Internal medicine

  • Chronic kidney disease cat
  • Giardia
  • Hypertension
  • Pancreatitis
  • Thyroid problems cat
  • Diabetes
  • Tritrichomonas infection cat
  • Cushing's disease

Chronic kidney disease cat

Chronic kidney disease cat

Kidneys have several essential functions, including a role in water management and the excretion of certain waste products. Kidneys have a huge reserve capacity, which is why we only see symptoms when more than 70% is lost. Kidney problems are seen more often in older animals. What causes it is usually impossible to determine. Kidney abnormalities are seen in some breeds, which are probably hereditary and where kidney failure can be seen at an early age.


It is difficult to determine exactly when damage to kidney tissue begins. It is usually a gradual process that can take weeks to months. In beginning kidney patients, you will not yet see any symptoms. Indications of a kidney problem in your pet are drinking a lot (it is normal if you hardly ever see your cat drinking!), urinating a lot, decreased appetite, increased vomiting, lethargy, smelling out of the mouth, bad fur, stiff walking and losing weight. With a blood screening in the cat (recommended from 8 years of age), we can find clues where some kidney tissue damage may already be suspected.


Several examinations are usually needed to get a good idea of the severity of the kidney failure and the prognosis. The examination of an (older) cat suspected of chronic kidney disease consists of:

  • Physical examination Blood test
  • Urinalysis
  • Blood pressure measurement
  • Physical examination

Physical examination

This involves checking your cat completely, but paying particular attention to weight, coat, kidney and bladder size, odor from the mouth and fluid balance.

Blood test

Certain kidney values can be measured in the blood: urea and creatinine. These substances are only elevated if a considerable part (more than 70%) of the kidneys are already damaged. If your animal has elevated kidney values, it is sometimes necessary to "flush" him/her via an infusion. This depends on the underlying cause and the animal's condition. If the kidney values were elevated due to another underlying problem, they may return to normal after flushing. If they remain high after flushing, there is permanent damage.

It is also important to check the minerals in the blood (potassium, phosphate, calcium) and the red blood cell count. This is important because these blood levels may be increased or decreased because of the kidney failure. As a result, your cat may feel less well and/or the abnormal mineral levels may worsen the kidney failure.

Urine examination

A cat with kidney failure has watery urine because the kidneys can no longer concentrate properly. Some animals have leakage of protein in the urine due to damage to kidney tissue. We can measure this. The higher the amount of protein, the worse the kidney failure is. The proteins worsen the kidney failure. If there is too much protein in the urine, we prescribe a medicine that inhibits this protein leakage. This makes your cat feel better.

Finally, we often do bacteriological tests of the urine. Kidney failure is frequently accompanied by a urinary tract infection which may be the cause or worsen the kidney failure. Interestingly, cats with such a urinary tract infection usually have no complaints.

Blood pressure measurement

A cat with kidney failure is more likely (65%) to have high blood pressure. High blood pressure can be the cause of the kidney failure but a cat with kidney failure can also develop high blood pressure. Therefore, it is important to keep checking blood pressure regularly (twice a year). High blood pressure leads to faster deterioration of the kidneys. If the blood pressure is elevated, your cat will be given medication for this.

For a long time, you will not notice anything about high blood pressure. Only at a late stage, when there is already a lot of damage, symptoms such as haemorrhaging in the retina, blindness, heart problems and brain haemorrhages develop.


Your cat will be a kidney patient for the rest of his/her life. Kidney failure cannot be cured. Treatment is mainly to prevent the kidney failure from worsening and to make your cat feel and stay well.


The most important thing in a kidney patient is that he/she eats and drinks well! Depending on how sick your cat is, we may recommend kidney diet, your old food or high-energy canned food (temporarily).

Kidney diet contains less protein, making it less stressful for the kidneys. It also contains more potassium and less phosphate and calcium. Kidney diet gives a marked improvement in quality and quantity of life, but only if it is eaten sufficiently.


Fluid intake should be encouraged as much as possible to avoid becoming dehydrated. You can do this by placing extra water bowls in the house (cats drink little water if it is next to food), running water/water fountain, adding extra water with food and/or giving wet food (contains 70-80% water).

