Cushing’s disease in cats is an uncommon disorder in which the body is exposed to too much cortisol. Veterinarians call it hyperadrenocorticism (HAC) or hypercortisolism. The most recognizable clues are fragile, thin skin; skin tears after minor trauma; a pendulous abdomen with muscle loss; increased thirst and urination; and diabetes that is unusually difficult to control. Those signs also occur with several more common diseases, so symptoms cannot establish the diagnosis. A veterinarian must combine the examination, routine laboratory work, feline-specific hormone testing and imaging before choosing treatment.
What Cushing’s disease means in a cat
Cortisol is a hormone made by the adrenal glands, two small organs near the kidneys. It helps regulate metabolism and the stress response. In HAC, the adrenal cortex remains excessively stimulated and cortisol stays too high for too long. The result can affect skin, muscle, liver, immune function and blood-glucose control.
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Most reported feline cases are pituitary-dependent. A usually small pituitary tumor produces too much adrenocorticotropic hormone (ACTH), which continually tells both adrenal glands to make cortisol. A smaller group has adrenal-dependent disease, generally from a tumor in one adrenal cortex. Adrenal tumors can also release sex steroids, producing some Cushing-like effects that do not fit a simple cortisol pattern.
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Outbyte Driver Updater FREEScan for outdated or missing drivers - takes under a minuteDriver Scan →Outbyte PC Repair FREEClear out junk files and repair common Windows errorsFree Scan →A 2017 review of more than 180 reported feline cases found approximately 80% were pituitary-dependent. That percentage describes published clinical cases, not the prevalence among all cats, and it should not be treated as a population risk estimate. Feline HAC itself is considered uncommon.
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Signs owners may notice
Signs often develop gradually. A cat may seem hungrier and thirstier, lose muscle over the back and limbs, and develop a rounded abdomen even while overall body weight falls. Skin changes are particularly useful clues in cats: the skin may become paper-thin, bruise easily or split during ordinary handling.
| Sign | Frequency in 167 reported cats | What it can look like |
|---|---|---|
| Increased thirst and urination (polydipsia/polyuria) | 81% | More water-bowl visits, larger urine clumps or accidents |
| Abdominal enlargement | 61% | “Pot-bellied” outline from muscle loss, organ changes or fat redistribution |
| Increased appetite (polyphagia) | 60% | Persistent food-seeking despite weight loss |
| Skin atrophy | 59% | Very thin, delicate skin that bruises or tears |
| Muscle wasting | 47% | Loss over the spine, hips and limbs; difficulty jumping |
| Weight loss | 47% | Declining body condition even with a good appetite |
| Lethargy | 41% | Less grooming, play or interaction |
| Hair loss (alopecia) | 37% | Thinner coat or bald areas, often without intense itching |
| Skin fragility or tears | 32% | Open splits after a minor bump, restraint or grooming |
| Unkempt coat | 30% | Greasy, matted or poorly groomed fur |
| Weakness or a plantigrade stance | 18% | Standing flat-footed on the hind legs or struggling to rise |
| Enlarged liver (hepatomegaly) | 13% | Found during examination or imaging |
| Weight gain | 12% | Some cats gain rather than lose weight |
These percentages come from the 2017 review’s collection of reported cases. They show how often signs were recorded in those cats; they do not show the chance that a cat with one sign has Cushing’s disease.
Why diabetes can confuse the picture
Excess cortisol promotes insulin resistance. Diabetes is therefore common in cats with HAC, and thirst, urination and appetite may be caused by either condition. AAHA’s 2023 feline guidance cautions that “poorly regulated diabetes in cats usually has an etiology other than HAC.” A cat needing frequent insulin adjustments should be assessed for common explanations first, such as dosing, diet, infection, dental disease, pancreatitis or other illnesses. HAC becomes more compelling when difficult diabetes occurs together with severe skin fragility, muscle wasting or other characteristic findings.
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When a cat needs prompt veterinary attention
Arrange an appointment when you notice a combination of increased drinking or urination, persistent hunger, a newly enlarged abdomen, progressive weakness, hair loss or unusually thin skin. Do not wait for a skin tear to heal on its own. Any open wound, bleeding, foul odor, discharge, fever, sudden collapse, repeated vomiting, refusal to eat or breathing difficulty warrants urgent veterinary care. Fragile skin can worsen quickly and secondary infections may involve the skin, nail beds, urinary tract, respiratory tract or gastrointestinal tract.
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Handle a suspected cat as little and as gently as possible. Avoid scruffing, tight restraint, rough brushing and unnecessary adhesive tape. Tell the clinic about possible skin fragility before transport so staff can plan low-trauma handling.
How veterinarians diagnose feline HAC
No single symptom or routine blood result proves Cushing’s disease. The veterinarian reviews the history, performs a careful examination, evaluates concurrent disease and then selects endocrine tests appropriate for cats.
1. History, examination and baseline tests
The visit usually includes body-condition and muscle assessment, skin inspection, blood pressure or other illness checks, a complete blood count, biochemical profile and urinalysis. Hyperglycemia and glucose in the urine are common when diabetes is present. Laboratory patterns that are familiar in canine HAC are less dependable in cats, so a “normal” or atypical routine profile does not rule the disease in or out.
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2. Urine cortisol:creatinine screening
AAHA allows a urine cortisol:creatinine ratio as an initial screen. To reduce stress-related false positives, the guidance recommends collecting at least two morning urine samples at home. A positive screen should be followed by a low-dose dexamethasone suppression test rather than being treated as a diagnosis.
