Final Stages of Cushing's Disease in Dogs: Saying Goodbye

We're sorry you're facing this with your dog. In the final stages of Cushing's disease in dogs, the signs can include muscle wasting and weakness, thin skin, infections that keep returning, and, in some dogs, diabetes or signs from a growing pituitary tumor, though many show up earlier too.

If your dog is with you now, a vet can look into new weakness, reduced appetite, or accidents in the house, and you can ask about pain relief and comfort care at any point. At home, rugs on slick floors and soft bedding can help a dog with tired legs.

Cushing's, which vets also call Cushing's syndrome, most often comes from a tumor in the pituitary gland, and less often from a tumor in an adrenal gland. If your dog was diagnosed recently, our guide to next steps after a Cushing's diagnosis covers tests, treatment, and daily life.

If your dog is having a seizure, has collapsed, or is struggling to breathe right now, call the vet on your comfort plan if you have one, or get care right away. The get-help section covers what to do if an emergency clinic is far away. If your dog has already died, we're so sorry, and there's a section for you further down.

Key Takeaways

• Cushing's means a dog has too much of the hormone cortisol. Among dogs with naturally occurring Cushing's, most have the pituitary form and the rest have an adrenal tumor.
• Common signs include a bigger appetite, heavy drinking and peeing, panting, thin skin, weak or wasting muscles, and infections that keep coming back. Not every dog shows every one.
• A vet may recommend a comfort plan that says which signs to call about. Without one, or if you're not sure, get care as soon as possible if your dog is struggling to breathe right now, and right away for a seizure or a sudden collapse.
• Survival figures for Cushing's describe groups of dogs, not yours. If you can see a vet, one who has examined your dog can say more.
• Treatment, comfort care, and euthanasia are all paths families take, and families decide about them at different points. The choice can change as your dog does.

What the Final Stages of Cushing's Disease in Dogs Can Look Like

In the final stages of Cushing's disease in dogs, changes can include muscle loss and weakness, thin skin, recurring infections, diabetes, and, if a pituitary tumor grows, changes in behavior or vision, though many signs appear earlier. The veterinary guides we use describe Cushing's by signs like these, not by formal stages.

Both main forms look alike from the outside: VCA explains that, regardless of type, the clinical signs of Cushing’s disease are essentially the same. A large pituitary tumor can also bring other signs, since it might press on or interfere with nearby structures, according to the same guide.

According to Merck, the pituitary form mostly affects middle-aged to older dogs. If your dog has other conditions too, our dog end-of-life guides walk through many of them one at a time.

Muscle Wasting, Weakness and Tiredness

AAHA's guidelines list muscle weakness or wasting as a sign of Cushing's. The belly muscles weaken and can eventually shrink too, which is part of why dogs with Cushing's can look pot-bellied, according to VCA. A dog with Cushing's may seem sleepier or move around less, which VCA calls lethargy and lists as a common sign. Weakness in the back legs has its own section below, with ways to help at home.

Skin, Hair Loss and Infections

Merck says hair loss is common with Cushing's. PetMD's vet-reviewed guide notes that it usually shows up evenly on both sides of the body, along the torso.

VCA says thin skin, chronic skin infections, dark spots, mineral deposits in the skin (calcinosis cutis), poor skin healing, and persistent bladder infections are common signs. In AAHA's guidelines, the extra urination can come with worse incontinence, accidents in the house, or getting up at night to pee. If your dog is with you now and having new accidents, a vet can check what's behind them.

Diabetes, High Blood Pressure and Other Illnesses

Diabetes comes along with Cushing's in some dogs, and Merck gives the figure: Approximately 10% of dogs with hyperadrenocorticism have concurrent diabetes mellitus. Hyperadrenocorticism is another medical name for Cushing's. Merck lists high blood pressure, congestive heart failure, and a blood clot in the lungs, called a pulmonary thromboembolism, among the uncommon problems.

AAHA's guidelines name a gallbladder mucocele, where thick mucus builds up in the gallbladder, and a diabetes complication called diabetic ketoacidosis among the illnesses that can come with Cushing's.

