Bulldog Cushing’s is an endocrine disease that leads to abnormally elevated levels of the stress hormone cortisone (Glucocorticoids)
Understanding the balance of cortisol levels is crucial in managing and diagnosing adrenal gland conditions in bulldogs.
A Bulldog who is drinking far more than usual, losing coat, or changing shape needs an examination rather than an assumption. Several conditions produce this picture, and the treatment for one is the wrong treatment for another. Never stop or change a steroid your veterinarian prescribed without speaking to them first.
“My four year old English Bulldog has been on steroids on and off for about two years for his itching. Nothing else ever touched it and the vet is happy to keep repeating it because it works so well. Lately he drinks constantly, he has a pot belly, his coat has gone thin and he has had three skin infections this year. Someone in a Bulldog group said it sounds like Cushing’s but he is only four. Is that even possible?”
Yes, it is possible, and the detail that makes it possible is the one you led with: two years of steroids on and off.
There are three kinds of Cushing’s. Two come from a tumor, one in the pituitary gland and one in the adrenal, and those belong to middle aged and older dogs. The third kind comes from steroid medication given over a long stretch, and that one does not care how old your dog is. It follows the medication rather than the birthday. A four year old can absolutely have it.
The rest of what you describe fits uncomfortably well. The constant drinking, the pot belly, the thinning coat and, the part owners rarely connect, the three skin infections in a year. Too much cortisol suppresses the immune system, so the skin stops defending itself and infections keep coming back. If you have been treating those infections one at a time and wondering why they return, that is your answer.
Here is the part I want you to hear clearly, because it is the one that goes wrong. Do not stop the steroid. A dog who has been on steroids for a long time cannot simply come off them. The body stops making its own cortisol while it is being supplied from outside, and stopping suddenly can make a dog seriously ill. Coming off is done slowly, on a plan, with your veterinarian.
What I would do is go back to the beginning on the itch. Two years of steroids and nothing else ever tried is not a treatment plan, it is a holding pattern, and it has now cost your dog something. There are other ways to manage allergic skin disease in this breed, some prescription and some not, and the section further down this page on safer alternatives sets them out. Take this message to your veterinarian more or less as you wrote it to me. It is a very clear history.
WHAT IS CORTISOL?
Cortisol, a type of glucocorticoid, plays a vital role in numerous bodily functions, including
- regulating metabolism
- anti-inflammation
- helping the body respond to stress
Let’s break down the implications of low and high cortisol levels in bulldogs.
Bulldog Cushing’s Syndrome: 5 Things to Know
- Cushing’s is an overproduction of the adrenal gland hormone due to a pituitary or adrenal gland tumor
- The pituitary tumor accounts for 85% of bulldog Cushing’s.
- Cushing’s is a disease of middle aged and older dogs, with one exception: Iatrogenic Cushing’s can happen due to exogenous overuse of steroid medication, and that form follows the medication rather than the birthday, so it turns up in young dogs too
- When possible, it’s best to replace steroids with less harmful drugs or combine them with bully non-RX bully therapeutics
- Prevention and care include Dr. Kraemer’s Bulldog Cushing’s Bundles.
Members of this bulldog community prefer prevention over RX
LOW CORTISOL / ADDISON DISEASE (Hypoadrenocorticism)
When the adrenal glands do not produce enough cortisol, this condition is known as hypoadrenocorticism, or more commonly, Addison’s disease.
This lack of cortisol can lead to a variety of symptoms, including weakness, lethargy, weight loss, vomiting, diarrhea, and in severe cases, an Addisonian crisis, which is a life-threatening condition requiring immediate medical attention.
HIGH CORTISOL / CUSHING’S SYNDROME (Hyperadrenocorticism)
Conversely, when the adrenal glands produce too much cortisol, the condition is known as hyperadrenocorticism, or Cushing’s syndrome. This overproduction can be due to an:
- adrenal tumor
- a pituitary gland tumor that produces too much ACTH (adrenocorticotropic hormone)
- or long-term use of corticosteroid medications
What Causes Cushing’s Syndrome in Bulldogs and French Bulldogs?
Hyperadrenal involves a complex interplay of hormonal imbalances that lead to characteristic clinical signs. Understanding the causes of Cushing’s syndrome in these breeds may help in the accurate diagnosis and effective management of the condition.
