Features October 2011 Issue

Detecting Addison's Disease in Your Dog

[Updated March 3, 2016]

Something’s wrong with your dog but you’re not sure what. She seems listless, her eyes have lost their spark, and she just seems “off.” You might notice intermittent muscle weakness, tremors, and an inability to jump into the car or onto a sofa. Or your dog frequently ignores her dinner, vomits, or has diarrhea. These vague symptoms, which may improve and then return, could stem from a dozen canine illnesses – or they might point to Addison’s.

Aiyana, a 3-year-old Italian Greyhound owned by Lydia Kunzler, developed Addison’s last fall, but like many dogs she was initially misdiagnosed. Aiyana is better now, but her medications still require some adjustment.

Addison’s disease, named for the 19th century physician who defined this adrenal gland dysfunction, is also known as hypoadrenocorticism or adrenal insufficiency. While fatal if left untreated, with appropriate treatment Addison’s can be managed so that affected patients lead normal, active lives. First diagnosed in dogs in the 1950s, it is considered an uncommon canine disorder. However, veterinarians who routinely test for Addison’s often find it, suggesting that the illness is not really rare but rather under-diagnosed and under-reported. You don’t find Addison’s unless you look for it. Some veterinarians speculate that Addison’s disease occurs in dogs at a rate as much as 100 times the rate in humans.

Aiyana, a three-year-old Italian Greyhound who lives with Lydia Kunzler in Northern Utah, developed symptoms when she was nine months old, but none of the several veterinarians Kunzler consulted could find the cause.

“Last fall I noticed Aiyana was starting to lose weight,” she says, “and because I had a lot of things going on I attributed her loss of appetite to stress and tried to feed her more. But a week after one of my other dogs passed away she became very sick. She was vomiting, very lethargic, and her digestive system just shut down, sometimes going days without a bowel movement. A few weeks went by, and we had to keep her on intravenous fluids or she’d get really sick again. Finally I decided to change vets. I knew all this vomiting, alternating diarrhea and constipation, and other symptoms weren’t normal.”

Aiyana’s new veterinarian immediately recognized the signs of Addison’s and did an ultrasound test, saw how small the dog’s adrenal glands were, and ordered an adrenal hormone blood test to confirm the diagnosis.

Recognizing Addison’s 

Dogs of any breed, either sex, and any age can develop Addison’s. About 70 percent of dogs with Addison’s are female, although in some breeds, including Standard Poodles and Bearded Collies, males and females are equally affected. The median age of dogs diagnosed with Addison’s disease is 4 to 6 years, but it has been reported in puppies and in dogs as old as 12.

Certain breeds may be predisposed to Addison’s, including Portuguese Water Dogs, Bearded Collies, Standard Poodles, Great Danes, Soft Coated Wheaten Terriers, Airedale Terriers, Basset Hounds, Springer Spaniels, West Highland White Terriers, Leonbergers, Labrador Retrievers, Rottweilers, Saint Bernards, Nova Scotia Duck Tolling Retrievers, German Shepherds, German Shorthaired Pointers, other Poodles, and mixes of these breeds.

Commonly reported symptoms, which can vary dramatically from dog to dog, include loss of appetite, weight loss, depression, listlessness, vomiting, diarrhea, hind-end pain, muscle weakness, tremors, shivering, increased thirst, excessive urination, a painful or sensitive abdomen, muscle or joint pain, and changes in coat, which may become thicker, thinner, longer, or even curly. About 15 to 20 percent of Addisonian dogs will have dark, tarry stools (melena, caused by gastrointestinal hemorrhage) or blood in their vomit. Symptoms often wax and wane, with the dog getting worse, then better, for months or even years.

Veterinarians examining Addison’s patients may notice mental depression, a thin or emaciated body, muscle weakness, dehydration, patches of darkened skin, a slow and weak pulse, low body temperature, low blood pressure, and pale mucous membranes. Blood tests may show any of the following: elevated potassium, low sodium, elevated BUN and creatinine, elevated liver enzymes, low glucose, high calcium, low protein (albumin and globulin), anemia, low cholesterol, and metabolic acidosis. Urine may be dilute (low specific gravity). A sodium/potassium ratio of less than 27 is strongly indicative of Addison’s, but a normal ratio does not rule it out as many veterinarians assume. A sick dog with normal or elevated lymphocytes and eosinophils (lack of a stress leukogram) can point toward Addison’s.

Addison’s disease, called “The Great Pretender,” is often misdiagnosed because it resembles so many other illnesses. Patients with Addison’s are often erroneously diagnosed as having gastrointestinal diseases such as inflammatory bowel disease (IBD), infections, parasites, cancer of the gastrointestinal tract, or poisoning. Acute renal failure, liver disease, urinary blockage, pancreatitis, insulinoma, hyperparathyroidism, and protein-losing enteropathy are other common misdiagnoses.

