Tests to diagnose Cushing's syndrome and Cushing's disease
Tests to diagnose Cushing's syndrome
It is important that the diagnosis of Cushing's syndrome is confirmed. First a doctor will test you for Cushing's syndrome. Once glucocorticoid medicines have been ruled out, there are 4 types of tests that are generally used to find out if you have Cushing's syndrome. These tests measure the amount of cortisol in samples of urine, blood, or saliva to determine how much cortisol is circulating in your body. If the tests show that the level of cortisol is too high, it means you have Cushing's syndrome. 1 If the test is not positive for high levels of cortisol, then signs and symptoms should be closely watched. If your symptoms get worse, check back with your doctor in 6 months. 1
In certain cases, doctors recommend specific types of tests based on a person's medical history. Some of these recommendations are included below.
UFC=urine-free cortisol; DST=dexamethasone suppression test; *=No recommendation stated.
Following are brief descriptions of tests that are used to diagnose Cushing’s syndrome. However, complete information about these tests, along with instructions for patients, should be obtained from your doctor.
Urine-free cortisol (UFC) test 1,2
What it measures:
Why it's used:
- Almost all people with Cushing's syndrome have high urine cortisol levels
- The UFC test only measures the type of cortisol that causes Cushing's syndrome, called "circulating, free cortisol." It does not measure "bound" cortisol, which increases in the blood from taking certain medicines such as estrogen, but does not cause Cushing's syndrome
How it's done:
- Urine samples are collected at every opportunity throughout a 24-hour period. The samples are then given to a lab for testing
Special instructions:
- During the 24-hour testing period, don't drink a lot of fluids or use glucocorticoid medicines or products, such as hemorrhoid or skin creams that contain steroids. This test needs to be done up to 3 times to be certain the results are accurate
Late-night salivary cortisol test 1,3
What it measures:
Why it's used:
- Normally, the amount of cortisol in saliva is lowest late at night. However, Cushing's syndrome will cause there to be more cortisol than normal in saliva at this time
How it's done:
- A saliva sample is obtained between 11 PM and midnight on 2 different nights. These are then given to a lab for testing
Special instructions:
- Don't eat licorice, smoke cigarettes, or chew tobacco on the days when samples are obtained
- Avoid situations that create extreme stress or excitement
- If bedtime is usually well past midnight, obtain samples at bedtime
Late-night plasma cortisol test 3,4
What it measures:
Why it's used:
- Normally, the amount of cortisol in blood is lowest late at night. However, Cushing's syndrome will cause there to be more cortisol than normal in blood at this time
How it's done:
- A blood sample is obtained at night while the patient is sleeping in a hospital. 4 This is then given to a lab for testing
Dexamethasone suppression test (DST) 1,3
What it measures:
Why it's used:
- Normally, low doses of dexamethasone will reduce cortisol levels. However, if a person has Cushing's syndrome, these doses will not have an effect on cortisol levels
Overnight DST (short test)
How it's done:
- A 1-mg dose of dexamethasone is taken between 11 PM and midnight
- A blood sample is taken at the doctor's office between 8 AM and 9 AM the next morning
Special instructions:
- Don't drink or eat anything for at least 10 hours before the blood test
48-hour DST (long test)
Why it's used:
- To better distinguish Cushing's syndrome from other conditions that can raise cortisol levels (such as depression, anxiety, morbid, obesity, alcoholism and diabetes) 1
How it's done:
- A 0.5-mg dose of dexamethasone is taken every 6 hours for 48 hours
- A blood sample is taken at the doctor's office 6 hours following the last dose
Special instructions:
- Be sure to take dexamethasone every 6 hours as instructed 2
(Note: The longer DST is considered more accurate in determining whether high cortisol levels are caused by Cushing’s syndrome or some other condition. 1 )
Tests to diagnosis Cushing’s disease
If a patient is diagnosed with Cushing’s syndrome after measuring the level of cortisol in his or her body, the next step is additional testing to diagnose if the cause of excess cortisol is Cushing’s disease (a pituitary tumor) or a different form of Cushing’s syndrome. 1
Tests to diagnose Cushing's disease
ACTH measurement
What it measures:
- Adrenocorticotropic hormone (ACTH) in the blood
How it's done:
- A blood sample is obtained. 4 This is then given to a lab for testing
Why it's used 4,5 :
- If ACTH levels are high, then Cushing's syndrome may be caused by a tumor in the pituitary (Cushing's disease) or somewhere other than the pituitary, most commonly on the lungs (ectopic Cushing's syndrome)
- If ACTH levels are low, then Cushing's syndrome may be caused by a tumor in the adrenal glands or another area of the body
Imaging tests
What it measures:
- Location of the tumor
How it's done:
- Doctors use an MRI* or CT* machine to scan areas of the patient's body to look for a tumor based on ACTH testing
- MRI scan of the pituitary gland if ACTH levels are high
- MRI or CT scan of the adrenal gland if ACTH levels are low 4
Corticotropin-releasing hormone (CRH) stimulation test
What it measures:
- How CRH changes ACTH and cortisol levels 2,4,5
How it's done:
- ACTH and cortisol levels are checked with a blood test, then a CRH intravenous injection is given 2,4
- After the CRH injection, blood tests are repeated several times to recheck ACTH and serum cortisol levels 2,4
- If these levels are higher, this helps to confirm that there is a pituitary tumor 2,4
Why it's used:
- The CRH test can be used to confirm that there is a pituitary tumor if either the ACTH measurement or the pituitary MRI is inconclusive 5
*MRI=magnetic resonance imaging; CT=computerized tomography.
Other testing
If a pituitary tumor is suspected but not found on MRI, it may be because either the tumor is too small to see, or it is not a pituitary tumor, but rather an ACTH-producing tumor in another part of the body. Additional imaging and/or tests are then needed. 2
A test called inferior petrosal sinus sampling (IPSS) test can be used to determine whether an ACTH-producing tumor is in the pituitary gland (Cushing’s disease). 4
Once the doctor knows what is causing the level of cortisol to be too high, then he or she can determine the most appropriate treatment.
References: 1. Nieman LK, Biller BMK, Findling JW, et al. The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93:1526-1540. 2. Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing’s syndrome. Lancet. 2006;367:1605-1617. 3. The Hormone Foundation’s patient guide to the diagnosis of Cushing’s syndrome. The Hormone Foundation. http://www.hormone.org/resources/patient_guides/upload/mgmt-cushings-syndrome-070609.pdf. Accessed August 4, 2009. 4. Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab. 2003;88:5593-5602. 5. Nieman LK, Ilias I. Evaluation and treatment of Cushing’s syndrome. Am J Med. 2005;118:1340-1346.
