Cushing's in Horses

Late Stage Cushing’s in Horses: Symptoms and Care Tips

As your horse ages into its senior years, you may notice changes in its appearance and behavior that could indicate Cushing’s disease in horses. This common endocrine disorder affects around 15-30% of horses over 20 years old and results when the pituitary gland produces excess cortisol. If left untreated, Cushing’s can lead to dangerous health complications.

Familiarizing yourself with the symptoms, like long, wavy coat or increased drinking and urination, allows you to seek veterinary diagnosis and care early. Providing proper nutrition, low-stress environments, and medications prescribed by your vet can help manage Cushing’s and give your elderly equine companion a good quality of life. This article explores the late stages of Cushing’s disease, from recognizing signs to implementing at-home care strategies.

What Is Cushing’s Disease in Horses?

Cushing's in Horses

Cushing’s disease, also known as pituitary pars intermedia dysfunction (PPID), is a hormonal disorder common in older horses. It’s caused by a tumor in the pituitary gland that produces excess cortisol, a stress hormone. Some signs of Cushing’s disease in horses include:

Chronic Laminitis

Excess cortisol can cause laminitis, an inflammation of the laminae in the hooves that attach the coffin bone to the hoof wall. This is one of the most common symptoms of Cushing’s disease and requires immediate veterinary care.

Muscle Wasting

The excess cortisol causes muscle loss and weakness. You may notice your horse has a pot belly appearance and loss of topline muscle along the neck and back.

Abnormal Fat Distribution

Too much cortisol leads to fat deposits in abnormal areas such as behind the eyes (“moon face”), over the tail head (“rat tail”), and along the crest of the neck (“cresty neck”).

Delayed Shedding

The excess cortisol can interfere with the normal hair shedding cycle. Your horse may retain its long, thick winter coat well into summer.

Increased Thirst and Urination

The high cortisol levels can cause increased thirst, which leads to increased urination. You may need to provide your horse access to fresh, unfrozen water at all times.

Recurrent Infections

High cortisol inhibits the immune system, leaving Cushing’s horses more prone to infections. Watch for signs of respiratory disease, skin infections, and hoof abscesses which require prompt treatment.

With proper diagnosis and treatment, Cushing’s disease can be managed to provide your horse a good quality of life. Early diagnosis and treatment provide the best outcome, so contact your vet right away if you notice any symptoms.

Common Causes and Risk Factors for Equine Cushing’s


Age is the greatest risk factor for developing Cushing’s disease in horses. The average age of diagnosis is 20 to 25 years old. As horses age, the pituitary gland produces less dopamine, a neurotransmitter that inhibits the production of cortisol. With less dopamine, the pituitary gland secretes excess adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce high levels of cortisol.


Overweight or obese horses have a higher risk of developing Cushing’s disease. Excess fat tissue produces cortisol and other hormones that can exacerbate the effects of Cushing’s disease. Obese horses also have more difficulty controlling their hormone levels and blood sugar. Losing weight can help manage symptoms and slow the progression of the disease.

Reproductive Status

Intact male horses (stallions) and females (mares) are more prone to developing Cushing’s disease than geldings. Reproductive hormones, such as estrogen in mares and testosterone in stallions, influence the pituitary gland and adrenal glands. Neutering a horse may decrease hormone levels and the risk of Cushing’s, especially if performed at a younger age.

In summary, the three most significant risk factors for Cushing’s disease in horses are advanced age, obesity, and intact reproductive status. By managing these factors with weight loss, diet, exercise, and possibly neutering, owners may be able to reduce health issues from this endocrine disease, improve their horse’s quality of life, and possibly slow the progression of symptoms. With diligent care and monitoring, horses diagnosed with Cushing’s disease can live comfortably for many years.

Recognizing the Symptoms of Advanced Cushing’s

Hair Loss and Thinning Coat

As Cushing’s disease progresses in horses, you may notice significant hair loss and a thinning coat, especially over the neck, shoulders, and back. This occurs because the excess cortisol produced inhibits hair growth and stimulates hair follicles to remain in the telogen or resting phase. The coat may also appear dull and lackluster. Providing a blanket, especially in cold weather, can help keep the horse warm if hair loss is extensive.

