Dechra - Client communication when treating cushing's

Client Communication

Complex endocrinopathies can often be difficult to talk about with owners, and knowing when and how is key in engaging and supporting owners with the treatment of their pet.

When to talk about Cushing's syndrome

  • If the pet owner’s concerns match the profile for a dog with Cushing’s
  • If you, the clinician, see signs of Cushing’s when you examine the dog
  • If you, the clinician, are addressing another condition and it is not responding as you expected. Could Cushing’s be concurrent and affecting your success treating the first condition?
  • Lab changes without history or clinical signs consistent with Cushing’s should not prompt pursuit of a diagnosis of Cushing’s

Focus on the patient first

You will hear something that the client says that triggers thoughts of Cushing’s:

  • Increased thirst
  • Increased appetite (a change in appetite)
  • Increased panting
  • Weakness
  • Hair changes - coat quality will not be good, changes in colour, shaved hair not returning
  • Skin changes - look at the ventral abdomen for decreased skin thickness, visible blood vessels, comedones
  • Abdominal distention due to enlarged liver, increased deposition of fat in the abdomen (adiposity), weakened abdominal muscles
  • Poor musculature   
    • Abdominal distention
    • Hind limb weakness

If the dog has a condition you've been treating and it is not responding as you expect, Cushing's may be causing the lack of response

How to talk about Cushing's syndrome

STEP 1                   Avoid leading questions when taking a history from the owner, ask open ended questions instead:

"Tell me about Rex's drinking habits" or "Tell me about Rex's water intake"

STEP 2                  Give clients a simple, defined overview of Cushing’s. Too much information can be confusing and create uncertainty in their mind

"Dogs have two glands near the kidneys that make an important hormone called cortisol. The body is supposed to keep that hormone level exactly where it needs to be, but in some dogs, the adrenal glands make too much cortisol, leading to signs like increased thirst and appetite, or hair loss"

STEP 3                   Guiding owners through diagnosis - It is important to manage expectations when discussing diagnostic testing, for example

"I recommend we run a blood test to see if Rex has Cushing's. It is usually all we need. However, if this first test lets us down, we can run a second test"

If the history and clinical signs seems subtle and are not overwhelmingly problematic for the dog or the owner yet, plant the seed that the dog may have Cushing’s and postpone diagnostics for 3 months.

If the patient is >20 kg, Dr Cook’s experience is that 50% of them have PDH and 50% have ADH. As the weight of a dog increases, the likelihood of ADH increases.

Do not delay diagnostic testing in large breed dogs who have a history or clinical signs consistent with Cushing’s because 50% of adrenal tumours are malignant. Delay could result in metastatic spread and a missed opportunity for potentially curative surgery.

You cannot make a diagnosis of Cushing’s WITHOUT knowing the signalment, history and clinical signs of the patient you ran the test on. You can ONLY interpret the results as consistent with Cushing’s.

Focus on the patient first, then the labwork. Labwork can be interpreted. Diagnosis requires knowledge of the patient.

Remember what you have heard, what you have seen or the difficulty observed treating the patient’s first disease.


Be realistic about the cost of treatment but not apologetic. Be positive that you can manage the patient successfully, but let the owner know it is a lifelong treatment

Putting the cost into context is often helpful. For example, the cost of treating their dog for Cushing’s can often equate to the cost of a daily latte. This helps the client relate the cost of a highly scientific treatment to the value of something that is quite simple.

You should make the owner aware of the benefits of treatment and the implications of not treating.



Dogs living with Cushing’s experience multiple symptoms that affect both theirs and their owners quality-of- life

Survival times in studies of dogs treated for Cushing’s vary greatly, but you can assure owners that their dog will have a better quality-of- life when the overproduction of cortisol is controlled

Having a positive attitude towards treatment will create a sense of confidence for the pet owners that they are doing the right thing


It is essential to know how the dog is doing over time. Consult with the owner regarding the dog’s clinical response at home. Upon each recheck, focus your impression on how the dog is doing before interpreting any bloodwork.

Cushing's and Communication

We understand that good communication can lead to increased compliance from owners, making the transition from suspicion to diagnosis that bit easier.

A series of short webcasts have been recorded with Dr Audrey Cook discussing the challenges of, and providing solutions to, communicating effectively with pet owners about Cushing's. Each webcast has been broken into short bite-size sections covering:

  • When to talk about Cushing's
  • Diagnosis walkthrough
  • Engaging and supporting pet owners with treatment


When to talk about Cushing's

Diagnostic test

Treatment and support