Dog Cushing’s Disease Care Costs: Testing Is the Expensive Part

With Cushing’s disease in dogs, the testing is the expensive part — not the pills. In 2026, the diagnostic workup commonly runs $600–$1,200 before treatment starts: screening and confirmatory hormone tests at $300–$650, abdominal ultrasound at $300–$600, and often more than one round of testing. Treatment itself is relatively modest at $50–$120 per month for trilostane by body size. The cost owners are not quoted up front is monitoring: ACTH stimulation tests at $200–$400 several times in the first year. Prices vary by region and clinic.

The signs that bring a dog in

• Drinking and urinating much more than usual — often the first thing owners notice
• A pot-bellied appearance despite normal or reduced appetite
• Panting more than the weather explains
• Thinning coat, hair loss on the flanks, or a coat that will not grow back
• Recurring skin and ear infections
• Muscle wasting over the back and hindquarters
• Lethargy, or sometimes restlessness and increased appetite

These signs overlap with several other conditions, including diabetes and kidney disease. That overlap is exactly why testing, not pattern-matching, is the diagnostic route.

Why the workup costs what it does

Cushing’s — hyperadrenocorticism — is diagnosed in steps, and no single test answers everything.

• Screening tests suggest whether the disease is present.
• Confirmatory or differentiating tests determine which form it is: pituitary-dependent (the majority) or adrenal tumor.
• Abdominal ultrasound looks at the adrenal glands, liver, and other organs, and helps rule out other explanations for the same signs.
• Repeat rounds are common because test results can be equivocal, especially early or in a dog with other concurrent disease.

This is a case where the testing genuinely earns its price. Starting lifelong medication on a guess is worse and more expensive than confirming the diagnosis first.

The monitoring cost owners are not quoted

Trilostane is effective, and it is also a drug that requires scheduled monitoring to dose safely. Too little and symptoms persist; too much and the dog can become unwell with low cortisol, which is a serious problem. The monitoring schedule is not optional and is not negotiable.

The usual pattern: a test shortly after starting, another after a dose adjustment, then periodic tests through the first year, then a stable schedule of a few tests per year depending on the dog. Each ACTH stimulation test typically runs $200–$400, and many protocols require the dog to be at the clinic for several hours.

The question to ask: “What does the monitoring schedule add per year, all in?” Ask before starting treatment, not after. It is a fair question and it does not make you difficult.

The honest framing of treatment

Cushing’s treatment manages symptoms and reduces complications. It does not remove the underlying cause in pituitary-dependent cases, and it does not restore a dog to age five.

For a very old dog with mild signs, “monitor without treating” is a legitimate route that many veterinarians support. The trade-off is not between sick and healthy; it is between symptoms and treatment burden. The relevant questions are:

• How much is this dog actually bothered by the signs?
• Can this dog be brought to the clinic for regular monitoring without distress?
• What other conditions are present, and how do they interact?
• What does the household’s budget look like when monitoring is included?

None of those are wrong questions. A dog with mild signs and a comfortable life may reasonably continue monitoring. A dog with uncontrolled thirst, recurring infections, and muscle wasting usually benefits from treatment.

What untreated Cushing’s risks

• Diabetes mellitus
• Recurring skin, ear, and urinary infections
• High blood pressure
• Blood clots, including the serious pulmonary thromboembolism
• Progressive muscle wasting and weakness
• Increased anesthetic risk for any future procedure

These are general associations, not guarantees, and not predictions about any individual dog. They are why the condition is taken seriously rather than dismissed as “just an old dog thing.”

Practical notes

• Ask for a written monitoring plan with dates and expected costs.
• Keep results in one place. Trending cortisol and liver values across visits is much easier with a home file.
• Do not adjust the medication on your own based on how the dog looks. The dose is set by testing.
• Report vomiting, weakness, or sudden appetite loss on treatment promptly. Those can be signs of over-treatment and need a call to the vet, not a wait-and-see.
• Treat concurrent problems. Skin and ear infections in a Cushing’s dog often need their own plan.

General information about typical costs. This is not veterinary advice, contains no dosing information, and does not diagnose any dog. Cushing’s disease can only be identified with specific testing interpreted by a veterinarian. If your dog is unwell, contact the treating veterinarian promptly.