1. Bulldog Cushing’s Pituitary Tumor
Pituitary-dependent hyperadrenocorticism (PDH) is the most prevalent form of Cushing’s Syndrome in Bulldogs and is triggered by a tumor in the pituitary gland. The pituitary gland, situated at the base of the brain, produces ACTH (adrenocorticotropic hormone), which stimulates the adrenal glands to produce cortisol. The tumor is usually a secreting benign tumor and can be managed medically for many years.
85% of bulldog Cushings are PDH
2. Bulldog Cushing’s Adrenal Tumor
While less common than pituitary tumors, adrenal tumors are a significant cause of Cushing’s Syndrome in Bulldogs, accounting for about 15% of cases. These tumors arise directly in one or both adrenal glands, which are located near the kidneys and are responsible for producing cortisol.
Adrenal tumors can be either benign (adenoma) or malignant (adenocarcinoma), with about 50% having the potential to metastasize (spread to other parts of the body). Regardless of their nature, these tumors directly increase cortisol production, leading to adrenal-dependent hyperadrenocorticism. The diagnosis and management of adrenal tumors may be more straightforward, as they can sometimes be identified and potentially removed surgically, depending on their size, location, and malignancy.
50% of Adrenal Tumor will metastasize
3. Iatrogenic Cushing’s Syndrome
Iatrogenic Cushing’s Syndrome occurs as a result of an exogenous long-term or excessive administration of glucocorticoids, such as pred, for the treatment of various conditions, like:
- ITCHING ALLERGIES
- Atopic environmental
- Food Allergy
- Contact Allergy
- Flea Allergy
- ORTHOPEDIC AND ARTHRITIS
- Muscle Strain
- Ligament Tear
- Joint dysplasia
- Osteoarthritis
- BACK PAIN & NEUROLOGY
- IVDD
- Spondylosis
- Vertebral Malformation
- CANCER
- Mast Cell Tumor
- Lymphoma
- Breast Tumor
- Other
Age usually tells you which Cushing’s you are looking at. The pituitary and adrenal forms belong to middle aged and older dogs. The steroid induced form does not. It follows the medication, not the birthday, so it is the one form that shows up in a young Bulldog, and in a young dog with these signs a steroid history is the first thing worth asking about.
The route there is almost always the itch. A steroid is inexpensive, it works within a day or two, and a miserable, scratching Bulldog is suddenly comfortable. Nobody in that room is doing anything unreasonable. The difficulty is what happens next: it worked, so it gets repeated, and the owner learns to ask for it by name because it is the fastest relief they have seen. Repeated courses are how a young dog ends up on this page.
If your Bulldog has had more than a couple of rounds of steroids for itching and allergic skin disease, that is worth raising with your veterinarian, together with the question of what else could carry the load between flare ups. The safer alternatives section further down this page goes through the options.
WHAT IS GLUCOCORTICOID MEDICATION?
Glucocorticoids are synthetic forms of cortisol, and their prolonged use mimics the effects of elevated cortisol levels, leading to the development of Cushing’s syndrome.
Managing iatrogenic Cushing’s involves carefully tapering off the offending medication, if possible, under the guidance of a veterinarian, to avoid withdrawal symptoms and adrenal insufficiency.
Iatrogenic Cushing’s, the steroid induced form, is a side effect of prescribed steroids
The three infections nobody connected
The sign owners almost never bring me is the one I find most useful, and it is not on any list of symptoms. It is the sentence that comes out sideways, usually near the end of the appointment: he keeps getting skin infections.
Too much cortisol, from any of the three causes, suppresses the immune system. The skin stops defending itself properly, so bacteria and yeast that live there harmlessly get the run of the place. The owner treats one infection, it clears, it comes back. They treat the ears, those clear, the folds go off. Each episode gets handled on its own and nobody steps back and asks why a dog who was fine for years is suddenly losing every fight on his own skin.
So when a Bulldog arrives with his third or fourth skin or ear infection of the year, I am not only looking at the skin. I am asking what has changed underneath it. Sometimes the answer is an underactive thyroid, sometimes it is this, and sometimes it is nothing at all. But the repeating pattern is the question, not the individual infection.
