How Do You Determine if a Canine Patient has Cushing’s Syndrome or Atypical Cortisol Estrogen Imbalance Syndrome (ACEIS)

Posted on March 3rd, 2017

Both conditions will have elevated amounts of cortisol.

How can you tell the difference?

Cushing’s syndrome is caused by the excess production of an active cortisol, created by the middle layer adrenal cortex referred to as the Zona Fasciculata.

When Cushing’s syndrome is present according to the internet, the following clinical signs may occur:

. Increased thirst (polydypsea)

. Increased urination (polyuria)

. Increased respiration

. Obesity

. Excess fat pad on the neck and the abdomen

. Loss of energy

. Loss of hair

When ACEIS is present, the following clinical signs that may be seen:

. Hypersensitivity

. Chronic vomiting

. Chronic diarrhea

. Allergic dermatitis

. Food allergies

. Inhalant allergies

. Chronic liver disease

. Chronic kidney disease

. Chronic pancreatitis

. SARDS (Sudden Acquired Retinal Degeneration Syndrome)

. Various forms of cancer

The following list represents some similar clinical signs that occur with both Cushing’s syndrome and ACEIS:

. Increased thirst (polydypsea)

. Increased urination (polyuria)

. Obesity

. Loss of energy

What is needed to differentiate the difference between Cushing’s syndrome and ACEIS?

Both syndromes may have elevated amounts of cortisol, however the difference is that the cortisol that is produced with the Cushing’s syndrome is active and the elevated amounts of cortisol that are produced with the ACEIS is defective.

Unfortunately, if the clinical signs do not match a typical Cushing’s syndrome, even if the cortisol is elevated, time and money may be wasted doing ACTH Stimulation Tests or Dexamethasone Suppression Tests.

Unfortunately, in the case of a critical disease like SARDS, the time spent doing diagnostic tests for Cushing’s syndrome may guarantee that the SARDS patient will never be able to recover lost vision. And since SARDS is an autoimmune disease, other autoimmune diseases and cancer may develop while waiting for the Cushing’s syndrome test results.

A simple way to determine if the cortisol is active or defective is to do a total estrogen (adrenal) test.

If the total estrogen test results are below 24.5pg/dL in both male and female canines, it indicates that the adrenal cortisol is active and the patient has Cushing’s syndrome.

If the total (adrenal) estrogen is above 25pg/dL in both males and female canines, it indicates that the adrenal cortisol is defective and the patient has ACEIS and NOT Cushing’s syndrome.

What are the following reasons, why a defective cortisol may occur?

. Genetics

. Aging

. Radiation

.  Surgery

. Xenoestrogens (estrogen mimicking chemicals)

. Phytoestrogens (plants that contain estrogen)

. GMO foods

. Pesticides and many more

When an adrenal cortisol is elevated and defective, it is not recognized by the hypothalamic-pituitary axis. The hypothalamus and the-pituitary glands will continue to release their hormones, CRF and ACTH, which in turn, will cause the inner layer adrenal cortex referred to as the Zona Reticularis to produce excessive amounts of adrenal estrogen.

The elevated amounts of adrenal estrogen will cause the following effects:

. Inflammation of all the endothelial cells that line the arteries in the


. It will bind the thyroid hormone receptor sites and cause a state of

  metabolic hypothyroidism and this will cause the obesity and loss of

  energy that is seen with Cushing’s syndrome.

. When estrogen is introduced to normal tissue in a Petri dish, the

  tissue will grow. The elevated adrenal estrogen may be an important

   reason why cancer occurs

. Adrenal estrogen regulates the immune system, and when the adrenal

  estrogen is elevated, it deregulates the immune system and two things

  may happen.

  • The immune cells will no longer function to protect the patient from many diseases that are caused by bacteria and viruses.
  • The immune cells will lose recognition of self tissue and this is why autoimmunity may occur.

In conclusion, it might be best to do the following tests if you and your veterinarian believe the cortisol that your pet is producing may be defective based upon your pets clinical signs.

The following are the tests that need to be done, in order to help correct this defective cortisol:

. Cortisol

. Total (adrenal) estrogen

. T3 (triiodothyronine)

. T4 (thyroxin)

. IgG

. IgM

. IgA

NOTE: The elevated adrenal estrogen will cause the immunoglobulin (antibody) production from the B-lymphocyte to become deficient.

When this occurs and the mucous membrane antibody, referred to as immunoglobulin A (IgA), is below 58 mgs,/dL, malabsorption will occur and often cause an increased thirst and possible increased urination that also occurs with Cushing’s syndrome.

Most veterinary laboratories are able to most of these tests, but not the total estrogen.

Most veterinary laboratories can do an estradiol test, but the estradiol levels have nothing to do with the total estrogen levels.

At this point in time, National Veterinary Diagnostic Laboratories is the only veterinary laboratory doing a total estrogen test.

Even with an elevated adrenal cortisol, if the clinical signs do not relate to the patient, the veterinary profession refers to this as an Atypical Cushing’s syndrome.

Hopefully this information will help you and your veterinarian to decide whether your pet has Cushing’s syndrome or ACEIS.


Dr. Al Plechner