The ACTH response test is the definitive test for Addison’s disease. The cortisol level of a dog’s initial blood sample is measured; then the dog is injected with ACTH. An hour later, another blood sample is taken, and the cortisol level measured again. If there is little or no change in the dog’s cortisol levels after the ACTH stimulus, Addison’s is the diagnosis.

The most dramatic Addison’s symptom is the endocrine emergency called Addisonian crisis. This occurs when the dog goes into shock due to circulatory collapse, and it can happen so quickly that a healthy looking dog is suddenly, within a few hours, close to death.

In an Addisonian crisis, the lack of adrenal hormones depletes sodium levels (hyponatremia) and body fluids (hypovolemia), resulting in potassium retention (hyperkalemia), bradycardia (slow heart rate), hypotension (low blood pressure), associated cardiac arrhythmias (abnormal heart beats), and collapse. In other diseases, hypovolemia and shock cause tachycardia (rapid pulse); in Addison’s, the pulse slows. Low blood sugar levels (hypoglycemia) can cause seizures. Vomiting and diarrhea are common.

For many dog owners, the crisis is their first sign that something is wrong. About 30 to 35 percent of dogs with Addison’s are initially diagnosed during a crisis. Patients treated in time with intravenous fluid therapy and glucocorticoid steroids show such rapid improvement that it seems a miracle cure, though some have to be monitored and treated for several days before their condition stabilizes. And the cure is temporary, for without appropriate maintenance care, another crisis will follow.

As many as 90 percent of dogs in adrenal crisis will have elevated creatinine and BUN, which can lead to a misdiagnosis of acute renal failure. Dehydration and low blood pressure cause blood filtration to drop, resulting in “prerenal azotemia,” where waste products build up even though the kidney itself is functioning. Gastrointestinal bleeding can also cause increased BUN. The response to treatment is more dramatic for dogs with Addison’s disease than for those with kidney disease.

Addison’s Anatomy

The adrenals are two small glands positioned next to the kidneys. The center of each gland is called the medulla and the outer area is called the cortex.

The adrenal medulla secretes the “fight or flight” hormones: adrenaline (also called epinephrine) and noradrenaline (also called norepinephrine). These hormones are generally not affected by Addison’s disease, which affects only those secreted by the adrenal cortex: glucocorticoid and mineralocorticoid hormones. Addison’s can cause deficiencies of both types of steroid hormones.

Glucocorticoids (primarily cortisol) affect nearly every tissue in the body. They help maintain blood pressure and cardiovascular function, activate the body’s stress response, regulate metabolism and blood glucose levels, stimulate appetite, modify red and white blood cell production, and promote a general sense of well-being. Glucocorticoid levels are controlled by adrenocorticotropic hormone (ACTH), which is produced by the pituitary gland.

Mineralocorticoids (primarily aldosterone) are responsible for regulating electrolytes (sodium, potassium, and chloride) and water balance, which affects blood pressure. Electrolytes also affect nerve and muscle function, including heart rate and rhythm.

Typical Addison’s, often called primary Addison’s, is caused by adrenal dysfunction that creates both glucocorticoid and mineralocorticoid deficiencies. The adrenal glands atrophy, usually because of an autoimmune response that may be hereditary. Other possible causes include granulomatous disease, tumors, injury, prescription drug side effects, infection, or inflammation. By the time symptoms appear, an estimated 85 to 90 percent of the adrenal cortex has been destroyed. Dogs with typical Addison’s will have electrolyte imbalances, but this alone is not enough to diagnose the disease, nor can normal electrolytes rule out Addison’s disease.

In atypical Addison’s, the adrenal cortex continues to produce aldosterone but not cortisol. Patients with atypical Addison’s have normal sodium and potassium levels. Most eventually progress to typical Addison’s disease within a few months or, in some cases, years.

In secondary Addison’s, the pituitary gland no longer produces ACTH because of immune-mediated damage, inflammation, trauma, or cancer. Similar to atypical Addison’s, only cortisol production is affected, but secondary Addison’s will never progress to the typical form of the disease. Because aldosterone is still produced by the adrenal cortex, secondary Addison’s disease does not cause electrolyte imbalances.

Addison’s disease can be brought on by treatment for Cushing’s disease designed to suppress or destroy overactive adrenal glands. The antifungal medication ketoconazole is sometimes used to treat Cushing’s because it suppresses adrenal function. The sudden withdrawal of prednisone or other cortisone medications after long-term use can also trigger an Addisonian crisis.

