats has been developed by a certified Master Herbalist and certified Canine Nutritionist with The Pet Health and Nutrition Center. Our Cushing's Protocol is the finest coordination of science and research-based recommendations that include diet, supplementation and herbal remedies to help support your dog or cat with cushing's disease. Everyone here at The Pet Health and Nutrition Center truly cares and wants to help your pet get better, so give our suggestions a try because we are confident you will be pleased with the results.

1. What is Cushings Disease?

Cushing's disease, also called hyperadrenocorticism or Cushing’s Syndrome, is the overproduction of hormones called corticoids by the adrenal cortex, which is the outer portion of the adrenal gland. The three layers of the adrenal cortex secrete the mineralocorticoid aldosterone, the glucocorticoid cortisol (hydrocortisone) and sex hormones. Depending on the cause of Cushings disease in your pet, the symptoms you see can be related to the hypersecretion of hormones by all three portions of the adrenal cortex. Often though the primary concern is the central portion of the adrenal cortex that produces cortisol because the effects on your animal can greatly reduce quality of life and eventually become life-threatening leading to heart disease, diabetes and increased susceptibility to infection.

What are the symptoms?

The symptoms we see in Cushing’s Disease are primarily related to the presence of higher than normal amounts of the hormone cortisol in an animal’s body. Cortisol’s primary actions include the ability to maintain normal blood glucose concentration, normal blood pressure and a healthy immune response. One interesting set of symptoms to look for is the alleviating of chronic allergies or arthritis so animals may appear considerably better in those respects when developing Cushings due to the heavy doses of cortisone they are giving themselves.

Generally either increased water intake and urination or changes in an animal’s coat will prompt an owner to have their dog evaluated by a veterinarian. It is estimated that 80-85% of animals have increased water consumption, drinking from 2-10 times their normal amounts; 85-100% have skin and coat changes; 80-90% have an increased appetite; and 90%-95% have a pot-bellied appearance. It is estimated that most animals display symptoms of Cushing’s disease for one to six years before Cushings is actually suspected and diagnosed because of the labeling of most symptoms as just signs of old age. The more common symptoms of Cushings are:

• Increased thirst
• Increased appetite
• Frequent urination
• Loss of hair
• Sagging, bloated, pot-bellied abdominal area
• Thin, wrinkled and/or darkly pigmented skin
• Fragile or bruised skin that heals slowly
• Excess panting or seeking cool surfaces to rest on
• High blood pressure
• Increased susceptibility to infections (especially urinary and skin)

Other symptoms of Cushings include:

• Incontinence in previously house trained dogs
• Weight gain or its appearance due to fat redistribution
• Loss of muscle mass giving the appearance of weight loss
• Diabetes
• Thinning of skull/head
• Exercise intolerance/lethargy
• Hind-leg weakness or reluctance to jump on furniture or people
• Symmetrically thinning hair or baldness on torso
• Coat changes like dullness, dryness or slow regrowth of hair after clipping
• Hard, calcified lumps in the skin (calcinosis cutis)
• Pancreatitis
• Seizures

When does it typically occur?

Because tumor incidence increases with age and is often the cause of Cushing's Disease, it is logical that Cushings is a problem seen most frequently in middle-aged or older dogs (6-10 years old is average) while being rare in cats; although, as mentioned below the use of corticosteroid drugs can cause the symptoms of Cushings to appear at any age.

In What breeds/sex is it most common?

All breeds may display Cushings, though some are at greater risk including: poodle, Yorkshire terrier, beagle, Boston terrier, boxer, dachshund, German shepherd, golden retriever, Labrador retriever, Scottish terrier and terriers in general. Pituitary dependent Cushings is more common in small dogs with 75% of cases being in dogs under 44 pounds (20 kilograms) while adrenal dependent Cushings is equally divided between smaller and larger animals. Cushings is more common in females with spayed/neutered animals at slightly greater risk.

2. Causes of Cushing's Disease

There are a number of primary causes of Cushings which we discuss below. Not included are potential issues with the hypothalamus which secretes anterior pituitary releasing and inhibiting hormones, although we provide support for this gland in our natural protocol.