This is an international website on Cushing's Disease, intended for healthcare professionals, patients and caregivers. The information on this site is not country-specific. Use of this website is governed by our Terms of Use and Privacy Policy.
Hond & Cushing
Geplaatst in Cushing bij de hond – behandeling
Wat gek, de uitslagen van de ACTH stimulatietest zijn “omgedraaid”
Is de dosering Vetoryl te hoog?
Vetoryl onderdrukt de aanmaak van cortisol (stresshormoon) in de bijnieren. Wanneer de dosering te hoog is, wordt deze aanmaak teveel onderdrukt. Dit geeft de verschijnselen van de ziekte van Addison (het tegenovergesteld van de ziekte van Cushing).
Dit zijn verschijnselen van de ziekte van Addison:
- Lethargie (futloos, depressief)
- Slechte eetlust
- Braken of voedsel opgeven
- Spierzwakte
- Afvallen
- Diarree
- Veel drinken en plassen
- Spiertrillingen
- Buikpijn
- Bloed bij braaksel of ontlasting
- Dronkenmansgang (ataxie)
- Epileptische aanvallen
- Instorten (shock)
Dit zijn verschijnselen om altijd alert op te zijn, vooral wanneer is gestart met het geven van Vetoryl, of wanneer de dosering onlangs is verhoogd.
Lethargie en slechte eetlust zijn beslist symptomen om direct de Vetoryl te staken en contact op te nemen met de dierenarts. Wanneer je hond instort, dan is de situatie uiteraard kritiek en moet hij met spoed naar een dierenkliniek toe. Het kan zijn dat je hond aan het infuus moet en/of prednison krijgt toegediend om weer op te krabbelen.
Als alles weer normaal is en de hond helemaal hersteld van de Addison verschijnselen kan wellicht een lagere dosering Vetoryl worden ingezet. Dit moet dan vervolgens goed worden gemonitord, hiervoor is de ACTH stimulatietest bedoeld. Dit is een bloedtest die aangeeft of de dosering Vetoryl goed, te hoog of te laag is. Mooie bloeduitslagen zijn een bevestiging dat de dosering goed is ingeregeld, maar het klinisch beeld is minstens zo belangrijk: doet de hond het goed, is hij blij en actief en zijn de Cushing verschijnselen verdwenen of sterk verminderd? Blijft dit zo goed gaan, zonder dat het beeld omslaat in Addison verschijnselen? Dan gaat de dosering goed.
Lees de bijsluiter ook goed door om goed geinformeerd je hond te monitoren. Tot oktober 2014 gaf de bijsluiter van Vetoryl een startdosering per kilo lichaamsgewicht aan, die voor sommige honden te hoog bleek te zijn. Daarom heeft de fabrikant de startdosering verlaagd naar 1 tot 2 mg Vetoryl per kilo lichaamsgewicht. Helaas zijn er nog steeds bijsluiters van voor oktober 2014 in omloop, zowel op papier als op internet. Wees hier alert op en wanneer je twijfelt over de dosering, bespreek dit punt dan met je dierenarts.
Bijsluiter Vetoryl van juni 2015: bijsluiter-vetoryl-2015
Vetoryl combineren met andere medicatie
Ik heb Sara Galac gevraagd om eens in te gaan op de combinatie van Vetoryl met andere medicijnen.
Als voorbeeld gaf ik ook Vasotop (werkzame stof is ramipril) op; dat is een ACE inhibitor tegen hartfalen en het werkt ook positief bij nierfalen, omdat het de doorbloeding verbetert. Dat middel gaat niet samen met Vetoryl, dus dan moeten eigenaren vaak kiezen voor het een of het ander.
Haar reactie op mijn mail was:
Het lijk me nuttig om een korte tekst toe te voegen op het blog, over de combinaties Vetoryl-andere medicaties, maar het kan ook gevaarlijk zijn, want soms zijn de combinaties zeer individueel.
Wat ik wel al nu kan vertellen is het volgende:
– vaccineren mag (moet!)
– pijnstillers: tramadol geen probleem, NSAID`s alleen op de volle maag
– antibiotica: in het algemeen geen probleem
– prednison therapie heeft geen nut in combinatie met de trilostane, want trilostane breekt prednison af. Dus in situaties dat de hond wel steroïden nodig heeft, moet je met de therapie stoppen. Wat vaak gezien wordt is dat een ziekte die met steroïden behandeld zou worden (atopie, voedsel alergie) tijdens onbehandelde Cushing eigenlijk geen klachten veroorzaakt, omdat de lichaam al zelf voldoende steroïden aanmaakt. Pas als Cushing goed onder controle is, komen de klachten van atopie (etc.) tevoorschijn. In zulke situaties is soms verlagen van de dosis van de trilostane voldoende om de klachten onder controle te houden. Maar – puur mijn gevoel – zijn zulke patiënten nooit goed gereguleerd.
Wanneer moet ik Vetoryl verdelen over de dag?
Ik heb Sara Galac, de specialist in Utrecht, vorig jaar eens gevraagd wat een aanwijzing zou zijn om over te stappen op 2 x daags de helft van de Vetoryl te geven i.p.v. 1 x daags de voorgeschreven dosis. Dit was het antwoord:
Er zijn enkele onderzoeken die laten zien dat 2 keer per dag trilostane geven beter is dan een keer per dag. Als endocrinoloog, denk ik ook dat het beter zou zijn om het hormoon cortisol de hele dag te gaan remmen en niet maar enkele uren per dag. Trilostane zou namelijk maar 6 tot 8 uur moeten werken, dus met 1 keer per dag toedienen is de daling van cortisol maar enkele uren. Maar toch hebben wij goede ervaring met 1 keer per dag therapie en omdat dit ook praktisch en `goedkoop` voor de eigenaar is, is het onze standaard om met 1 keer per dag te starten.
