Addisons disease, also called hypoadrenocorticism, is caused by a deficiency in the adrenal

glands in which they do not make the normal amount of hormones. There are two main types of
hormones that are deficient with Addisons disease: glucocorticoids and mineralocorticoids.
Glucocorticoids help to regulate numerous systems throughout the body and help the body deal
with stress. Cortisol is the main glucocorticoid in the body. Mineralocorticoids regulate sodium
and potassium in the body. Aldosterone is the main mineralocorticoid in the body. Most dogs
with Addisons disease are deficient in both glucocorticoids and mineralocorticoids, but some
dogs only have deficiencies in one of these hormones (atypical Addisons disease).

History, Symptoms, and Physical Examination

Dogs with Addisons disease can have a wide variety of symptoms, which causes Addisons
disease to be mistaken for other diseases including gastrointestinal diseases, renal failure, and
heart disease. Symptoms of Addisons disease may include:

Vomiting
Diarrhea
Decreased appetite
Lethargy, exercise intolerance, playing less, depression
Increased thirst and urination
Weight loss
Collapse
Severe weakness, unresponsiveness

Often dogs have waxing and waning symptoms. Symptoms may worsen during times of stress.
Some dogs will have mild to moderate signs and some dogs will be so sick that they will have to
be rushed to the hospital in an emergency crisis.
On physical examination, dogs with Addisons disease may have muscle wasting, generalized
weakness, slow heart rate, and poor pulses or may be fairly normal on physical examination.
Sometimes in Rottweilers, their fur will turn to a silver tone.

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Common breeds with Addisons disease include: Standard Poodle, Rottweiler, Saint Bernard,
and West Highland white terrier. Females are more likely to have Addisons disease than males.
Any age dog can have Addisons disease, but it is most often seen in middle aged dogs.

Diagnosis
A test called an ACTH stimulation test is used to diagnose Addisons disease. This test
evaluates cortisol and occasionally aldosterone levels. Dogs with Addisons disease have very
low levels of these hormones at the baseline blood draw and when blood is drawn after the
administration of the stimulatory medication.

Treatment
There are two different prongs to the treatment of Addisons disease: supplementation with
prednisone or prednisolone as glucocorticoid supplementation and DOCP or Florinef as
mineralocorticoid supplementation.
1. Glucocorticoid supplementation: This aspect of the therapy usually uses prednisone or
prednisolone, although dexamethasone can also be used. Whichever medication is used,
the medication must be every day for the rest of the dogs life. When this treatment is
first started, higher doses are used. As the dog becomes more stable, the dose of the
prednisone is slowly decreased to the dogs maintenance level. There is no blood test to
tell what the best dose is for a specific dog. Instead, we use the clinical signs your pet is
showing to help us optimize the prednisone treatment. Usually, when the dose is too
high, the dog is drinking, urinating, and eating a lot. If you notice these signs, we may
need to decrease the amount you are giving your pet each day. Usually, when the dose is
too small, the dog is more lethargic and may show signs of gastrointestinal upset
(vomiting, diarrhea, and decreased appetite). As you get used to having a dog with
Addisons disease, you will be able to sense when your dog needs to have his or her dose
increased or decreased based on what you are seeing at home. During times of stress, the
body usually makes more glucocorticoids to help the body cope with the stress.
Therefore, during stressful or exciting times, you should give twice the dose your dog
usually gets each day. If you know a stressful time is coming (for example, the 4th of
July if your dog is afraid of fireworks), you may want to increase the dose of prednisone
starting a day or two before the stressful day. After the stressful or exciting period has
passed, you can decrease back to your dogs normal daily dose.
2. Mineralocorticoid supplementation: This aspect of the therapy can be accomplished
with one of two medications, DOCP and Florinef.

