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1Scan for outdated or missing drivers - takes under a minute2Repair Windows errors before they cause bigger problems3Fix the driver behind crashes, sound loss and screen glitchesFeline hyperadrenocorticism (HAC), also called Cushing’s syndrome or hypercortisolism, is an infrequent condition in which a cat has excess glucocorticoid activity. Signs such as fragile skin, weakness, and a swollen abdomen warrant veterinary assessment, but they are not enough to diagnose HAC. A veterinarian combines the cat’s history and examination with endocrine testing; treatment and follow-up depend on the cause and any concurrent illness.
What Cushing’s disease means in cats
HAC describes excessive adrenal hormone activity; in this context, it usually means too much glucocorticoid activity over time. Most affected cats have pituitary-dependent disease, although adrenal-dependent HAC also occurs. Exposure to glucocorticoid medication is a less frequent cause in cats than in dogs. The 2023 AAHA Selected Endocrinopathies of Dogs and Cats Guidelines characterize feline HAC as infrequent.
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The published literature remains limited. A 2017 review counted a little over 180 reported cases at that time and gave a mean age at diagnosis of 10 years. Those are publication-era figures, not a current estimate of prevalence or a prediction for an individual cat. Boland and Barrs, Journal of Feline Medicine and Surgery, 2017.
Signs to watch for—and why they can be hard to interpret
- Skin that bruises or tears easily: Marked skin fragility is a recognized concern and can make handling, diagnostic procedures, or surgery riskier. It does not occur in every affected cat. The 2017 review summarized reports of extreme skin fragility in up to a third of cats with HAC; this is a literature-review figure, not an individual forecast.
- Weakness, a distended abdomen, or hair that does not regrow: These are among the signs reported in affected cats.
- Weight loss, lethargy, or gastrointestinal signs: These are possible but less common in the AAHA summary.
- Increased thirst, urination, or appetite: Many cats with HAC also have diabetes mellitus, which may be difficult to regulate. In a diabetic cat, these changes can reflect persistent high blood glucose rather than HAC itself.
Poorly controlled diabetes alone does not establish Cushing’s disease. AAHA cautions that most difficult-to-regulate diabetic cases have another explanation, so a veterinarian weighs the full clinical picture rather than inferring HAC from diabetes signs alone.
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How a veterinarian investigates suspected HAC
Diagnosis is not based on one visible sign or a home test. The veterinarian interprets the history, examination findings, concurrent illnesses, and endocrine test results together. The choice and timing of tests should account for the cat’s overall condition.
Urine cortisol-to-creatinine ratio as an initial screen
AAHA describes the urine cortisol-to-creatinine ratio (UCCR) as a possible screening test. The guideline advises collecting at least two morning urine samples at home and submitting them for evaluation. A positive result should be followed by a low-dose dexamethasone suppression test; a negative result likely rules out HAC. A urine sample is only part of a veterinarian-directed diagnostic process, not a diagnosis by itself.
Low-dose dexamethasone suppression test
AAHA identifies the low-dose dexamethasone suppression test (LDDST) as the most reliable diagnostic test in cats. In the guideline, a lack of cortisol suppression at four or eight hours supports HAC. The test involves an intravenous medication dose specified for veterinary use; it is not an at-home test or an instruction for owners to administer medication.
Why the ACTH stimulation test is not the initial diagnostic choice
AAHA does not recommend the ACTH stimulation test for initial diagnosis of feline HAC because its sensitivity is poor. If HAC has been established, a veterinarian may consider additional testing to help determine whether the disease is pituitary- or adrenal-dependent. That distinction can affect which treatment options are worth discussing.
Treatment options depend on the cause and the cat
Treatment decisions are veterinary-led and individualized. The discussion typically considers the likely source of excess hormone, concurrent diabetes or other illness, expected benefits and risks, and the monitoring required. Medical treatment is not interchangeable with surgery or radiation, and no option is appropriate for every cat.
Medical management with trilostane
AAHA identifies trilostane as the mainstay of medical treatment in cats. The guideline gives an approximate regimen, but the dose and formulation must be prescribed and tailored by the attending veterinarian. Capsule sizes may require formulation adjustments for a prescribed dose. Do not use a guideline figure to dose a cat yourself.
The aim is to control clinical signs and improve quality of life, including changes in weight, thirst and urination, appetite, and general wellbeing. The veterinarian balances clinical response and any concurrent disease against the risk of suppressing cortisol too much.
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For some cats with a unilateral adrenal tumor, unilateral adrenalectomy may be curative. Radiation therapy may benefit some cats with pituitary-dependent disease. These approaches require specialist assessment; their suitability depends on the confirmed disease source and the individual cat’s health.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Follow-up and monitoring matter
For cats starting trilostane, AAHA recommends a complete blood count (CBC), biochemical profile, and urinalysis 7–14 days after treatment begins, then every 3–4 months thereafter. The veterinarian may also use cortisol testing to help monitor treatment. UCCR and ACTH stimulation testing have both been used in this context to help avoid hypocortisolism, or excessive cortisol suppression.
Monitoring is not just a laboratory schedule: clinical signs, concurrent disease, and the possibility of excessive suppression inform dosing decisions. Ask the veterinarian which changes at home should prompt an earlier call and what follow-up is planned for the cat’s specific treatment.
Quick Recap
Questions to discuss with your veterinarian
- What findings make HAC a concern in this cat, and what other explanations are being considered?
- Which test is appropriate first, and how will its result guide the next step?
- If HAC is confirmed, does the evidence point toward pituitary-dependent or adrenal-dependent disease?
- How do diabetes or other concurrent conditions change the risks and goals of treatment?
- What monitoring is planned, and what signs could indicate inadequate control or excessive cortisol suppression?
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