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3. Low-dose dexamethasone suppression test
AAHA identifies this as the most reliable diagnostic test for feline HAC. The feline protocol uses 0.1 mg/kg dexamethasone intravenously, a higher dose than the canine protocol. Cortisol is measured before treatment and afterward; failure to suppress at four or eight hours supports HAC. This is a clinic-based test requiring timed blood collection and interpretation by the treating veterinarian.
In a 2014 retrospective series of 30 cats from 10 referral institutions (median age 13 years), the test was consistent with HAC in 27 of 28 cats tested, or 96%. That small, selected series illustrates performance in that group; it is not a guarantee for every laboratory or patient.
4. Why ACTH stimulation is not the preferred first test
AAHA does not recommend ACTH stimulation as an initial diagnostic test in cats because sensitivity is poor. In the same 30-cat case series, results were suggestive in only 9 of 16 cats (56%). A negative result therefore cannot reliably exclude feline HAC.
5. Locating the source after confirmation
Once HAC is established, abdominal ultrasound can evaluate both adrenal glands and look for other disease. Advanced imaging may be indicated when a pituitary lesion is suspected or when surgery is being considered. Ultrasound classification agreed with the final diagnosis in 28 of 30 cats in the 2014 series, but imaging must be interpreted with the clinical and hormone-test results; it does not replace confirmation of HAC.
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Treatment choices depend on the cause and the cat’s health
| Approach | Typical role | Potential benefit | Main considerations |
|---|---|---|---|
| Trilostane medication | Medical control for pituitary- or adrenal-dependent disease when surgery is unsuitable or unavailable | Reduces cortisol production and aims to control clinical signs | Prescription-only; dose is individualized; requires repeated examinations and laboratory monitoring; excessive suppression can cause dangerous hypocortisolism |
| Unilateral adrenalectomy | Selected cats with a removable tumor in one adrenal gland | May remove the source and can be curative | Specialist surgery; risks include hemorrhage, thromboembolism, wound problems, infection, pancreatitis, hypoglycemia and iatrogenic hypoadrenocorticism |
| Transsphenoidal hypophysectomy | Specialist treatment for selected pituitary-dependent cases | Targets the pituitary source and may be curative | Available only at specialist centers and carries substantial procedural and postoperative demands |
| Radiation therapy | Some pituitary-dependent cases, particularly when surgery is not chosen | Can improve clinical signs in some cats | Response is variable and treatment requires specialist planning and follow-up |
There is no universally best option. The decision incorporates pituitary versus adrenal origin, tumor operability, diabetes and other illnesses, anesthesia risk, access to specialists, expected monitoring and the owner’s ability to manage follow-up.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Trilostane: what ongoing care involves
AAHA describes trilostane as the mainstay of medical treatment. The veterinarian selects and adjusts the dose according to clinical response, concurrent disease and avoidance of hypocortisolism. Feline pharmacokinetics were not well studied in the evidence summarized by the 2017 review, so a dose prescribed for another cat or another species must never be substituted.
- Give only the formulation and schedule prescribed for your cat. Do not alter, stop or share it without veterinary instructions.
- Return for a complete blood count, biochemical profile and urinalysis 7–14 days after starting treatment, as recommended by AAHA.
- Repeat those checks every 3–4 months thereafter, or sooner if the veterinarian requests it.
- Record appetite, thirst, urination, energy, weight, insulin doses and any skin changes. These observations help the veterinarian judge response.
- Seek urgent advice for vomiting, diarrhea, marked weakness, collapse, refusal to eat or sudden deterioration, which can signal excessive cortisol suppression or another complication.
Insulin requirements can change as HAC improves. A diabetic cat therefore needs closer glucose and clinical monitoring during treatment changes. AAHA notes that the treatment goal is control of clinical signs and that “strict monitoring of cortisol levels may not be critical for treatment success.” Cortisol measurements may still help the treating veterinarian, but a single numeric target should not replace clinical assessment and safety monitoring.
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Special risks from skin fragility and infection
About one-third of cats in the reviewed cases had skin fragility or tears. Venepuncture and ordinary restraint can damage skin, so ask the clinic to use the gentlest practical technique. Keep the cat indoors, prevent rough play with other animals and inspect the skin daily without vigorous handling.
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Contact the veterinarian promptly for a new split, redness, swelling, discharge, odor, limping, painful nail beds, urinary changes, coughing or gastrointestinal signs. Secondary infections can occur in several body systems. Do not apply human creams, antiseptics or supplements unless the veterinarian specifically recommends them; fragile skin may react unpredictably and topical products can interfere with wound assessment.
Prognosis and what the evidence can—and cannot—tell you
Untreated feline HAC has a poor prognosis in the 2017 review. Cats generally respond less favorably to medical therapy than dogs, although some improve substantially when the underlying disease and concurrent diabetes are controlled. Outcome depends on whether the source is pituitary or adrenal, tumor behavior, diabetes and other illnesses, treatment choice, complications and the individual response.
The available evidence is dominated by retrospective case series and case reports, including the 30-cat 2014 study, rather than large prospective trials. It does not establish one dependable life-expectancy timeline or promise of cure for every cat. A veterinary internal-medicine or endocrinology referral can help clarify the source and discuss realistic options for an individual patient.
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Sources used for the clinical guidance
- American Animal Hospital Association, “Feline Hyperadrenocorticism/Hypercortisolism,” April 12, 2023.
- Lara A. Boland and Vanessa R. Barrs, “Peculiarities of feline hyperadrenocorticism: Update on diagnosis and treatment,” Journal of Feline Medicine and Surgery, 2017.
- “Clinical Findings, Diagnostic Test Results, and Treatment Outcome in Cats with Spontaneous Hyperadrenocorticism: 30 Cases,” Journal of Veterinary Internal Medicine, published March 1, 2014.
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