be adjusted during this time. Most dogs with hypoadrenocorticism have an excellent prognosis after proper stabilization and treatment. Addisonian crisis Treatment is directed towards (1) correcting hypotension, hypovolemia, electrolyte imbalances, and metabolic acidosis; (2) improving vascular integrity, and (3) providing an immediate source of glucocorticoids. Rapid correction of hypovolemia is the first priority. Restoring blood volume is vital to correcting hypotension, hypovolemia, and addressing electrolyte and metabolic imbalances. This is achieved by the rapid administration of fluids. This helps to correct hyponatremia, restore perfusion to organs, and reduce hyperkalemia through increased GFR and dilution effects. Further treatment of hyperkalemia is addressed if necessary. Often, the fluid therapy can sufficiently address hyperkalemia, but in the presence of significant cardiac abnormalities, the addition of calcium gluconate may be necessary in addition to glucose, insulin, or bicarb to promote intracellular shift of potassium. Most patients show dramatic improvement within 24 to 48 hours of appropriate fluid and glucocorticoid therapy. Over the ensuing 2 to 4 days, a gradual transition from IV fluids to oral water and food is undertaken, and maintenance mineralocorticoid and glucocorticoid therapy is initiated. Failure to make this transition smoothly should raise suspicion of insufficient glucocorticoid supplementation, concurrent endocrinopathy (e.g. hypothyroidism), or concurrent illness (especially renal damage). It is important that after the crisis is corrected that the patient is put on a maintenance therapy of corticosteroids and mineralocorticoids. Epidemiology Hypoadrenocorticism is typically a disease of young to middle-aged female dogs, although Standard Poodles and Bearded Collies of both sexes are prone to the condition. Hypoadrenocorticism is an inherited disease in the following breeds (and therefore a higher proportion of dogs within these breeds are affected, compared to other breeds): Bearded Collie Nova Scotia Duck Tolling Retriever Portuguese Water Dog Standard Poodle Some breeds are at increased risk of hypoadrenocorticism: Airedale Terrier Basset Hound Bearded Collie Great Dane Rottweiler Springer Spaniels: English Springer Spaniel and Welsh Springer Spaniel Saint Bernard Soft-Coated Wheaten Terrier West Highland white terrier Some breeds have a reduced risk of hypoadrenocorticism: Boxer Cocker Spaniel Golden Retriever Pit Bull Terrier Lhasa Apso Yorkshire Terrier History The first case of hypoadrenocorticism in dogs was recorded in 1953, over 100 years after it was described in humans by Thomas Addison. References Dog diseases