Iatrogenic Hyperadrenocorticism - We feel the most common cause of Cushing’s disease occurs at the veterinarian’s office. This is due to the excessive use of cortisol-like medications like prednisone that unnaturally increase the levels of corticosteroids in the body. If this continues to be administered for an extended period symptoms of Cushings will begin to display with the result over time being two very small, atrophied adrenal glands.

Pituitary Dependent Hyperadrenocorticism - Some will say this is the most common cause of Cushing’s Disease in animals. Occurring due to a benign tumor on the anterior portion of the pituitary gland prompting the hypersecretion of the hormone ACTH that stimulates secretion of adrenal cortex hormones. Animals with this type of Cushings tend to have two very large adrenal glands because both are constantly working to keep up production of excess cortisol.

Generally these pituitary tumors are microscopic, but in 10-15% of cases they can be larger placing pressure on brain tissue and nerves causing blindness, circling, seizures, or other neurological problems not directly related to hyperadrenocorticism.

Adrenal Dependent Hyperadrenocorticism - Alternatively, in approximately 15% of Cushing cases there may be an adrenal tumor responsible for secreting too much cortisol. Of these tumors 50% are benign and 50% are malignant that can spread to the lungs and liver. As with pituitary-based tumors the mechanisms used to balance hormone secretion don’t function as they should and the adrenal cortex keeps secreting too much cortisol irrespective of what the brain is telling it. In these animals, one adrenal gland tends to be extremely enlarged (due to the tumor and the overproduction of cortisol) and the other tends to be extremely small.

3. Standard Veterinary Medicine Approach

Diagnostic Testing

There is no single test to diagnose Cushing’s disease. An animal’s medical history, physical exam, results of blood and urine tests indicate changes that have occurred over time and often provide a strong suspicion of this disorder. Blood work may reflect increases in the liver enzyme ALP (serum alkaline phosphatase), cholesterol and blood glucose. Some white blood cells may be elevated (neutrofils), and others decreased (lymphocytes, esinophils). A urinalysis may show dilute urine reflected by high levels of protein and low specific gravity.

X-rays may show calcium in the area of one of the adrenal glands that is indicative of an adrenal tumor or an enlarged liver caused by the extra workload placed upon this organ. Ultrasound of the belly may show enlargement of both adrenal glands in pets with pituitary dependent Cushings or enlargement of just one of the adrenal glands in pets with an adrenal tumor. In some pets with an adrenal tumor, the tumor can be seen growing into large blood vessels close to the adrenal gland. A CT scan can be used to search for a pituitary tumor, though this is not a common diagnostic procedure. More specific tests include a urine cortisol/creatinine ratio test, an ACTH stimulation test and low and high dose dexamethasone suppression tests.

Treatment

If your are fortunate, your animal’s Cushings could be caused by a corticosteroid drug. In this case it is possible to wean your dog off the drug under professional supervision to avoid complications. This weaning process may be over a few days, if the course of the drug was short, but may take weeks or months if the animal has been on long-term corticosteroid treatment. Abrupt withdrawal may lead to an Addison’s crisis so this should be done responsibly.

Surgery

For an adrenal tumor surgery can be performed to remove a tumor and the affected adrenal gland. In theory, this can cure adrenal dependent Cushing's disease because tumors tend not to recur on the remaining adrenal gland and prognosis is very good for dogs with benign adrenal tumors. There are high risks associated with adrenalectomies and given that patients are often elderly animals owners may think twice about pursuing this route. Since 50% of adrenal tumors are malignant and may have already metastasized to the liver or lungs this should be looked into further and taken into account before any surgery is performed.

Pituitary tumors are generally not removed surgically because they tend to be very small and slow-growing and cause little or no damage on their own aside from overstimulating the adrenal glands. There is the possibility in a small percentage of cases that they grow and cause other problems as mentioned previously that include neurological problems so owners should keep a look out for these symptoms should they occur. Generally for animals with a suspected pituitary tumor the symptoms themselves are treated as opposed to the root cause.

