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All About Atypical Cushing's Disease

Updated: Jul 17


What is atypical Cushing’s disease?


Atypical Cushing's is a condition characterized by the following:


  • clinical signs and symptoms consistent with Cushing’s disease

  • negative results on Cushing’s screening tests, such as the Low Dose Dexamethasone Suppression Test.

  • elevated levels of sex steroid hormones and precursors, as confirmed by adrenal panel testing (described below). These steroid hormones are progesterone, androgens, and estrogens.


Clinical Signs


The clinical signs of atypical Cushing’s disease are similar to the clinical signs of other types of Cushing’s. Dogs may present with a variety of symptoms, including excessive urination, increased thirst, a ravenous appetite, muscle wasting, enlarged abdomen, and hair loss. And bloodwork will most likely show an elevated alkaline phosphatase (ALP).


Diagnosis


Veterinarians diagnose atypical Cushing’s based on evaluation of symptoms and laboratory testing. If a dogs is showing signs of Cushing's disease but testing shows cortisol within normal limits, a veterinarian may recommend an adrenal steroid panel to check levels of sex steroid hormones.


At the moment, the most specific test for measuring sex steroid hormones is the adrenal steroid panel offered by the University of Tennessee’s College of Veterinary Medicine (UTCVM). A blood sample can be submitted to UTCVM through your veterinarian. You can find more information about UTCVM’s testing program on their website.


Note


It's worth noting that atypical Cushing's is a controversial topic in veterinary medicine. The core disagreement is whether the disease is primarily caused by elevated sex hormones or whether there is a slight, intermittent increase in cortisol that standard testing misses. Some researchers argue that the current reference ranges and cutoffs for Cushing's screening tests are too high, causing early or mild cases to be misdiagnosed as atypical.


Treatment


There are differing views about how atypical Cushing’s should be treated. UTCVM recommends treating atypical Cushing's with a combination of melatonin and lignans supplements, which they say can take up to four months or longer to be effective. If symptoms are substantial, some veterinarians will treat atypical Cushing's with a low dose of Vetoryl (trilostane).


Purchasing melatonin and lignans


If you want to purchase melatonin and lignans for your pet, options include:




References





 
 
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