About Canine Hyperadrenocorticism (Cushing's Disease)
Hyperadrenocorticism, or Cushing’s syndrome, is one of the most commonly diagnosed canine endocrine disorders. It is usually seen in older dogs and can be either spontaneous or iatrogenic (caused by other treatments). In dogs with Cushing’s syndrome, there is a chronic overproduction of cortisol over weeks and months. Although the concentration of cortisol in the blood of a dog with Cushing’s also fluctuates greatly, it tends to be, on average, much higher than in healthy dogs. The excessive amount of cortisol released into the bloodstream has a harmful effect on the function of many organs and the body’s metabolism. The resulting symptoms can significantly impact the dog's quality of life, and if left untreated, is potentially life threatening.
Cushing’s syndrome cannot typically be cured with medication, but it can be successfully managed. Proper diagnosis, monitoring, and accurate treatment adjustments are essential elements in successfully managing Cushing’s syndrome.
Hyperadrenocorticism (also known as Cushing's disease) is a condition in which excess levels of the hormone cortisol are produced. Cortisol is normally released from the adrenal gland into the bloodstream at times of stress. In dogs with hyperadrenocorticism, the level of cortisol produced is excessive and, if left untreated, becomes incapacitating.
Characteristic signs are:
Proper monitoring of Cushing’s syndrome patients is essential to ensuring optimal treatment results. Scheduling follow-up appointments and educating the pet owner on the importance of reporting any signs of change in their pet are vital to the treatment process.
The dose of VETORYL® Capsules (trilostane) should be titrated according to individual response as determined by monitoring of clinical signs, physical examination and laboratory test results (ACTH stimulation test and serum biochemistry, including electrolytes).
Once treatment with VETORYL Capsules has been initiated, samples should be taken for serum biochemistry (including electrolytes) and an ACTH stimulation test 10-14 days later, 30 days later, 90 days later and every 3 months thereafter.
After the administration of VETORYL Capsules with food, cortisol levels are most significantly suppressed for 3 to 8 hours. Therefore, in order to obtain results at the peak time of effect, the ACTH stimulation test should be performed at 4-6 hours post-dosing. This will ensure you are assessing the dog’s cortisol levels when they will be at their lowest, thus uncovering any unintended over suppression of the adrenal glands that would indicate the need to decrease the dose.
A positive response to the administration of VETORYL Capsules will manifest as an improvement in clinical signs and post-ACTH serum cortisol concentration between 1.45 - 9.1 μg/dL (4-6 hours after dosing with food).
For detailed information on monitoring dogs treated with VETORYL Capsules and guidance on dose changes, please refer to the monitoring and treatment flowchart and the full prescribing information.
In addition to the technical references available from Dechra Veterinary Products, we also offer a VETORYL Capsules Monitoring Form for use in the hospital. This form is intended to be filled out by the client and offers your staff a checklist of information necessary to know from the client before they drop their dog off for an ACTH Stimulation Test.
As with all drugs, side effects may occur. In field studies and post-approval experience, the most common side effects reported were: anorexia, lethargy/depression, vomiting, diarrhea, elevated liver enzymes, elevated potassium with or without elevated sodium, elevated BUN, decreased Na/K ratio, hypoadrenocorticism, weakness, elevated creatinine, shaking, and renal insufficiency. In some cases, death has been reported as an outcome of these adverse events. VETORYL Capsules are not for use in dogs with primary hepatic or renal disease, or in pregnant dogs. Refer to the prescribing information for complete details.