Cushing's syndrome in dogs - the significance of laboratory tests. Cushing's syndrome in dogs - symptoms and treatment of the disease

The hormonal system is a complex and subtle mechanism for regulating biochemical processes in the body. Deviation of the level of hormones from the physiological norm can lead to serious, sometimes irreversible consequences. One of the most common endocrine disorders in dogs is Cushing's syndrome.

The cause of this pathological condition is an excessive amount of cortisol in the blood of an animal with a constant long-term effect on the body.

Normally, it promotes blood clotting, regulates blood pressure, and has an anti-inflammatory effect. In critical situations, its powerful release into the blood allows you to quickly mobilize the body.

Cortisol (hydrocortisone, a stress hormone) is produced by the adrenal glands.

The work of these endocrine glands, in turn, depends on the influence of the pituitary gland. The pituitary gland is also a gland that is located in the brain and regulates the functioning of the whole organism.

For the adrenal glands to function properly, the pituitary gland secretes adrenocorticotropic hormone (ACTH), allowing you to maintain normal cortisol levels. Violation of this interdependent system leads to the emergence of this endocrinopathy.

Other names for the pathology: Itsenko-Cushing's syndrome, hyperadrenocorticism, hypercortisonemia.

Causes

Genetically determined causes are not well understood. The rest are usually divided into the following forms:

Cushing's disease(spontaneous hyperadrenocorticism) caused by pituitary adenoma or hyperplasia;
Cushing's syndrome(glucosteroma) caused by an adenoma or carcinoma of one or two adrenal glands;
iatrogenic hyperadrenocorticism, may occur with excessive intake of hormones from the outside (long-term treatment with corticosteroid drugs).

Possible consequences

Due to the high concentration of cortisol in the blood, the animal's body is in a state of constant readiness to withstand adverse effects. This leads to rapid wear of the body, depletion of its energy reserves and early old age.

Risk group

This syndrome most often dogs are susceptible from the second half of life, but there are also cases of disease in animals younger than 2 years. The most susceptible breeds are:

Symptoms

Given the wide impact of cortisol on the functioning of the whole organism, Cushing's syndrome affects the immune, nervous, reproductive, genitourinary, reproductive, cardiovascular and musculoskeletal systems. Kidneys, skin, liver can suffer. Other glands also change the normal production of hormones.

The disease develops gradually, so you should know the main symptoms of Cushing's syndrome in dogs:

increased thirst and urination;
excessive appetite;
deterioration of the coat with the appearance of bald patches.

You can also observe other signs of a developing disease. Along with the increased urge to urinate, urinary incontinence appears. The dog gains excess weight, and the fat leaves the subcutaneous tissue and is localized mainly in the neck, abdomen and chest.

With the deterioration of the coat, its loss begins and the appearance of alopecia (symmetrical bald patches) in the kidney area. Further, baldness spreads throughout the back, chest, neck and tail. Hyperpigmentation and calcification can be seen on the skin.

There is muscle weakness and a sagging belly as a result. In females, the sexual cycle is disrupted, up to extinction, and in males, atrophy of the testicles is possible.

The dog becomes lethargic and sleepy. Unbalanced behavior may be noticed. In the case of pituitary adenoma, coordination disorders and depression are possible.

As concomitant diseases, the following symptoms of Cushing's disease in dogs are observed: pyoderma, thromboembolism, signs of secondary diabetes mellitus, infections of the genitourinary system. The animal may experience drops in blood pressure, signs of gastritis.

Cushing's disease in dogs is accompanied by osteoporosis with possible fractures, a disorder of the cardiovascular system.

Severe symptoms of the disease can be diagnosed already with a visual examination. Additional methods for diagnosing a dog include general and biochemical blood and urine tests.

The next step will be conducting functional tests associated with the introduction of dexamethasone and the hormone ACTH. Judging by the reactions of the body to these drugs, the work of the adrenal glands is evaluated.

The focus and cause of the disease should be determined.

To do this, an ultrasound of the abdominal cavity is performed, which will reveal the possible presence of neoplasms or an increase in the adrenal glands. X-ray will detect their mineralization, identify a possible enlargement of the liver, characteristic of Cushing's syndrome.

