Addisonian Crisis

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Addisonian Crisis or acute hypoadrenocorticism  is an extremely serious condition where the adrenal glands (small glands situated just above the kidneys) are not producing enough hormones (glucocorticoids and/or mineralocorticoids).  Seek urgent veterinary treatment.

Symptoms include shock, collapse, extreme thirst, trembling, cardiac arrhythmias (irregular heartbeat), vomiting, abdominal pain /discomfort , black tarry stools (melaenia) & possibly a slow pulse. Urgent emergency care is required to provide intra-venous fluids in order to increase circulating blood volume.  Large amounts of IV fluids can be needed, especially if the dog has suffered from diarrhea and/or vomiting.  These symptoms can be mistaken for other conditions, for example pancreatitis.

An ACTH (adrenocorticotropic hormone) test will confirm the diagnosis & this is normally performed prior to administration of steroids. Fast acting corticosteroids such as dexamethasone & prednisone are used to improve the situation. Abnormal levels of electrolytes in the blood including potassium & sodium occur & blood sugar can drop below normal – these levels must be corrected quickly.

There are other reasons why adrenal glands fail, but in relation to AIHA/IMHA, an Addisonian Crisis can happen when corticosteroid doses (prednisone) are lowered too quickly or stopped altogether.  When dogs have been treated with prednisone for some time, careful, slow weaning is the safest way to avoid an Addisonian Crisis.  Because the adrenal glands may atrophy (or shrink) during treatment, they need  time to “wake up” & start functioning normally again.  Sometimes prednisone dosage has to be lowered more quickly than the usual protocol for various clinical reasons, so close observation of your dog is vital.

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