When a Pituitary Tumor Grows: Neurological Signs, Appetite and Vision

In about 15% of dogs with the pituitary form, roughly 1 in 7, the tumor grows and affects the brain, often resulting in neurological signs, VCA explains.

AAHA's guidelines link decreased appetite, behavioral changes, and other neurological signs to a growing pituitary tumor and say the tumor causes them, not the cortisol. Merck mentions stupor, meaning a dog who's very hard to rouse, and seizures among these signs. Vision problems are common with these large tumors too, according to VCA's guide to pituitary macroadenomas.

In AAHA's guidelines, Cushing's is called hypercortisolism. Anorexia is the medical word for not eating. If your dog is with you now and eating less, a vet can look for the cause, since the guidelines say hypercortisolism does not cause anorexia, vomiting, or diarrhea. For a dog with signs of a growing pituitary tumor, the treatment section and the comfort and goodbye sections cover the paths families take.

Symptoms of a Dog Dying From Cushing's

If your dog is with you now, these are changes some families notice. Some come from Cushing's itself, and some from other illnesses, and a vet can look into each. These changes can also be part of thinking about a goodbye:

• Weakness that makes standing or getting outside hard
• Eating little or nothing
• Sores or skin and bladder infections that don't clear
• Stupor, seizures, or behavior changes, with a growing pituitary tumor

Not every dog has these, and they don't tell you how much time is left, so if you're not sure what you're seeing, we'd suggest calling a vet clinic and describing what's going on. The section on when to euthanize covers how families weigh these changes. If your dog has died, the section further down is for you.

When to Get Help Now

A vet-created comfort-care plan may already list which signs to call about. If you don't have one, or you're not sure, these are among the signs DoveLewis, a 24-hour animal hospital, lists as needing care:

• Struggling to breathe, right now: get care as soon as possible
• A seizure or a sudden collapse, right now: seek immediate care

Panting on its own is a common sign of Cushing's. The breathing on this list is breathing that looks like a struggle. If an emergency clinic is far away or not an option, call any vet clinic you can reach and ask what to do. These signs are about getting help now, not about how much time your dog has.

Why Cushing's Syndrome Weakens a Dog's Back Legs

Weak back legs in a dog with Cushing's syndrome can be part of the muscle weakness and wasting the illness brings. A 2024 study in Animals describes Cushing's muscle change as most often atrophic, meaning the muscles shrink. Merck says Cushing's muscle disease can cause a stiff or stilted walk, most noticeable in the back legs.

Less often, Cushing's comes with other problems, and Merck's list of uncommon problems with Cushing's includes a torn knee ligament (cranial cruciate ligament rupture), nerve and muscle disorders, and a stiffness disorder called pseudomyotonia. That stiffness disorder is rare, the Animals study's authors write. In their study, 8 of 1,130 newly diagnosed dogs at three veterinary schools had this stiffness or a related one, and six of the eight had the pituitary form. These are less common than the muscle weakness above, which Merck lists among the common signs. If your dog is with you now and something about their legs changes, tell a vet.

Helping a Dog With Weak Back Legs at Home

If your dog is with you now, small changes at home can help tired legs. VCA's palliative care guidance suggests:

• Non-skid floors, using area rugs or the foam interlocking tiles sold for play areas and gyms
• Blocking stairs, or staying with your dog on them, and using a sling or vest to help them up if carrying isn't possible
• Using soft and easily cleaned bedding to make them as comfortable as possible, in VCA's words
• Ramps to reach a bed or a favorite piece of furniture
• Food and water bowls set in front of a dog who isn't getting up much, wherever they're comfortable resting
• Comfortable spots close to you, so your dog stays part of what's going on

A vet can tell you whether physical therapy, pain relief, or something else might help your dog's legs.

Are Dogs in Pain With Cushing's Disease?

Pain isn't on Merck's list of common Cushing's signs, but some Cushing's-related problems can hurt, including pancreatitis and rare muscle stiffness. If your dog is with you now and seems sore or restless, a vet can look into the cause and help with pain relief.

Merck's guide for pet families lists Cushing's as a risk factor for pancreatitis, and Merck explains that vets usually give pain medicine for pancreatitis because it's assumed to cause belly pain.