To detect tumors in the pituitary or adrenal glands, MRI and CT are used where this type of diagnosis is available. Cushing's syndrome causes irreversible consequences, tk. affects all systems and organs.

The life span of an animal varies from a few weeks to 7-8 years after diagnosis.

Treatment

Treatment for Cushing's syndrome is surgical and medical. If a tumor of one of the adrenal glands is detected in the absence of metastases, it is removed.

Surgical removal of both affected adrenal glands is possible, after which further lifelong replacement therapy is prescribed in the form of taking glucocorticoids and mineralcorticoids.

With a pituitary adenoma, it is possible to use drugs that suppress the production of cortisol. Unfortunately, these drugs are very expensive and inaccessible.

Conservative treatment involves the use of Mitotan, Lysodren, Chloditan, L-deprenil, Ketoconazole, Cyproheptadine.

The choice of the drug, dosage and frequency of use is strictly individually prescribed by the veterinarian.

The course of treatment is prescribed based on the clinical picture, localization of the pathological focus and constant monitoring of the dog's condition.

As an additional alternative treatment, you can use the homeopathic preparation Gormel, which generally normalizes the functioning of the hormonal system and is compatible with conservative treatment.

The main indicator of correctly chosen treatment tactics is to reduce the amount of water consumed by the dog. Also, the animal will need regular monitoring of the condition with the help of a blood test and ultrasound.

The results of treatment can be different and depend on many factors, including how attentive and responsible the attitude of the owner of the dog will be.

For more information, check out the video about Cushing's syndrome in dogs:

Cushing's syndrome in dogs is a pathology in which the pituitary gland ceases to control the production of a special hormone, cortisol, by the adrenal glands. Its surplus leads to the fact that the dog's body begins to work at its limit, is quickly depleted, and the disease often ends in the death of the animal. At an early stage, it is impossible to make a diagnosis based on symptoms alone. If your pet does not behave as usual for some time, feels unwell and does not get better - do not expect a miracle, consult a doctor.

The adrenal glands, at the signal of the pituitary gland and under its control, produce cortisol. The hormone cortisol is the stress hormone. It is responsible for increasing blood pressure and producing blood sugar. In a stressful situation, when a dog has to spend a lot of energy on defense or attack, such a state is justified. She becomes stronger, faster and more resilient. But at this moment, other body systems (digestive, genitourinary, immune) do not receive sufficient nutrition and blood supply. If this does not last long, the animal suffers without consequences and is easily restored.

In Cushing's disease, the pituitary gland in dogs ceases to control the production of cortisol. It enters the bloodstream in larger quantities than necessary, many times over. The body is in a state of constant stress, all systems work for wear and tear, which leads to exhaustion and early aging.

The disease develops in different ways: sometimes the deterioration of the dog's condition occurs slowly, and sometimes rapidly.

Most often, animals get sick after 7 years, but in some cases Cushing's syndrome is also diagnosed in young pets. Dachshunds, terriers, boxers, basset hounds are more susceptible to this disease.

Types of disease

The disease is classified according to the cause of the disease, the symptoms in all cases are the same:

Iatrogenic Cushing's syndrome occurs due to the fact that the treatment of any disease of the dog was carried out with hormonal drugs haphazardly, and without control. They contained a hormone similar to cortisol. With regulatory therapy, the level of the hormone is lowered, but in the future the adrenal glands may stop producing it. You will have to inject cortisol in the form of injections until the last days of the pet.
Genetic Cushing's syndrome is more common in young dogs. Its reasons are unknown.
A type of disease that occurs due to a brain tumor of any kind. The neoplasm is located either inside the pituitary gland, or nearby. As the tumor grows, the pituitary gland is compressed and stops working. Signals to the adrenal glands stop coming. With this type of disease, cortisol enters the blood in excess, or is not produced at all.
A disease associated with dysfunction of the adrenal glands. The signal comes from the brain, but the adrenal glands do not carry it out. The cause may be neoplasm or toxic poisoning.

Symptoms

With Cushing's syndrome in dogs, some symptoms do not appear immediately. Primary signs:

intense thirst. The animal drinks water avidly - often and a lot;
profuse urination. The pet does not have enough walks two or three times a day, as before. Sometimes he stops asking and leaves puddles anywhere;
the dog begins to smell like urine;
increased appetite, the pet eats a lot and does not eat up;
promiscuity in food. Because of the increased appetite, he even eats the food that he previously refused.

