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Senior dog with high liver enzymes, no symptoms. Treat or wait?

Updated On September 23rd, 2025

Pet's info: Dog | Labrador Retriever | Male | neutered | 12 years and 3 months old | 70 lbs

My 13 year old lab has increased liver enzymes and my vet is thinking he may have Cushings Disease. He has absolutely no symptoms and seems to be in perfect health. He does not think he needs any further testing unless he starts exhibiting symptoms. Due to his age, my vet seems to be indicating that he would not treat him at all unless he becomes symptomatic. What are your thoughts on this and what is the treatment?

3 Answers

Most Helpful Answer

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Answered By Chad Brown, DVM

Veterinarian

Published on July 19th, 2018

Hello and thank you for your interesting question. The first thing I would do is schedule another blood work up appointment to look at the liver enzymes in about two weeks after the first sample was taken. If the liver enzymes, specifically ALT, are still elevated, then there is some evidence that there’s been hepatocellular or liver disease or damage. I understand the veterinarian not wanting to test for Cushing’s disease, especially with the age and the lack of symptoms. But if the enzymes are still elevated, I would ask the vet if it would be worthwhile to start a liver protectant daily medication such as Denamarin. This medication given daily could potential he slow the damage to the liver cells and you may never exhibit clinical signs for the remainder of life and this medication has very little side effects. The other thing that you could possibly do if the liver enzymes are elevated used to start a liver protectant diet which is usually a prescription diet that is dispensed that your veterinary clinic. Again, these are two fairly easy, noninvasive ways to protect your pets liver from whatever is causing the cellular damage. I hope I’ve given you some information that helps. Have a great day.

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Other Answers

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    Answered By Dr. B. DVM, DACVIM (Oncology)

    Veterinarian

    Published on March 2nd, 2019

    The liver enzymes may have nothing to do with the adrenal gland. The next steps for evaluation of liver enzymes would be sampling of the liver (if the rest of the ultrasound is normal, no medications the animal is taking that could have caused the elevation). This could be via needle aspiration or biopsy. We usually start with aspiration first but there are some diseases of the liver that require biopsy. Labs are a breed that have a higher incidence of chronic active hepatitis +/- copper excess and biopsy is ultimately needed to diagnose this in most cases. The adrenal gland mass could be a benign adenoma, a malignant tumor called a carcinoma, or a malignant tumor called a pheochromocytoma. Additional endocrine testing would be required to help better differentiate these. A good test to rule out cushing's is called a UCCR (urine cortisol to creatinine ratio). You could talk to your vet about running this first as it just requires you to collect urine at home so is non invasive. Consultation with a veterinary internist could also be considered to help with deciding what tests to do next. I hope this helps and thank you for using Petco Pet Education Center, formerly Petcoach!

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    Answered By Kevin Sanada, DVM

    Veterinarian

    Published on October 12th, 2018

    The ACTH test is a good test for diagnosing Cushing's and may be helpful in determining if it is adrenal, or pituitary. However, if Mitch does not have any clinical signs of Cushing's, then I would seriously question the value of the test. There can be many other reasons for an elevated ALP and I would want to see other abnormalities before going down the track of diagnosing Cushing's. Cushing's is also a disease that we don't rely 100% on the lab findings. Instead, we rely on clinical signs and lab findings together to make a diagnosis. I'm not going to say that your vet is wrong to test for Cushing's, because there may be some missing information here, or a misunderstanding. I recommend discussing this with your vet again, or seeking a second opinion if you still are not convinced that the test is worthwhile. Below is a link to some good information about Cushing's, which should help you decide in the test is necessary. https://vcahospitals.com/know-your-pet/cushings-disease-in-dogs I hope that helps and all is well with Mitch.

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