Er zijn wel situaties dat de trilostane 2 keer per dag gebruik wordt:
- De hond krijgt al een tijdje trilostane, maar heeft nog steeds klachten van Cushing (veel drinken en plassen, etc.). Dus het idee zou zijn om de dosis te verhogen, maar de ACTH stimulatie test laat zien dat de dosis NIET verhoogd mag worden – anders lopen wij risico op bijwerkingen. In zulke gevallen wordt de conclusie getrokken dat de trilostane zeer waarschijnlijk te kort werkt en wordt het medicijn 2 keer per dag gegeven. Tot nu toe is er nog geen test om te beoordelen hoe lang trilostane werkt. Wij dachten dat de UCCR (urine cortisol:kreatinine ratio) een goede methode zou kunnen zijn, maar dat is niet zo gebleken – tot mijn grote teleurstelling. De vraag is welke dosis gegeven moet worden als je van 1 naar 2 keer per dag gaat. In principe zou de huidige dosis 2 keer per dag gegeven kunnen worden, maar dat kan gauw te veel zijn. Dus wordt de dosis liever gesplitst. Bij voorbeeld: 20 mg 1 keer per dag laat onvoldoende effect zien, dan is de volgende stap 2 keer per dag 10 mg.
- De tweede indicatie om 2 keer per dag trilostane te gaan geven is als de hond ook diabetes heeft. Dan beginnen wij meteen met 2 keer per dag, de dosering is 1 mg/kg 2 keer per dag. Dit omdat de insuline ook 2 keer per dag gegeven wordt en omdat de cortisol spiegel op deze manier stabieler wordt.
Startdosering Vetoryl aangepast per 22 juli 2014
Dechra, de fabrikant van Vetoryl heeft in juli jl. op basis van ervaringsgegevens de startdosering van Vetoryl verlaagd naar 2 mg per kilo lichaamsgewicht. Dit zal ook genoemd worden op de nieuwe bijsluiter.
In dit artikel staat ook een mailadres van Dechra genoemd: technical@dechra.com.
Ik heb het benut om hen maar eens een mailbericht te sturen met het verzoek om meer diversiteit aan te brengen in de dosering van Vetoryl, dat tot op heden alleen verkrijgbaar is in 10 mg, 30 mg, 60 mg en 120 mg. Misschien vind je het zinvol om dit ook te doen; je kunt dan de tekst kopieren en Dechra per mail aanschrijven:
Hond & Cushing
Contactgegevens
Mijn naam is Monique Post. Mijn mailadres is: post.monique@gmail.com
Geef je commentaar Reactie annuleren
Heerlijk om deze site te ontdekken, wij hebben al jaren whippets, ik herken meteen hun manier van kijken, luieren,gezellig bij elkaar liggen enz.We wonen in Duinkerken, zal kijken naar foto’s, hebben op het ogenblik DAPHNE,binnenkort 7 jaar en haar halfzusje CHIARA, ook binnenkort 7 jaar, daarvoor hebben MERRYL en MARQUIS en ook nog EURYDICE, heel laat geadopteerd, ons helemaal vertederd. Op het moment dat ik dit schrijf ligt DAPHNE in hun mand en laat me merken dat ik eigenlijk al lang op de bank had moeten zitten ( ik doe veel aan textielkunst s’avonds met aan elke kant een whippet, zeer aangenaam maar wel eens ingewikkeld).CHIARA ligt bij het baasje in bed, maar komt straks ook wel tevoorschijn..Even plassen,dan het brokje en dan moet het vrouwtje snel de naalden,spelden,wol en andere materialen van HUN bank afhalen, ze willen onder een plaid liggen en als dat allemaal klaar is kan ik weer verder werken..
Hallo, zag dat de berichten alweer van een paar jaar geleden. Mijn jack russel heeft ook ziekte van cushing en probeerde op medicanimals vetoryl te bestellen maar krijg als bericht dat ze niet naar Nederland sturen. Zou iemand me kunnen vertellen hoe ik het wel kan bestellen? Er was wel een persoon die dat al jaren besteld op die site, haar naam in bericht heet “ups”. Alvast bedankt!
http://www.petdrugsonline.co.uk/prescription-information Ik bestel al 3,5 Jaar de Vetoryl voor mijn hond ( standaard ruwhaar teckel) je hebt wel een recept nodig van je DA, en je bent zeker goedkoper uit , MVg, Sandra
Helaas heb ik afscheid moeten nemen van Missy, de medicijn Vetoryl hielp niet en de waardes verbeterde niet. Ze zat al op 60 mg en dat was voor ons de limiet. Ze mocht tot 100 mg gaan maar dat vonden wij toch te heftig. Ze was ook in 3 weken ruim 4 kg aangekomen. Heb ook foto’s laten maken en scan van haar buikje daar was niks op te zien, kreeg ook daarbij longziekte en was benauwd. DA heeft ook Utrecht gebeld en werd gesuggereerd dat de tumor zo groot was dat de medicijnen niet aansloeg. We hebben alles gedaan wat mogelijk was maar helaas de strijd tegen “ziekte van cushing” verloren. Heb een schat van een DA en veel steun gekregen, was moeilijk om knoop door te hakken, maar volgens DA waren we al veel verder gegaan en was goed om de limiet tot 60 mg als streef te stellen. Ze zal altijd in ons 💗 blijven. Haar zusje is nog steeds de weg kwijt en mist haar erg.
Ik heb nog vetoryl over dus als er nog iemand nodig heeft van 60 mg hoor ik het wel.
Beste Thea, het spijt me te lezen dat Missy er niet meer is. Onze Maxi heeft een inoperabele bijnier tumor, en moet aan de vetoryl, dus ik wil ze graag van je overnemen. Laat maar weten hoe en waar. Mvg Celine
hoi, ik ben nieuw hier en wilde even ons verhaal wat kwijt, ongeveer een jaar geleden ben ik met onze Pippi staff bull naar de DA geweest ze zat als maar te hijgen en ze was zo dik, ik bleef vol houden dat ik haar echt niet meer gaf dan haar maatje Stilo am staff. Maar goed ze moest op dieet ect niets hielp, in mn achter hoofd zei telkens een stemmetje dit is niet goed! en zeker niet toen ze ook nog eens een blik soep helemaal gespleten had met haar tandjes van de honger zucht nog een keer naar de DA, nee mevrouw niets wijst ergens op, totdat ze een darminfectie kreeg voor de 2 de keer (kantje boord toen wij op vakantie waren maar gelukkig toch hersteld) toen vroeg de andere DA is ze altijd zo dun behaard geweest? haar staartje werd ook kaal en dat kon ze niet zelf gedaan hebben daar was ze met allle respect te dik voor dat ze niet bij haar staartje kon dus ja vergeleken bij onze andere hond wel, er ging nog niet echt een lampje branden, totdat ik ging googlen ik kwam daar een verhaal tegen toen sloeg de schrik me om het hart dit was pippi’s verhaal. Meteen de DA gebeld en wilde dat ze daar op getest werd, jullie weten hoe dat gaat, en ja ze bleek Cushing te hebben. Leverpunctie en echo gehad die zat vol met cortisol en dan ook echt vol, tevens heel erg vergroot, haar nieren waren er niet al te best aan toe ook met een holle naald steriel urine eruit gezogen zat vol met eiwitten. Al met al er was voor haar geval geen behandel optie alles zou averechts werken.