Confirming Diagnosis

The ACTH (adrenocorticotropic hormone) response (or stimulation) test is considered definitive for Addison’s. Dogs must be off all corticosteroid hormones except dexamethasone for at least 12 to 36 hours (or more, if they’ve been on steroids for a long time) to prevent the drugs from affecting test results.

The cortisol level of an initial blood sample is measured; then the dog is injected with a form of the pituitary hormone ACTH that signals the adrenals to produce cortisol. One hour later, the blood cortisol level is measured again. In healthy dogs, cortisol levels rise, indicating a normal adrenal response. If the dog’s initial cortisol level is low and there is little or no response after ACTH stimulation, the diagnosis is Addison’s disease.

Synthetic ACTH (cosyntropin, Cortrosyn) is preferred for consistency; ACTH gels are not recommended for this test, because the results may not be accurate. An older protocol used one vial (250 mcg) of Cortrosyn for every dog, but only 5 mcg/kg is needed to achieve maximal adrenal stimulation when given intravenously. This can translate into a substantial cost saving for small dogs.

If the ACTH response test is positive and electrolytes are normal, then a separate test to measure endogenous ACTH levels can differentiate between primary and secondary Addison’s. Endogenous ACTH levels will be greatly elevated with primary Addison’s but low or undetectable with secondary Addison’s. Dogs with secondary Addison’s will never develop electrolyte abnormalities, making treatment and monitoring much less expensive.

Two situations can result in a misdiagnosis of Addison’s disease. Dogs from breeds originating around the Pacific Rim, including the Akita, Shiba Inu, and Jindo, often have elevated potassium values. This can be confused with Addison’s, particularly when symptoms are similar.

Whipworms can create a syndrome nearly identical to Addison’s, including low sodium and elevated potassium. Fecal tests for whipworms are often negative because eggs are shed infrequently.

In both cases, ACTH response tests will be normal. Always confirm a diagnosis of Addison’s disease before beginning mineralocorticoid supplementation.

Treating Addison’s

In Addisonian crisis, treatment with intravenous fluids, glucocorticoids such as dexamethasone, and sometimes glucose as well can literally save a dog’s life. Once the patient’s condition has stabilized, treatment moves to the life-long replacement of adrenal hormones, along with careful monitoring of electrolyte levels for dogs with typical Addison’s.

Glucocorticoid hormones such as prednisone, prednisolone, methyl-prednisolone (Medrol), or hydrocortisone are needed for all Addisonian dogs. For atypical and secondary Addison’s, this is the only drug prescribed. Prednisolone and methylprednisolone have been converted to a bioactive form, a process which otherwise must be done by the liver, so these may be good choices for dogs with elevated liver enzymes. Methylprednisolone and hydrocortisone may be associated with fewer side effects. Hydrocortisone is synthetic cortisol, closest to the natural form.

The starting dose is 0.1 to 0.2 mg prednisone (0.4 to 0.8 mg hydrocortisone) per pound of body weight daily. This is a physiologic dose, meant to mimic the amount of cortisol the body would produce itself if it were able. It should not cause the type of side effects associated with prednisone given at therapeutic levels for dogs with problems such as allergies or autoimmune disorders.

Many dogs do well on 0.05 mg prednisone (0.04 mg Medrol, 0.2 mg hydrocortisone) per pound of body weight daily. Even large dogs usually do not require more than 5 mg daily, except during times of stress. The dosage is best divided in half and given every 12 hours in order to keep cortisol levels more even, particularly when using hydrocortisone, which has a much shorter half-life.

Dogs with typical Addison’s also need mineralocorticoid supplementation. Two options are available: fludrocortisone acetate (Florinef) and desoxycorticosterone pivalate (DOCP, commonly known by the brand name Percorten-V).

Florinef is an oral medication that is given once a day in the morning or split into two daily doses. Missing even a single dose can be dangerous. It can be difficult to regulate dogs taking Florinef, and increases in the initial dosage are frequently required, especially during the first year, as any remaining adrenal function is lost.

Percorten-V is given by subcutaneous injection once every 25 days or so. Experts find that in addition to having fewer side effects, Percorten-V regulates electrolytes more effectively than Florinef. Dogs who have problems when taking Florinef, including excessive thirst, urination, or incontinence, may do better with Percorten-V.

Aiyana, the Italian Greyhound who was finally diagnosed with Addison’s disease, was initially treated with Florinef. “Her electrolytes wouldn’t stabilize, and she didn’t respond as expected,” says Kunzler. “My vet switched her to Percorten-V injections, which has made a lot of difference.”