If a dog has such signs and does not go away, this is already a reason to think and contact a veterinary clinic for an examination. If treatment is not started, the disease progresses. The appearance of the pet and its behavior is changing:

severe and sudden weight loss, regardless of the fact that the entire portion is eaten and the dog asks for a supplement;
a strong increase in the abdomen;
atrophy of all muscles, including the abdominal ones, due to which the stomach begins to sag;
hair loss. Baldness occurs on the abdomen, sides and partially on the back. Bald patches are formed symmetrically. Hair does not fall out on the head, paws and tail.
the formation of purple stripes on the skin of the abdomen. The skin becomes thinner, with minor damage, wounds and erosion are formed. There is no itching, the dog does not itch;
frequent fractures due to thinning of the bones;
after some time, the females stop estrus, and the testicles atrophy in males.

A characteristic external sign of Cushing's disease is a dog with thin paws, a sunken sternum and a strongly sagging large belly. Symmetrically bald body, skin in places with small cracks.

In addition to these symptoms, the pet experiences changes in behavior, and mental disorders may occur. Secondary diseases appear: diabetes mellitus, gastritis, jumps in blood pressure, arrhythmia.

More recently, a perky, beautiful pet becomes like an old, feeble dog. Outwardly aging, all body systems are aging.

Diagnostics

A qualified specialist can determine the diagnosis by external signs, but a laboratory examination is indispensable. Diagnosis in the veterinary clinic is carried out in order to accurately determine the disease and establish its cause. It depends on which course of treatment will be chosen. Diagnostics includes:

general blood analysis;
biochemical blood test;
urinalysis to find out if the protein content is normal;
x-ray and ultrasound to determine if there is a neoplasm in the adrenal glands, the degree of their mineralization, liver enlargement, bone porosity;
examination to detect violations in the work of the pituitary gland;
dexamethasone tests, which measure the functioning of the adrenal glands.

It is impossible to establish Cushing's disease only by determining the level of cortisol in the blood. The hormone can increase with other pathologies, or with external influences on the mental state of the dog. For some excitable pets, going to the veterinary clinic is the most stressful, so at the time of taking the analysis, the level of cortisol may be elevated.

Treatment

It is no longer possible to completely restore the health of a dog and the functioning of the body, just as it is impossible to restore youth to an old person. Therapeutic measures are aimed at lowering the level of cortisol, improving the functioning of the organs, and in some cases, removing the neoplasm. You cannot refuse treatment. The disease will progress and lead to death.

Therapeutic measures and supportive therapy improve the general condition of the pet and prolong its life by at least 2.5-3 years, which is a long time for a dog.

Surgical measures

If the tumor is found in the adrenal gland, surgical measures are taken to remove it. It is important that the neoplasm is benign and there are no metastases in other organs.

Operations to remove neoplasms in the brain are not carried out in our country. The veterinarian may prescribe drugs that stop its growth. At the same time, they may suggest surgery to remove both adrenal glands in order to stop the production of hormones. In the future, continuous administration of cortisol in the form of injections and hormone replacement therapy is required.

Surgery may not be possible for all dogs. In some cases, the pet may be weakened due to age, or have other serious illnesses. In such cases, the operation will be ineffective and worsen the general condition of the animal.

Medical treatment

Another method of treatment is the appointment of drugs to reduce cortisol levels and normalize it. It is important to prevent a decline below normal or a cessation of production, which happens with a progressive disease.

Drugs should not be taken without a doctor's prescription. It is important to correctly calculate their dose, which is affected by the general condition of the dog, age, weight. The intake of hormonal drugs is carried out under the supervision of a physician. In the course of treatment, the composition of the blood is examined, an ultrasound examination is performed. With any changes, the dose is changed.

In addition to hormone therapy, restorative treatment is carried out, which is aimed at reducing pressure, normalizing the work of the heart, gastrointestinal tract, and strengthening the immune system.

One of the signs that the dog is on the mend is a decrease in appetite and lack of thirst.

There are no preventive measures to prevent Cushing's disease. Only the iatrogenic variety of this disease can be prevented. Just do not self-medicate the animal, especially when it comes to taking hormonal drugs.