Ik heb zelf voor de vetoryl gekozen 30 mg inmiddels de test gedaan of het genoeg was en dat was het gelukkig geval, maar haar lever is er slecht aan toe, de waardes mogen zijn max 200 maar Pippi zit aan de 1300 ze slikt het nu 7 weken. Ze is zelf een stuk rustiger ze slaap en snurkt soms heerlijk , maar ze moet pijn hebben want de lever zelf heeft geen pijn prikkels maar om de lever zit een soort zak en die rekt uit wat pijnlijk is alleen zo moeilijk te zien. Honden uiten dat haast niet en dit ras is toch al niet kleinzerig, ik voel me hulpeloos verloren, we willen haar nog zo graag bij ons houden, maar de vraag is, is het eerlijk tegenover haar.
Hoe gaat het intussen met Pippi ? Grs Imelda
hoi imelda wat lief dat je naar pippi vraagt..eerlijk gezegd hebben we haar al 2x vleugeltjes willen geven.omdat we merkten dat het niet lekker met haar ging en om verder lijden te voorkomen want we willen echt niet tot het uiterste gaan (heb gelezen dat hondjes stikken Door het vocht in de longen dit drama willen we echt voorkomen 😌)…Maar goed dan was ze toch in ene weer wat opgeknapt. .volgende week terug voor tussentijd test naar de DA inmiddels 1 x gehad en met 10 mg de vetoryl verhoogd haar leverwaardes waren nog torenhoog ze heeft ook nier falen maar deze nier waardes waren hetzelfde gebleven ..Ze is nog steeds een Michelin poppetje veel vocht houdt ze vast .vroeger kwam ze lekker in mn knieholte liggen maar dan kan ze allang niet meer ze moet languit liggen ..En Ze heeft nog steeds honger het enige waar ik echt wel verschil in merk is dat ze rustiger is ..Dus niet meer dat constante hijgen ..Dat is voor haar en ons een verademing 😉
dus Pippertje is er gelukkig nog en we geven haar cbd olie baadt het niet schaadt het niet
nogmaals bedankt voor je interesse in Pippi … Ik zit ook op de Facebook pagina daar heb ik ook wat dingetjes opgezet..Als je geen Facebook heb zal ik jou persoonlijk op de hoogte houden zodra ik volgende week meer weet
ondertussen de acthtest gehad , moest met 10 mg omhoog waardes waren te hoog, terwijl ze met de lagere dosis beter zat … dat heb ik dus niet gedaan de verhoging want er zat 4 uur tussen de acthtest ipv 3 uur,assistent vergeten te melden , ze zei ja daar kunnen we rekening mee houden toen ik er later navraag na deed.ik ga over 5 weken een opnieuwe acth test weer doen
Pippi is misselijk ben ik achter gekomen door de andere lotgenoten ze deed veel bank likken dat blijkt misselijkheid te zijn , nu heb ik druppels besteld voor de lever omdat ze daar een aandoening aan heeft dat de misselijkheid kan veroorzaken monique heeft me een link gestuurd, heb ze meteen besteld die komen vandaag aan ,hopelijk dit weer een stapje in de goed richting .
met vriendelijke groet sonja
Hallo, ik ben Mary, mijn teckel van 12, 5 jaar is onlangs gediagnosticeerd met Cushing. Hij gebruikt nu 4 weken Vetoryl en is flink opgeknapt. Alleen de vraatzucht is nog niet afgenomen en dat vind ik voor de hond zo erg.
De arts zei dat hij de hele dag enorme honger heeft en ik wil hem echt niet teveel laten aankomen
Ook ben ik op zoek naar mensen die Vetoryl over hebben, want het is inderdaad erg prijzig.
Ik ben benieuwd naar de raad en daad!
Helaas hebben wij gisteren onze Duitse Herder Indra in moeten laten slapen. Ze leed aan Cushing en kreeg 240 mg Vetoryl per dag. Daar heeft ze nog een aantal maanden goed op gedraaid (werd weer levendig en het dwangmatige eten en drinken was helemaal weg) maar ineens ging het mis. Haar nieren hebben het opgegeven. Ze is 10 jaar geworden maar we zijn heel verdrietig. Wij waren ongeveer 350,00 per maand kwijt aan de Vetoryl (tabletten van 120 mg). Ik heb nog 45 tabletten over ter waarde van 209,00. Ik wil ze graag verkopen voor 125,00. Is er iemand die interesse heeft?
Bij onze lieve Flo (Spaanse galgo) is helaas ook Cushing waargenomen.
Ze is ongeveer 6/7 jaar.
Zou ik mogen weten aan welk bedrag ik ongeveer zou moeten denken voor het verwijderen van de hypofyse?
Iatrogenic Hyperadrenocorticism in Dogs (Cushing’s Syndrome)
Iatrogenic hyperadrenocorticism is what veterinary dermatologists see most in the face of GC use for the diseases we manage- allergies (canine atopic dermatitis), autoimmune diseases (pemphigus foliaceus) and other immune mediated skin conditions. The diagnosis of iatrogenic hyperadrenocorticism is made based upon history, exam findings, general laboratory work findings (complete blood count, serum biochemistry test, urinalysis, urine cortisol to creatinine ratio) and tests to evaluate the pituitary adrenocortical axis (ACTH stimulation test, low-dose dexamethasone suppression test). Abdominal ultrasounds may also be done as a screening test.