Muscle Wasting

The catabolic effects of high cortisol levels cause loss of muscle mass, especially over the topline and hindquarters. Your horse may develop a pot belly appearance as muscle tone decreases in the abdominal area. Reduced muscle mass and tone can also lead to fat deposits over the shoulders, neck, and tailhead. Carefully monitored exercise and diet changes may help slow further muscle wasting.

Laminitis and Hoof Issues

Laminitis or inflammation of the laminae in the hoof is a common complication of Cushing’s disease. The high cortisol levels can disrupt blood flow to the hooves and stimulate insulin resistance, promoting laminitis. Careful hoof care and farrier work are essential to managing this condition. Other signs of hoof problems may include seedy toe, white line disease, and abscesses. Radiographs can check for rotation or sinking of the pedal bone within the hoof capsule.

Increased Appetite and Water Consumption

The stimulation of gluconeogenesis caused by excess cortisol often leads to an increased appetite and thirst in Cushing’s horses. You may need to carefully monitor your horse’s diet to avoid obesity while still ensuring proper nutrition. Providing access to fresh, clean water at all times is also important to avoid dehydration from the increased water consumption.

Close monitoring of your horse for these symptoms, especially as the disease progresses, can help you and your vet determine the best treatment options and management strategies. Early diagnosis and treatment provide the best prognosis for horses with Cushing’s disease.

Diagnosing Cushing’s Disease in Horses

Diagnosing Cushing’s disease in horses can be challenging and may require multiple tests to confirm an accurate diagnosis. Early detection of the disease is critical to managing symptoms and slowing progression.

Medical History and Physical Exam

Your veterinarian will first review your horse’s full medical history and perform a comprehensive physical exam. They will check for common signs of Cushing’s disease like abnormal fat distribution, muscle loss, and laminitis. Blood pressure will also be evaluated as it is often elevated in horses with Cushing’s.

Blood Tests

The two most common blood tests for Cushing’s disease are the dexamethasone suppression test and the ACTH response test. The dexamethasone suppression test measures how well the pituitary gland is functioning. In a normal horse, dexamethasone will suppress the pituitary gland and decrease cortisol levels. In a Cushing’s horse, the pituitary tumor prevents this suppression, and cortisol remains high.

The ACTH response test measures how the adrenal glands respond to adrenocorticotropic hormone (ACTH) stimulation. In Cushing’s horses, the adrenal glands become less responsive to ACTH due to chronic overstimulation from the pituitary tumor. Failure to adequately respond indicates the horse likely has Cushing’s disease.

Additional Diagnostics

Further testing such as abdominal ultrasounds, CT scans or MRIs may be recommended to visualize the pituitary gland tumor and determine its size or position. These advanced imaging techniques, though expensive, can provide valuable information about disease progression and the best course of treatment.

Early diagnosis and treatment of Cushing’s disease is critical to managing this disorder and maintaining your horse’s quality of life. By understanding the signs of Cushing’s and working closely with your veterinarian, you can get the necessary testing completed and the right treatment plan in place as quickly as possible. With proper management, horses with Cushing’s disease can live comfortably for many years.

Treatment Options for Horses With Cushing’s

Once Cushing’s disease has been diagnosed in a horse, there are several treatment options available to help manage the symptoms and slow the progression of the disease. The most common treatment is medication, typically pergolide or cyproheptadine, to help regulate cortisol levels.


Pergolide is the most commonly prescribed medication for Cushing’s disease in horses. It works by controlling the pituitary gland to regulate cortisol production. Pergolide is usually very effective at managing the symptoms of Cushing’s, including excessive thirst and urination, laminitis, and lethargy.

The dosage needs to be carefully monitored by a vet to find the right level for each horse. Frequent blood testing will be required, especially when first starting pergolide, to monitor cortisol levels and ensure the proper dosage.


For some horses, cyproheptadine may be used as an alternative to pergolide. It works in a similar way by controlling cortisol levels in the body. Cyproheptadine may cause drowsiness and irritability in some horses. It typically requires more frequent dosage adjustments and monitoring than pergolide.

However, for certain horses it may be better tolerated and effective. Your vet can determine if cyproheptadine is an appropriate treatment option based on your horse’s condition and medical history.

