Pet Costs

Cushing's Disease in Dogs: Treatment Cost, Testing, and Why Monitoring Is Most of the Bill

By PetPawCalc Team · November 03, 2026 · 9 min read · How we write

Cushing’s disease (hyperadrenocorticism) is one of the most common hormonal diseases in older dogs. The body makes too much cortisol, usually because of a small, benign tumor in the pituitary gland, and less often because of a tumor in one of the adrenal glands.

It’s rarely an emergency, which makes it easy to underestimate. The signs come on slowly — more drinking, more urinating, a big appetite and a pot belly — and the treatment is a daily capsule. What surprises owners is the monitoring: much of the cost of Cushing’s is the blood tests that keep the dose safe.

What It Costs

Typical US price ranges:

Item What it covers Typical cost
Initial workup Exam, bloodwork, urine test About $160–$490
ACTH stimulation test Two blood samples an hour apart, around an injection About $150–$300
Low-dose dexamethasone suppression test (LDDST) Samples over about 8 hours at the clinic Ask in advance; it takes most of a day
Abdominal ultrasound, if needed Looks at the adrenal glands to tell the two forms apart Commonly several hundred dollars
Trilostane (Vetoryl) Daily capsules, dosed by weight About $2.49 (5 mg) to $4.61 (60 mg) per capsule at one large pet pharmacy
Monitoring rechecks Exam plus a cortisol test About $150–$300 each if an ACTH stimulation test is used

Trilostane works out at roughly $75–$280 a month, depending on the capsule strength your dog needs and whether it’s given once or twice a day. Many vets now start at a lower dose given twice daily, which can mean more capsules.

What a Year Costs

Adding up the ranges above:

  First year Each year after
Diagnosis $310–$1,290 —
Rechecks 5–6 in the first year: $750–$1,800 About 4 a year: $600–$1,200
Trilostane $900–$3,360 $900–$3,360
Total About $1,960–$6,450 About $1,500–$4,560

Rechecks are a big share of the total, and they’re the part with the most room to save, as described below.

Testing: Why Testing a Dog Without Symptoms Wastes Money

There’s no single perfect test for Cushing’s. The 2023 AAHA guidelines on endocrine diseases in dogs and cats recommend:

Testing healthy-seeming dogs is more common than it should be. In a 2025 survey of more than 2,000 responses from vets in nine European countries, about 60% said they sometimes screened dogs that had abnormal lab results but no supportive clinical signs, which the authors flagged as a risk of overdiagnosis. If your vet suggests testing, it’s reasonable to ask which signs make them suspect it.

Treatment and Monitoring

Trilostane (sold as Vetoryl) is the usual treatment. It’s a daily capsule, given with food, that reduces how much cortisol the adrenal glands make. The labeled dose is 2.2–6.7 mg per kg per day, but many vets now start lower and give it twice daily.

Monitoring follows a set rhythm:

  1. 10–14 days after starting or changing the dose — mainly to make sure the dose isn’t too high.
  2. About 30 days — the dose may be increased if signs are still uncontrolled.
  3. About every 90 days once the dog is stable.

The main risk is too much suppression. If your dog becomes lethargic, vomits, has diarrhea or stops eating, stop the trilostane and call your vet.

Where the savings are

Why Treating It Matters

Cushing’s grows slowly, so owners sometimes wonder whether treatment is worth it. In a study of 43 dogs with the pituitary form at a primary-care hospital (Nagata et al., 2017), untreated dogs had a median survival of 506 days, and 52% of trilostane-treated dogs were alive at two years compared with about 9% of untreated dogs. The study was small and dogs weren’t randomly assigned, but the gap was large.

Untreated Cushing’s also makes other problems more likely and harder to manage, including urinary infections and diabetes. Dogs with both diabetes and Cushing’s often need more insulin until the Cushing’s is controlled — see Dog Diabetes Treatment Cost.

The Signs to Watch For

Because these appear gradually in middle-aged and older dogs, they’re often put down to age. Senior checkups are where most cases are first suspected. Our Dog Vet Visit Scheduler shows when they’re due, and How Often Should You Take Your Dog to the Vet? covers what they cost.

A Note on Insurance

Accident-and-illness policies often cover Cushing’s diagnosis, medication and monitoring, as long as the signs didn’t appear before coverage began. Because it’s a long-term condition of older dogs, a policy bought when the dog was young is what usually pays. Check whether your policy has annual limits that a year of monitoring could reach.

Frequently Asked Questions

How much does it cost to treat Cushing’s disease in a dog? Roughly $1,960–$6,450 in the first year and $1,500–$4,560 a year after that, based on typical prices. The biggest parts are daily trilostane — roughly $75–$280 a month depending on the dog’s dose and whether it’s given once or twice a day — and the monitoring rechecks, which happen several times in the first year and then about every three months.

How much is a Cushing’s test for dogs? An ACTH stimulation test generally costs about $150–$300. The low-dose dexamethasone suppression test (LDDST), which the 2023 AAHA endocrine guidelines prefer for screening, takes about eight hours at the clinic, so ask for its price in advance. Basic bloodwork and a urine test usually come first, and an abdominal ultrasound may be added to look at the adrenal glands.

Should my dog be tested for Cushing’s if it has no symptoms? Usually not. The 2023 AAHA guidelines recommend testing only when there are two or more signs or lab findings that point to Cushing’s, because stress and other illnesses can cause false-positive results. A 2025 survey of European vets found about 60% screened some dogs without supportive signs, which the authors flagged as a risk of overdiagnosis.

How long can a dog live with Cushing’s disease? In a study of 43 dogs with the common pituitary form (Nagata et al., 2017), untreated dogs had a median survival of 506 days, and 52% of trilostane-treated dogs were alive at two years compared with about 9% of untreated dogs. The study was small and not randomized, but it suggests treatment matters for survival as well as for comfort.

What are the side effects of trilostane? The main risk is suppressing the adrenal glands too much. If your dog becomes lethargic, starts vomiting or having diarrhea, or stops eating, stop the medication and contact your vet for a recheck. This is why the first rechecks happen at about 10–14 days and 30 days after starting or changing the dose.

What are the signs of Cushing’s disease in dogs? The classic signs are drinking and urinating much more than usual, a big appetite, a pot-bellied look, thinning hair or a coat that doesn’t regrow after clipping, thin skin, and panting. They come on gradually in middle-aged and older dogs, which is why they’re often mistaken for normal aging.