Iatrogenic hyperadrenocorticism is often seen in toy and small breed dogs, but large breed dogs may also be affected. The average age is 10-14 yrs and the average time on a GC medication is 9.4 months. We see this with oral, injectable, and topical use of GC. It may be seen with both appropriate and excessive use of these medications. Signs may include an enlarged liver upon palpation of the abdomen, a “pot belly” appearance of the abdomen, obesity, muscular atrophy, lethargy, excessive water consumption, excessive urinations, and excessive appetite. Skin changes include thinning of the hair coat and skin, prominent cutaneous vasculature, hair loss that may or may not be symmetrical, hyperpigmentation of skin, scaling, bruising, poor wound healing, and calcinosis cutis (mineralization of the skin).
Related: Treatment for Calcinosis Cutis in Dogs
Secondary infections of the skin may occur with bacteria, yeast and some fungi (dermatophyte) due to impaired immune defenses. A mange, demodex mites, may also be a secondary problem. Laboratory work may reveal elevated liver enzymes, cholesterol, triglycerides, and blood glucose. The urine is usually dilute and there may be a urinary tract infection. Complete blood counts also have characteristic features. A definitive test may be done, ACTH stimulation test, and would be consistent with exogenous use of GC by showing a suppressed cortisol concentration at baseline and poor stimulation of cortisol production 1 hour after ACTH administration. Management of dogs with iatrogenic hyperadrenocorticism involves monitored discontinuation of exogenous GC, treatment of any secondary infections, and monitoring of the laboratory work. Identification and control of the primary disease for which GC were being administered warrants careful review and alternative therapies.
About Northeast Veterinary Dermatology Specialists (NVDS): Northeast Veterinary Dermatology Specialists is a full-service dermatology practice, with a dedicated team of veterinary staff treating diseases involving the skin, hair, ears, and nails. Services, tests and procedures provide the most effective, safe and state-of-the-art care in New York and Connecticut.
Animal dermatology and allergy specialists Dr. Nina Shoulberg and Dr. Lauren Pinchbeck, and their veterinary technicians, treat diseases stemming in part from allergies, bacterial infections, fungal infections, parasitic infestations, endocrine disorders, and immune-mediated diseases.
Services include: intradermal and serum testing for airborne allergens, immunotherapy, the diagnosis and treatment of ear diseases using video otoscopy, and removal of skin tumors using a carbon dioxide laser.
©2018 Northeast Veterinary Dermatology Specialists. All rights reserved.
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Hund cushing
for diagnosing diabetics
Cushing's Disease (or syndrome) occurs when the adrenal glands produce excess amounts of cortisol, also known as cortisone. Cushing's is also known as hyperadrenocorticism. Hyper = above normal; adreno = relating to the adrenal glands; corticism = relating to the cortex & cortisol production. So, Cushings is a disease of elevated cortisol production by the adrenal cortex. Cushing's is much more common in dogs than in cats, so this page focuses on Cushings in dogs.
Reasons why the balance between ACTH and cortisol can be upset:
- Pituitary gland tumor- also called Pituitary Dependent Hyperadrenocorticism (PDH) – This is the most common type of Cushings and it is found in about 85% of all cases. A tumor in the pituitary gland causes an increased production of ACTH, which in turn tells the adrenal cortex to produce more cortisol. The pituitary tumor can be very tiny or large and it can be benign or malignant. Poodles, terriers, German shepherds, Dachshunds, beagles, and boxers are more commonly diagnosed with PDH than other breeds.
Not all of these signs may be present, but as the disease progresses, they may become more pronounced or more signs may be seen. How common the sign is is shown for many of the items.
- Increased appetite (polyphagia) - 80-95% will show this sign.
- Increased drinking (polydypsia) and urination urination (polyuria) - due to interference with production of antidiuretic hormone. 80-90%.
- Muscle weakness, lethargy, lack of activity - excess cortisol causes protein breakdown (catabolism) which leads to muscle weakness. 75-80%
- Obesity, bloated abdomen, and "potbelly" - due to an increase of fat in the abdomen, increase in liver size (hepatomegaly), cronically full bladder, stretching of the abdominal wall, and the abdominal well becoming weaker. 90-95%
- Panting - due to increased fat in the rib area (thorax), muscle weakness, and increased abdominal contents exerting pressure on the diaphragm. A "common" sign.
- Poor hair coat, thinning hair (usually on the sides), hair does not regrow . "Common".
- Skin infections - due to excess corticosteroids suppressing the immune system.
- Thin skin, flaky or greasy skin & bruising - many processes that control skin structure and health are effected.
- Fasting hyperglycemia (elevated blood glucose) - seen in 40-60% of dogs.
- Insulin resistance - seen in up to 85% of dogs
So as you can, some of the signs of diabetes and Cushing's are identical.
Diagnosis of Cushing’s can be complicated and difficult. It is important to determine the type of Cushings (adrenal, pituitary, or iatrogenic) so that the appropriate treatment can be undertaken.
- Routine lab tests are usually performed – complete blood count, biochemistry, urinalysis – and abnormalities in these tests may suggest Cushing’s.
- An abdominal x-ray may show an enlarged liver or adrenal gland changes.
- An abdominal ultrasound is often performed to evaluate liver and adrenal glands.
- A urine test measuring cortisol to creatinine ration is sometimes performed, but it is not a very specific test because many health problems can cause abnormal test results. This is a screening test only – a negative result rules out Cushing’s. A positive result does not confirm Cushing’s and more tests will need to be performed.
- More definitive diagnostic testing looks at adrenal gland function. Cortisol levels in the blood are measured before and after a drug that would normally effect cortisol levels is given. Two commonly used tests are the ACTH stimulation test and the Low-dose dexamethasone suppression test . During the ACTH stimulation test, a pre-test blood sample is taken, then a dose of ACTH is given. After 2 hours, cortisol levels are measured again. If the cortisol levels are higher than expected, Cushing’s may be diagnosed. Dexamethasone is a cortisone-type drug that provides negative feedback on the pituitary gland to turn off ACTH production, and that in turn causes a decrease in adrenal cortisol production. In a normal animal (non-Cushing’s) a dip in cortisol would be seen 8 hours after giving dexamethasone. If a pituitary tumor exists, no drop in cortisol level is seen during the low-dose dexamethasone test. During a high-dose dexamethasone suppression test , cortisol levels will be suppressed in about 75% of dogs with PDH and will not be suppressed in the remaining 25% of dogs with PDH or in 100% of dogs with an adrenal tumor.
Diabetic animals can pose a special problem when testing for Cushing's .
