Tier 1 — must know
Canine
Endocrine
High yield
Cushing's disease
Hyperadrenocorticism · classic PU/PD + panting outpatient · endocrine workup trap-heavy
⏱ 2–3 min read · Topic 3 of 141
5
Practice Qs
4
Traps
High
Exam freq.
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Your status
Study step
High-yield takeaways
- Recognize the classic presentation, then narrow the case using signalment, timeline, exam findings, diagnostics, and response to treatment.
- Use the decision framework, traps, differentials, and related questions to rehearse NAVLE-style next-best-step reasoning.
- This educational study page is not a clinical protocol; confirm patient-specific decisions with current references and clinician judgment.
30-second revision
Classic patternPU/PD + panting + pot belly
Supportive labALP often marked ↑
Common testLDDST
Big history questionAsk about steroids
Common treatmentTrilostane
Look-alikeHypothyroidism can mimic the coat
Critical trapALP alone ≠ diagnosis
Exam core — read this first
Classic pattern → PU/PD, polyphagia, panting, pendulous abdomen
Do not diagnose from ALP alone → laboratory support is not definitive by itself
Common endocrine test → LDDST for many stable suspects
Most common treatment → trilostane for pituitary-dependent disease
Clinical mechanism — only what matters
Excess cortisol → insulin resistance + protein catabolism → muscle wasting, hepatomegaly, hyperglycemia risk
Skin thinning → alopecia, poor hair regrowth, calcinosis cutis in severe cases
ADH antagonism → PU/PD and dilute urine
The NAVLE emphasis is not the pathway. It is recognizing the chronic pattern and not overcalling the diagnosis from screening abnormalities.
Pattern recognition
Core pattern
PU/PD
Panting
Pot-bellied older dog
Supporting clues
Polyphagia
Thin skin / poor hair regrowth
Bilateral alopecia
Recurrent UTI
Marked ALP elevation
NAVLE trigger: The chronic “PU/PD + panting + pot belly” cluster is the signal. High ALP helps, but it is never the diagnosis by itself.
Decision core — what NAVLE actually asks
Classic stable suspect
→ Choose endocrine testing rather than diagnosing from routine chemistry alone
Dog receiving chronic exogenous steroids
→ Think iatrogenic hyperadrenocorticism before spontaneous disease
Single abnormal chemistry clue only
→ Do not diagnose from ALP alone; require a compatible clinical pattern and endocrine testing plan
Confirmed pituitary-dependent disease
→ Trilostane is the board-style long-term answer with monitoring
Key interpretation
ALP
↑ Often marked
Common clue, not proof
Urine SG
Often low
Dilute urine with PU/PD
LDDST
Screen / diagnose
Frequently tested choice
CBC
Stress leukogram
Supportive, not diagnostic
Glucose
May be high
Cortisol drives insulin resistance
Iatrogenic clue
Steroid history
History can answer the question
⚠ Marked ALP elevation supports the pattern, but boards often punish diagnosing Cushing's from chemistry alone.
Treatment
PDH
Trilostane
Most common board answer for pituitary-dependent hyperadrenocorticism.
Monitor
Clinical signs + scheduled endocrine monitoring
Over-suppression can create an Addisonian picture, so monitoring matters.
Alt.
Mitotane or surgery for selected cases
The exam usually wants trilostane first unless it is clearly an adrenal tumor question.
NAVLE traps — where students lose marks
High ALP does not equal Cushing's
It is common support, not confirmation. Test the patient with the right clinical pattern.
Ask about steroid exposure
Iatrogenic Cushing's is a classic history-based board trap.
Do not confuse with hypothyroidism
Both can have alopecia, but Cushing's gives PU/PD, panting, polyphagia, and thin skin.
Treatment can overshoot
If therapy suppresses cortisol too far, the dog can look weak or Addisonian.
Do not screen every old dog
Testing works best when the clinical syndrome fits; low-pretest-probability testing creates confusing results.
Do not skip adrenal-versus-pituitary context
Confirmed disease still needs source and severity thinking before treatment planning.
Differentials — how to separate these on NAVLE
Fast separator: Cushing's is the chronic PU/PD + panting + pot-belly dog. The board often contrasts it with hypothyroidism, diabetes mellitus, and steroid administration.
| Disease | PU/PD | Skin pattern | Key separator |
|---|---|---|---|
| Cushing's disease | Yes | Thin skin / poor regrowth | Panting + pot belly + ALP up |
| Hypothyroidism | No / mild | Symmetric alopecia | Weight gain + lethargy, not classic PU/PD |
| Diabetes mellitus | Yes | Variable | Persistent hyperglycemia / glycosuria |
| Iatrogenic Cushing's | Yes | Thin skin | History of chronic glucocorticoids |
| Chronic liver disease | Variable | Variable | No classic endocrine testing pattern |
Clinical application tools
Use these to sanity-check concurrent problems and medication planning. They do not replace endocrine case selection.
Related questions
Pre-built NAVLE-style · Cushing's disease
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An older small-breed dog presents with polyuria, polydipsia, panting, polyphagia, and a pendulous abdomen. Which diagnosis best fits this overall pattern?
A dog has been receiving prednisone for months for allergic skin disease and now shows thin skin, panting, and PU/PD. What is the most likely explanation?
A stable dog strongly fits the Cushing's pattern and has a markedly increased ALP. Which next step is most appropriate?
A dog has confirmed pituitary-dependent hyperadrenocorticism. Which long-term treatment is most commonly expected on NAVLE?
Which statement about routine laboratory abnormalities in canine Cushing's disease is most accurate?