Hello.
KeeKee has been a Cushing’s dog for almost 11 months, so I thought I would share KeeKee’s journey with Cushing’s and to ask the community for ideas on managing her trilostane intolerance. Her current state is that her gastrointestinal tract is becoming increasingly intolerant to trilostane. The trilostane does help with her water consumption and panting, but her GI tolerance of the medication is dropping. So we are wondering how others that have run into this have managed their treatment. If you are taking breaks from trilostane, how long a break are you taking? Has anyone had success managing Cushing’s symptoms with anything other than trilostane, including alternative treatments?

KeeKee details:
Weight: 65 lbs
Age: 11-12 years (a bit unknown as she was an adult rescue)
Breed: Hound/Cattle dog mix
Other health conditions: hypothyroid (on low dose of thyroxine), periodic acute back pain

Here is KeeKee’s treatment journey:
In September 2024, we noted a significant increase in the amount of water she was drinking and excessive panting on walks. Also extreme drive for more food.
Full blood panel labs all looked good
Urine specific gravity abnormally low
Diabetes Mellitus ruled out (blood sugar was fine)
11/4/2024 Diagnosed with Cushing’s
LDDS test 4.4 → 2.9 → 3.7
Cause: Adrenal ultrasound showed adrenal hyperplasia, but no adrenal tumor. Diagnosis was that Pituitary tumor was driving the condition.

11/13/2024 started trilostane 30mg x2 day (we use the name brand Vetoryl and provide her doses at meal times about 12 hours apart)
12/3/2024 ACTH stimulation test 2.3 → 6.7
12/9/2024 trilostane 35mg x2 day
12/30/2024 ACTH stimulation test 2.8 → 6.8
1/6/2025 trilostane 45mg x2 day
1/9/2025 – 1/10/2025 multiple vomiting episodes
1/10/2025 stopped trilostane
1/11/2025 – 1/14/2025 Managing vomiting with Cerenia. Full blood work shows no issues.
1/11/2025 trilostane 35mg x2 day
1/17/2025 vomit at lunch. Stopped trilostane
Paused on trilostane through 2/16/2025 (due to intolerance to trilostane and surgery to remove a sarcoma tumor unrelated to Cushings)
2/17/2025 trilostane restarted at 15 mg x2 day
3/15/2025 trilostane 20 mg x2 day
3/29/2025 ACTH stimulation test 2.5 → 7.6
4/21/2025 ACTH stimulation test 5.3 → 7
7/17/2025 ACTH stimulation test 3.4 → 6.5
Water consumption at historic good level (< 2L per day)
8/23/2025 Probiotics started due to diarrhea
Last week of August 2025 had consecutive days of diarrhea, ending with vomiting
Ruled out Giardi
9/1/2025 – 9/8/2025 held trilostane
9/9/2025 Started back on trilostane 20mg x1 day
9/19/2025 Diarrhea came back
9/20/2025 Holding trilostane

Any ideas on how to manage this?

Thank you,
Greg