Supportive Care

In addition to medication, supportive care for a Cushing’s horse is very important. A proper diet, limited pasture access, and regular exercise are all necessary to help manage symptoms. Providing salt blocks, fresh water, and soaked hay cubes or pellets can encourage your horse to stay hydrated while limiting excess calories and sugar intake. Frequent hoof trimming and shoeing, especially for foundered horses, will also help provide relief from pain and support hoof health.

With proper treatment and management, the symptoms of Cushing’s disease can be controlled well for many horses. However, Cushing’s is a progressive disease, so ongoing monitoring and care will be required to keep your horse as healthy and comfortable as possible. By working closely with your vet, you can develop the best treatment plan for your horse’s individual condition.

At-Home Care Tips for Horses With Cushing’s

If your horse has been diagnosed with Cushing’s disease, there are several measures you can take to help manage the condition and keep them comfortable at home.

Daily Exercise

For Cushing’s horses, daily exercise is essential to maintaining muscle tone and preventing weight gain. Take your horse on walks, light rides, or turnout as much as possible. Exercise helps stimulate their metabolism and circulation, which can be impaired by Cushing’s. Try to exercise your horse for at least 30-60 minutes a day, 5-6 days a week.

Dietary Adjustments

An appropriate diet for a Cushing’s horse should be low in sugar and starch, as excess can exacerbate symptoms. Feed your horse a forage-based diet with grass hay and rationed concentrates. Measure out portions to avoid overfeeding, which can lead to obesity and worsen insulin resistance.

Commercial feeds formulated for Cushing’s horses, or for weight loss and maintenance, can also help ensure proper nutrition. Supplements like flaxseed oil, which is high in omega-3 fatty acids, may help reduce inflammation in the body.

Monitor Vital Signs

It is important to regularly monitor your horse for any changes in health or behavior that could indicate a complication. Check your horse’s vital signs, like temperature, pulse, and respiration at least once a week.

Watch out for signs of infections or other illnesses, which Cushing’s horses may be more susceptible to. Weigh your horse regularly to catch any significant weight loss or gain. Report any concerns about your horse’s health or behavior to your veterinarian right away.

Provide Supportive Care

There are a few measures you can take to help support your Cushing’s horse and keep them comfortable. Make sure they have access to shade and shelter, especially in hot weather. Blanket them as needed in cold weather.

Keep their hooves well-trimmed and schedule regular farrier visits, as Cushing’s can make hooves more prone to infection or laminitis. Finally, give your horse plenty of affection and mental stimulation. Spending time grooming, hand walking and doing quiet groundwork or trick training can help combat symptoms of lethargy or depression.

Following these at-home care tips, along with any medications or treatments prescribed by your vet, will help provide your Cushing’s horse the best quality of life possible. With attentive management of the condition, many Cushing’s horses can continue to lead happy and fulfilling lives for years.

Nutritional Considerations for Horses With Cushing’s

Horses with Cushing’s disease have unique nutritional requirements to properly manage the condition. As the disease progresses, nutritional adjustments will need to be made to account for changes in the horse’s metabolism and body condition.

Reduce Carbohydrates

For Cushing’s horses, reducing carbohydrate intake is essential, as excess cortisol can reduce insulin sensitivity, making it difficult for the horse to metabolize sugars and starches. Limiting grain, molasses, and treats high in sugar is recommended. Instead, forage should make up the majority of the diet. When additional calories are needed, vegetable oil, rice bran, or beet pulp can be used.

Increase Protein

As muscle mass declines in later stages of Cushing’s, additional protein is necessary. High-quality grass hay, alfalfa, and legume hays provide extra protein. Commercial senior feeds formulated for Cushing’s horses may also be used. Soybean meal and flaxseed meal are plant-based sources that can be top-dressed on feed.

Provide Constant Access to Forage

Free choice forage, grass hay, and or pasture turnout help keep the Cushing’s horse’s gastrointestinal tract moving, as motility can decrease with the disease. Forage also provides a constant source of nutrients to help prevent drops in blood glucose that could lead to laminitis. Limiting forage is not recommended for Cushing’s horses.

