Addison’s disease (hypoadrenocorticism) is the opposite of Cushing’s: the adrenal glands make too little cortisol and aldosterone, the hormones that help control salt and water balance, blood pressure and the body’s response to stress.
It’s much less common than Cushing’s, and it’s easy to miss — the signs are vague and come and go. Once it’s diagnosed, though, it’s very treatable, and most of the long-term cost comes from one monthly injection whose price depends on your dog’s weight. That’s also where a recent clinical trial offers real savings.
What It Costs
Typical US price ranges:
| Item | Typical cost |
|---|---|
| ACTH stimulation test (diagnosis) | About $150–$300 |
| Addisonian crisis, hospital treatment | About $1,500–$4,000+ |
| DOCP injection — Percorten-V (4 mL vial) | About $247 retail, roughly $62 per mL |
| DOCP injection — Zycortal (4 mL vial) | About $356 retail, roughly $89 per mL |
| Fludrocortisone tablet (alternative to DOCP) | About $0.74 per 0.1 mg tablet; larger dogs need several a day |
| Daily prednisone | Usually inexpensive |
| Stable maintenance, all in | About $80–$350 a month |
A typical year, once stable, comes to about $960–$4,200. A first year that begins with a crisis can reach roughly $2,460–$8,200 or more. Injection appointments and electrolyte rechecks are often billed separately, so ask how your clinic charges.
Why Dog Size Drives the Bill
Most dogs with Addison’s need two kinds of replacement:
- Cortisol, usually as a daily low dose of prednisone tablets — cheap.
- Aldosterone, usually as a monthly injection of DOCP (desoxycorticosterone pivalate, sold as Percorten-V or Zycortal) — the expensive part.
DOCP is dosed by body weight, at a label dose of 2.2 mg per kg about every month. At the retail prices above, the drug alone works out roughly like this:
| Dog’s weight | Label dose (2.2 mg/kg) | Low dose (1.1 mg/kg) |
|---|---|---|
| 10 kg (22 lb) | About $54–$78 a month | About $27–$39 a month |
| 30 kg (66 lb) | About $163–$235 a month | About $81–$117 a month |
| 45 kg (99 lb) | About $244–$352 a month | About $122–$176 a month |
Ranges run from Percorten-V to Zycortal prices; clinic prices and injection fees vary. Researchers at Michigan State University estimated the label-dose cost at about $475 a year for a West Highland White Terrier and $2,851 a year for a Great Dane — and about $15,585 over a Great Dane’s expected lifetime after diagnosis.
The Low-Dose Protocol
The biggest saving available is the dose itself. In a randomized, double-blinded trial (Vincent et al., 2021, Journal of Veterinary Internal Medicine), 37 newly diagnosed dogs received either the standard 2.2 mg/kg or half that, 1.1 mg/kg, every 30 days for 90 days:
- Both groups kept electrolytes controlled, and no dog developed electrolyte problems that needed treatment.
- Dogs on the full label dose were more likely to show lab signs of overtreatment, such as over-suppressed renin and lower urine concentration. Low potassium occurred at least once in 9 dogs on the standard dose and 6 on the low dose.
- The authors concluded that low-dose protocols appear safe and effective for most dogs.
For a large dog, halving the dose can save well over $1,000 a year. It isn’t a change to make on your own: the dose is adjusted from electrolyte results, usually checked about 10–14 days and about 25–30 days after an injection while the dose is being set. Ask your vet whether a lower starting dose is appropriate for your dog.
Fludrocortisone: Cheaper per Tablet, Not Always Cheaper
Some dogs are treated with fludrocortisone tablets instead of DOCP injections. Each tablet costs well under a dollar, and it replaces both hormones, but larger dogs often need several tablets a day. Whether it works out cheaper than low-dose DOCP depends on your dog’s size and response, so it’s worth asking your vet to compare the two for your dog.