The Animals study reported that the rare stiffness was painful in five of the eight dogs found with it, and pain medicine was the type of medication the eight dogs were given most often.

How Long Can a Dog Live With Cushing's Disease?

Survival figures describe groups of dogs, not yours. According to VCA, the outlook with Cushing's depends on the form. For the pituitary form, which most dogs have, Merck reports an estimated median survival of about 2 years. A median means half lived longer, and half didn't live as long.

How Long Do the Final Stages of Cushing's Last?

How long the later part of Cushing's lasts varies from dog to dog, and none of the studies or veterinary guides we rely on give a timeline for it. The two survival studies below count time from diagnosis, not from when a dog starts to decline. If your dog is with you now, a vet can talk through what comfort looks like from here, whichever path you take, and the signs to watch further down are one way to notice changes.

The Pituitary Form

VCA explains that medical treatment can't cure Cushing's, but control is possible for many years if the pituitary tumor is small, and that the outlook is less favorable when a large tumor affects the brain. Families weigh this alongside their dog's age, other illnesses, and what treatment involves.

The Adrenal Form

With an adrenal tumor, the outlook depends on whether the tumor is benign or cancerous, and VCA describes the outlook for a malignant adrenal tumor as guarded to poor. The treatment section covers surgery and other options for an adrenal tumor.

Untreated Cushing's in Dogs

The University of Illinois veterinary college's pet health column notes that dogs with untreated Cushing's face a higher risk of recurrent infections, such as urinary tract or skin infections, as well as urinary incontinence, high blood pressure, and diabetes. A vet can help with each of those as they arise.

One small study at a primary-care hospital in Japan, where vets and families chose which dogs to treat based on signs, side effects, and cost, compared survival between treated and untreated dogs. From diagnosis, untreated dogs with the pituitary form had a shorter median survival than dogs on trilostane, and the authors cite the lack of random assignment as the study's major limitation. These findings describe groups of dogs, not yours, whether your dog is with you or has died. If your dog is with you now, a vet can talk with you about comfort on either path.

How Long Can an Older Dog Live With Cushing's?

In vet practices in England, a 2020 Veterinary Record study found a median survival of 510 days (about 17 months) from diagnosis in dogs of all ages with Cushing's, most on trilostane, including deaths from any cause. A definitive cause of death was rarely recorded, so the study couldn't say how many of those deaths came from Cushing's. For a 12-year-old dog, there's no single number. If you can see a vet, one who has examined your dog can weigh any other conditions in a way no study can.

What Do Dogs With Cushing's Usually Die From?

These findings describe groups of dogs, not yours. The English study above rarely recorded a definitive cause. In the Japanese study above, the cause was uncertain in most cases. The deaths those authors think may have been linked to Cushing's involved breathing problems, neurological signs, diabetes, gallbladder mucoceles, or pancreatitis.

If a vet saw your dog before they died, that clinic may be able to talk through what the vet noticed. If no vet saw your dog and questions stay with you, talking with a pet loss grief counselor is one option.

Treating Cushing's in an Older Dog, or Choosing Not To

When vets treat Cushing's, they most often use trilostane, a daily medicine, according to Merck. Treatment includes rechecks and blood tests. Some adrenal tumors are treated with surgery instead. Treatment aims to improve quality of life, a University of Illinois veterinarian says. Treatment, comfort care, and euthanasia are all paths families take.

Trilostane and Rechecks

For the pituitary form, VCA says trilostane (Vetoryl) is the most commonly used drug. AAHA's guidelines cover both the pituitary form (PDH) and the adrenal form (ADH): Trilostane is FDA approved for treatment of PDH and ADH. Mitotane (Lysodren) is another option, VCA notes. If your dog starts trilostane, the guidelines describe rechecks at 2 weeks, then a month later, then every 3 to 6 months, with your dog's signs as the main guide for dosing.

If your dog takes trilostane now, VCA's medication guide says to stop it and contact a vet immediately if your dog develops vomiting, diarrhea, lethargy, shaking, increased drinking or urination, weakness, or collapse. Some of these overlap with Cushing's itself, so ask your vet what counts as a change for your dog.

