Adrenal Tumor Treatment in Canine Cushing’s Syndrome – Vet Options and Outcomes for 2025 🐾🧠

When a dog is diagnosed with Cushing’s syndrome caused by an adrenal tumor, owners and vets must decide between surgical removal and medical management. In this detailed 2025 guide, Dr Duncan Houston reviews how to determine if a tumor is benign or malignant, the complexities of adrenal surgery, and the risks and benefits of different treatment approaches. 🧬⚠️

🔎 Is the Tumor Benign or Malignant?

Only ~15% of canine Cushing’s cases involve adrenal tumors. Of these, roughly half are benign and half malignant. Determining type is key for choosing treatment. 🧪

• Chest X-rays: Check for tumor spread to lungs
• Abdominal ultrasound or CT: Evaluate tumor size and invasion

Important: A tumor without visible spread is not always benign. But no evidence of metastasis can favor surgical removal. 💚

🚗 If the Tumor Is Malignant

• 💳 Surgery may be too risky if there's invasion or widespread metastasis
• 📈 Medical management with trilostane or high-dose lysodren is preferred
• 🤝 Partial tumor removal may relieve symptoms but not cure the disease

Referral to an oncologist for advanced medication protocols may be recommended. 📅

💉 Understanding Adrenalectomy Surgery

Adrenalectomy is considered one of the most difficult surgeries in veterinary practice. The adrenal gland is surrounded by critical arteries and veins, nicknamed the "Bermuda triangle" by surgeons. 📊

Risks include:

• 💔 Hemorrhage
• ⚕️ Delicate anatomy and vessel damage
• 🛌 Poor healing due to existing Cushing’s symptoms (hypertension, skin thinning)

Recovery requires hormone support with prednisone and sometimes florinef. ACTH stim testing is used to monitor post-op needs. ⚖️

🌊 Laparoscopic Surgery Reduces Risks

Where available, laparoscopy provides a safer alternative. Smaller incisions, less bleeding, and faster recovery are key advantages. 🔸

🤞 Medical Management Options

• Lysodren (mitotane): Chemotherapy that erodes cortisol-producing adrenal layers
• Trilostane: Inactivates steroid hormones without tumor shrinkage

Note: Higher doses are needed than when treating pituitary Cushing’s. Side effects and drug reactions are more likely. Average survival with medication: ~16 months. ⏱️

🚀 New Options: Stereotactic Radiotherapy

A promising study using hypofractionated stereotactic radiotherapy showed that 11 of 12 treated dogs had excellent results with tumor control at 1 year. 🚀🚨

This therapy is less invasive but requires specialized equipment and access to veterinary oncology centers. 🏫

🚨 Decision-Making Tips

• Consider surgery only if no evidence of metastasis and patient is stable
• Pre-treat with medical therapy to reduce surgical risks
• Use a board-certified surgeon for adrenalectomy
• Explore oncology consults for medical management or radiotherapy

📢 Ask A Vet

Not sure if your dog is a candidate for surgery? Use the Ask A Vet app to consult a veterinarian about imaging, hormone control, and specialist referrals. 📲