If that sounds like your dog, write down the dates of each infection before your appointment. Four dates on a piece of paper will do more for the diagnosis than any description of how the skin looked.
What Signs Might I Notice at Home?
- Pot Belly: distended belly
- PU/PD: Excessive drinking, & Excessive urination
- PP: Excessive eating & weight gain
- Thin Skin: Abnormally thin skin
- Hair Loss: baldness usually dorsal back trunk area
- Pyoderma: skin infections
- Panting
- Muscle wasting
- Urine: Clear, water-like urine
- UTI: Persistent urinary tract infection
- Calcinosis Cutis: Calcium black scabby deposit on the skin
How Is Cushing’s Syndrome Diagnosed in a Bulldog?
- EXAM:
- pot belly
- thin skin
- balding
- pyoderma
- calcinosis cutis
- BLOOD:
- High liver enzymes (Alk Phos)
- Stress Leukogram (abnormal white blood cell reading consistent with stress)
- URINE CULTURE: to help rule out UTI
- URINEANLYSIS: Diluted urine (very low urine specific gravity)
- BLOOD PRESSURE: Help rule out hypertension
- ULTRASOUND: check for abnormal adrenal glands and metastatic disease
- CYTOLOGY: Skin Cytology or/and Biopsy for Calcinosis Cutis
- URINE CORTISOL LEVEL
- SUPPRESSION or STIMULATION TEST:
- Dexamethasone suppression
- ACTH Stimulation test
The cheapest prescription in the building
I want to be careful here, because nothing in this section is a criticism of any particular veterinarian, and steroids are genuinely good medicine used well. They are also the single easiest thing in practice to overuse, and it is worth understanding why.
Picture the appointment. A Bulldog is miserable, scratching himself raw, and the owner has been up half the night with him. A steroid is inexpensive, it is available right there, and it works within a day or two. The dog is comfortable by the weekend and everybody is relieved. Nothing unreasonable has happened.
What happens next is where the trouble starts. It worked, so when the itch returns it gets repeated. The owner learns to ask for it by name, because it is the fastest relief they have ever seen, and asking for the slower, more expensive, more involved approach feels like being difficult. The vet is busy and the owner is happy. A few years of that is how a young Bulldog ends up on this page with a pot belly and a thin coat.
The honest fix is not to be frightened of steroids. It is to treat a second or third course as a signal that the underlying allergy needs a proper plan rather than another rescue. That plan takes longer and costs more at the start, and it is the one that leaves you with a dog who still has his adrenal glands working in five years.
If your Bulldog has had more than a couple of courses for itching, that is the conversation to have at the next visit.
Preventing and Treating Cushing’s Syndrome in Bulldogs
Steroids are potent anti-inflammatory and immunosuppressive agents, making them invaluable for treating a range of conditions, from allergies and skin issues to autoimmune diseases and inflammation. However, their benefits come with significant risks if used inappropriately.
We recommend judicious use of steroid medications such as:
- pred
- depo-medrol
- triamcinolone
- dexamethasone
Best Strategies to Avoid Iatrogenic Cushing’s
- Short-term Use: Whenever possible, steroids should be prescribed for the shortest duration necessary to treat the condition effectively.
- Lowest Effective Dose: Using the minimum dose that achieves therapeutic goals may help mitigate the risk of adverse effects.
- Tapering Off: For dogs that have been on steroids for a longer period, gradual tapering of the dose is essential, rather than abrupt discontinuation, to allow the adrenal glands to resume normal function.
- Monitoring: Regular monitoring of pets on steroid therapy is crucial. This involves not just watching for signs of Cushing’s but also monitoring for the effectiveness of the treatment and any other potential side effects.
- Alternative Therapies: In some cases, nonsteroidal medications or treatments can be effective and might be preferred to avoid the risks associated with steroids.