The dog's body is a unique system in which many biochemical processes take place that determine the level of physical and intellectual development of the dog.

The state of the hormonal background depends on the proper functioning of the internal secretion organs, which, in turn, ensures the good health of the dog, its psycho-emotional development and is responsible for the life span of the animal. But, unfortunately, a malfunction in your pet's endocrine system can cause such a complex disease as Cushing's syndrome in dogs.

What is a syndrome?

This disease is not uncommon in animals older than seven years, but sometimes young dogs can also get sick.

In order for the blood coagulation system to work properly in the dog’s body, blood pressure was normal, and he could cope with inflammation, the adrenal glands of the animal produce the hormone cortisol. Due to the fact that in critical situations during excitement, fright, a large amount of this substance is ejected from the dog's blood, it is also called the stress hormone.

But the adrenal glands cannot "dispose" of cortisol on their own - the command to produce the hormone is given to them by the pituitary gland, which regulates its concentration in the body. If the pituitary gland ceases to control the level of cortisol, then an increase in its content in the blood becomes the cause of Cushing's syndrome in dogs.

Veterinarians divide this pathology into:

Cushing's disease appears as a result of damage to the pituitary gland by an adenoma;
caused by the appearance of an adenoma or carcinoma of the adrenal glands in dogs;
Iatrogenic hyperadrenocorticism - occurs as a result of long-term use of hormonal drugs.

Thus, we see that the causes of the disease are problems with the adrenal glands or the pituitary gland in the dog.

Some breeds have a special predisposition to the occurrence of this syndrome, so the owners of terriers, beagles, boxers, shepherd dogs need to carefully monitor the well-being of their pets and periodically do tests that reveal this pathology.

Symptoms

Cushing's syndrome in dogs has a rather striking manifestation, faced with which, veterinarians may suspect the presence of this disease in your pet. From the attention of the owners of the dog, such characteristic signs as:

pathological thirst;
very frequent urination, in which the dog cannot stand to walk and urinate at home;
excessive appetite;
apathy and weakness;
weakening of the abdominal muscles and sagging it;
hair loss, not accompanied by itching;
violation of coordination and behavior of the dog.

Since Cushing's disease is a systemic disease, that is, affecting almost all organs and systems, it is accompanied by many more different symptoms and causes various complications. Complications of the disease include: diabetes mellitus, osteoporosis, arterial hypertension, disorders of the reproductive organs.

Diagnostics

If the disease is already in an advanced stage, then external signs will be visible to the naked eye. The main ways to diagnose Cushing's syndrome are:

clinical blood test;
determination of biochemical parameters of blood;
urinalysis with protein determination;
tests with the introduction of dexamethasone and adrenocorticotropic hormone.

In order to identify neoplasms on the adrenal glands of a dog, an ultrasound of the abdominal organs is performed. If there is a suspicion of a pituitary tumor, then it is advisable to do a CT scan or MRI to the animal to confirm or refute these fears.

Treatment

Depending on the lesion of which organ caused Cushing's syndrome, the treatment of this disease can be conservative or surgical.

If a tumor of the adrenal gland is detected, then a surgical intervention is possible, during which the adrenal gland is removed. If problems are found with both adrenal glands, both organs are removed, and the dog is prescribed lifelong medication to correct the hormonal background of the dog.

Standard drug therapy is carried out using proven drugs:

The hormonal agent "Mitotan" reduces the level of cortisol. Its initial dose is 50 micrograms of medication per kilogram of animal weight. Taking this amount of medicine can be divided into 2-3 times a day. Two weeks later, a control blood test is done and if the veterinarian notes a decrease in cortisol to normal levels, then the drug is given to the dog once a week at the same dose.
Another popular method in veterinary practice is the treatment with Ketoconazole. This drug is especially indicated for those dogs in which the disease provoked the appearance of a skin fungus. During treatment, a gradual increase in dose occurs: 1 week - 10 mcg per 1 kilogram of weight (for 2 doses per day), 2 weeks - 20 mcg / 1 kg, 3 weeks - 30 mcg / 1 kg.

With a correct diagnosis and well-chosen treatment, the owner almost immediately notices the effect of therapy - the dog stops “drinking in basins”, and its general condition improves. If, during treatment, the pet's condition worsens, then most likely this is caused by complications of the disease.

The veterinarian prescribes repeated tests and instrumental studies to control treatment and search for the causes of deterioration.

With an iatrogenic form of the syndrome, hormonal therapy must be discontinued. But it is necessary to carry out the cancellation gradually, carefully reducing the dose of the drug and monitoring the condition of the dog with the help of tests.

Animal life forecast

From this we can conclude that the life prognosis for a dog with this syndrome will not be very optimistic - even with timely treatment, it will be able to live for about three years.

Do not despair if your pet is diagnosed with this difficult diagnosis, because care, proper treatment and good care will extend the life of the dog for several more years and give you the joy of communicating with him.

Difficult diagnosis - Cushing's syndrome in dogs. What kind of diagnosis is this? How does it threaten the animal, what are the prognosis for recovery, how to treat this disease? Let's take a closer look. Cushing's syndrome is an unhealthy pathological condition of the animal, during which the pituitary gland loses control over the production of a special hormone, cortisol, by the adrenal endocrine glands.

An excess of this hormonal substance eventually leads to the fact that the dog's metabolism is greatly activated, the body begins to function at the limit, all this can lead to its premature exhaustion and even death in the animal. However, if the disease is only in its infancy, it is often very difficult to make a correct diagnosis. Therefore, if you notice that the dog is not behaving as usual, consult your veterinarian immediately.

What is Cushing's Syndrome in Dogs

The body of a dog, like any highly organized living being, is designed in such a way that it contains a large number of interconnected endocrine glands. All of them have a great influence on various functions of life.

The adrenal glands produce a special hormone called cortisol. The level of its secretion occurs under the direct influence of the pituitary gland. Cortisol is an important substance that allows you to regulate the body's behavior during stressful situations. When this substance is produced, the dog's blood pressure rises and glucose production increases.

During stress, the animal usually requires a lot of energy, which is used for defensive behavior or aggression. In the external environment, when the animal is forced to survive, such a state is quite normal. The same thing happens in humans and other mammals. The creature gets a lot of additional strength, reaction speed, endurance. However, all this is done by muting the functions of other biological systems of the body, which during this short period do not receive sufficient nutrition and blood supply. Under normal conditions, stress usually does not last long and the body quickly recovers from the effects of stress.

When Cushing's syndrome occurs, the canine pituitary gland loses the ability to properly control cortisol secretion. This hormone begins to be released in significant quantities, greatly exceeding the usual rate. At the same time, the animal's body begins to be in a strong stressful state, this negatively affects all its systems. The dog literally burns before our eyes from excessive exhaustion.

Symptoms of Cushing's disease in dogs usually proceed in different ways, when the disease develops slowly, calmly, and when the dog begins to quickly burn out right in front of its owner. The most susceptible to this disease are middle-aged dogs who are already seven years old, but sometimes younger animals are also diagnosed. The most commonly affected breeds are Boxers, Dachshunds and Terriers.

Types of disease

Veterinary medicine has several types of Cushing's syndrome, which can occur for various reasons. However, the symptoms of all these species are almost the same.

Cushing's syndrome in dogs of the iatrogenic type may occur due to the fact that the animal was incorrectly treated with various hormone-based drugs, and this treatment was carried out haphazardly and uncontrolled. Most likely, cortisol was present in the composition of the hormones taken. With proper treatment of this type of Cushing's syndrome, specialists will lower the level of the hormonal substance, but it is possible that the adrenal glands will stop producing it altogether. In this case, the substance will have to be administered to the animal for the rest of its life by injection.
Genetic Cushing's syndrome can be observed in young pets. The causes of its occurrence are still unknown to veterinary science.
A tumor variety of Cushing's syndrome can occur due to the fact that a malignant or benign neoplasm begins to grow in the animal's brain. The tumor is usually located either near the pituitary gland or inside it. During the development of a neoplasm, the gland shrinks and ceases to perform its function. This stops the control over the secretion of cortisol by the adrenal glands. Cortisol either ceases to be produced altogether, or is produced in excess.
A disease that occurs due to malfunctions in the adrenal glands. In this case, the pituitary gland is working normally, but the adrenal glands do not receive its signals and produce cortisol at abnormal levels. The cause of this situation is usually either a tumor or some kind of poisoning with toxic substances.