Chemotherapy

Chemotherapy drugs are used for treating pituitary dependent Cushing's Disease. These drugs work by selectively permanently destroying adrenal cortex tissue that is producing the excess glucocorticoid hormones. Treating with these drugs can be effective but requires a serious owner commitment to monitoring their dog because of the potential for serious side effects (such as going into Addison’s disease if too much adrenal tissue is destroyed) and continuous veterinarian monitoring of cortisol levels.

Radiation

Pituitary tumors may be treated with radiation in an attempt to shrink them and thus relieve the neurological symptoms caused by their presence and the pressure they place on brain tissue. Radiation involves thousands of dollars and repeated anesthesia, either of which may be difficult to justify with an elderly patient and both of which have associated potential serious side effects. Radiation would be the only option if an animal is showing neurological symptoms related to a growing pituitary tumor.

Various Pharmaceutical Drugs

There are a number of drugs used for this condition. They usually have the primary goal of suppressing hormone production and balancing brain chemicals. None that we have researched have a great track record and some have side-effects such as the risk of severe liver damage. If you wanted to try a medication we recommend you research it thoroughly so you can weigh the risk/reward for your animal. There is mention of European drugs not yet approved in the U.S. that have shown some promise.

4. Our Natural Cushing's Disease Protocol for Dogs and Cats

The goal of our Natural Cushing’s Disease Protocol is to reduce the effects of increased levels of glucocorticoid hormones for your animal in a safe and natural manner. We use diet; organic, whole food supplementation; and organic herbs to support and strengthen the challenged organs and glands, which in this case are primarily the hypothalamus, pituitary, adrenals and liver, with the goal of making your dog or cat stronger and healthier down the road.*

Following our suggestions will help to alleviate the often debilitating symptoms of Cushing’s Disease and return a quality of life to your animal for as long as possible. With Cushing’s Disease a “cure” may not be attainable because of the tumors that may be present in the pituitary or adrenal glands, but a better quality of life can be achieved and maintained for as long as possible. However, if Cushings is caused by the use of corticosteroid drugs very often a “return to normal” can be accomplished and the adrenal glands returned to a healthier state with the right support.

Core Recommendations Suggested products are included in the Core Cushing's Disease Package found below.

Our "Core Recommendations" form the backbone of our Natural Cushings Protocol. They consist of supplement recommendations that we feel are the most important to provide to your animal companion for this condition. They are displayed as a package and individually at the bottom of this page along with other helpful products from which you may make additional selections. Pet foods can be purchased at your finer, local pet stores. If you desire more individualized attention please feel free to use our Consultation Form to provide detailed information about your dog or cat so we can better help you.

  Core Recommendation #1 - Daily Multi Plus

Our Daily Multi Plus is formulated with organic, whole foods that are extremely important to an animal's nutritional needs but are often missing from the majority of canine and feline diets. This special formula provides the enzymes, probiotics, prebiotics, glandulars, vitamins, minerals, antioxidants and phytonutrients that are so beneficial to the body's daily maintenance and repair needs for healthy aging. In this formula you will find the vitamins, minerals and antioxidants recommended by the veterinarian community for this condition - only in an organic, whole food form!

 Core Recommendation #2 - Adrenal Calm

This is an organic herbal preparation formulated by a certified Master Herbalist specifically for those dogs and cats suffering with Cushing's Disease. It features potent herbs that support the pituitary and adrenal glands along with the liver that together are so important for balancing the levels of glucocorticoids like cortisol in the body. This formula will help to strengthen your animal and their resistance to stress and illness while reducing the uncomfortable symptoms of Cushings.

  Core Recommendation #3 - BioPreparation Microalgae Formula

This special blend of four unique algae was developed by a Russian Scientist, Dr. Michael Kiriac after decades of research. It is grown in controlled hydroponic conditions so it is the purest microalgae supplement on the planet. Its thousand of nutrients are so bioavailable they do not have to be digested, they easily pass through the digestive tract and feed cells on a cellular level. BioPreparation can cross the blood brain barrier to feed the brain, support the hypothalamus (so important for Cushing's Disease) to help balance the entire endocrine system and even cross the blood retinal barrier to nurture the eyes. We have had outstanding success with this product so it is a Core Recommendation. Select the F2+ Core for this condition.