The Expensive Start: Addisonian Crisis
Many dogs are first diagnosed during an Addisonian crisis — sudden severe weakness, vomiting, diarrhea and sometimes collapse. It’s a life-threatening emergency treated with IV fluids, glucose and steroids, and hospital care commonly costs $1,500–$4,000 or more.
The signs before a crisis are vague and come and go, which is why Addison’s is nicknamed “the great pretender”: lethargy, poor appetite, vomiting, diarrhea, weight loss, more drinking and urinating, trembling and weakness. If your dog has recurring “mystery” bouts of vomiting or weakness, it’s worth asking your vet whether Addison’s has been ruled out.
It’s most common in young to middle-aged dogs, and breeds including Standard Poodles, West Highland White Terriers, Bearded Collies, Great Danes, Portuguese Water Dogs, Labrador Retrievers, Rottweilers and Wheaten Terriers are over-represented.
A Link With Cushing’s Treatment
Over-treating Cushing’s disease with trilostane can suppress the adrenal glands too far and cause a form of Addison’s. That’s why dogs on trilostane have regular rechecks, and why lethargy, vomiting or loss of appetite in a dog on trilostane means stopping the drug and calling the vet. See Cushing’s Disease in Dogs: Treatment Cost.
The Outlook
There’s no cure, and treatment is lifelong. But according to Cornell’s Riney Canine Health Center, with appropriate treatment and monitoring, many dogs have an excellent prognosis and live normal lives. Untreated, the disease can be fatal.
A Note on Insurance
Accident-and-illness policies often cover Addison’s disease — diagnosis, emergency care and ongoing medication — as long as signs didn’t appear before coverage started. Because it often starts in young adult dogs, a policy taken out in puppyhood is what usually pays. A lifelong monthly injection can add up to tens of thousands of dollars for a large dog, so check annual limits.
Frequently Asked Questions
How much does it cost to treat Addison’s disease in a dog? Once a dog is stable, treatment usually costs about $80–$350 a month, or roughly $960–$4,200 a year, depending mostly on the dog’s size. The first year is higher: an ACTH stimulation test to diagnose it costs about $150–$300, and if the disease is found during an Addisonian crisis, hospital treatment typically adds $1,500–$4,000 or more.
Why is DOCP so expensive for large dogs? Because it’s dosed by body weight. The label dose is 2.2 mg per kg every month, so a 45 kg dog needs about four times as much as an 11 kg dog. At published retail prices of roughly $62 per mL for Percorten-V and $89 per mL for Zycortal, a large dog’s monthly dose can cost a few hundred dollars before the injection fee.
Is a lower DOCP dose safe? In a randomized, double-blinded trial of 37 newly diagnosed dogs (Vincent et al., 2021), half the label dose — 1.1 mg/kg every 30 days — kept electrolytes controlled in both groups, and no dog developed electrolyte problems needing treatment. Dogs on the full label dose were more likely to show lab signs of overtreatment. Any dose change should be made by your vet with electrolyte checks.
What is an Addisonian crisis? A sudden, life-threatening collapse caused by very low adrenal hormones, with signs such as severe weakness, vomiting, diarrhea and collapse. It needs emergency treatment with IV fluids, glucose and steroids. Many dogs are first diagnosed during a crisis, which is why the first-year cost can be so much higher than later years.
Can a dog live a normal life with Addison’s disease? Yes. There’s no cure and treatment is lifelong, but with appropriate treatment and monitoring, many dogs have an excellent prognosis and live normal lives, according to Cornell’s Riney Canine Health Center. Untreated, it can be fatal.
What are the signs of Addison’s disease in dogs? They’re often vague and come and go, which is why it’s nicknamed ‘the great pretender’: lethargy, poor appetite, vomiting, diarrhea, weight loss, drinking and urinating more, trembling and weakness. It’s most common in young to middle-aged dogs, and breeds such as Standard Poodles, West Highland White Terriers, Bearded Collies, Great Danes and Portuguese Water Dogs are over-represented.