Use Dietary Supplements Wisely

Some supplements, such as chromium, magnesium, and vitamin E, may provide benefits for Cushing’s horses. However, supplements are not regulated and may interact with medications. It is best to only use supplements under the guidance of a veterinarian. They can evaluate if a supplement may be helpful for an individual horse’s needs and will be aware of any possible interactions with prescribed medication.

With diligent management of diet and nutrition, the symptoms and side effects of equine Cushing’s disease can be minimized, helping to maintain the horse’s condition and quality of life. Nutrition is one of the most important tools for properly caring for a horse with Cushing’s. By working closely with a veterinarian, an appropriate diet plan can be developed to meet each horse’s unique needs.

Lifestyle Changes to Help Manage Equine Cushing’s

To help manage Cushing’s disease in horses and improve your horse’s quality of life, certain lifestyle changes and management practices should be implemented.

Providing a low-stress environment is essential. Reducing stress hormones like cortisol can help mitigate Cushing’s symptoms. Keep a regular schedule for feeding, exercise, and social interaction with other horses. Limit abrupt changes to routine or housing when possible.

Exercise is important for Cushing’s horses to maintain muscle tone and mobility, but it should be moderate. Gentle exercise like light riding, lunging, or turnout is good, but avoid intense training schedules. Start slowly and build up endurance over time as your horse’s condition allows.

Dietary changes are also important. Feed a high-fiber, low-starch and low-sugar diet to prevent obesity and control blood glucose levels. Grass hays, soaked beet pulp, and ration balancers can be good options. Limit or eliminate grain and molasses. Provide constant access to clean with fresh water.

Medication Management

Follow your veterinarian’s recommendations carefully regarding medication, dosage, and frequency. Pergolide and cyproheptadine are commonly prescribed to manage Cushing’s. Have your horse’s ACTH levels retested as recommended to monitor treatment efficacy and make dosage adjustments. Never change or discontinue medication without consulting your vet.

Hoof Care

Cushing’s horses often develop laminitis, so frequent farrier visits are important. Use radiographs to monitor hoof health and make sure trimming and shoeing are supporting the coffin bone properly. Apply padding, casts or boots as needed for additional support.

By making appropriate changes to your horse’s lifestyle, environment, diet and exercise, Cushing’s disease can often be well-managed. However, due to health complications associated with Cushing’s, frequent veterinary checkups and diagnostic tests are necessary to monitor your horse’s condition and adjust treatment as needed. With time and patience, many Cushing’s horses can live comfortably with a good quality of life.


As we’ve explored, Cushing’s disease in horses is a serious condition that requires diligent monitoring and care. While the symptoms can often go unnoticed in early stages, being attentive to changes in your horse’s appearance and behavior is key for early intervention. Implementing a customized care plan that manages pain, promotes healthy hoof and coat growth, and balances nutrition is essential for providing your equine companion comfort.

Though Cushing’s has no cure, with thoughtful management of diet, exercise and medical treatment, you can greatly improve your horse’s quality of life. By staying informed and working closely with your veterinarian, you have the power to make a real difference for a horse facing this challenging diagnosis. With a commitment to compassionate daily care, you can ensure your horse lives out his senior years feeling as happy and healthy as possible.

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How do you take care of a horse with Cushing’s disease?

Care for a horse with Cushing’s disease involves medication, regular exercise, a low-sugar diet, and attentive monitoring for symptoms.

What do you feed a senior horse with Cushings?

Feed a senior horse with Cushing’s a low-sugar diet consisting of grass hay, rationed concentrates, and limited treats to manage insulin levels.

What are the symptoms of advanced Cushing’s disease in horses?

Symptoms of advanced Cushing’s disease in horses include hair loss, muscle wasting, laminitis, increased appetite and water consumption.

How long can a horse live with Cushing’s?

With proper management, horses with Cushing’s disease can live comfortably for many years, although individual prognosis varies.

What not to feed a horse with Cushing’s?

Avoid feeding horses with Cushing’s disease high-sugar and high-starch foods such as grains, sweet feeds, and sugary treats.

Can a horse recover from Cushing’s?

Cushing’s disease in horses cannot be cured, but it can be managed with medication and proper care to improve quality of life and slow disease progression.

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