Further therapies depend on your cat's condition:

  • If your animal is very dehydrated and apathetic, an infusion (into the blood vessel or subcutaneously) may be required.
  • Medication if there is protein leakage from the kidneys (lifelong).
  • Medication if there is high blood pressure (lifelong).
  • Medication if minerals in the blood are abnormal.
  • Antibiotic if there is bacterial cystitis (temporary).
  • Medication to control vomiting (temporary).
  • Medication to stimulate appetite. Appetite may be less due to nausea, abdominal pain due to constipation and/or stomach/intestinal ulcers. (temporary).


Once we have diagnosed kidney failure in your cat, your cat will be graded as having kidney failure (stage 1 to 4) depending on the blood and urine tests. A treatment plan will be drawn up. Regular check-ups are important to give your cat the best quality of life possible and to detect any complications quickly.

After 1 month, we recommend you come for a check-up. Then we repeat the clinical examination, blood and urine tests and blood pressure measurement. After that, we recommend having the urine checked every 3 months and the blood test and blood pressure measurement every 6 months. Of course, please contact us if things do not seem to be going well in the interim.


There is no predicting how long it will stay well. There are cats that live for years with elevated kidney values, while in other patients the treatment does not work. Of course, it also depends on how bad the kidney failure is at the time of diagnosis. By regularly checking kidney values, blood pressure, protein leakage and minerals, we keep a close eye on the kidney problem. Always contact us if your cat starts crawling away, stops eating or drinking or shows other signs of illness.

Do you have any questions following the above information? If so, please contact us.



Giardia is a single-celled organism that occurs in various stages of development. The single-celled animal has long swishing tails and swims in the dog's intestines. Animals infect themselves by eating the parasite.

Transmission occurs via the feacal-oral route. This means that the animal defecates the cysts and another animal or human infects itself with them by ingestion through the mouth. (Most likely, the parasite is animal-specific and you need not worry about being infected by your dog). Often Giardia infections, in healthy animals, progress without symptoms but do periodically excrete the infectious cysts.

However, in young animals and animals with reduced resistance, e.g. due to illness or stress, symptoms do appear. If your dog/cat has chronic diarrhoea (this means that the diarrhoea is present for several weeks or even months, has already been treated with medication and/or modified food and this has not shown any results), it is wise to have faeces tested for Giardia. It is also wise to have faeces tested for Giardia in case of constantly changing stools, if medication and an adapted diet have not yielded any results. Giardia causes thin stools or mushy smelly diarrhoea. It may include mucus and blood. Sometimes animals are nauseous and may vomit, but they often retain their appetite.

Giardia occurs in two forms

  1. The parasite stage = trophozoite. Shows up as a small multicellular whip animal, which can only be seen with a microscope at high magnification. Propagation takes place by division and therefore multiplication can be explosive. A cyst form from each trophozoite.
  2. Cyst or also called oocyst. This is the highly infectious stage. After excretion in the faeces, the cyst is infectious for weeks or even months under cool and humid conditions. Treatment As therapy, metronidazole or fenbendazole can be given.

There are Giardia strains that are not sensitive to metronidazole and are sensitive to fenbendazole and vice versa. Cats are treated for 5 days with fenbendazole (50mg/kg) or for 7 days with metronidazole (22-25mg/kg). Dogs are treated for 3 days with fenbendazole (50mg/kg) or for 5 days with metronidazole (20-22mg/kg). At our practice, fenbendazole is always treated first as it gives the best results. Re-infection the dog/cat can re-infect itself with oocysts of the giardia that got into the fur.

This can happen when the diarrhoea (containing the oocysts) sticks to the fur. The animal licks itself and that way they can reinfect themselves. It makes sense to wash your entire dog on the 3rd and 5th day after the start of treatment to prevent this from happening (in cats, this is a bit more difficult but keep a close eye to ensure that no faeces remain in the hair). If you see poo on the hairs, wash it away immediately with a disposable flannel. It is wise to clean the litter box thoroughly on the 3rd and 5th day after the start of treatment to prevent reinfection.