Symptoms of Cushing's Syndrome

With Cushing's disease, the animal begins to show a number of specific symptoms. However, not all of them are detected in the early stages.

Intense thirst in the animal. The dog drinks liquid very often and a lot, sometimes the thirst is so pronounced that the pet tries to drink not only water, but also other liquids, sometimes even non-food ones.
Very strong urination. A four-legged friend begins to ask to go to the toilet very often, the usual number of walks is not enough for the pet to fulfill all its natural needs. Sometimes the dog does not even ask to go outside and makes puddles at home or other places.
A strong smell of urine begins to emanate from the dog.
Increased appetite in the animal. The dog eats a lot and often, but does not gorge. Because of this, symptoms of poor digestion and indigestion are added.
Indiscriminate eating. The dog eats everything, even the food that he did not like before. Sometimes the animal tries to eat even obviously inedible objects.

If you notice the above signs in your pet, then this is a clear reason to immediately contact your veterinarian. If treatment is not started in time, the disease begins to develop further and progresses. This changes the behavior and appearance of the animal:

Very sharp weight loss, while the pet eats all the food offered to him, asks for more. The ribs are starting to show through.
Significantly increases the belly of the animal.
All muscles, including the abdominal muscles, strongly atrophy, the belly begins to sag.
The dog begins to grow bald sharply and strongly, the hair falls out on the sides and stomach, the back of the animal is partially bald. There are no bald patches on other parts of the body of the four-legged friend.
Specific purple streaks appear on the skin of the abdomen. The skin becomes thin, various wounds and injuries appear, while the dog does not experience any itching and does not have any attempts to scratch.
The skeleton becomes thinner, because of this, frequent fractures occur.
In females, periods of estrus stop, and in males, the sex glands (testes) begin to atrophy.

With further progression of Cushing's disease, the dog takes the following form: it has thin paws, a sunken chest, and a disproportionately enlarged belly. The skin of the animal is bald, there are small cracks on the skin.

Diagnosis of the disease

An experienced specialist in a veterinary clinic can easily identify the diagnosis based on the appearance of the animal, but in this case, a special laboratory examination is also necessary. It is done in order to most accurately determine the type and cause of Cushing's syndrome in a dog and begin the most correct treatment. The diagnostic complex for this disease usually includes:

Carrying out a general blood test, including measuring the number of red blood cells, platelets and white blood cells.
A biochemical blood test, including measuring the level of cortisol in it.
A urine test that measures protein content.
Ultrasound examination and fluoroscopy. These procedures allow you to find out if there are any tumors in the adrenal glands, what is the level of their mineralization, if there is an increased porosity of the bones, if the liver is enlarged.
A study that reveals the stability of the pituitary gland.
Tests that check the proper functioning of the adrenal glands.

It is impossible to make a diagnosis based on the level of cortisol in the blood of a dog. After all, the secretion of this important biological substance can change under various external circumstances. For example, an animal may be in a state of deep stress just because it was brought to a veterinary clinic for an examination. Therefore, in such cases, the level of cortisol in the blood of the animal is temporarily overestimated.

Treatment of Cushing's disease

Treatment of Cushing's syndrome in dogs is performed by two main methods, surgical and medical. The choice of one method or another depends on the type of disease.

Surgical treatment is carried out if the neoplasm was found in the adrenal gland. It is very important to pay attention to the good quality of the tumor due to the risk of metastases.

Treatment of tumors in the brain in dogs in our region is not performed. The veterinarian can only prescribe medication that inhibits the development of the tumor. At the same time, they may try to remove the adrenal glands in order to stop the production of cortisol in the blood. But further, continuous maintenance therapy in the form of injections of cortisol into the blood will be required.

The second method of treatment is the use of drugs that reduce the level of cortisol in the blood of the animal. The main thing is not to underestimate its level and not stop at all.

With this disease, it is extremely important not to make any attempts at self-treatment. This can lead to a sharp deterioration in the health of the animal and even death! An important sign that the animal is beginning to recover is a decrease in appetite and normal fluid intake. Monitor the condition of your pet, and then the dog will delight you with a long and fulfilling life.