As you can see, diabetes and Cushing’s share many of the same signs (increased drinking, urination, eating, lethargy, enlarged liver). Uncontrolled diabetes can lead to complications that in turn cause increased cortisol levels and signs that are identical to Cushing’s. Testing and diagnosis of Cushing’s in a non-diabetic dog can be complicated, and it can be extremely complicated in a dog that has diabetes. The situation is even worse for a stressed or poorly controlled diabetic because stressed diabetics and Cushing’s dogs can have similar blood panel abnormalities and blood chemistry abnormalities. Plasma ACTH levels, the ACTH stimulation test results, and low-dose dexamethasone suppression test results can be abnormal in a stressed DM dog; the high-dose dexamethasone suppression test results can be abnormal in an unregulated DM dog. There are clinical signs that help distinguish the two disease so your general vet and specialist must consider the “whole picture” of your dog’s physical condition and test results.
Cushings caused by a pituitary gland tumor (PDH) . Surgery to remove a tumor in the pituitary gland is very risky and is rarely performed. Controlling the growth of the tumor may be attempted with radiation. Medication is used to control this type of Cushings.
- The drug most commonly used is o,p’DDD, also know as Lysodren or mitotane. This drug works by destroying the cortisol-producing cells in the adrenal cortex. Careful monitoring is required during treatment to be sure that too much drug is not given and too many adrenal cortex cells are not killed. Too much drug would result in too little cortisol being produced (resulting in Addison’s disease, the opposite of Cushing’s). Treatment involves an “induction” or “loading” phase where Lysodren is given on a daily basis. This loading phase rapidly brings the some of the Cushing’s symptoms under control. Owners are usually instructed to closely monitor their dog’s eating and drinking. When drinking is normal (about 50-60 mL water per pound body weight per day) induction is complete and the “maintenance” phase begins. In maintenance, Lysodren is given two to three times a week to keep the cortisol levels within acceptable levels. ACTH stimulation tests are repeated every three to four months to ensure adequate control and dosing.
Anipryl or L-deprenyl is another drug that is used to treat pituitary-dependent Cushing’s. It was approved for use in the United States in 1997. Anipryl is used to treat cognitive dysfunction in dogs and has shown to be effective in clinical trials in controlling Cushing’s in about 70% of dogs. The drug works by influencing dopamine concentrations (a chemical used to by brain cells to communicate with each other), which in turn influences production of ACTH by the pituitary gland. The effectiveness of this drug is controversial, but since the side effects are less severe than those of Lysodren, it is used in some dogs, especially those who are older or have multiple health problems. Anipryl does not involve an induction or loading phase.
Ketoconazole is another drug used to treat PDH or dogs who have adrenal gland tumors. It works by blocking production of cortisol in the adrenal gland. It has the potential to damage the liver.
Cushings caused by an adrenal gland tumor may be treated surgically or with Lysodren or Ketoconazole . Surgery is difficult and may have many complications. Removal of the adrenal gland may require life-long supplementation with glucocorticoids and mineralocorticoids (both normally produced by the adrenal gland).
Iatrogenic Cushing’s – treatment requires slowly discontinuing the cortisone that is being given. This must be done in a controlled manner so that other problems do not occur. The disease that is being treated with cortisone will probably recur. If damages has been done to the adrenal glands, that will need to be addressed.
With a possible diabetic and/or Cushoid animal there are three different scenarios that can occur:
- Your animal may be both diabetic and have Cushing's. As the Cushing's is brought under control your animal's insulin needs will be greatly reduced. Therefore it's very important to monitor your animal's blood glucose until the correct maintenance dose is determined so an overdose of insulin doesn't happen.
You can read Kiri's story - she lived with diabetes, Cushing's and hypothyroidism for over 6 years.
With a diabetic it is very important to take every means possible to stabilize them on their insulin before a Cushing's test is even tried. Some questions to ask your vet:
- If your animal is unregulated--ask your vet at what amount of insulin they would consider your animal to be needing to bring the glucose levels under control.
- If your animal has only been on one type of insulin, are they willing to try another type.
- Would a change in food, feeding schedule, or amount of food make a difference.
Updated April 2006
Copyright. All rights reserved.
This site is for information purposes only. Please consult your veterinarian.
Canine Cushings Disease
Canine Cushings disease or Hyperadrenocorticism is a serious disease that is most often seen in middle aged and older dogs; some breeds are more prone to this disease than others.
Dachshunds are one of the breeds that are affected by this disease, along with Poodles, Boxers, Beagles and others.
Sometimes this disease can be mistaken for symptoms of old age or an infection in the urinary tract.
What is Canine Cushings Disease?
The two endocrine glands involved in Cushings disease are the pituitary gland which sits at the base of the brain and the adrenal gland which is found in the area of the kidneys.
The adrenal gland produces cortisol which is important for normal body function but it is when an excess of the corticosteroid hormone is produced that Cushing's disease develops.
The leading cause for the excessive corticosteroid hormone production is usually a tumor, either in the adrenal or pituitary glands. These tumors called adenomas, are slow growing and not normally life threatening.
Most dogs suffer from pituitary-dependant hyperadrenocorticism, which is when a tumor has grown on the pituitary gland, causing this gland to product excessive amounts of a hormone known as adrencorticotropic (ACTH) hormone which travels through the blood to the adrenal glands.
This leads to an over stimulation of the adrenal glands where excessive amounts of corticosteroid hormone are then produced.
Symptoms of Canine Cushings Disease
- Dogs affected with this disease show a marked increase in thirst which in turn increases their urine output, the dogs appetite often increases also.
- Affected dachshunds will often show a pot-belly appearance, suffer from a lack of energy and put on extra weight.
- Their skin often develops an unhealthy look becoming thin and greasy; this can also be accompanied by loss of hair which can result in baldness.
- Heat can also cause discomfort for dogs suffering from Cushing's and they will pant to try to get some relief
Treatments available for cushings disease in dogs
Medication, surgery and also radiation therapy are treatments used to control Cushing's disease. If tumors in the adrenal gland are the cause then surgery may be used but medication is also an option.
If the tumour is in the pituitary gland, surgery is not usually done as this operation is very complex. Medication or radiation therapy is the usual treatment.
With this disease there are a number of prescription medications available, such as Vetoryl, Anipryl and Lysodren.
Some owners have chosen an alternative treatment; for a number of reasons, perhaps their dog may be having bad reactions to the drugs prescribed or perhaps they are just not happy with using drugs and want to find a natural approach.
Whatever your reason, with any alternative treatment, it’s still important to continue to work closely with your vet to monitor your dog’s condition; vets are professionally trained so keep them in the loop.