Some dogs develop Cushing's from steroid medicine a vet prescribed for another condition. For that form, VCA explains, treatment means stopping the steroid gradually, in a controlled way. If your dog is with you now, the vet who prescribed it can talk through what that means for your dog, including for the condition the steroid was treating.

Surgery and Radiation

AAHA's guidelines name surgery to remove the adrenal gland (adrenalectomy) as the preferred therapy for the adrenal form, and note that families may decline it because of cost, possible complications, and other illnesses. VCA says the outlook after surgery depends on whether the tumor is benign or cancerous.

For the pituitary form, VCA explains that surgery or radiation may be an option at certain referral centers. Merck names radiation for a large tumor in a dog with neurological signs. VCA's guide to these tumors says: Radiation is administered several times per week for four to six weeks. The guide explains that radiation typically doesn't remove the tumor but often shrinks it enough to ease the signs.

The same guide lists the risks of repeated anesthesia among radiation's side effects, and notes that finding the tumor takes imaging such as a CT or MRI under anesthesia at a specialty hospital or university. Merck adds that after radiation, Cushing's signs can take several months to ease.

Radiation means travel, repeated anesthesia, and weeks of visits, and it isn't possible or right for every dog or family. If your dog is with you now and has a large pituitary tumor, a vet can talk through what radiation, comfort care, or euthanasia would look like for your dog.

Choosing Not to Treat the Cushing's

Families decide about treatment in different ways. The vets who ran the Japanese study write that, in their experience in primary-care hospitals, families of dogs with the pituitary form often decline treatment because of the cost, side effects that affect their dog's quality of life, and uncertainty about whether treatment would add time.

If treating Cushing's doesn't fit your dog or your household, comfort care can focus on what matters day to day: infections, footing, rest, time together, and help with diabetes if your dog has it. A vet can help with each of those.

What Cushing's Care Costs

Cushing's care costs come from a few places: a daily medicine that may be lifelong, rechecks with cortisol tests on the schedule above, care for infections or diabetes, and, for some dogs, imaging, surgery, or radiation at a specialty hospital. Merck notes that the cost of treatment is similar with either trilostane or mitotane.

If you're weighing options now, ask a clinic for an itemized estimate for each one, including comfort care at home, and whether rechecks and blood tests are included. You can also ask about payment plans or lower-cost monitoring options. A vet can walk you through options at different price points.

Comfort Care for a Dog With Cushing's

Comfort care for a dog with Cushing's focuses on what makes the days hard: weak legs, skin and bladder infections, other illnesses like diabetes, and any pain. A vet may be able to ease some of these with medicine. For a dog with you now, comfort at home can include good footing, a cool place to rest, and time near you when you can be there.

Small Things That Help at Home

VCA lists increased drinking and urination among the most common signs, so some dogs with Cushing's drink a lot and need to go out at night. Extra water bowls around the house and more chances to go out can help, along with washable bedding for your dog's bed. Merck also lists heat intolerance as a common sign, along with panting, so a cooler spot can help on warm days. If the panting is keeping your dog up, our guide to an old dog panting at night covers what to check and what can help them settle.

If your dog is with you now, a gentle touch may be comforting. VCA's palliative care guide mentions massage, either by a trained provider or taught for at-home use. Since Cushing's can thin the skin and slow healing, a vet can recommend what's gentle enough for your dog.

House accidents can be hard on everyone. Our guide to managing incontinence in a senior pet covers bedding, cleanup, and what a vet can check. The back-leg tips above, from rugs to ramps, also help a dog who's weak overall.

Food and Water for a Dog With Cushing's

No single diet cures Cushing's, according to PetMD's guide, which says food should be complete and balanced and suited to your dog's age, health, body condition, and any other illnesses. Because some dogs with Cushing's have high cholesterol or triglycerides, the guide explains that a vet may suggest a controlled-fat food. If your dog takes a supplement for Cushing's, or you're considering one, a vet can tell you how it fits.

