Iatrogenic Cushing's in dogs: how to withdraw corticosteroids
6-year-old French Bulldog on immunosuppressive prednisolone for 5 months for an immune-mediated disease now in remission. He has polyuria/polydipsia, a pot belly, thin skin and comedones. Post-ACTH cortisol is very low.
What is the correct management?
chevron_right Show answer and explanation
A. Start trilostane to control the hypercortisolism
The adrenals are suppressed and produce no cortisol: the signs are due to the drug. Trilostane is useless and would increase the risk of hypoadrenocorticism.
B. Stop prednisolone abruptly so the axis recovers sooner
Abrupt withdrawal after months of corticosteroids can trigger secondary hypoadrenocorticism (lethargy, vomiting, hypoglycaemia, hypotension).
C. Switch to dexamethasone at an equivalent dose, which causes fewer adverse effects
At equivalent doses, dexamethasone has the same glucocorticoid effects and suppresses the axis as much or more; it does not solve the problem.
D. Taper prednisolone gradually over weeks to months, using another immunosuppressant if needed
Correct. Gradual tapering allows the pituitary–adrenal axis to recover. If the underlying disease needs treatment, steroid-sparing drugs are added; signs resolve over weeks to months.
lightbulb Key takeaway
With Cushing's signs in a dog receiving corticosteroids (including topical, otic or ocular), think of iatrogenic Cushing's: the ACTH stimulation test shows a suppressed axis. Treatment is gradual steroid withdrawal, never trilostane.
Test yourself with 10 random questions
Endocrinology · 100 questions, a different test every time
Related questions
Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.