In the world of herbal and holistic remedies there is a wide choice, but the one that seems to work particularly well for many dogs with this disease is Cushex Drops a 100% herbal remedy from PetAlive.
This natural remedy we think is one of the most effective, non-toxic support available for this disease. Positive results for many owners and their dogs is encouraging.Get more info on natural remedy for Cushing's Disease
Ensure treatment is well supervised by your vet, regular checks and blood tests are required; Keep a regular check on your dog’s water consumption and also his activity level.
Once your dachshund is stabilized, visit your vet promptly if there are any significant changes.
Diet is also important with this disease a diet of raw food is helpful as many of the nutrients that are important to your dog’s health are lost when food is cooked.
You can prepare food yourself or perhaps you would prefer to try Easy Raw Dehydrated Dog Food from Natural Pet Store.
Canine Cushings disease usually requires lifelong management, but with close monitoring dogs affected can typically lead a good life.
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Tests to diagnose Cushing's syndrome and Cushing's disease
Tests to diagnose Cushing's syndrome
It is important that the diagnosis of Cushing's syndrome is confirmed. First a doctor will test you for Cushing's syndrome. Once glucocorticoid medicines have been ruled out, there are 4 types of tests that are generally used to find out if you have Cushing's syndrome. These tests measure the amount of cortisol in samples of urine, blood, or saliva to determine how much cortisol is circulating in your body. If the tests show that the level of cortisol is too high, it means you have Cushing's syndrome. 1 If the test is not positive for high levels of cortisol, then signs and symptoms should be closely watched. If your symptoms get worse, check back with your doctor in 6 months. 1
In certain cases, doctors recommend specific types of tests based on a person's medical history. Some of these recommendations are included below.
UFC=urine-free cortisol; DST=dexamethasone suppression test; *=No recommendation stated.
Following are brief descriptions of tests that are used to diagnose Cushing’s syndrome. However, complete information about these tests, along with instructions for patients, should be obtained from your doctor.
Urine-free cortisol (UFC) test 1,2
What it measures:
Why it's used:
- Almost all people with Cushing's syndrome have high urine cortisol levels
- The UFC test only measures the type of cortisol that causes Cushing's syndrome, called "circulating, free cortisol." It does not measure "bound" cortisol, which increases in the blood from taking certain medicines such as estrogen, but does not cause Cushing's syndrome
How it's done:
- Urine samples are collected at every opportunity throughout a 24-hour period. The samples are then given to a lab for testing
Special instructions:
- During the 24-hour testing period, don't drink a lot of fluids or use glucocorticoid medicines or products, such as hemorrhoid or skin creams that contain steroids. This test needs to be done up to 3 times to be certain the results are accurate
Late-night salivary cortisol test 1,3
What it measures:
Why it's used:
- Normally, the amount of cortisol in saliva is lowest late at night. However, Cushing's syndrome will cause there to be more cortisol than normal in saliva at this time
How it's done:
- A saliva sample is obtained between 11 PM and midnight on 2 different nights. These are then given to a lab for testing
Special instructions:
- Don't eat licorice, smoke cigarettes, or chew tobacco on the days when samples are obtained
- Avoid situations that create extreme stress or excitement
- If bedtime is usually well past midnight, obtain samples at bedtime
Late-night plasma cortisol test 3,4
What it measures:
Why it's used:
- Normally, the amount of cortisol in blood is lowest late at night. However, Cushing's syndrome will cause there to be more cortisol than normal in blood at this time
How it's done:
- A blood sample is obtained at night while the patient is sleeping in a hospital. 4 This is then given to a lab for testing
Dexamethasone suppression test (DST) 1,3
What it measures:
Why it's used:
- Normally, low doses of dexamethasone will reduce cortisol levels. However, if a person has Cushing's syndrome, these doses will not have an effect on cortisol levels
Overnight DST (short test)
How it's done:
- A 1-mg dose of dexamethasone is taken between 11 PM and midnight
- A blood sample is taken at the doctor's office between 8 AM and 9 AM the next morning
Special instructions:
- Don't drink or eat anything for at least 10 hours before the blood test
48-hour DST (long test)
Why it's used:
- To better distinguish Cushing's syndrome from other conditions that can raise cortisol levels (such as depression, anxiety, morbid, obesity, alcoholism and diabetes) 1
How it's done:
- A 0.5-mg dose of dexamethasone is taken every 6 hours for 48 hours
- A blood sample is taken at the doctor's office 6 hours following the last dose
Special instructions:
- Be sure to take dexamethasone every 6 hours as instructed 2
(Note: The longer DST is considered more accurate in determining whether high cortisol levels are caused by Cushing’s syndrome or some other condition. 1 )
Tests to diagnosis Cushing’s disease
If a patient is diagnosed with Cushing’s syndrome after measuring the level of cortisol in his or her body, the next step is additional testing to diagnose if the cause of excess cortisol is Cushing’s disease (a pituitary tumor) or a different form of Cushing’s syndrome. 1
Tests to diagnose Cushing's disease
ACTH measurement
What it measures:
- Adrenocorticotropic hormone (ACTH) in the blood
How it's done:
- A blood sample is obtained. 4 This is then given to a lab for testing
Why it's used 4,5 :
- If ACTH levels are high, then Cushing's syndrome may be caused by a tumor in the pituitary (Cushing's disease) or somewhere other than the pituitary, most commonly on the lungs (ectopic Cushing's syndrome)
- If ACTH levels are low, then Cushing's syndrome may be caused by a tumor in the adrenal glands or another area of the body
Imaging tests
What it measures:
- Location of the tumor
How it's done:
- Doctors use an MRI* or CT* machine to scan areas of the patient's body to look for a tumor based on ACTH testing
- MRI scan of the pituitary gland if ACTH levels are high
- MRI or CT scan of the adrenal gland if ACTH levels are low 4
Corticotropin-releasing hormone (CRH) stimulation test
What it measures:
- How CRH changes ACTH and cortisol levels 2,4,5
How it's done:
- ACTH and cortisol levels are checked with a blood test, then a CRH intravenous injection is given 2,4
- After the CRH injection, blood tests are repeated several times to recheck ACTH and serum cortisol levels 2,4
- If these levels are higher, this helps to confirm that there is a pituitary tumor 2,4
Why it's used:
- The CRH test can be used to confirm that there is a pituitary tumor if either the ACTH measurement or the pituitary MRI is inconclusive 5
*MRI=magnetic resonance imaging; CT=computerized tomography.
