# Nosebleeds in Dogs with Cushing's Disease A nose bleed in dogs with Cushing's usually traces back to two things: high blood pressure and changes in how the blood clots. Cushing's means your dog's body is flooded with cortisol, and that excess hormone can quietly damage blood vessels and push blood pressure up. The result can be a sudden bleed from one or both nostrils, sometimes with no obvious injury. This article is educational and is not a substitute for veterinary diagnosis or treatment. ## Quick Answer - Cushing's dogs often have a hypercoagulable state, meaning their blood clots more easily than normal, and that same process can leave vessels fragile and prone to bleeding [1][2]. - High blood pressure is a common complication of Cushing's and a leading reason for nosebleeds in these dogs. - A nosebleed in a Cushing's dog is not something to watch at home. It needs a veterinary exam, often the same day. - Bleeding that will not stop, is heavy, or comes with weakness, pale gums, or collapse is an emergency. - Good control of Cushing's, plus blood pressure monitoring, lowers the chance of repeat bleeds. ## What Is Cushing's Disease in Dogs? Cushing's syndrome is any disorder where the body has too much cortisol [3]. The most common form is pituitary-dependent hyperadrenocorticism, also called Cushing disease, which happens when a tumor in the pituitary gland makes too much ACTH and drives the adrenal glands to overproduce cortisol [4][3]. This form accounts for 80% to 85% of reported cases [3]. A less common form comes from a tumor on an adrenal gland that secretes cortisol directly [3]. Your veterinarian may use the term Cushing syndrome as an umbrella term for both, and Cushing disease for the pituitary type [4]. If you want a deeper comparison of the two forms, see [Cushings Disease in Dogs: Pituitary vs Adrenal Hyperadrenocorticism Guide](/knowledge/veterinary-medicine/internal-medicine/cushings-disease-in-dogs-pituitary-vs-adrenal-hyperadrenocorticism-guide). ## Why Cushing's Dogs Get Nosebleeds ### High Blood Pressure Cortisol excess affects the whole cardiovascular system. Over time, it can raise blood pressure, and high pressure puts stress on small, delicate vessels. The nose has a rich blood supply in a small space, so it is one of the first places a pressure problem shows up. When a vessel in the nasal lining breaks, you see blood at the nostril, on the bedding, or in a sneeze. ### Clotting Changes Cushing's does not simply make blood "thin." Research using thromboelastography, a test that measures how blood forms clots, found that dogs with naturally occurring Cushing syndrome had stronger clot formation than healthy dogs, shown by higher maximum amplitude and clot strength values [1]. Platelet counts and related platelet measures also tend to run higher in dogs with uncomplicated pituitary-dependent Cushing's, which fits with a hypercoagulable state [2]. That sounds like the opposite of a bleeding problem, and it is a real risk for clots. But the same disease also weakens vessel walls and raises blood pressure, so a fragile vessel can still rupture. In other words, the bleeding and the clotting risk can exist side by side. ### Other Causes That Still Matter Not every nosebleed in a Cushing's dog is caused by Cushing's. Older dogs can develop nasal tumors, and nasal adenocarcinoma, the most common nasal tumor in dogs, often shows up first as epistaxis (the medical word for nosebleeds), discharge, and sneezing [5]. Bleeding disorders, infections, foreign bodies, and dental disease can also cause epistaxis. A rare condition called cryoglobulinemia has been reported in a dog with epistaxis and skin lesions [6]. Your veterinarian will look at the whole picture instead of assuming Cushing's is the only cause. ## Signs Owners Notice Owners often describe a few drops of blood on the nose, a smear on a paw after rubbing, or blood-tinged sneezes. Some dogs have a steady trickle from one nostril. Others have a larger bleed that stops on its own and then returns. Watch for these related signs: - Blood on bedding, floors, or food bowls - Sneezing with blood or bloody discharge - Crusting or discoloration around the nostrils - Pale gums, weakness, or a wobbly walk - Increased thirst and urination, which are classic Cushing's signs [4][3] - A pot-bellied appearance, panting, muscle wasting, and skin or coat changes [3] If your dog is drinking and urinating far more than usual, that alone is worth a vet visit. This article explains why: [How to Tell If Your Dog's Increased Thirst Is a Sign of Cushing's Disease](/knowledge/veterinary-medicine/senior-and-chronic-care/dog-increased-thirst-cushings-disease). ## Causes and Risk Factors The main risk factor is having Cushing's at all, especially if it is not well controlled. Middle-aged and older dogs are most often affected, and the disease is diagnosed more often in certain breeds. Your veterinarian can tell you whether your dog's breed and age raise the odds. Other factors that raise bleeding risk include: - Uncontrolled high blood pressure - Kidney disease, which is common in older dogs and can affect clotting - Liver changes, since the liver makes clotting proteins - Nasal tumors or polyps [5] - Dental disease or nasal foreign bodies - Medications that affect clotting, including some pain relievers One study looked at dogs with uncomplicated pituitary-dependent Cushing's and excluded dogs