many presenting complaints. Females are overrepresented (~70% of cases), and the disease often appears in middle age (four to seven years), although any age or gender may be affected. Dogs with hypoadrenocorticism may also have one of several autoimmune disorders. Because it is an endocrine disorder, they may also have neuropathy and some endocrine-related eye diseases. Addisonian crisis If deterioration of the adrenal glands progresses far enough, a dog may experience an Addisonian crisis, an acute episode during which potassium levels increase (hyperkalemia), disrupting normal functions of the heart. Arrhythmia can result and blood pressure may drop to dangerously low levels, while the dog's kidneys may cease to function properly. Some 35% of canine Addison's cases are diagnosed as the result of an Addisonian crisis. It is a medical emergency. Whipworms Dogs with infected with the whipworm Trichuris trichiura can exhibit low sodium and high potassium values, as is seen in hypoadrenocorticism; however, their ACTH values are normal. Pacific Rim Breeds that began in the Pacific Rim, among them Akitas and Shiba Inus, tend to have higher potassium values in laboratory test, and elevated levels are not abnormal. Dogs who do not have hypoadrenocorticism have normal values on ACTH tests. Treatment Aggressiveness of therapy depends on the clinical status of the patient and the nature of the insufficiency (glucocorticoid, mineralocorticoid, or both). Many dogs and cats with primary adrenal insufficiency are presented in Addisonian crisis and require immediate, aggressive therapy. In contrast, secondary insufficiency often has a chronic course. Hypoadrenocorticism is treated with oral daily administration of fludrocortisone (trade name Florinef) or a monthly injection of desoxycorticosterone pivalate, DOCP (Percorten-V or Zycortal) and daily prednisone or prednisolone. One drug is needed to supplement mineralcortidoids and the other to supplement corticosteroids. This effectively replaces what the adrenal cortex is failing to produce. Routine blood work is necessary in the initial stages until a maintenance dose is established. Most of the medications used in the therapy of hypoadrenocorticism cause excessive thirst and urination. It is absolutely vital to provide fresh drinking water for a canine with this disorder. If the owner knows about an upcoming stressful situation (shows, traveling etc.), the animals generally need an increased dose of prednisone (2-4 times maintenance) to help deal with the added stress. Avoidance of stress is important for dogs with hypoadrenocorticism. Physical illness also stresses the body and may mean that the medication(s) need to