Hi Julie,

Great question. While an elevated ALP (alkaline phosphatase) level often makes a veterinarian suspicious of Cushing’s disease, we have to rely on the history and clinical signs as well as a confirmatory test.  The ALP enzyme is what we call membrane-bound, or essentially on the surface, of the liver cells.  Many causes can exist that would increase this value.

Some of these can include liver tumours, hepatitis, toxicity/poisoning, gallbladder disease, some medications such as anti-epileptic medications, and even a few benign conditions.  Additionally, there are alternate forms called isoenzymes that are related to bone which can also cause the value to go up. Depending on what else is going on with your dog, more tests including some radiographs (x-rays) or ultrasound may be needed.  Regardless of whether your pet is showing any signs, I would recommend having it looked into further by your veterinarian.

All the best.

Dr. Ryan Llera