All animals in the family should be treated because of reinfection, some animals may carry the giardia parasite but have no symptoms. In this regard, good personal hygiene is important. As an owner, wash your hands after contact with your dog/cat. Clean and disinfect (vacuum and mop) the environment where your animal lives, this is to prevent reinfection.

Persistent diarrhoea

If the diarrhoea does not disappear completely after treatment with fenbendazole and/or metronidazole, then dietary adjustment and gastrointestinal support is necessary. We will then look for an easily digestible food, food with more fibre or food with a foreign protein source that provides the right support for your dog/cat's gastrointestinal tract. Sometimes, additional investigations are also needed to rule out other causes of chronic diarrhoea.

Do you have any questions following the above information? If so, please contact us.



High blood pressure (hypertension) is an abnormality that can occur secondary and primary. Secondary means that high blood pressure is caused by an underlying disease such as kidney problems, diabetes, an overactive thyroid gland (hyperthyroidism), Cushing's disease or when taking certain medications.

Primary means there is no known underlying disease. How high blood pressure is in an animal is determined by heart rate, the strength of the heart and the amount of blood in the vessels. In addition, blood pressure is determined by how viscous the blood is and whether the small vessels in the body are more open or more closed.

Blood pressure is highest when the heart contracts (systolic pressure or upper pressure) and lowest when the heart is relaxed (diastolic pressure or lower pressure). Several systems in the body collectively regulate blood pressure. The body produces hormones that affect blood pressure.

Blood pressure can rise because:

  • The heart starts beating faster or more vigorously.
  • More fluid (blood) circulates in the vessels.
  • The small vessels in the tissues constrict more.

Longer excessive blood pressure affects the organs, especially the brain, heart, kidneys and eyes. The walls of the blood vessels in these organs become stiffer, too much blood and fluid can leave the vessels (oedema, bleeding) and tissue deterioration, lack of oxygen and scar tissue formation can occur. This may cause the kidneys to leak protein out through the urine (proteinuria) and more and more kidney filters will break down.

Bleeding may occur in the eyes and severe changes in the retina may occur. This can even cause retinal detachment or such damage to the optic nerve that permanent blindness occurs. In cats, blindness is often the first thing noticed from high blood pressure. At the heart, you can see that hypertension causes the muscle wall to thicken.

In animals, blood pressure is measured when signs of hypertension are visible (indications of eye problems or brain haemorrhage), in animals with thickened heart muscle and animals with a disease in which we might expect high blood pressure (such as kidney disease, diabetes, hyperthyroidism). For a blood pressure measurement, rest is important, so you as the owner may be present during the blood pressure measurement. We always do a number of blood pressure measurements in succession, from which we take the average result.

We recommend that the blood pressure measurement is always carried out by the same veterinary nurse or veterinarian. If it turns out that your animal's blood pressure is too high, and the possible causes have been treated, medication will be prescribed. After starting medication, the advice is to repeat the blood pressure measurement after a few weeks. The results will determine whether they medication needs to be adjusted and when the next check-up will take place.

Do you have any questions following the above information? Please contact us.



The pancreas or pancreas is a flat, thin organ located in the front of the abdomen, close to the stomach. The pancreas contains two main types of cells. One group of cells (endocrine pancreas) produces hormones that regulate blood sugar levels. The other group of cells (exocrine pancreas) produces digestive enzymes, which are released into the small intestine to digest food. Pancreatitis is inflammation of the exocrine part of the pancreas. When the pancreas becomes inflamed, it becomes painful and swollen.

Pancreatitis can also affect the stomach, small intestine and portions of the liver. Swelling and irritation of the stomach, small intestine, pancreas and part of the liver are responsible for most of the symptoms that can be seen. Causes There are two forms of pancreatitis: acute and chronic pancreatitis. In cats, we see the chronic form much more than the acute form. Most cats have a longer history of vague abdominal symptoms and the cause of pancreatitis is usually unknown.

Many cats with pancreatitis also have chronic bowel disease (IBD) and/or inflammation of the bile ducts (cholangiohepatitis). An underlying problem can lead to any or all three of these inflammatory conditions in a cat. Many cats with enteritis and bile duct inflammation are sensitive to the type of proteins in their diet, and in some cats the pancreatitis may therefore result from a particular food hypersensitivity.