SAFER ALTERNATIVES TO GLUCOCORTICOID MEDICATION
Glucocorticoids are widely used in veterinary medicine due to their powerful anti-itching, analgesic, anti-inflammatory, and immunosuppressive effects. However, their use can be associated with side effects, especially with long-term administration. In many cases, it may be possible to substitute or combine glucocorticoids with safer drugs and nonprescription therapeutics to minimize these risks. Here are some alternatives:
Bulldog Allergy and Itch Control Steroid Replacements
Use bully supplements and topical therapeutics for itch allergies and itch control
- RX
- Cyclosporin (Atopica)
- Apoeqel
- Cytopoint
- V4B Bully ItchLess Bundles
- V4B Bully Allergy Bundles
Bulldog Pain and Inflammation Control Steroid Replacements
- RX
- NSAIDs (Metacalm, Rimadyl, and Previcox)
- Analgesics (Gabapentin, Tramadol)
- Cyclosporin
- Stem Cell Therapy
- Laser Therapy
- V4B Bully PainLess and Anti Arthrhtic Bundle
- V4B Joint Support Bundle
Bulldog Back and Disc Health Steroid Replacements
- RX
- NSAIDs (Metacalm, Rimadyl, and Previcox)
- Analgesics (Gabapentin, Tramadol)
- Stem Cell Therapy
- Laser Therapy
- V4B Bully Disc & Back Bundles
Bulldog Immunity and Cancer Steroid Replacements
- RX
- Chemotherapy
- Radiation
- Bulldog Immune Support Bundles
Treating Steroid Side Effects
Steroids, such as glucocorticoids (e.g., pred, dexamethasone), are powerful drugs widely used in veterinary medicine. While they can be incredibly effective for managing a range of conditions, their use can also lead to a variety of side effects. Addressing these side effects often requires a multifaceted approach, including dietary supplements, medications, and lifestyle adjustments. Here’s how some of these side effects might be managed:
Chronic high levels of blood steroids, whether due to conditions like Cushing’s syndrome or excessive use of exogenous steroidal drugs, can indeed lead to a variety of side effects, including:
- Hypertension: Elevated steroid levels can cause increased blood pressure, which can contribute to hypertension.
- Diabetes: Steroids can interfere with insulin regulation and glucose metabolism, leading to insulin resistance and an increased risk of developing diabetes mellitus.
- Infection: Due to their increased susceptibility to infections, steroids can suppress the immune system, making individuals more prone to infections such as urinary tract infections, skin infections, and respiratory infections.
- Gastric ulcers: Prolonged steroid use can lead to irritation of the stomach lining, increasing the risk of developing gastric ulcers.
- Pancreatitis: Steroids can disrupt normal pancreatic function, potentially leading to inflammation of the pancreas known as pancreatitis.
- Orthopedic problems: Steroids can weaken bones and connective tissues, increasing the risk of osteoporosis, fractures, and tendon injuries.
- Kidney disease: Steroids can cause fluid retention and electrolyte imbalances, putting strain on the kidneys. Prolonged steroid use may lead to conditions such as glomerulonephritis, kidney stones, or even chronic kidney disease.
- Heart disease: Steroids can have several effects on the cardiovascular system
STEROID-INDUCED SIDE EFFECT REMEDIES
There are various remedies that you can integrate to help reduce the adverse effects associated with high levels of blood cortisol
1. Steroid-induced Gastrointestinal Disease
Steroids can irritate the stomach lining, potentially leading to ulcers or gastrointestinal bleeding. They may also disturb the balance of the gut microbiome.
- Anti-acid Medications: Medications such as
- H2 blockers (e.g., ranitidine)
- proton pump inhibitors (e.g., omeprazole) can reduce stomach acid production, helping to protect the stomach lining and decrease the risk of ulcers.
- Bully Probiotics These beneficial bacteria may help restore the natural balance of the gut microbiome, potentially reducing gastrointestinal side effects.
2. Steroid-Induced Hepatopathy
This condition involves liver damage or dysfunction due to prolonged steroid use, affecting the liver’s ability to function properly.
- S-Adenosylmethionine (SAM-e): SAM-e is a compound that occurs naturally in the body and can support liver health. It has been shown to improve liver function in humans and animals with liver disease, potentially helping to mitigate steroid-induced liver damage.
3. Steroid-induced Immune Suppression
Steroids suppress the immune system, which can be beneficial in autoimmune diseases but also makes the body more susceptible to infections.
- Multivitamins and Immune-Boosting Supplements: While a balanced diet is crucial for maintaining overall health, certain supplements may support the immune system.
- Bully Immne Support
- Bully Multivitamin.
4. Steroid-induced Chronic Dermatitis
The excess cortisol weakens the immune system, making the skin more susceptible to infections, allergies, and other dermatological issues. This can exacerbate the skin problems Bulldogs are already prone to, such as interdigital cysts, hot spots, and infections within skin folds.
