Pituitary-adrenal function in dogs with acute critical illness.
OBJECTIVE
To evaluate pituitary-adrenal function in critically ill dogs with sepsis, severe trauma, and gastric dilatation-volvulus (GDV).


METHODS
Cohort study.


METHODS
31 ill dogs admitted to an intensive care unit (ICU) at Washington State University or the University of Pennsylvania; all dogs had acute critical illness for < 48 hours prior to admission.


METHODS
Baseline and ACTH-stimulated serum cortisol concentrations and baseline plasma ACTH concentrations were assayed for each dog within 24 hours after admission to the ICU. The change in cortisol concentrations (Delta-cortisol) was calculated for each dog. Morbidity and mortality data were recorded for each patient.


RESULTS
Overall, 17 of 31 (55%) acutely critically ill dogs had at least 1 biochemical abnormality suggestive of adrenal gland or pituitary gland insufficiency. Only 1 (3%) dog had an exaggerated response to ACTH stimulation. Dogs with Delta-cortisol < or = 83 nmol/L were 5.7 times as likely to be receiving vasopressors as were dogs with Delta-cortisol > 83 nmol/L. No differences were detected among dogs with sepsis, severe trauma, or GDV with respect to mean baseline and ACTH-stimulated serum cortisol concentrations, Delta-cortisol, and baseline plasma ACTH concentrations.


CONCLUSIONS
Biochemical abnormalities of the hypothalamic-pituitary-adrenal axis indicative of adrenal gland or pituitary gland insufficiency were common in critically ill dogs, whereas exaggerated responses to ACTH administration were uncommon. Acutely ill dogs with Delta-cortisol < or = 83 nmol/L may be more likely to require vasopressors as part of the treatment plan.
Martin
Linda G
LG
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA.
Groman
Reid P
RP
Fletcher
Daniel J
DJ
Behrend
Ellen N
EN
Kemppainen
Robert J
RJ
Moser
Valerie R
VR
Hickey
Kathy C
KC
D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000662:veterinary*; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000818:Animals; D001774:Blood Chemical Analysis / Q000662:veterinary; D015331:Cohort Studies; D016638:Critical Illness; D004283:Dog Diseases / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D004285:Dogs; D005260:Female; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D010912:Pituitary-Adrenal Function Tests / Q000379:methods / Q000662:veterinary; D010913:Pituitary-Adrenal System / Q000502:physiology*; D016019:Survival Analysis
D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone