title: Controversies surrounding critical illness-related corticosteroid insufficiency in animals.
abstract: OBJECTIVE
  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.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Low-dose hydrocortisone is the treatment of choice for patients with CIRCI.
  
  
  CONCLUSIONS
  If the patient survives the critical illness, prognosis for resolution of CIRCI and hydrocortisone dependence is very good.
authors.affiliation: Critical Consultations, Wichita Falls, Texas.
authors.forename: Jamie M Burkitt
authors.initials: JM
authors.lastname: Creedon
mesh_terms: D000305:Adrenal Cortex Hormones / Q000172:deficiency*; D000309:Adrenal Insufficiency / Q000188:drug therapy / Q000662:veterinary*; D000818:Animals; D002371:Cat Diseases / Q000188:drug therapy*; D002415:Cats; D003422:Critical Care; D016638:Critical Illness; D004283:Dog Diseases / Q000188:drug therapy*; D004285:Dogs; D004334:Drug Administration Schedule; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014730:Veterinary Medicine
chemical_list: D000305:Adrenal Cortex Hormones; D006854:Hydrocortisone
keywords: glucocorticoid; hydrocortisone; relative adrenal insufficiency; septic shock