- Bully Antiseptic Medicated Shampoo
- Yeasty Bully Antiseptic Gel
- Bully Skin & Coat DermaCare Tab
- Bully Fish Oil EFA
5. Steroid-induced Persistent Urinary Tract Infection
Steroids suppress the immune system, reducing the body’s ability to fight off infections, including those in the urinary tract that lead to
- Antibiotics: might be required, at least in the short term
- Bully Urinary Health Supplements: that reduce bacterial adherence to the urinary tract lining.
Bulldog Cushings economical bundles are available HERE
Medical and Surgical Treatment of Bulldog Cushing’s
Treatment can vary depending on the underlying condition
Bulldog Adrenal Cushings Treatment:
Surgery is required for benign tumors. Metastatic ones have less favorable prognoses and should be managed with medication palliatively.
Bulldog Pituitary Cushings Treatment:
Lifelong medication and diligent monitoring are required.
- Mitotane (lysodren)
- Nizerol
- Trailstane
Trailstane is the most commonly used drug
Bulldog Iatrogenic Cushings Treatment:
It usually requires tapering down the exogenous use of steroids, most of which are in the form of prescription pred for the management of itching allergies.
Let me be plain about this one. Cushing’s caused by a tumor needs prescription medication and veterinary monitoring, and there is nothing on a shelf anywhere that substitutes for that. If a site offers you a supplement for your dog’s adrenal glands, I would close the tab.
Where my store is genuinely relevant is one step earlier. The steroid induced form of this disease almost always starts with an itch that nobody managed any other way, so anything that reduces how often a Bulldog needs another course of steroids is working on the real problem. That is what the Itchless Advance Care Bundle is built for, with a smaller basic version if you want to start lighter. These are used alongside what your veterinarian prescribes, not instead of it, and the decision about the prescription stays with them.
Two supplements are worth a mention for honest reasons. Excess cortisol weakens the immune system, which is why the skin and ear infections keep returning, so the Immune Support Plus Chews may help as general support, and the Skin and Ear Chews may help where the skin and ears are both unsettled. When a secondary infection is already established, your veterinarian may recommend an appropriate product from the antiseptic Yeasty Bully range, used together with what they prescribe.
Bulldog Cushing’s Syndrome: Tips and Warnings
BULLDOG CUSHINGS CALCINOSIS CUTIS TIP
Calcinosis cutis is a skin condition unique to crushing’s, You can treat it with therapeutic shampoos and lotions as well as topical DMSO.
CUSHINGS THERAPEUTIC BULLY TOPICALS TIP
Pred and other forms of steroids are often prescribed for itching allergies.
To help limit the adverse effects of those drugs, try using or complementing with nonprescription safe supplements & topicals such as
- V4B bully-medicated shampoos, conditioners, sprays, and lotions.
- V4B Bully therapeutic bully fish supplements.
Bulldog skin & allergies economical bundles are available HERE
BULLDOG CUSHINGS AND OTHER DISEASE WARNING
Other diseases can clinically present like Cushing’s, so they must be ruled out. Examples are
- kidney disease
- diabetes (excessive drinking and urination)
- and hypothyroidism (weight gain, hair loss).
CUSHINGS STEROID RX
Bulldogs treated with oral and injectable steroids for allergies or other medical conditions could suffer from iatrogenic Cushing’s. When so, you must slowly taper off the medication.
Even topical ointment or spray steroid treatment can cause Cushing’s when used excessively and for a long duration.
BULLDOG CUSHINGS HYPOADRENAL ADDISON DISEASE
An overdose of Cushing’s prescription medication can result in a serious condition called atypical Addison, which is a depleted endogenous adrenal production of the stress hormone cortisone.
In those cases, your dog might appear unusually depressed, especially in a stressful situation. In those cases, you must avoid stress, substitute with a low dosage of pred, and see your veterinarian for testing and medication adjustments.
BULLDOG CUSHINGS ADRENAL TUMOR SURGERY
Adrenal tumor surgery can be curative but should be done by experienced surgeons and carefully monitored postoperatively
BULLDOG STEROIDS AND NSAID’S WARNING
It’s advised against using nonsteroidal and steroidal drugs simultaneously as they share similar pathways, which could lead to complications in the stomach and kidneys.
