Lathan P & Tyler J
Canine Hypoadrenocorticism: Diagnosis and Treatment.

Compend Contin Educ Pract Vet, 27(2): 121-133, 2005
ISSN: 0193-1903 The Compendium on Continuing Education for the Practicing Veterinarian (PubMed)

Abstract
In dogs, hypoadrenocorticism is an uncommon but potentially life-threatening disease. Presumptive diagnosis is based on history, clinical signs, and laboratory findings. An adrenocorticotropic hormone stimulation test is required for definitive diagnosis. Patients most commonly have a history of waxing and waning gastrointestinal disease. A sodium:potassium ratio of less than 27:1 is consistent with hypoadrenocorticism; however, several other common diagnostic differentials should be considered. Treatment of acute hypoadrenocorticism (i.e., addisonian crisis) begins with aggressive intravenous fluid therapy to correct hypovolemia and electrolyte and acid-base abnormalities. In cases of life-threatening hyperkalemia, administering dextrose and regular insulin, calcium gluconate, or sodium bicarbonate in addition to fluid therapy may be necessary. Dexamethasone should be administered to correct glucocorticoid deficiency. Maintenance therapy includes fludrocortisone or desoxycorticosterone pivalate and prednisone. The long-term prognosis is good if a timely and accurate diagnosis is made and patients are properly treated and monitored.