About the author: Anna Aleksandrovna Maksimenkova

Practicing veterinarian in a private clinic. Directions: therapy, oncology, surgery. Read more about me in the "About Us" section.
endocrinologist

Introduction
Cushing's syndrome is perhaps the most interesting problem in veterinary endocrinology. The interest lies in overcoming the difficulties associated with the treatment of this endocrinopathy in dogs in our country.
The disease itself and the problems of its treatment will be discussed in this article.

What it is?
Let's start with a definition.
Cushing's syndrome called a pathological condition of the body caused by prolonged excess levels of cortisol in the blood. So, the culprit of Cushing's syndrome is cortisol. What is this substance?
cortisol is a steroid hormone that is involved in most of the metabolic processes.
But perhaps its main property is to protect the body from adverse effects. We can say that it is a stress hormone. It allows the body to survive negative influences with minimal losses. How does this happen?
Cortisol helps maintain blood pressure, accelerates blood clotting, and has a powerful anti-inflammatory effect.
But most importantly, it mobilizes the body's energy reserves to combat hostile influences. That is, it stimulates the use of fat reserves and proteins to maintain a normal or increased concentration of glucose (the main source of energy) in the blood.

Cortisol is secreted by the adrenal glands. These are two small endocrine glands, which, as the name implies, are located near each kidney.
The adrenal glands are not normally independent organs, their activity is regulated by the pituitary gland - the structure of the brain.
The pituitary gland secretes adrenocorticotropic hormone (ACTH) into the blood, which, acting on the adrenal glands, stimulates their work. Without going into details, we can say that there is something like a vertical “pituitary - adrenal glands”. In this vertical, the so-called negative feedback mechanism operates, which allows you to keep the concentration of cortisol in normal values. When the concentration of cortisol reaches a certain level that the body needs, it interacts with the pituitary gland and inhibits the release of ACTH into the blood. The concentration of ACTH decreases, which means that the adrenal glands cease to be stimulated and secrete less cortisol.

In Cushing's syndrome, this mechanism is disrupted, and cortisol begins to be excessively and uncontrollably released into the blood. This can happen for two reasons:

if one or both adrenal glands is affected by a tumor capable of uncontrolled secretion of the hormone
if the pituitary gland has a tumor (usually an adenoma) that secretes an excessive amount of ACTH.

In both cases, the concentration of cortisol in the blood will be constantly increased. That is, the biochemical picture that occurs during stress will be modeled.
A situation arises in which the body struggles for months and years with adverse effects that are not actually there. Of course, in this case, the energy reserves of the body will be depleted, which will lead to disruption of metabolic processes, and hence disruption of the work of various organ systems. As a result, Cushing's syndrome leads to "burnout" of the body.

Who is sick?
When it comes to small pets, Cushing's syndrome is extremely rare in cats and, at the same time, is one of the most common endocrine diseases in dogs.
Dogs older than middle age get sick.
Cushing's syndrome can occur in any breed of dog, but is more common in dachshunds, terriers, small poodles, and boxers.

What does it look like?
Cushing's syndrome begins imperceptibly and develops gradually, symptom by symptom.
With a detailed clinical picture, the usual complaints voiced by the owners of an animal with Cushing's syndrome look something like this.

most often there are complaints of excessive thirst and urination
the second most popular place is the deterioration of the quality of wool and the appearance of extensive bald patches. Hairless areas are distributed symmetrically, localized in the area of the trunk, tail and neck.
quite soon after the first signs of the disease appear, bitches disappear in heat
animals become less mobile
the physique changes: there is a loss of fat from the subcutaneous fatty tissue, muscles atrophy. Due to the weakness of the muscles of the abdominal wall, the abdomen increases in volume and sags.

The result is a thin dog with a voluminous belly and extensive bald patches.
A doctor who has an idea about Cushing's syndrome can most often suspect this disease already by the patient's appearance.
But only the appearance and the history told by the owner of the animal is not enough to make a diagnosis, even if everything is obvious.
Why? Because the treatment of Cushing's syndrome is not easy, expensive and not safe. So, before starting treatment, taking into account these three "H", you need to be sure that we are treating Cushing's syndrome.

Diagnostics
As soon as there is a suspicion of Cushing's syndrome, we begin to conduct additional diagnostic methods, which include clinical and biochemical blood tests.
These studies provide additional indirect evidence of Cushing's syndrome. And when enough evidence is collected, we resort to specific tests, that is, tests that prove the presence of a disease.
In principle, if you think about it, the first thing that comes to mind when we suspect Cushing's syndrome is to measure the concentration of cortisol in the patient's blood. In theory, it should be above the norm, because, as we remember, Cushing's syndrome develops precisely because of a long-term persistent increase in the concentration of cortisol in the blood.
But cortisol levels can rise not only with damage to the pituitary or adrenal glands. It can also rise against the background of some other diseases and in some other conditions. Therefore, determining just the baseline level of cortisol in the blood is not an appropriate test.

So-called functional tests are recommended to confirm Cushing's syndrome.
Tests that evaluate adrenal function (if it is excessive or normal).
The most common are the low dose dexamethasone test and the ACTH test. The essence of the tests is that in addition to determining the basic level of cortisol, its concentration is also determined after the administration of dexamethasone or an ACTH preparation. And according to how its concentration in the blood changes after the use of these drugs, it is judged whether there is a pathological excess work of the adrenal glands or not.

Once Cushing's syndrome is confirmed, one should try to find out where the pathological focus is localized - in the pituitary gland or in the adrenal glands.
Some data on this issue can give a test with a small dose of dexamethasone (small dexamethasone test). But more valuable are visual diagnostic methods (methods that allow you to see the adrenal glands and pituitary gland in one way or another).
We have an ultrasound of the adrenal glands. We can evaluate the ultrasound structure of the organ, compare the right and left adrenal glands and, together with other additional studies, suggest how likely it is that one of the adrenal glands is tumor affected.
Unfortunately, computed and magnetic resonance imaging are not yet available to us. These are quite informative types of visualization of the organ, which allow with great accuracy to identify neoplasms in the pituitary or adrenal glands and assess the degree of their spread.
I think that after some time, such studies will be easily accessible to domestic veterinary medicine.

Treatment
The choice of treatment for Cushing's syndrome primarily depends on the location of the pathological focus - the pituitary or adrenal glands.
If the tumor affects one of the adrenal glands and no metastases are found in the lungs and liver, then the method of choice is the removal of the affected adrenal gland. In this case, the approach is relatively simple.

The situation is somewhat more complicated when the cause of the development of Cushing's syndrome is a pituitary adenoma.
That is, formally, everything is easy. In this form of Cushing's syndrome, the use of drugs that suppress the production of cortisol by the adrenal glands is recommended. But in fact, the acquisition of these drugs is a big problem. They are not supplied to the domestic market, and their price is very high. Therefore, in order to choose a drug treatment, you need to be able to purchase the drug abroad (Germany, USA, Canada) and have enough money to purchase it. Several patients are treated in this way in our clinic. But, unfortunately, not everyone can buy the drugs mentioned above.
There are two ways left. Use alternative methods of medical treatment or resort to surgery.
Alternative therapies refer to the use of drugs that have little or no proven efficacy. Recommending drugs with low efficacy and a high likelihood of side effects or simply with zero efficacy seems wrong to me. Therefore, I rarely resort to the use of these drugs.

Surgical treatment of Cushing's syndrome caused by damage to the pituitary gland is to remove both adrenal glands.
Given that the adrenal glands synthesize vital hormones, namely mineral and glucocorticoids, their removal should suggest further replacement therapy. That is, lifelong intake of some of the missing hormones will be required. These hormones include mineralcorticoids and glucocorticoids, which are easy to take.
It seems that the surgical removal of both adrenal glands (adrenalectomy) today may be the most appropriate treatment for Cushing's syndrome in our country. That is why we are trying to work out the implementation of adrenalectomy (removal of the adrenal glands).
This operation is not indicated for every animal suffering from Cushing's syndrome. Before recommending surgery, the benefits of surgical treatment are weighed against the risk of complications. And not always the choice is made in favor of surgical treatment. This is due to the fact that, as a rule, animals suffering from Cushing's syndrome are at a very advanced age and by that time have some diseases that are superior in importance to Cushing's syndrome.

As a result, it should be said that the treatment of Cushing's syndrome in small pets in our country faces certain difficulties, which are quite serious, but quite surmountable.
And the search for an optimal solution to existing problems is one of the priority tasks facing us.