BULLDOG CUSHINGS LIFELONG MONITOR
Cushing’s disease patients who are managed on medication must be carefully monitored; routine blood tests are recommended.
My Bulldog is only four. Is he too young for Cushing’s?
For the tumor forms, yes, those belong to middle aged and older dogs. For the steroid induced form, no, and that is the whole point of separating them. That one follows the medication rather than the age, so a young Bulldog with a long steroid history can certainly have it. If your dog is young and showing this picture, the first question is not his age, it is what he has been given and for how long.
He is drinking and urinating far more than he used to. Is that Cushing’s?
It is one of the reasons to investigate, and it is usually the change owners notice first because it is hard to miss. It is also not specific to this. Several conditions raise thirst and urination, and some of them are serious in a different way, so the honest answer is that it needs an examination and bloodwork rather than a guess from a web page. Note roughly how much he is drinking in a day before you go, because that measurement is genuinely useful and almost nobody brings it.
Should I stop the steroids my vet prescribed?
Not on your own, and this is the one thing on this page I would ask you to take literally. When a dog has been on steroids for a long stretch, the body stops producing its own cortisol because it is being supplied from outside. Taking that supply away suddenly can make a dog seriously ill. Coming off is done gradually, on a plan your veterinarian sets. Raise the question with them by all means, and raise it soon, but let them manage the reduction.
Why does my Bulldog keep getting skin and ear infections?
That repeating pattern is worth taking seriously on its own. Excess cortisol suppresses the immune system, so the skin and ears stop defending themselves and the same infections keep returning however well each one is treated. The same happens with an underactive thyroid. If your dog has had several rounds in a year, the question to ask your veterinarian is what is sitting underneath them, rather than which cream to try next.
How do I know this is Cushing’s and not something else?
You do not, from the outside, and neither do I. Hypothyroidism produces a similar coat and a similar slowing down. Seasonal flank alopecia produces similar bald patches, but in a younger dog, usually at the same time each year, with the dog otherwise perfectly well. A yeast or bacterial infection often sits on top of all of them. Telling them apart is what the examination and the bloodwork are for, and the history you bring is a large part of it.
What is the outlook?
It depends which form it is. The steroid induced kind usually improves once the medication is reduced on a proper plan, which is the most encouraging thing on this page. The tumor forms are managed rather than cured, with medication and regular monitoring, and many dogs do well on that for a long time. An adrenal tumor is a different conversation again. Your veterinarian will be able to tell you which of the three you are dealing with once the testing is done, and that is the point at which the outlook stops being a general answer and becomes your dog’s.
More Help from Dr. Kraemer
- Hypothyroidism in Bulldogs and French Bulldogs
- Allergic and atopic itch dermatitis
- Flank alopecia and seasonal baldness
- Yeast infection of the skin and ears
- Bacterial skin infection in Bulldogs
- Prevention and wellness in senior Bulldogs
Trusted by Vets ~ Recommended by Owners ~ Approved by Bulldogs
See the Cushing’s care range →
References
- Behrend EN, Kooistra HS, Nelson R, Reusch CE, Scott-Moncrieff JC. Diagnosis of spontaneous canine hyperadrenocorticism, ACVIM consensus statement. Journal of Veterinary Internal Medicine.
- Melian C, Perez-Alenza MD, Peterson ME. Hyperadrenocorticism in dogs. Textbook of Veterinary Internal Medicine.
- Ramsey IK. Trilostane in dogs. Veterinary Clinics of North America: Small Animal Practice.
- Huang HP, Yang HL, Liang SL, Lien YH, Chen KY. Iatrogenic hyperadrenocorticism in dogs. Journal of the American Animal Hospital Association.
- American College of Veterinary Internal Medicine. Cushing’s disease in dogs.
- Merck Veterinary Manual. Cushing Disease, Pituitary Dependent Hyperadrenocorticism, in Animals.
To be clear: supplements or topicals are not substitutes for prescribed treatment. If your dog is unwell, is being treated for a condition, or is already on medication, review any supplement or topical with your veterinarian so it fits the plan you are already following. This page is educational and is not a diagnosis or a treatment plan for your own dog.