In dogs, we see the acute form the most, but the chronic form is also common. In many cases, the cause of pancreatitis in dogs cannot be determined, but it is known that eating food that the dog does not normally get or food high in fat can increase the risk of acute pancreatitis.

Other risk factors include obesity (obesity), liver disease, diseases of the small intestine or Cushing's disease. In a few cases, canine pancreatitis is caused by abdominal surgery, certain medications, injury to the abdomen or tumors or inflammation near the pancreas.


The most common symptoms of chronic pancreatitis are lethargy and poor appetite. Vomiting, dehydration and a painful abdomen when feeling down are symptoms sometimes seen, especially during temporary deterioration. It is common for the symptoms to come and go.

Even if the dog or cat r feeling well again, the pancreas may still be inflamed. Some dogs or cats with chronic pancreatitis develop diabetes when the insulin-producing cells in the pancreas are damaged. The temporary flare-up of chronic pancreatitis can make controlling diabetes difficult.

Over time, with chronic pancreatitis, the exocrine part of the pancreas may also be lost, leading to diarrhoea due to poor digestion of food (EPI). In dogs, the most common symptoms of acute pancreatitis are seen as vomiting, dehydration, a painful abdomen, lethargy and fever. However, these symptoms are not always obvious and, moreover, may also occur in other diseases. These possibilities should therefore be investigated. Occasionally, acute pancreatitis ends fatally.

The dog or cat then dies because the pancreatitis causes other organs to stop functioning. Treatment Cats and dogs with acute pancreatitis usually have to be admitted to the clinic.

There, they receive infusions and medication for pain and vomiting, possibly supplemented by other supportive measures. Most cats and dogs with chronic pancreatitis do not need to be admitted. As food hypersensitivity or allergy is often the underlying problem in cats, a change of diet may be necessary.

After consulting with the vet or nutritionist, about what your cat is currently eating, a suitable diet for your cat can be sought. In addition, temporary medication is often given for nausea and abdominal pain. If the cat does not improve on the new diet, anti-inflammatory drugs can be tried. Dogs are switched to a low-fat diet and are also often given temporary medication for nausea and abdominal pain.

If the dog does not improve on the new diet within two to three weeks, further investigations may be necessary. Dogs with a sudden worsening of chronic pancreatitis may need to be temporarily admitted for infusion. Dogs and cats with chronic pancreatitis are also looked for other diseases of the liver and intestines, as the presence of these diseases can delay and complicate recovery. Chronic pancreatitis can be a frustrating disease to treat. It often requires trying different things and adjusting therapy in the interim. Follow-up and prognosis Two to three weeks, after starting treatment, a repeat blood test is recommended.

Based on the blood test, it can be seen whether the treatment is succeeding. The prognosis of chronic pancreatitis is generally good, especially if a change of food alone is enough to control the inflammation. Your dog or cat should be closely monitored to make sure no complications arise. The prognosis for a dog or cat with acute pancreatitis requiring hospitalization is difficult to give.

Do you have any questions following the above information? If so, please contact us.

Thyroid problems cat

Thyroid problems cat

Does your cat suffer from hyperthyroidism?

Cats with hyperthyroidism have a thyroid gland that produces too many hormones. Too high concentrations of thyroid hormone have a major impact on the cat's metabolism, placing a heavy burden on organs such as the heart and kidneys. The thyroid gland is an endocrine gland, which in the cat is located in the neck and is divided into two parts, the lobes, each on a side of the trachea. The thyroid gland produces the thyroid hormones triiodothyronine and thyroxine.

The functions of these hormones include the following:

  • They are essential for the normal growth of body cells and for their differentiation into cells with certain functions in the body.
  • They play an important role in the metabolism of proteins, fats and carbohydrates in the body.
  • They are involved in the regulation of heat production and oxygen uptake and therefore important in very many metabolic processes.

