By MJ Wixsom, DVM
It started like so many quiet medical mysteries do: a tired little white dog and a worried mom. Buffy waddled into the exam room with a sway that wasn’t age so much as effort. She panted even at rest, her belly rounded like a rising loaf, and her once-silky coat felt sparse under my fingertips. Her mom’s first words were equal parts apology and exasperation: “She’s drinking the water bowl dry, she’s peeing on the carpet again, and she’s just not herself.”
I nodded. The routine story is never routine when it’s your dog and your carpets, your heartbreak and your half-slept nights. Buffy’s symptoms—excessive drinking and urination, a pot-bellied appearance, thinning hair, and muscle weakness—fit neatly into a diagnosis that rarely announces itself with drama but quietly rearranges a dog’s life: Cushing’s disease.
Cushing’s is the body’s own stress hormone, cortisol, gone into overdrive. The adrenal glands, which normally provide the body with carefully balanced cortisol, start producing too much—either because of a small pituitary tumor whispering “more” from the brain (the most common form), or an adrenal mass doing its own off-the-rails manufacturing. The result is a cascade we can see and feel: hunger that never seems satisfied, thirst that refills as soon as the bowl does, urine accidents that feel like betrayal even though they’re not, hair that loosens from its roots, and muscles that give up stairs and couches long before the heart is ready.
Cortisol isn’t the villain of the story; excess is. In normal amounts, cortisol helps dogs adapt to stress, maintain blood sugar, and regulate metabolism. In excess, it becomes a sledgehammer where a scalpel is needed. The liver works overtime, the immune system grows sluggish, the skin thins, and the body’s elegant balance tips toward discomfort. Owners notice the early signs in the ways that life gets sticky: puddles on the carpet, panting in a cool room, a dog that begs for dinner and then begs for second dinner. It can look like “just getting old,” which is why so many Buffys arrive after months of small accommodations—more water bowls, more late-night trips outside, more patience and paper towels.
Diagnosis, like most good medicine, begins with listening. Buffy’s mom told me the story; Buffy’s body confirmed it. From there, we followed the map. We started with a thorough physical exam. Her abdomen was round but not painful, her muscles a touch wasted along her spine, her skin a bit delicate. Routine bloodwork gave us the first strong hints: liver enzymes nudging upward, cholesterol a bit elevated, a stress-white pattern in her white blood cells. A urinalysis showed very dilute urine, which is consistent with all that drinking and a body that’s lost its fine-tuned control of water balance. We also checked to make sure there wasn’t a urinary tract infection riding along—Cushing’s can invite those.
Then came the specific tests. There are a few ways to catch a cortisol story in the act. The low-dose dexamethasone suppression (LDDS) test measures how cortisol responds when we tell the body, gently, to quiet down. In most dogs, dexamethasone says “hush,” and cortisol listens. In Cushing’s, cortisol keeps talking. An ACTH stimulation test, on the other hand, asks the adrenal glands to perform on cue; in many Cushing’s dogs, they overperform. We chose the right test for Buffy based on her initial screening and the practicalities of her day—some tests take several hours and multiple blood draws. Imaging, like an abdominal ultrasound, can help us determine whether we’re dealing with pituitary-dependent disease or an adrenal tumor, but the first truths usually show up in the numbers and the pattern.
Buffy’s numbers spoke clearly: hyperadrenocorticism—Cushing’s disease. Delivering that diagnosis is two parts science and one part reassurance. People hear “tumor” and jump to worst-case scenarios. The reality is that most Cushing’s in dogs is pituitary-dependent, meaning a tiny gland in the brain is sending the wrong hormone signals. We can’t remove those signals surgically in most cases, but we can manage the effect—bring cortisol back into line and give a dog her life back.
So we built a plan. Cushing’s is a marathon, not a sprint, and treatment is about balance. We started medical therapy designed to dial cortisol back into a healthy range. This isn’t a one-and-done fix; it’s a careful partnership. We begin at a conservative dose and watch—not just Buffy’s lab values, but Buffy herself. Is she drinking less? Is she having fewer accidents? Is the panting easing, the appetite looking normal instead of bottomless? We schedule monitoring—rechecks and blood tests, typically including ACTH stimulation at set intervals—to make sure we’re treating Buffy and not a textbook. The dose is adjusted to her response, because every dog’s “just right” is a little different.
I like to set expectations honestly. The first wins often aren’t glamorous; they’re practical. Carpets that stay dry. Water bowls that survive into the evening. Sleep that doesn’t get broken by urgent, anxious trips to the door. Over weeks to months, the deeper changes come: a coat that thickens, skin that heals better, a belly that softens toward normal as muscle tone improves. We talk about side effects to watch for—lethargy, vomiting, diarrhea, loss of appetite—signs we may have turned cortisol down too far. Cushing’s is about correction, not suppression. The goal is a dog that can handle life’s bumps without living under a flood.
Here’s the part that makes the science worth doing: two weeks later, Buffy came trotting back in with the lightness of a dog relieved from invisible weight. Her mom didn’t lead with lab values; she led with relief. “She’s not peeing on the carpet,” she said, half laughing, half crying. The water bowl is no longer drained by noon. The panting is down, her naps look restful instead of ragged, and there’s something unmistakably hopeful in her step. Buffy had found that sweet spot where the numbers and the dog agree.
People sometimes ask me what success looks like in cases like this. It’s not only a normal cortisol curve on a lab printout—though we aim for that. It’s a family sleeping through the night. It’s a dog who climbs onto the couch again, not because she “should,” but because she can. It’s a house that smells like home again, and a leash that triggers a little dance instead of a tired glance. Success is measurable and also deeply, wonderfully ordinary: quiet floors, contented sighs, a bowl half-full at dinner.
We also talk about the long game. Cushing’s is manageable, and with consistent monitoring and dose adjustments, most dogs live longer and live better. We’ll recheck Buffy at regular intervals, repeat the ACTH stimulation test as recommended, and keep an eye on her liver values and her overall comfort. If things change—if drinking creeps up again, if accidents return—we don’t panic. We recalibrate. Medicine is a conversation, not a verdict.
Owners often ask how long it will take for the coat to improve or the belly to look less round. The answer is measured in weeks and months, not days. Hair grows in its own time; muscles rebuild with regular, gentle movement. I encourage short walks, puzzle feeders to engage the brain without overfeeding the body, and a steady routine. Dogs thrive on predictability, and so do their hormones.
Cushing’s doesn’t have to be a thief. With the right diagnosis, careful treatment, and steady monitoring, dogs like Buffy get back to themselves. She won’t be the glossy puppy of old; time is still time. But she will be Buffy—comfortable, present, and joyfully herself for more days than her mom thought possible when she first walked in, worried, with a leash and a list of accidents. And her mom gets something just as valuable: the confidence that this isn’t chaos, it’s care.
In veterinary medicine, we often say we practice for the wins you can’t photograph: the quiet transformations, the houses that smell like home again, the bowls that don’t empty too fast. We mark progress in pawsteps on a dry floor and in the sound of deep, even breathing from the dog bed at midnight. Buffy’s mom got her little white dog back. And that, as far as I’m concerned, is a very big diagnosis indeed—with an even bigger outcome.
If your dog is drinking more, asking to go out constantly, panting without cause, or leaving tufts of hair on your hands months after shedding season, listen to the pattern and let us listen, too. The story matters. The numbers help. Together, they can turn a frustrating mystery into a plan—and a plan into more good days.