Dogs on Percorten-V require glucocorticoid supplements, such as prednisone, in addition to their monthly injections. Fludrocortisone has some glucocorticoid activity, so about half of the dogs who take this medication do not require regular glucocorticoid supplements, and others may need supplements every two or three days rather than daily.

All dogs with Addison’s need additional glucocorticoids during times of stress, injury, or illness. What constitutes stress will vary from one dog to another. Stress can be physiological, such as a medical procedure, injury, or even a particularly active play session. Stress can also be emotional, such as from a move, the loss of a human or animal companion, thunderstorms, fireworks, a visit to the vet’s office, or anything that disrupts familiar routines.

Stress increases the need for glucocorticoids from two to four times the maintenance level. A dog undergoing surgery may need even more, starting with a high dose and quickly tapering back to normal during the following week. An alternative would be to give an injection of dexamethasone during surgery, followed by oral steroids after. Fluid support should always be provided for Addisonian dogs during surgery.

Monitoring Treatment

With appropriate treatment, dogs with Addison’s share an excellent prognosis, with no anticipated disease-related problems affecting their life expectancy. Dogs usually feel better within days of starting treatment, and most symptoms are gone within two to four weeks. The main challenges to life-long treatment are its expense and the effort involved in monitoring electrolyte levels, administering medication, and keeping a close eye on the patient for signs of problems.

It’s important to monitor electrolytes through regular blood tests, especially when treatment begins. With Florinef, blood tests are initially done weekly, then gradually decreased once electrolytes reach normal levels, with continued monitoring two to four times a year after the dosage has stabilized. Dogs receiving Percorten-V are tested before each injection as the dosage is tapered to the lowest level needed, and then tested at least once or twice a year thereafter. Electrolytes should also be tested whenever the dog seems “off.” Dogs with atypical Addison’s require monitoring as well, in case the disease progresses to the typical form.

Dehydration or elevated potassium is indicative that the dosage may be too low. Dehydration causes tacky gums or shoulder skin that doesn’t snap back when pinched. Elevated potassium levels may slow the heart rate – a normal pulse for large dogs ranges from 60 to 100 beats per minute, and for smaller dogs 100 to 160 beats per minute. Severe muscle weakness may be due to low potassium from a dosage that is too high. Symptom changes should be reported as soon as they occur so that medication can be adjusted.

Cortisol levels are monitored not through blood tests but by observation of behavior. The goal is to give the lowest dose of glucocorticoids needed to keep your dog symptom-free, eating well, and happy.

Symptoms such as excessive thirst and urination, ravenous appetite, panting, hair loss, muscle atrophy, elevated liver enzymes, and frequent infections are indications that the glucocorticoid dosage is too high. Lack of appetite or energy, vomiting, diarrhea, and weakness or lethargy indicate that the dosage may be too low. Similar problems may be seen with too much or too little Florinef.

Zala Bu, a five-year-old Great Dane who lives with Jenny Schultz of Denver, North Carolina, was diagnosed with Addison’s at 18 months. “Her previous family did not follow up with their vet by doing continual blood testing to monitor her progress,” says Schultz. “To add to that, their vet was not prescribing a high-enough dose of Florinef, her first medication. As a result, Zala’s health declined. She came to me as a foster dog when she was in her second crisis and her family was fed up with dealing with her illness. She was anorexic, vomited frequently, and had chronic diarrhea. She had lost 30 pounds in six months.”

Schultz changed Zala’s medication to Percorten-V, which she says is “by far our preferred choice as it keeps the dog’s electrolytes consistent throughout the month and helps get a dog back to good health much faster.

“Her life started over the day she joined my pack,” she says. “Zala has been healthy for three years now and is a very active Dane. She takes an extremely low dose of Percorten-V as a shot that I give her at home, along with 1 mg prednisone daily. She gets her electrolytes checked every two to three months at the vet’s office to make sure the medicine is working well and that her electrolytes are balanced. Zala Bu started on 2.8 ml of Percorten-V and I have tapered her down to a .9‑ml dose.”

According to Schultz, a big challenge after an Addison’s diagnosis is to find a veterinarian who is willing to fine-tune the dog’s medication. “When dogs are at their lowest effective dose, they feel their best,” she says. “There are still many vets who don’t know how to treat this disease. As a result, dogs in their care are not as healthy as they could be.”

If problems continue after electrolytes are stabilized and the appropriate glucocorticoid dose is determined, consider other concurrent causes, such as liver disease, spay incontinence, or gastrointestinal disease. Dogs with Addison’s may be particularly prone to other autoimmune diseases such as hypothyroidism.