Other Recommendations

  Whole Food Nutrition

With a serious condition like Cushing's Disease, in which the body needs the highest value nutrition possible so it has the energy necessary to rebalance itself, we highly recommend a raw food diet. Raw food is how carnivores, like canines and felines, have evolved to eat and they do best on a high protein, low carbohydrate diet. This is, unfortunately, the opposite of how most pets are fed since the majority of commercial diets are low protein with 50% or more carbohydrates.

In addition, kibble diets are harder for an animal to digest and this is the last thing your pet needs at this point. Without the right nutrition that is easily digested, absorbed and metabolized your animal will have a more difficult time getting better. If a raw food diet is not your cup of tea, the next best thing would be a cooked, whole food diet. There are now many quality premixes to choose from to which you can add your own raw or cooked meat. If you decide to make a homemade diet please research the proper way to do this and make sure to add a calcium source. For more information read our articles How to Feed Your Dog or How to Feed Your Cat that can be found in our Education section.

 Fish Oil High in Omega 3's

Omega 3 fatty acids are renowned for their anti-inflammatory benefits. They are particularly important to brain health because lipids, such as omega 3's, comprise a significant portion of this organ. One recent study found that aging humans who consumed more omega-3s had increased gray matter brain tissue volume and development. Omega 3's not only support brain cell structure, but they increase the production of vital neurotransmitters which could benefit those animals suffering with Cushing's Disease.

  Systemic Enzymes

Reducing inflammation and supporting a healthy immune system is important with Cushing's Disease. However, it should be done in a way that will benefit the immune system, not fight it and suppress it as do steroids and NSAIDs. Suppressing the immune system with drugs is unhealthy and dangerous with not only potentially severe side effects but the greater possibility of cancer and other serious disease in the future. Using Systemic Enzymes between meals on an empty stomach allows these enzymes to enter the blood stream where they eliminate metabolic waste products and harmful proteins to reduce inflammation and balance the immune system.

Exercise

By exercising your dog you will help to maintain or potentially increase lean muscle mass and naturally reduce levels of stress hormones in the body. Exercise also acts to benefit the lymphatic system helping the body to eliminate metabolic waste. It is important not to overdo exercise sessions by taking the age and fitness level of your animal into account. Smaller more frequent sessions may be better than one longer, more demanding one.

References

Connick,K. Canine Cushing’s Disease. Retrieved from http://www.kateconnick.com/library/cushingsdisease.html
Cushing’s Disease. Retrieved from http://www.vetmed.wsu.edu/ClientED/cushings.aspx
Hoffman, D. (2003). Medical herbalism: The science and practice of herbal medicine. Rochester, VT: Healing Arts Press.
Messonnier, S. (2001). Natural health bible for dogs & cats: You’re a-z guide to over 200 conditions, herbs, vitamins and supplements. New York, NY: Three Rivers Press.
Murray, M. T., & Pizzorno, J. E. (1998). Encyclopedia of natural medicine (2nd ed.). New York, NY: Three Rivers Press.
Pitcairn R. H., & Hubble-Pitcairn S. (1995). Dr. Pitcairn’s complete guide to natural health for dogs & cats. Emmaus, PA: Rodale Press, Inc.
Pitchford, P. (2002). Healing with whole foods: Asian traditions and modern nutrition (3rd ed.). Berkeley, CA: North Atlantic Books.
Puotinen, CJ. (2000). The encyclopedia of natural pet care (2nd ed.). Los Angeles, CA: Keats Publishing.
Tilford, G. L., & Wulff, M. L. (2009). Herbs for pets: The natural way to enhance your pet’s life. (2nd ed.). Irvine, CA: BowTie Press.
Thibodeau, G.A., & Patton, K.T. (2008). Structure & function of the body. St. Louis, MO: Mosby.


5. Natural Remedies for Dogs and Cats with Cushing's Disease