with a secondary disease or blood pressure of 160 mmHg or higher [2]. That cutoff matters because hypertension is a known complication, and it is one of the things your vet will check. ## How Nosebleeds in Cushing's Dogs Are Diagnosed Your veterinarian starts with a full history and physical exam. Expect questions about how long the bleeding has lasted, which nostril, how much blood, and whether it stops on its own. ### Tests Your Vet May Run | Test | What It Looks For | |---|---| | Blood pressure measurement | Hypertension, a common Cushing's complication | | Complete blood count | Platelet count and other blood cell changes [2] | | Chemistry panel | Liver, kidney, and protein values | | Clotting tests | How well the blood clots | | ACTH stimulation test | Confirms hyperadrenocorticism [4] | | Low-dose dexamethasone suppression test | Confirms hyperadrenocorticism [4] | | Urine cortisol:creatinine ratio | Screening test for hyperadrenocorticism [4] | | Nasal imaging (CT or scope) | Tumors, foreign bodies, or structural causes [5] | Diagnosing Cushing's itself can take more than one test. Your vet may combine history, exam findings, lab work, and endocrine testing to reach a diagnosis [3]. If a nasal tumor is suspected, imaging and a biopsy may be needed [5]. ## Treatment Options Treatment has two goals: stop the current bleed and address the underlying problem. ### Stopping the Bleed For an active nosebleed, your vet may apply pressure, use cold compresses, pack the nostril, or give medications that help constrict vessels. If your dog has lost a lot of blood, supportive care such as fluids or a transfusion may be needed. Do not try to pack your dog's nose at home unless your vet walks you through it. ### Treating the Cushing's Medical treatment is the most common approach. Trilostane is one option, and a study of dogs with hyperadrenocorticism found that trilostane treatment reduced markers of oxidative stress, which is a form of cell damage caused by the disease [7]. Your veterinarian calculates the dose from your dog's weight and health, then adjusts it based on follow-up testing. Never change the dose on your own. Other options include radiation or surgery for certain cases [4]. The right choice depends on the type of Cushing's, your dog's age, and other health problems. ### Managing Blood Pressure If your dog has high blood pressure, your vet may prescribe medication to bring it down. This is often the single most helpful step for preventing repeat nosebleeds. Blood pressure should be rechecked on a schedule your vet sets. ### Watching for Clotting Risk Because Cushing's dogs can be hypercoagulable [1][2], your vet may also monitor for clot-related problems. Platelet measures such as count, plateletcrit, mean platelet volume, and platelet distribution width can be tracked over time and may guide treatment decisions [2]. Ask your vet whether these values are being followed for your dog. ## Recovery, Outlook, and Long-Term Management Most nosebleeds that are treated promptly stop, and many dogs go home the same day. The outlook depends on the cause. If high blood pressure is the trigger and it is controlled, repeat bleeds often become less frequent. If a nasal tumor is the cause, the plan shifts toward tumor-directed care [5]. Long-term management usually means: - Regular blood pressure checks - Periodic blood work, including platelet values [2] - Cushing's monitoring tests to keep treatment in the right range - Watching for behavior changes, which can signal poor control. See [Cushing Disease Dog Behavior Problems](/knowledge/veterinary-medicine/behavior/cushing-disease-dog-behavior-problems) and [Cushing Disease Dog Behavior Problems At Night](/knowledge/veterinary-medicine/behavior/cushing-disease-dog-behavior-problems-at-night). - Keeping a simple log of any bleeding episodes, including date, duration, and which nostril Some dogs need dose adjustments over time. Your vet will set the schedule, often with repeat testing every few months at first, then less often once your dog is stable. ## Prevention You cannot prevent Cushing's, but you can lower the chance that it causes a nosebleed. - Keep every monitoring appointment. Uncontrolled Cushing's is the biggest risk factor. - Ask for a blood pressure check at each visit. It is quick and painless. - Give medications exactly as prescribed, and never skip doses or double up. - Tell your vet about any new medication, including over-the-counter pain pills, before you give it. - Keep your dog at a healthy weight and manage other conditions such as kidney or dental disease. - Note any nosebleed, even a small one, and report it. A pattern is easier to treat than a crisis. ## Limitations and When to Contact a Veterinarian Veterinary research on nosebleeds specifically in Cushing's dogs is limited. Much of what we know comes from studies of clotting and platelet changes in dogs with hyperadrenocorticism [1][2], plus general knowledge about hypertension. Your dog's individual case needs a veterinarian who can examine him, measure his blood pressure, and review his lab work. **Call an emergency clinic now if:** - Bleeding is heavy, spraying, or will not stop after 5 to 10 minutes of gentle pressure - Your dog is weak, wobbly, collapsing, or has pale or white gums - Your dog is breathing hard, coughing blood, or has blood from both nostrils plus other bleeding - Your dog has a swollen, painful, or