How Much Does Treating Cushing's Disease in a Dog Cost? ACTH Testing, Trilostane, and the Recheck Schedule Priced Out
A dog with Cushing's disease rarely gets one bill -- it gets a recurring one. Most of the cost isn't the medication, it's the monitoring around it. Here's what each piece runs.
Diagnosis costs $400-$800 before treatment even starts
A workup starts with bloodwork and urinalysis (roughly $150-$250), then a hormone test: an ACTH stimulation test runs $150-$300, or a low-dose dexamethasone suppression test in the same range. Add an abdominal ultrasound at $300-$600 to check the adrenal glands, and a straightforward case lands at $400-$800 before a single dose is given.
Two different diseases share the same name
About 85% of dogs have the pituitary-dependent form, where a small pituitary tumor overdrives both adrenal glands. The other 15% have a tumor on one adrenal gland itself. Both look identical on bloodwork, which is why the ultrasound matters -- it's usually the only step that shows which one is present, and that decides whether surgery is even an option.
Trilostane runs $80-$250 a month, priced by weight
Trilostane (Vetoryl) is the only FDA-approved daily medication for both forms. Dosed by body weight, most owners land in the $80-$250-a-month range, or $2-$10 a day. There's no generic yet, so this cost stays fixed for as long as the dog takes it.
The recheck schedule is where the real spending happens
Starting trilostane isn't a one-time prescription. The standard recheck runs an ACTH stimulation test at 10-14 days, again at 4 weeks, again at 12 weeks, then every 3-6 months once the dose is stable -- each visit repeating the same $150-$300 test, commonly four to six rounds in year one. The pill is cheap by comparison; the lab work that finds a safe dose is not optional.
Year one: $1,500-$5,000+. After that, it settles lower
Diagnosis, dose-finding rechecks, and medication together typically total $1,500-$5,000 or more in year one. Once a stable dose is found, ongoing cost -- medication plus twice-yearly monitoring -- settles to roughly $500-$2,000 a year. Trilostane controls the disease, not cures it, so dogs stay on it for life.
Surgery is rare, and it's the expensive branch
If the ultrasound finds an operable adrenal tumor, removing it (adrenalectomy) can cure that form outright. It's specialist surgery at a facility equipped for the complications that can follow, running $3,000-$8,000 -- well above a year of medical management. Most owners never face this choice, since the pituitary-dependent form has no surgical fix.
Where insurance actually helps here
Cushing's is costly because it's chronic, which is where coverage for ongoing conditions matters more than for a one-time injury. A policy bought before symptoms appear can cover the workup and the monitoring; one bought after diagnosis will almost certainly exclude it for life as pre-existing.
Putting the numbers in order
① Diagnosis: $400-$800. ② Medication: $80-$250 a month, for life. ③ Monitoring: an ACTH recheck at 10-14 days, 4 weeks, 12 weeks, then every 3-6 months, each $150-$300. ④ Year one total: commonly $1,500-$5,000+. ⑤ Ongoing years: roughly $500-$2,000. ⑥ Surgery, only for the ~15% with an operable tumor: $3,000-$8,000. Worth comparing: arthritis management costs and routine bloodwork on its own.
Sources: PetMD and AAHA guidance on ACTH stimulation testing and trilostane monitoring; MSPCA-Angell dosing guidance; Pawlicy Advisor and Vetlens cost breakdowns (accessed September 2026). Costs vary by region, clinic, and weight. General cost information only, not veterinary advice.
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