Jenn, a chocolate Labrador Retriever belonging to Margaret Daunt of Modena, New York, developed typical Addison’s 10 years ago at age 4. One year later she was diagnosed with hypothyroidism. At age 13 she survived bloat (“I believe quick action on my part saved her life,” says Daunt), and earlier this year, she was diagnosed with the tick-borne disease ehrlichiosis.

“Jenn has led an active life,” says Daunt. “She competed in agility, trained in obedience, and even dabbled in drug detection work. Now that she has recovered from ehrlichiosis, 14-year-old Jenn is back to her old self!”

It’s important to be alert, as Daunt was, to all symptoms. Don’t assume that every time your dog doesn’t feel well it must be due to Addison’s disease. Addison’s dogs develop illnesses just as other dogs do. If an Addison’s dog is sick from something else, her prednisone dosage may need to be increased temporarily.

The Cost Factor

To make Addison’s treatment affordable, many caregivers purchase compounded fludrocortisone from a compounding pharmacy. “The compounded version is much more cost-effective for larger dogs than brand-name Florinef,” says Schultz, who participates in online forums for canine Addison’s. Most dogs who receive Percorten-V injections and about half of those who take Florinef require a small daily oral dose of inexpensive prednisone as well.

The online Addison’s groups share information about the disease and suggestions for reducing costs. “Our FaceBook and Yahoo groups help people understand lab test results and talk to their veterinarians about adjusting medications,” says Schultz. “We also help people find lower-cost options for treating their pets. In some cases owners were able to keep their pets when they couldn’t afford the prices their vets were charging. One single mom was paying $300 per month for her Great Dane’s shots until she switched to compounded medications that cost only $30 per month. Two years later, her Dane is still with her and doing well.”

Other money-saving strategies include giving shots at home to avoid having to pay for an office visit for each injection, purchasing medications online at a discount with the help of veterinarians willing to write the necessary prescriptions, or negotiating with veterinarians to keep office visit costs to a minimum. Schultz estimates her monthly expenses at $35 for Percorten-V and another $25 for electrolyte tests. “We test Zala Bu every other month now because we’re adjusting her dose downward,” she says. “She is small for a Dane, weighing in at 102 pounds. I get a large script for prednisone filled at a pharmacy for $4. Zala Bu is the poster child for low-dose effectiveness in big dogs.”

Elizabeth Andrews of Pleasantville, Nova Scotia, Canada, joined the online AddisonDogs Yahoo group in 2006, when Raider, her 75-pound Labrador Retriever, was diagnosed with typical Addison’s. Raider is now six years old and thriving, and Andrews is a list moderator. “The AddisonDogs group was founded in 2002 and currently has 4,594 members,” she says. “We also run a 501(c)(3) non-profit organization called AddisonDogs to educate and support the companion animal community about this condition, and the AddisonDogs website helps re-home dogs with Addison’s disease and assists with vet bills and other expenses. I am also the owner of a new FaceBook Group, ‘Addison’s Disease in Dogs,’ which has 559 members and is growing daily.”

Andrews explains that in the U.S., brand-name Florinef costs about $1 per 0.1-mg tablet, and the minimum starting dose is 0.1 mg per 10 pounds of body weight with dogs normally needing two to three times the starting dose. In Canada, Florinef costs about 27 cents per tablet when purchased at a drugstore. Florinef can also be purchased in the U.S. from compounding pharmacies, which reduces the total monthly cost regardless of dose to about $30.

Percorten-V purchased online costs $150 to $190 per vial depending on the supplier. “Most AddisonDogs members buy it for $150 from the online pharmacy 1-800-PetMeds,” says Andrews, “because that company price-matches the lowest price online. However, many veterinarians in the U.S. refuse to give their clients a prescription for Percorten-V, arguing that the drug sold online may be counterfeit. A few vets will price-match. Veterinarians pay approximately $130 U.S. for a 4-ml (100-mg) multi-use vial directly from the manufacturer, Novartis, but this life-saving drug often has a high retail markup.”

The typical starting dose of Percorten‑V is 1 mg per pound of body weight. Dr. David Bruyette, DVM, DACVIM, of VCA West Los Angeles Animal Hospital and an internal medicine specialist with an emphasis on Addison’s disease, prefers to start large dogs (over 60 pounds) at half that amount, because their metabolism is slower. He points out that electrolytes should be measured more frequently when using a lower starting dose; he recommends checking at two, three, and four weeks after the first injection.

Julia Bates, DVM, of Veterinary Specialty & Emergency Care in Madison, Wisconsin, is a veterinary internist whose research during her residency involved the use of low-dose Percorten-V in the management of Addisons disease. She routinely treats dogs diagnosed with Addison’s disease with a low dose of Percorten-V. In her experience, the majority of those dogs do very well.