rapidly growing mass on the nose or face **Call your vet the same day if:** - A nosebleed stops but returns within hours - You see blood-tinged sneezes or discharge for more than a day - Your dog is on Cushing's treatment and has any new bleeding - Your dog seems more tired, is eating less, or is drinking much more than usual **Schedule a routine visit if:** - You have seen one small nosebleed and your dog otherwise seems fine - Your dog's Cushing's monitoring is overdue - You want to discuss blood pressure screening For general guidance on nosebleeds in dogs, see [Dog Bleeding from Nose: Emergency or Not?](/knowledge/veterinary-medicine/vet-visit-decisions/dog-bleeding-from-nose). ## Frequently Asked Questions ### Is a nosebleed in a Cushing's dog an emergency? It can be. A small bleed that stops quickly still needs a same-day call to your vet, because it may signal rising blood pressure or a clotting problem. Heavy bleeding, weakness, or pale gums is an emergency and needs immediate care. ### Can Cushing's medication cause nosebleeds? Trilostane and other Cushing's medications are not a common direct cause of nosebleeds. More often, bleeding reflects the disease itself through high blood pressure or vessel changes. If bleeding starts after a dose change, tell your vet right away so the plan can be reviewed. ### Will treating the Cushing's stop the nosebleeds? Treating Cushing's often lowers the risk over time, especially when blood pressure is also controlled. Some dogs still have occasional bleeds, and others have a separate cause such as a nasal tumor. Your vet will track the pattern and adjust the plan. ### How can I tell if my dog has high blood pressure? You usually cannot tell at home. High blood pressure in dogs often has no obvious signs until something bleeds or an organ is affected. The only reliable way to know is a blood pressure measurement at your vet's office. ### Should I stop my dog's Cushing's medication if he has a nosebleed? No. Stopping medication suddenly can cause a dangerous drop in cortisol. Call your vet, describe the bleeding, and follow the instructions you are given. Dose changes should only happen under veterinary guidance. ## The Bottom Line for Owners A nose bleed in dogs with Cushing's is a signal, not a random event. It often points to high blood pressure or vessel and clotting changes driven by too much cortisol [1][2]. Prompt veterinary care, steady Cushing's control, and regular blood pressure checks give your dog the best chance of fewer bleeds and a better quality of life. ## Related Articles - [Cushing Disease Dog Behavior Problems](/knowledge/veterinary-medicine/behavior/cushing-disease-dog-behavior-problems) - [How to Tell If Your Dog's Increased Thirst Is a Sign of Cushing's Disease](/knowledge/veterinary-medicine/senior-and-chronic-care/dog-increased-thirst-cushings-disease) - [Cushings Disease in Dogs: Pituitary vs Adrenal Hyperadrenocorticism Guide](/knowledge/veterinary-medicine/internal-medicine/cushings-disease-in-dogs-pituitary-vs-adrenal-hyperadrenocorticism-guide) - [Dog Bleeding from Nose: Emergency or Not?](/knowledge/veterinary-medicine/vet-visit-decisions/dog-bleeding-from-nose) - [Cushing Disease Dog Behavior Problems At Night](/knowledge/veterinary-medicine/behavior/cushing-disease-dog-behavior-problems-at-night) - [Dog Cushing's Disease: What to Expect from Diagnosis to Daily Management](/knowledge/veterinary-medicine/senior-and-chronic-care/dog-cushings-disease-management) ## References 1. [Comparison of coagulation patterns in dogs with Cushing syndrome and prednisolone treatment assessed by thromboelastography](https://pubmed.ncbi.nlm.nih.gov/41831398/). American journal of veterinary research, 2026. 2. [Evaluation of platelet parameters in dogs with uncomplicated pituitary-dependent hyperadrenocorticism](https://pubmed.ncbi.nlm.nih.gov/42671889/). Acta veterinaria Hungarica, 2026. 3. [Cushing Syndrome (Hyperadrenocorticism) in Animals - Endocrine System](https://www.merckvetmanual.com/endocrine-system/the-adrenal-glands/cushing-syndrome-hyperadrenocorticism-in-animals). Merck Veterinary Manual. 4. [Cushing Disease (Pituitary-Dependent Hyperadrenocorticism) in Animals - Endocrine System](https://www.merckvetmanual.com/endocrine-system/the-pituitary-gland/cushing-disease-pituitary-dependent-hyperadrenocorticism-in-animals). Merck Veterinary Manual. 5. [Complete Response to the Combination of Immunotherapy and Targeted Therapy in Stage IV Nasal Adenocarcinoma of a Dog: A Case Report](https://pubmed.ncbi.nlm.nih.gov/41772973/). Veterinary medicine and science, 2026. 6. [Cryoglobulinemia Associated With Multiple Myeloma in a Dog Presenting With Epistaxis and Skin Lesions](https://pubmed.ncbi.nlm.nih.gov/39427324/). Veterinary medicine and science, 2024. 7. [Canine Cushing syndrome elevates oxidative stress that is attenuated by trilostane](https://pubmed.ncbi.nlm.nih.gov/41043486/). American journal of veterinary research, 2025. ## Further Reading - [American Veterinary Medical Association: First Aid Tips for Pet Owners](https://www.avma.org/resources-tools/pet-owners/emergencycare/first-aid-tips-pet-owners) - [Merck Veterinary Manual: Dog Owners](https://www.merckvetmanual.com/dog-owners) - [Cornell Richard P. Riney Canine Health Center: Canine Health Information](https://www.vet.cornell.edu/departments-centers-and-institutes/riney-canine-health-center/canine-health-information)