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a. Florinef This is a daily oral medication to supplement your dogs with

mineralocorticoids. It is crucial that your dog receives this tablet medication
every day if this is the mineralocorticoid supplementation you elect to use. In
middle sized to larger dogs, this option may be more expensive than DOCP
injections. Also, a fraction of dogs will begin to become resistant to this
medication and, over time, the dose may need to be increased. To monitor if the
Florinef dose is optimal, we will be rechecking your dogs electrolytes (sodium
and potassium). The first recheck is usually 1 week after starting this medication.
Florinef can also provide some glucocorticoid support. Therefore some dogs who
take this medication are able to reduce the dose or completely stop supplementing
with prednisone.
b. DOCP - This medication is an injectable mineralocorticoid supplementation. The
first several doses will need to be given by a veterinarian as we determine how
frequently your dog will need to receive this medication. On average, dogs need
to receive this injection every 25 days, but some dogs need the injection more
frequently and some dogs need it less frequently. We have had one dog that
needed injections only once every 9 weeks. We recheck electrolytes frequently
during the first two doses of this medication to help us determine how frequently
your dog needs the medication to be given. We can discuss with you various
options on how frequently to give the medication based on your dogs needs and
your schedule. While the published dose of this medication is 2.2 mg/kg, we only
use this dose for small dogs. For medium and larger dogs we give all dogs 1 ml
of DOCP. Very large dogs are given 1.5 ml of the medication. Michigan State
University has been using this dosing regimen for years and is currently
publishing results of a study showing that this dosing regimen work well for most,
but not all, dogs. The MSU method of dosing is significantly less expensive in
most dogs. When DOCP is given, we recheck your dogs electrolytes 2 weeks
after giving the DOCP and then, as long as your dog is doing well, every 3 days
starting at day 22 after the injection. When the electrolytes are at the edges of the
reference range, we give the next dose of the medication.
We will be monitoring your pets electrolytes as explained above to help us determine
the best dose and frequency of mineralocorticoid supplementation.

Complications

Addisonian crisis: This is the most concerning complication of Addisons disease.

Often when a dog has a crisis, it is caused by stress of some time. This may be
environmental or emotional stress or it may be due to the fact that they got sick with
something else (such as an infection) and this caused their body to become unregulated.
An Addisonian crisis can become a life threatening situation; therefore, it is very

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important to get your dog to a veterinarian immediately if you suspect he or she is having
an Addisonian crisis. Symptoms include: vomiting, diarrhea, decreased appetite, lethargy,
collapse, weakness, stumbling, unable to get up, unresponsive, and coma. During an
Addisonian crisis, your dog may need to be hospitalized and given higher doses of
glucocorticoids as well as intravenous fluids to make sure that he or she does not become
dehydrated.
Infections, including urinary tract infections: Dogs with Addisons disease are more
prone to infections. One of the most common types of infection that Addisons disease
dogs get is urinary tract infections. Some dogs will show signs of urinary tract infections
such as frequent small volume urinations, straining to urinate, urgency in urination, and
bloody urine. Some dogs will have a urinary tract infection without any outward signs of
infection. Therefore, Addisonian dogs should have sterilely obtained (cystocentesis or
catheterized urine) urine cultures twice a year even if they are not having any signs of
urinary problems. Other types of infections can include pneumonia and skin infections
but these are not very common.

Prognosis:
With proper management, dogs with Addisons disease can have a normal lifespan and a great
quality of life. There is a risk of Addisonian crisis, though, which can be life-threatening without
speedy aggressive emergency management.

Follow-up:
Addisons disease can be treated but can never be cured. Therefore, your dog will need lifelong
treatment and will need close supervision by a veterinarian. Once you have worked with a
veterinarian to get your dog well regulated, as long as he or she is doing well, recheck
evaluations by a veterinarian should be performed at least twice a year. During these rechecks,
electrolytes (including sodium and potassium), urinalysis and urine culture should be evaluated.
Also, if your dog starts to act sick in any way, it is important that you take him or her to be
evaluated by a veterinarian. Addisonian dogs can become sick very fast so it is best to be
proactive if your dog starts to look a little off.

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