Other testing
If a pituitary tumor is suspected but not found on MRI, it may be because either the tumor is too small to see, or it is not a pituitary tumor, but rather an ACTH-producing tumor in another part of the body. Additional imaging and/or tests are then needed. 2
A test called inferior petrosal sinus sampling (IPSS) test can be used to determine whether an ACTH-producing tumor is in the pituitary gland (Cushing’s disease). 4
Once the doctor knows what is causing the level of cortisol to be too high, then he or she can determine the most appropriate treatment.
References: 1. Nieman LK, Biller BMK, Findling JW, et al. The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93:1526-1540. 2. Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing’s syndrome. Lancet. 2006;367:1605-1617. 3. The Hormone Foundation’s patient guide to the diagnosis of Cushing’s syndrome. The Hormone Foundation. http://www.hormone.org/resources/patient_guides/upload/mgmt-cushings-syndrome-070609.pdf. Accessed August 4, 2009. 4. Arnaldi G, Angeli A, Atkinson AB, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab. 2003;88:5593-5602. 5. Nieman LK, Ilias I. Evaluation and treatment of Cushing’s syndrome. Am J Med. 2005;118:1340-1346.
This is an international website on Cushing's Disease, intended for healthcare professionals, patients and caregivers. The information on this site is not country-specific. Use of this website is governed by our Terms of Use and Privacy Policy.
Vetoryl
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What is Vetoryl?
Vetoryl is used to treat dogs with hyperadrenocorticism (Cushing's Disease). Vetoryl (Trilostane) is a competitive inhibitor of the enzyme 3-beta-hydroxysteroid dehydrogenase used in dogs for the treatment of pituitary dependent Cushing's Disease and Cushing's Disease due to adrenocortical tumors. It may be necessary to wait at least one month after discontinuing Lysodren before starting treatment with Vetoryl. Vetoryl requires a prescription from your veterinarian.
Dogs & Puppies (weighing 3.8+ lbs)
- Treats Cushing's Disease in dogs and puppies weighing over 3.8 lbs
- Improvement may be seen within several weeks
- Available in 10 mg, 30 mg, 60 mg or 120 mg capsules (based on weight)
How does Vetoryl work?
Vetoryl controls the adrenal gland's excess production of cortisol, a hormone released into the bloodstream during times of stress.
Do not give this medication to dogs with kidney or liver disease. Vetoryl Capsules should not be given to dogs taking certain medications or dogs that are pregnant. Speak with your veterinarian about all medications your dog is taking, including over-the-counter medicines.
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What is the most important thing I should know about Vetoryl?
Vetoryl is a prescription medication FDA approved for veterinary use in the treatment of Cushing's Disease. Vetoryl is indicated for use in pituitary-dependent hyperadrenocorticism. Vetoryl also has a Minor Use designation for treatment of Cushing's Disease caused by adrenal tumors. Vetoryl is available as 10 mg capsules, 30 mg capsules, 60 mg capsules and 120 mg capsules. The usual initial starting dose to treat Cushing's Disease in dogs is 1.0 to 3.0 mg/lb given once a day based on body weight and capsule size. For dogs weighing 3.8-10 lbs, give one 10 mg capsule once a day. For dogs weighing 10-22 lbs, give one 30 mg capsule once a day. For dogs weighing 22-44 lbs, give one 60 mg capsule. For dogs weighing 44-88 lbs, give one 120 mg capsule. For dogs weighing 88-132 lbs, give one 120 mg capsule and one 60 mg capsule, totaling 180 mg. For dogs weighing over 132 lbs, give the appropriate combination of capsules. Vetoryl should be given with food. After approximately 10 to 14 days, your pet will need to be re-examined and dosage adjustments may be required. Pets may require further re-examination at 30 days, 90 days, and every 3 months thereafter.
What should I discuss with my veterinarian before giving Vetoryl to my pet?
Tell your veterinarian if your pet has kidney or liver disease. Tell your veterinarian about any other medical problems or allergies your dog has now or has had in the past. Tell your veterinarian about any medications your dog is taking including over the counter products and nutritional supplements. Tell your veterinarian if your pet is pregnant, nursing, or if you plan to breed your dog.
How should Vetoryl be given?
Give this medication exactly as directed by your veterinarian. Give this medication with food. Do not open capsules and do not attempt to split or divide capsules. Wash your hands after use. Do not handle the capsules if you are pregnant or trying to become pregnant. If you do not understand the directions ask the pharmacist or veterinarian to explain them to you.
What are the potential side effects of Vetoryl?
If any of the following serious side effects occur, stop giving Vetoryl and seek emergency veterinary medical attention; an allergic reaction (difficulty breathing; swelling of the lips, tongue or face; hives), severe depression, bloody diarrhea, collapse, or other severe reactions. Other less serious side effects such as unexpected decrease in appetite, vomiting, diarrhea, and lethargy may occur. Other side effects may also occur. Talk to your veterinarian about any side effect that seems unusual or bothersome to your pet.
What happens if I miss giving a dose of Vetoryl?
Give the missed dose as soon as you remember. However, if is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not give a double dose of the medication.
What happens if I overdose my pet on Vetoryl?
Seek emergency veterinary medical treatment. Symptoms of Vetoryl overdose may include lethargy, weakness, vomiting, or collapse.
What should I avoid while giving Vetoryl to my pet?
Do not give Vetoryl to dogs with kidney or liver disease. Do not give to pregnant or nursing dogs or dogs intended for breeding. Do not touch Vetoryl capsules if you are pregnant or trying to become pregnant.
What other drugs will affect Vetoryl?
Before giving Vetoryl, tell your veterinarian if your pet is also taking ACE inhibitors such as enalapril, potassium sparing diuretics such as spironolactone, ketoconazole, or potassium supplements. Talk to your veterinarian or pharmacist before giving any prescription or over the counter medicines or nutritional supplements.
Vetoryl Directions:
- Vetoryl is used to treat dogs with hyperadrenocorticism, also known as Cushing's Disease.
- Vetoryl capsules should be given with food.
Do not open capsules and do not attempt to split or divide capsule.
Vetoryl Dosage for Dogs/Puppies (weighing 3.8+ lbs):
Store Vetoryl at controlled room temperature (77°F) with excursions to 86° F allowed. Keep this medication away from children and other pets.
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