Ideally, the dose is gradually tapered down until the lowest effective dose is found. “We know that lowering the dose works,” says Andrews, “as many in our Yahoo group have been doing so for over five years.”

As mentioned, dogs should be monitored while their drug dosages are being adjusted. “With Percorten-V, blood electrolytes should be tested at day 14 and then at day 25,” says Andrews. “The day-14 electrolytes show how well the Percorten-V is working, and the day-25 electrolytes show whether the dog will be ready at day 28 for more Percorten-V and whether the dose can be reduced. It is very common for a dog not to be ready for more during the first few months. Giving more Percorten-V before the dog is ready just drives potassium levels down. By waiting for potassium levels to rise and then reducing the dose, you ‘balance’ the electrolytes. Once the lowest effective dose has been found, you can test electrolytes every six months or whenever the dog’s behavior or symptoms seem different.”

Adjusting patients to Florinef requires much closer monitoring of electrolyte levels. “It’s important to test weekly until they stabilize,” says Andrews. “Most dogs need their dose increased frequently over the first few weeks and months. Once you find a dose that maintains stable electrolytes for a few weeks, you can move to biweekly testing and then monthly tests. After an effective dose has been found, testing every three months is recommended for life. Of course not everyone does this, and those who don’t generally end up having a dog go into crisis.”

Living the Good Life

All the experts agree that a properly treated dog can live a normal, happy, healthy life despite Addison’s disease.

“Since stress can be an issue for dogs with Addison’s,” says Jenny Schultz, “caregivers may have to cut back on stressful activities depending on their dogs’ temperament. My Great Dane used to make therapy dog visits to a nursing home. She enjoyed the activity and it didn’t seem to stress her too much. A little extra prednisone as a boost and a good nap was all she needed to continue on with her day. She is by far the most active dog in our pack. Some dogs with Addison’s continue to compete in agility and obedience events with no problem after their condition has been stabilized.”

In her book Addison’s Disease in Dogs, Stephanie Kenrose describes the importance of long-term stress management and supplying extra prednisone whenever an Addison’s dog is stressed by injury, trauma, illness, or other events. She also discusses the stress created by annual vaccinations and heartworm prevention medications, noting that titer tests can be used to monitor immunity to common canine illnesses, and decisions about heartworm prevention depend on one’s location as well as the dog’s condition. “You’ll want to discuss these risk factors with your veterinarian,” she says, “so that you can decide whether it’s worth giving these medicines to your Addison’s dog.”

After eight months of treatment, Aiyana, the Italian Greyhound, is doing much better. “She was spayed just three weeks ago,” says Lydia Kunzler, “which caused her Addison’s to flare and her electrolytes to go a bit off again, but she was much easier to stabilize this time. The blood work we took last Wednesday was the best it’s been since she was first tested!

“She still struggles with muscle weakness especially in her rear from time to time, and she needs a little extra prednisone some days, but getting her spayed so those hormones weren’t complicating things seems to have made a big difference. I’ve also stopped feeding any dry food, per my vet’s advice, as we were having a hard time maintaining her hydration levels. She mainly eats raw now, or canned food if I’m going to be traveling, and I feed her three to four small meals a day instead of two big meals to make it easier on her GI system.”

Caring for a dog with Addison’s disease can seem overwhelming at first, both financially and emotionally. But properly treated, your Addisonian dog can live just as long and just as well as her disease-free counterparts.

Freelance writer CJ Puotinen lives in Montana. She is the author of The Encyclopedia of Natural Pet Care and other books and a frequent contributor to WDJ.

Mary Straus is the owner of DogAware.com. She and her Norwich Terrier, Ella, live in the San Francisco Bay Area.

Comments (11)