Excess thyroid hormones will accelerate metabolism in every cell of the body, causing cells to require more energy. Cats with hyperthyroidism will therefore eat more to meet the greater energy needs. The worse the form of hyperthyroidism, the more energy the cat needs. Often, the amount of energy the cat needs is so great that the daily diet is no longer enough. As a result, the cat will start losing weight. The complaint we then see is weight loss combined with an increased appetite. Another complaint is restlessness and an increased heart rate, both of these are due to the increased metabolism. Increased metabolism also causes extra production of body heat, hyperthyroidism patients will therefore often seek cooler places.

In 98% of cases, hyperthyroidism is caused by a benign change in the thyroid lobes. In all these cats, proper treatment will lead to a suppression of the disease, after which the cat can continue to live an almost normal life. Only in 2% of cases, the enlargement is due to a malignant change and thus will not be well suppressed with medication.

In addition to the above symptoms, we also often see the following symptoms in a cat with hyperthyroidism:

  • Quickly becoming irritable
  • Poor maintenance of own coat
  • Diarrhoea
  • Vomiting
  • Frequent urination
  • Drinking more

During the physical examination, one or two enlarged thyroid lobes can often be felt. However in some cats no enlarged thyroid can be felt, this may be because the overactive thyroid tissue is in an unusual (ectopic) location (often this is in the thoracic cavity). To confirm the diagnosis of hyperthyroidism, a blood test is performed. Because hyperthyroidism is most common in older cats, a comprehensive blood test is done. A comprehensive blood test looks at all organs including the liver and kidneys. Hyperthyroidism can be successfully treated. The aim of treatment is to reduce the amount of thyroid hormones to normal levels.

There are several methods for this:

Treatment with a medication that inhibits the formation of thyroid hormones
Three weeks after starting this medication, the vet will examine your cat again and order another blood test to check whether the cat has responded sufficiently to the medication. Based on the examination and the blood results, the vet will adjust the dosage of the medication if necessary. The medicine should be given daily and for life. Indeed, treatment will not cure the disease, but only suppress it. Regular (blood) monitoring is therefore very important if your cat is taking thyroid medication.

Special food
Low iodine food helps normalize thyroid hormone production. It contains controlled phosphorus and low sodium, which supports kidney health. The urinary tract is supported by a controlled magnesium content and achieving a urinary pH of 6.4-6.6. It also contains high levels of omega-3 and omega-6 fatty acids to promote healthy skin and coat. The cat should only eat Hill's Y/D food and NO other food or snacks, this is due to the fact that other food contains too much iodine for proper thyroid treatment.

Thyroidectomy (surgical removal of affected thyroid tissue)
This can provide long-term to permanent healing. However, it sometimes happens that hyperactive thyroid tissue develops again. Prior to surgery, a scintigraphy should be made. A scintigraphy involves injecting radioactive material into the animal. The injection of the radioactive substance reveals where the overactive tissue is. For 3-4 weeks prior to surgery, the cat should be given thyroid inhibitors. Additional heart disease should also be treated if necessary. If both thyroid lobes are enlarged then they can be surgically removed, however, the cat should then be administered thyroid hormones for the rest of his/her life. If ectopic thyroid tissue is present in the body, then surgery is not an option.

Radioactive iodine
This is given with a single injection into the muscle, which can cure your animal of hyperthyroidism. In fact, it also treats the ectopic tissue. Prior to surgery, a scintigraphy should be made. In scintigraphy, radioactive material is injected into the animal, injecting the radioactive substance reveals where the overactive tissue is. Based on the scintigraphy, the amount of iodine to be administered is determined. Radioactive iodine is administered by subcutaneous injection, the iodine is then absorbed by the overactive (abnormal) thyroid tissue but not by other tissues in the body. This leads to a selective local accumulation of radioactive material in the overactive thyroid tissue. The radiation destroys the abnormal thyroid tissue but does not damage the surrounding tissue or parathyroid glands.

The advantages of radioactive iodine are that it leads to healing, has no side effects for the patient, no anaesthesia is required and it effectively treats all the abnormal tissue at once regardless of the location of the tissue. But handling and injecting radioactive material is necessary for this, protective measures must be taken for the people who come in contact with the cat. Because of this, the treatment can only be carried out in certain clinics with special licenses and a treated cat must remain there in admission until the radioactivity has decreased sufficiently.

Do you have any questions following the above information? If so, please contact us.



