Canine Hypoadrenocorticism (Addison's Disease): 10 Talking Points

Veterinary ECC Small Talk

Dogs (and cats) having a crisis as a result of hypoadrenocorticism (Addisonian crisis) can be in a life-threatening state and this represents one of the true small animal emergencies. Stabilisation of these patients starts with appropriately aggressive intravenous fluid therapy as the first priority and treatment for clinically significant hyperkalaemia and hypoglycaemia may also be needed very early on. Intravenous glucocorticoids are typically then required to continue stabilisation. In this episode I discuss ten talking points relating to canine hypoadrenocorticism, namely:

• “The Great Pretender”
• Likely Genetic Basis
• Aldosterone may be low in ‘atypical’ cases
• Hypoglycaemia may be severe
• Bradycardia is not always present and not just due to hyperkalaemia
• ACTH stimulation test provides definitive diagnosis
• Single resting plasma cortisol may be useful for screening – but limited role in emergencies?
• Intravenous fluid therapy
• Client communication and education
• Prognosis is good with appropriate management – yey!

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PAPERS that helped inspire some of the content for this episode are:

Baumstark ME, Sieber-Ruckstuhl NS, M?ller C, et al. Evaluation of Aldosterone Concentrations in Dogs with Hypoadrenocorticism. J Vet Intern Med 2014; 28:154–159. (Open access online)

Boag AM, Catchpole B. A Review of the Genetics of Hypoadrenocorticism. Topics in Companion Animal Medicine 2015 (Accepted manuscript pending publication).

Bovens C, Tennant K, Reeve J, Murphy KF. Basal Serum Cortisol Concentration as a Screening Test for Hypoadrenocorticism in Dogs. J Vet Intern Med 2014; 28:1541–1545. (Open access online)

Lennon EM, Boyle TE, Hutchins RG, et al. Use of basal serum or plasma cortisol concentrations to rule out a diagnosis of hypoadrenocorticism in dogs: 123 cases (2000–2005). J Am Vet Med Assoc 2007; 231:413–416. (Abstract)