My miniature male poodle was diagnosed with Addison's Disease when he was 9 yrs old after being anorexic, vomiting, diarrhea. For 2 yrs he was on 1mg florinef and .25 mg prednisone daily, also sprinkling salt on his food. He returned to great health immediately - playful, happy, loving his food. This year he had 3 episodes of anorexia, etc. and his electrolytes were tested and the florinef was increased. This week, the 3rd episode ... but this time his electrolytes are good. he has lost 2 lbs. since the last time on June 2014. This time, I just "felt" there was something very wrong when I looked into his eyes and observed his body language. Vet did a full checkup but regular heartbeat, lungs, no lumps, etc. so Vet did a complete blood chemistry yesterday. He has a .8 liver count. Terminal liver cancer, almost no functioning of the liver, nothing can be done -- too far gone. It is secondary liver cancer, from an inner anal cyst that was benign for 2 years. When checked in June 2014, it was still benign. Now, his sleeping beside me, on Tramadol for pain, continuing florinef and prednisone, and also has anti-nausea medication. Because he won't eat ANYTHING, I have to put the pills at the back of his tongue and hold his mouth shut until he swallows. Heartrending! Yesterday, vet injected saline solution, pain med. & anti-nausea. If he doesn't eat anything by Monday, no choice but to euthanize. This is so quick. He can't eat anything at all since Tuesday this week; now, can't drink water this morning. He is not in pain because of the pain killers and is just weak and mostly sleeping. All that is left to do is hold him, tell him he's a good boy, and let him go to sleep pain-free. In hindsight, we probably should have checked further than Addison's when he had his 2nd episode in June this year. Maybe he could have been helped. Anyways, I just wanted you to be aware that Addison's can be controlled, with a great quality of life, but ... when/if episodes of anorexia, etc. recur too often, get a full chemistry done. It seems that cancer, at least this cancer of the liver, can have the same symptoms. I'm heartbroken but determined that he will leave this life without pain. Good luck to everyone who has an Addison's dog. It is a hard thing to deal with, but yes, there is a happy life once the meds dosage are right. BUT please, don't forget to insist on further investigation if the episodes increase too often.

Posted by: Tiger | October 17, 2014 6:02 AM    Report this comment

My miniature male poodle was diagnosed with Addison's Disease when he was 9 yrs old after being anorexic, vomiting, diarrhea. For 2 yrs he was on 1mg florinef and .25 mg prednisone daily, also sprinkling salt on his food. He returned to great health immediately - playful, happy, loving his food. This year he had 3 episodes of anorexia, etc. and his electrolytes were tested and the florinef was increased. This week, the 3rd episode ... but this time his electrolytes are good. he has lost 2 lbs. since the last time on June 2014. This time, I just "felt" there was something very wrong when I looked into his eyes and observed his body language. Vet did a full checkup but regular heartbeat, lungs, no lumps, etc. so Vet did a complete blood chemistry yesterday. He has a .8 liver count. Terminal liver cancer, almost no functioning of the liver, nothing can be done -- too far gone. It is secondary liver cancer, from an inner anal cyst that was benign for 2 years. When checked in June 2014, it was still benign. Now, his sleeping beside me, on Tramadol for pain, continuing florinef and prednisone, and also has anti-nausea medication. Because he won't eat ANYTHING, I have to put the pills at the back of his tongue and hold his mouth shut until he swallows. Heartrending! Yesterday, vet injected saline solution, pain med. & anti-nausea. If he doesn't eat anything by Monday, no choice but to euthanize. This is so quick. He can't eat anything at all since Tuesday this week; now, can't drink water this morning. He is not in pain because of the pain killers and is just weak and mostly sleeping. All that is left to do is hold him, tell him he's a good boy, and let him go to sleep pain-free. In hindsight, we probably should have checked further than Addison's when he had his 2nd episode in June this year. Maybe he could have been helped. Anyways, I just wanted you to be aware that Addison's can be controlled, with a great quality of life, but ... when/if episodes of anorexia, etc. recur too often, get a full chemistry done. It seems that cancer, at least this cancer of the liver, can have the same symptoms. I'm heartbroken but determined that he will leave this life without pain. Good luck to everyone who has an Addison's dog. It is a hard thing to deal with, but yes, there is a happy life once the meds dosage are right. BUT please, don't forget to insist on further investigation if the episodes increase too often.

Posted by: Tiger | October 17, 2014 5:58 AM    Report this comment

My 10 year old standard poodle was diagnosed with Addison's after he survived an auto immune disorder triggered by an antibiotic from the vet. He had 2 blood transfusions and was in the ICU for a week. He survived and is now on 10mg prednisone daily. He eats, drinks, urinates and seems happy in himself but he is lethargic and has no energy. Just did a blood test that showed everything was normal except his red cell count is low. Just had a CBC test and waiting the results to check his red cell count to see if the auto immune has been triggered. I was told that too much prednisone affects the weakness in the legs and stamina. Reading this article, my dog at 88lbs may be getting too much? Can anyone help clarify or help me.

Posted by: Kanga | September 26, 2014 12:37 PM    Report this comment

My 10 year old standard poodle was diagnosed with Addison's after he survived an auto immune disorder triggered by an antibiotic from the vet. He had 2 blood transfusions and was in the ICU for a week. He survived and is now on 10mg prednisone daily. He eats, drinks, urinates and seems happy in himself but he is lethargic and has no energy. Just did a blood test that showed everything was normal except his red cell count is low. Just had a CBC test and waiting the results to check his red cell count to see if the auto immune has been triggered. I was told that too much prednisone affects the weakness in the legs and stamina. Reading this article, my dog at 88lbs may be getting too much? Can anyone help clarify or help me.