Diabetes (diabetes mellitus) is a regularly occurring disease. It is seen more in cats than in dogs. Obesity and little exercise play an important role in the development of diabetes. In a cat with diabetes, there is a lot of sugar (glucose) in the blood. This cannot be used because they no longer/barely produce insulin. Insulin ensures that blood sugar is transported from the blood to the tissues so that it can be used there. So without insulin, blood sugar will remain in the blood.

This will rise so much that the capacity of the kidneys is exceeded and the blood sugar is excreted through the urine. Because the cat has a lot of blood sugar in the blood, but cannot use it, they start producing other substances from which they can get their energy. Unfortunately, these can cause your pet to feel worse, stop eating/drinking and vomit.

So it is important to treat your animal once diagnosed. A few cats start producing insulin again when treated for diabetes. As an owner, you may notice that your animal drinks and urinates a lot. They also eat very happily and yet lose weight. If you notice this, it is important to make an appointment with your vet as soon as possible. The vet can diagnose diabetes by determining blood sugar and fructosamines. These are then both elevated.

Blood sugar is also often found in the urine, which in turn can lead to a bladder infection. This above story also applies almost entirely to the dog. If diagnosed in dogs, it is almost always irreversible, while in some cats it is seen that they do start making insulin again on their own. In the unsterilized bitch, diabetes can develop, which is due to hormone production from the ovaries. In these dogs, sterilization should be performed, which can make the symptoms of diabetes disappear again. Once diagnosed, it is important that your pet goes on a low-sugar diet. Occasionally, you see in cats that a diet alone may be sufficient.

If this does not work sufficiently, it is important to start giving insulin. This is administered by injection under the skin by the owner. This is practiced with you in our practice. We start with a low dose of insulin, because if the dose of insulin is too high, hypoglycemia (low blood sugar) can occur. In the cat, insulin should be taken twice daily, at set times, 12 hours apart. In dogs, it should also be taken twice a day. It is important that your animal eats well when you give them insulin.

They should also not vomit or have diarrhoea. Here, the dose of insulin should be adjusted. Since you are giving insulin, your animal will be able to transport the blood sugar back out of the blood into the tissues and thus the blood sugar can be used again. This will eventually cause the blood sugar in the blood to drop again to the point where it does not end up in the urine. So your animal, if properly set up with insulin, will no longer drink/ urinate much and will also gain weight again. This gaining weight is not always good, as animals with diabetes are often already overweight. You can get information about this at our clinic.

In the beginning, you will come for regular check-ups with us to check the level of blood sugar. This will demand a lot from you and from your animal, but your animal will benefit in the end. A major complication can be hypoglycemia (too low sugar). These are animals that show disturbed behaviour (neurological), are restless, search for food, have epileptic seizures, may meow very loudly, appear to be blind or comatose. Because of the risk of hypoglycemia, it is wise as an owner to have dextrose powder in the house.

You can either apply this to the inside of the lips or under the tongue. You can also dissolve it in a little water and give it in the mouth. Of course, the animal must then be able to swallow. These are emergency patients, so contact your vet immediately. It is important to look for the cause of the hypoglycemia. Poor eating, vomiting, diarrhoea or too much insulin? You can discuss this with us. Another complication may be ketoacidosis. If an animal has had high blood sugar for a long time, but cannot use it, they start to produce another source of energy. This can cause your animal to stop eating/drinking and possibly vomiting. These are also patients you should come to as soon as possible.

Do you have any questions following the above information? If so, please contact us.

Tritrichomonas infection cat

Tritrichomonas infection cat

Tritrichomonas is a single-celled intestinal parasite that can occur in the cat's intestine. The parasite lives mainly in the colon and the last part of the small intestine. Tritrichomonas mainly causes colon diarrhoea that recurs regularly. Characteristics of colon diarrhoea are often having to defecate small bits with some mucus and/or blood attached. By pressing on the small bits of stool, the anus may be somewhat red and swollen.

Tritrichomonas can occur at all ages, but the symptoms are mainly seen in cats up to 2 years of age, most of which are under 12 months of age. The majority of cats with Tritrichomonas come from (kitten) shelters and bread breeders. Cats infected with Tritrichomonas are often in good condition. They do not behave ill and will not actually lose weight. We often see complaints of diarrhoea that passes but also returns.