If your dog is losing weight now, a vet can weigh how much fat is right for them. For a dog with high blood pressure now, veterinarian Jennifer Coates writes for PetMD that a vet will recommend avoiding saltier foods. For a dog who's drinking a lot now, she writes that clean water should be available. If your dog is eating less now, a vet can look at why.

Palliative Care, Hospice and a Plan

AAHA's senior care guidelines define palliative care as symptom and pain management that can be provided along with curative treatment, and hospice as the final stage of palliative care. The guidelines describe a daily and crisis plan, and a discussion about how the family would like the end to go, such as euthanasia or a palliated death, meaning a death from the illness with comfort care.

For a dog with Cushing's, a plan like that might cover which signs to call about, what to do about trilostane on bad days, how to handle weak legs at night, and who to call after hours. You can find pet hospice and palliative care providers near you, or online, in the Love, Baxter directory, and our guide to how pet hospice works explains what hospice care can include.

When to Euthanize a Dog With Cushing's Disease

You can weigh when to euthanize a dog with Cushing's disease at any point, with a vet if you have one, by looking at how much help your dog needs to stand, infections or illnesses that keep returning, eating, signs from a pituitary tumor, and what your household can manage, including cost.

Families come to this decision in different ways, some over months and some in a day. If you'd like, you can talk with a vet about cost, time, distance, and how much lifting you can manage.

Signs to Watch in the Final Stages of Cushing's Disease in Dogs

If your dog is with you now, these are things worth keeping track of:

• Standing and walking: whether your dog needs lifting to get up, or help outside
• Eating: skipped meals, or a drop in appetite that's new
• Infections: skin or bladder infections that come back soon after treatment, or sores that don't heal
• Behavior and vision: anything new, even small
• Other illnesses: how diabetes or anything else is going

Notes can show slow changes over time while your dog is with you. Colorado State University suggests marking good and hard days on a calendar. The HHHHHMM quality-of-life scale gives you seven areas to score, including hurt, hunger, and mobility, and our guide to deciding on a goodbye for your dog walks through the decision more broadly. For another perspective, a quality-of-life consultation with a provider from the Love, Baxter directory can help you look at where your dog is, in person or online.

Planning a Goodbye

Euthanasia can happen at a clinic or at home, and AAHA's senior care guidelines note that home euthanasia services have become more available. Some families choose home, and some choose a clinic, each for their own reasons. Our guide to in-home vs. clinic euthanasia walks through how families choose, and the directory lists in-home euthanasia providers who may be able to reach you, along with providers who offer virtual support.

Some families choose euthanasia, and some hope for a palliated death, a death from the illness with comfort care. If you're hoping for that, AAHA's guidelines include palliative sedation in that conversation with a vet. Our guide to letting a pet die naturally explains that path in more detail.

When there's time, some families decide a few things ahead:

• Clinic or home, and who you'd call for each
• Whether you'd like to be in the room, and who else you'd like there, if anyone
• A blanket, bed, or toy your dog knows, with pads underneath
• What to do about trilostane and other medicines that day, which a vet can answer
• Cremation or burial

Some families find grief starts while their dog is here, and our resources on anticipatory grief for pets are there for that part too, before and after a goodbye.

If Your Dog Has Died

We're so sorry your dog has died. Dogs with Cushing's can decline slowly or die suddenly, at home or at a clinic. Some families chose the day.

If you have questions and a vet saw your dog, you can call the clinic and ask for a few minutes to go over what they found, including anything you're wondering about from the last days or the medicines. If no vet saw your dog, a grief counselor can help you talk through those questions. Not every question has an answer, even for vets.

After a long illness, some families feel tired or relieved alongside the grief, and after a sudden loss, shock can last a while. If you'd like support, you can find pet loss grief counselors in the Love, Baxter directory, including online counselors.

Next Steps in the Final Stages of Cushing's Disease in Dogs

In the final stages of Cushing's disease in dogs, a few concrete steps can help. If your dog is with you now and you can see a vet, you could bring any notes you have, along with three questions: what a comfort plan would look like, what to do about medicines on bad days, and who to call after hours. You can also ask whether a hospice or in-home provider from the directory can visit. Help for weak legs, infections, and pain can be part of any path you choose. If your dog has died, the section just above is for you.

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