Posted by: Kanga | September 26, 2014 12:36 PM    Report this comment

Check out group for dogs with Addison's Disease on Facebook--Addison's Disease in Dogs. Great group with experts in low dosing of the medicines. A group on Yahoo too. Check it out. You will be glad you did!

Posted by: Judy J | January 9, 2014 4:07 PM    Report this comment

My 2 yr old Standard Poodle just diagnosed with Addison's. It was so hard to find a diagnosis, we went to our bush property and she went for a wander and would normally only go to the river or hang around with our other standard, she went out onto the highway and luckily we found her and called her back in. Then a very sick dog, no appetite, collapse in hindsight all the classic symptoms of addison's but we thought she must have been bitten by a snake, picked up a poison etc Vet checked for all types of toxin's, she was on a drip for 11 days, testing for everything. Vet noticed she responded really well when he gave her electrolytes or steroids but then fail again the next day. He then tested for Addison's and we had an answer. She is still very weak but on injections & tablets. She was a very active standard - running flat out and loved to swim. Can I expect her to ever get back to full fitness? I am scared to exert her and my other dog is very bored without our daily morning 5km walk or afternoon swims. Can't take one and leave the other behind. How long will it take before she is literately up & running again?

Posted by: Unknown | December 6, 2013 7:27 PM    Report this comment

Hi my four year old female Boerboel has just been diagnosed with Addisons, I was due to have a litter from her next season, could this be harmful now with this condition?

Posted by: Unknown | August 24, 2013 3:12 PM    Report this comment

My mini bull terrier Finn was diagnosed with Addison's around 3 years ago. At first they said he had liver failure. I had already been doing research on my own and his symptoms weren't conducive to liver failure so I took him for a second opinion. My new vet was relentless is finding the diagnosis. Unfortunately shortly after diagnosis, he was bit by a baby copperhead which made getting on track and better twice as hard. Through the unwavering dedication of my vet an myself he was nursed back to health. He takes .9cc of Percorten injections every 25 days. Prednisone barely, more just as needed. This article was great to read. I just recently posted the letter Fiona Apple wrote to her fans when she had to cancel her tour to go home and be with her dog, who was older and about to pass, who also lived with Addison's til 14 years old. Thank you for writing this.

Posted by: Unknown | August 6, 2013 6:46 AM    Report this comment

My Standard Poodle, 1.5 year female, got bit 3 months ago. While at the vet to get stitched up she was given a saditive and that caused a huge reaction, she had diaeriha all over the floor almost immediately. Since than she has never been the same, mostly diaherra or very loose stools. She has been on animal digest, low residual food and flagel twice a day since, not much improvement. She also seems more nervous now. Her energy level is good but has lost 4 lbs in the last month. We haven't done the addisons test yet but I suspect it and suppose we should do it ASAP.

Posted by: Unknown | August 15, 2012 10:03 PM    Report this comment

Thank you for getting the word out on K9 Addison's. The Yahoo K9 Addison's support group was instrumental in helping me manage Duke's (80# Lab-Sheppard X) Addison's. He was diagnosed while in crisis. Fortunately, our Vet had some experience w/ Addison's and confirmed w/ test. He's been on Fludrocortisone (purchased from compounding pharmacy on-line) for 3 yrs now. It took a year to find his "sweet spot". He only gets prednisone (just a quarter tab) in advance of situations like July 4th fireworks because Flud has some prednisone in it naturally. Duke is a picture of health, and cost can be managed. Work with a knowledgeable vet, communicate your concerns with the Addison's support group, and don't be afraid to share your opinion with your Vet and be the voice of your animal. I elected to take the advice of my extremely knowledgeable moderators from Yahoo support group, and had to insist with my vet to move to, in my case a higher dosesage, than what his "book" recommended. But it worked--in Addison's--"it takes what it takes".

Posted by: Linda D | October 27, 2011 9:04 AM    Report this comment

Thank you for a great article on Addison's disease. I received this issue four days too late for my 5-year-old Bichon, Shasta, who I had put to sleep on Tuesday for liver failure. She was one of those pups that always had a medical problem. Reading this article and articles about liver failure put many of her problems into perspective; and, possibly treatable. I wish the vet had put together her recurring bouts of diarrhea, vomiting, and then finally bloody diarrhea in March, and had started looking for a cause. When she got sick last week with a high fever, vomiting, and diarrhea; again, they treated her for the symptoms not for an underlying problem. I definitely will push harder at the vet's office in the future to find a problem early before it reaches a point of no return.

Posted by: Viki N | October 2, 2011 11:47 AM    Report this comment

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