Infection is most seen in groups of cats and multi-cat households, where the organism is presumably spread between cats by close and direct contact. There is no evidence yet of spread through other animal species, or spread through food or water.

The long-term prognosis for infected cats is good. They will eventually overcome the infection although this can take a long time (on average nine months but sometimes as long as 2 years). Most infected cats continue to excrete small amounts of Tritrichomonas for months to years after the diarrhoea stops.

It is unproven but plausible that Tritrichomonas foetus can also infect humans, especially those with impaired immunity are at risk. Therefore, it is important to observe basic hygiene rules, such as washing hands and keeping the litter box clean/clean and cleaning the environment properly at home. This is also important to avoid spreading the infection to other cats. It is wise to wash the hindquarters of the cat(s) with a disposable flannel to prevent the cat from re-infecting itself and/or infecting other cats.

Do you have any questions following the above information? If so, please contact us.

Cushing's disease

Cushing's disease

Cushing's disease is one of the most common hormonal diseases in dogs. Dogs drink a lot and therefore urinate a lot, want to eat more, become bald, lose muscle mass and/or develop a fatter belly. In the longer term, they may develop diabetes, develop joint problems and become more susceptible to infections.

In Cushing's disease, the adrenal glands produce too much of the hormone cortisol. This hormone is the cause of all the symptoms mentioned above. Cushing's disease is easily treatable.

The disease comes in two forms:

  • Pituitary-dependent Cushing's: due to a (generally small) tumor in a gland near the brain.
  • Adrenal-dependent Cushing's: due to an adrenal tumor.

To choose the right treatment, it is important to know which form of the disease your dog has.


Cushing's disease is diagnosed in the Netherlands by measuring the amount of cortisol in the urine. This test should be performed with care. After this urine test, in one in three animals, additional tests are needed to find out which form of Cushing's disease the dog has (adrenal or pituitary form) and to see how far the disease has progressed. This additional examination may include an ultrasound of the abdomen, an X-ray of the lungs and/or a CT scan of the pituitary gland.

Why a treatment?

In some dogs, we still see few symptoms when Cushing's disease is detected. The condition is not immediately life-threatening. Treatment costs a lot of money and is not without risks. Nevertheless, it is important to start treatment right away. After all, your dog really suffers from this disease and the symptoms will only get worse over time. With successful treatment, the aforementioned symptoms will disappear completely. In the best-case scenario, your dog may even be completely cured.

If your dog is not treated, complaints may eventually develop that will not go away after treatment. These include diabetes and calcifications in the skin. Also, with Cushing's disease, your dog is more susceptible to infections (e.g. renal pelvic inflammation), which can cause permanent damage. If diagnosed or started too late, Cushing's disease can be treated, but some of the damage done is permanent.

Treatment of Cushing's disease

In 15% of cases, Cushing's disease is caused by an adrenal tumor. In that case, surgery is usually the best treatment. Treatment with a drug containing the active ingredient trilostane is also possible.

By far the largest number of animals (85%) with Cushing's disease have the pituitary form. The pituitary gland is a small gland located in the skull, just below the brain. Inside the pituitary gland of these dogs is a (often pinhead-sized) tumor. This is almost always benign and generally grows slowly. Both surgery (removing the tumor) and drug treatment are possible.

So treatment is surgical or with a drug containing the active substance trilostane. Both treatments are good, but both have advantages and disadvantages. Surgical treatment means that your dog will go under anaesthesia and must recover from surgery. When treated with medication, there is a risk of side effects. The dosage should also be monitored regularly. This is done through physical and blood tests.

Itching in Cushing's disease

Cushing's is a condition that is easily treatable. If your dog is recovering and thus starts drinking and eating normally, he may experience itching. If your dog used to have an allergy, it may have been suppressed by Cushing's disease. Now that this disease is under control, the old allergy returns. Another reason for itching is hair regrowth. Due to Cushing's disease, hair growth has stopped. Now that your dog is getting new hair, the stubble can lead to itching.

Do you have any questions following the above information? If so, please contact us.

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