Addison's disease: Beyond the classical presentation

When we asked Chen Gilor, DVM, PhD, DACVIM, for highlights from his CVC presentation on diagnosing Addison's disease, he pinned down these two pointers:

1. Don't just think about the sodium-potassium ratio-there's a lot more to Addison's disease than just the classical presentation. It's important to remember that there are lots of other presentations: Some dogs have gastrointestinal signs, some look like they have protein-losing enteropathy, and some come in with just megaesophagus.
2. Be screening for Addison's, even if your index of suspicion is not very high. You can skip ACTH stimulation testing at first and measure a baseline cortisol concentration, which is relatively quick, inexpensive and readily available. If the baseline cortisol concentration is high or high normal, it's very unlikely the dog has Addison's disease. If the concentration is low, then do an ACTH stimulation test. "You will do a lot less ACTH stimulation tests in dogs that do not have Addison's by running baseline cortisols. And you will do a lot more ACTH stimulations in dogs that do have Addison's if you run baseline cortisol," says Gilor.

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