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Controversies surrounding critical illness‐related corticosteroid insufficiency in animals
Author(s) -
Creedon Jamie M. Burkitt
Publication year - 2014
Publication title -
journal of veterinary emergency and critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.886
H-Index - 47
eISSN - 1476-4431
pISSN - 1479-3261
DOI - 10.1111/vec.12270
Subject(s) - medicine , hydrocortisone , critical illness , corticosteroid , adrenal insufficiency , dexamethasone , critically ill , glucocorticoid , etiology , glucocorticoid receptor
Objectives To describe the controversies surrounding critical illness‐related corticosteroid insufficiency (CIRCI) and the use of hydrocortisone in critically ill patients, and to present published diagnostic and therapeutic strategies in companion veterinary species. Etiology Critical illness‐related corticosteroid insufficiency may be due to hypothalamic‐pituitary‐adrenal (HPA) axis dysfunction, alterations in cortisol‐plasma protein binding, target cell enzymatic changes, changes in glucocorticoid receptor (GR) function, or a combination of these or other factors present during critical illness. Diagnosis Appropriate tests to diagnose CIRCI are unknown. The diagnosis in people is currently based on response to treatment with hydrocortisone. There is currently no consensus on appropriate diagnostic feature(s) in veterinary species. Therapy Low‐dose hydrocortisone is the treatment of choice for patients with CIRCI. Prognosis If the patient survives the critical illness, prognosis for resolution of CIRCI and hydrocortisone dependence is very good.