Canine Addison’s review highlights persistent diagnostic blind spots
Bottom line
A new review in Tierärztliche Praxis. Ausgabe K, Kleintiere/Heimtiere revisits how canine hypoadrenocorticism presents in practice and how it should be worked up diagnostically. The paper by Deborah Anna Dobosz and Astrid Wehner underscores a familiar but still consequential point: Addison’s disease in dogs remains easy to miss because signs are often vague, intermittent, and overlap with far more common GI, systemic, and emergency presentations. Across the broader literature, the ACTH stimulation test remains the diagnostic gold standard, while resting cortisol is useful mainly to rule the disease out, not confirm it. Recent guidance also emphasizes that some dogs have normal electrolytes, which can delay recognition if clinicians rely too heavily on the “classic” sodium-potassium pattern. (pubmed.ncbi.nlm.nih.gov)
Why it matters: For veterinary teams, this is a reminder that hypoadrenocorticism belongs on the differential list more often than its rarity might suggest, especially in dogs with waxing and waning GI signs, weakness, collapse, or unexplained illness without a stress leukogram. AAHA guidance notes that a baseline cortisol greater than 2 µg/dL essentially rules out hypoadrenocorticism in dogs not recently exposed to cross-reactive steroids, but a low resting cortisol still needs confirmation with ACTH stimulation testing. That distinction matters for avoiding both missed cases and overdiagnosis. (aaha.org)
What to watch: Expect continued interest in lower-friction screening approaches, including urine-based cortisol and corticoid-creatinine testing, but for now those methods appear promising rather than practice-changing. (thieme-connect.com)
Key facts
- Topic
- Canine hypoadrenocorticism, or Addison’s disease
- Article focus
- Clinical presentation and diagnostic workup
- Journal
- Tierärztliche Praxis. Ausgabe K, Kleintiere/Heimtiere
- Authors
- Deborah Anna Dobosz and Astrid Wehner
- Diagnostic gold standard
- ACTH stimulation test
- Resting cortisol use
- Useful mainly to rule out disease, not confirm it
- Screening threshold
- Baseline cortisol greater than 2 µg/dL can essentially rule out hypoadrenocorticism in dogs not recently exposed to cross-reactive steroids
- Electrolytes
- Some dogs have normal sodium and potassium values
- Common signs
- Vague, intermittent GI signs, weakness, collapse, and unexplained illness
A new review article on canine hypoadrenocorticism is putting the spotlight back on one of small animal medicine’s most persistent diagnostic traps: Addison’s disease often doesn’t look dramatic until it does. In Tierärztliche Praxis. Ausgabe K, Kleintiere/Heimtiere, Deborah Anna Dobosz and Astrid Wehner examine the clinical presentation and diagnostic approach to canine hypoadrenocorticism, a rare endocrinopathy whose early signs can be nonspecific enough to blend into everyday internal medicine and emergency caseloads. (pubmed.ncbi.nlm.nih.gov)
That framing aligns with years of published guidance describing canine hypoadrenocorticism as a “great pretender.” Reviews and guidelines consistently note that affected dogs may present with lethargy, inappetence, vomiting, diarrhea, weakness, weight loss, or episodic collapse, while more severe cases can arrive in hypovolemic shock or Addisonian crisis. Primary disease is the most common form, though clinicians also need to consider isolated glucocorticoid deficiency, secondary hypoadrenocorticism, and iatrogenic disease. (pubmed.ncbi.nlm.nih.gov)
The core diagnostic message has stayed remarkably consistent, and the new review appears to reinforce it: ACTH stimulation testing is still the gold standard. AAHA’s 2023 endocrinology guidance says the diagnosis relies on confirming cortisol deficiency with ACTH stimulation, and that a post-ACTH cortisol below the diagnostic cutoff supports hypoadrenocorticism. The same guidance stresses that a resting cortisol above 2 µg/dL can effectively rule out the disease in dogs that have not recently received interfering glucocorticoids, but a resting cortisol below that threshold is not diagnostic on its own because many dogs with low baseline cortisol do not have Addison’s disease. (aaha.org)
That nuance matters because the “classic” picture is no longer enough. AAHA notes that a sodium-to-potassium ratio below 27 can be suggestive, but sodium and potassium may remain within reference intervals in nearly one in four cases. Reviews in Canine Medicine and Genetics and other sources likewise emphasize that dogs without hallmark electrolyte abnormalities can still have hypoadrenocorticism, which helps explain why diagnosis is often delayed in atypical or early cases. Endogenous ACTH and aldosterone testing may help distinguish primary from secondary disease when presentation is less straightforward. (aaha.org)
Recent expert-facing education has largely echoed that practical approach rather than challenging it. A 2025 Today’s Veterinary Practice review states that definitive diagnosis still depends on demonstrating diminished cortisol reserve with ACTH stimulation, while also acknowledging that clinicians may reasonably pursue ACTH testing even when baseline cortisol sits just above the usual screening cutoff if suspicion remains high. That’s less a shift in protocol than a reflection of how messy real-world cases can be. (todaysveterinarypractice.com)
There are also signs that researchers are still looking for easier screening tools. At the 2026 DVG meeting, investigators reported prospective multicenter data suggesting that urine cortisol and a urine corticoid-creatinine quotient could serve as non-blood screening alternatives, with high sensitivity but limited specificity. In that study, both markers performed similarly to baseline cortisol as rule-out tools, not confirmatory tests. That’s useful signal for future workflow innovation, but it doesn’t displace ACTH stimulation in current practice. (thieme-connect.com)
Why it matters: For veterinary professionals, the value of this review is less about a brand-new algorithm and more about diagnostic discipline. Hypoadrenocorticism is uncommon, but its presentations are common: chronic GI signs, episodic malaise, weakness, dehydration, collapse, and lab work that doesn’t quite fit the degree of illness. The practical takeaway is to keep Addison’s on the list even when electrolytes are normal, use resting cortisol appropriately as an exclusion test, and move to ACTH stimulation promptly when suspicion persists. That can shorten time to diagnosis, reduce repeat visits for undifferentiated illness, and help prevent the unstable emergency presentation that many teams know too well. (aaha.org)
What to watch: The next developments are likely to come from refinement, not replacement, of current testing, especially around urine-based screening, endocrine differentiation in atypical cases, and tools that help general practice teams identify which dogs need ACTH stimulation sooner. (thieme-connect.com)