Relative Adrenal Insufficiency in Dogs with Sepsis

Burkitt, Jamie M.; Haskins, Steve C.; Nelson, Richard W.; Kass, Philip H.

doi:10.1111/j.1939-1676.2007.tb02953.x

Cited by 64 publications

(69 citation statements)

References 42 publications

(50 reference statements)

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“…As in humans and dogs, 4,46 an impaired cortisol response to a supraphysiologic dose (100 mg) of exogenous ACTH was significantly correlated with an increased incidence of MODS and shock in hospitalized foals, and with decreased survival in septic foals. Thus, these findings suggest that lack of an appropriate cortisol response to a supraphysiologic 100 mg dose of exogenous ACTH may identify critically ill foals with concurrent HPA axis dysfunction, even if basal cortisol concentrations are appropriately increased.…”

Section: Discussionmentioning

confidence: 94%

Hypothalamic‐Pituitary‐Adrenal Axis Dysfunction in Hospitalized Neonatal Foals

Hart

Slovis

Barton

2009

Veterinary Internal Medicne

124

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Background: Transient hypothalamic-pituitary-adrenal (HPA) axis dysfunction occurs frequently in critically ill humans and impacts survival. The prevalence and impact of HPA axis dysfunction in critically ill neonatal foals are not well characterized.Hypotheses: (1) HPA axis dysfunction occurs in hospitalized neonatal foals, and is characterized by inappropriately low basal serum cortisol concentration or inadequate cortisol response to exogenous adrenocorticotropic hormone (ACTH); (2) hospitalized foals with HPA axis dysfunction have more severe disease and are less likely to survive than hospitalized foals with normal HPA axis function.Animals: Seventy-two hospitalized foals and 23 healthy age-matched foals. Methods: Basal ACTH and cortisol concentrations were measured and a paired low-dose (10 mg)/high-dose (100 mg) cosyntropin stimulation test was performed at admission in hospitalized foals. HPA axis dysfunction was defined as (1) an inappropriately low basal cortisol concentration or (2) an inadequate increase in cortisol concentration (delta cortisol) after administration of cosyntropin, with cut-off values for appropriate basal and delta cortisol concentrations determined from results obtained in healthy age-matched foals.Results: Forty-six percent of hospitalized foals had an inappropriately low basal cortisol concentration and 52% had an inadequate delta cortisol concentration after administration of the 100 mg dose of cosyntropin. An inadequate delta cortisol response to the high (100 mg) dose of cosyntropin was significantly correlated with shock and multiple organ dysfunction syndrome in hospitalized foals, and with decreased survival in a subgroup of septic foals.Conclusions and Clinical Importance: HPA axis dysfunction occurs frequently in hospitalized neonatal foals, and negatively impacts disease severity and survival.

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Section: Discussionmentioning

confidence: 94%

Hypothalamic‐Pituitary‐Adrenal Axis Dysfunction in Hospitalized Neonatal Foals

Hart

Slovis

Barton

2009

Veterinary Internal Medicne

124

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“…The mechanism leading to relative adrenal insufficiency is not known. Most observations of this condition have been made in human beings; however, it has also been described in dogs (Burkitt et al, 2007). We are not aware of any comparable studies in wildlife or in wildlife surrogates, such as ranch mink.…”

Section: Discussionmentioning

confidence: 97%

Fuel Oil–induced Adrenal Hypertrophy in Ranch Mink (Mustela Vison): Effects of Sex, Fuel Oil Weathering, and Response to Adrenocorticotropic Hormone

Mohr

Lasley

Bursian

2010

Journal of Wildlife Diseases

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ABSTRACT:Environmental contamination by petroleum hydrocarbons from anthropogenic sources can be a cause of stress for free-ranging wildlife. The response of wildlife to chemical contaminants requires that the hypothalamic-pituitary-adrenal (HPA) axis be precisely regulated to allow for proper glucocorticoid-mediated adaptive responses. Chronic oral exposure to low concentrations of bunker C fuel oil causes the development of adrenal hypertrophy in male ranch mink (Mustela vison) without increasing serum or fecal glucocorticoid concentrations. This hypertrophy is an adaptive response to fuel oil-induced adrenal insufficiency. To determine if the same phenomenon occurs in female mink or male mink exposed to artificially weathered fuel oil, female mink were fed 0 ppm (mineral oil) or 420 ppm fuel oil and male mink were exposed to 0 ppm, 420 ppm fuel oil, or 480 ppm artificially weathered fuel oil in the diet for 60-62 days. At the end of the exposure, serum glucocorticoid concentrations were assayed along with body and organ weight measurements. Fecal glucocorticoid concentrations were assayed at time points throughout the exposure. Male mink fed fuel oil or weathered fuel oil and female mink fed fuel oil had adrenal enlargement without any significant increases in the serum or fecal concentration of glucocorticoids, which is consistent with fuel oil-induced adrenal insufficiency. To address the physiological consequences of adrenal insufficiency, fuel oil-exposed male mink were administered an adrenocorticotropic hormone (ACTH) stimulation test. Fuel oil-exposed animals had a smaller incremental increase in serum glucocorticoid concentration after ACTH challenge compared to control animals. Our findings provide further evidence that the HPA axis of fuel oilexposed animals is compromised and, therefore, not able to respond appropriately to the diverse stressors found in the environment.

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“…Our findings demonstrate that delta cortisol concentrations cannot be used as an isolated parameter when evaluating the ''reserve'' of the adrenal gland in acute canine illness. We would therefore argue that studies which ignored the basal cortisol concentrations when according patients the status of ''relative adrenal insufficiency'', should be viewed with caution (Burkitt et al, 2007). After many years of negating this fact and not taking basal cortisol concentrations into account when determining adrenal status, a recent publication in human critical care has shown that non-surviving patients had a lower delta cortisol than survivors.…”

Section: Discussionmentioning

confidence: 99%

“…The dearth of information on ACTH-stimulated and delta cortisol concentrations in canine critical illness has been highlighted in a recent review (Martin and Groman, 2004). A more recent study purported to document relative adrenal insufficiency in a group of critically ill septic dogs based on a dichotomized delta cortisol cutoff of 83 nmol/l (Burkitt et al, 2007). However, this study did not report the basal cortisol in non-survivors versus survivors and found no association between survival and delta cortisol when it was assessed as a continuous, non-dichotomized variable.…”

Section: Introductionmentioning

confidence: 99%

Adrenal response to the low dose ACTH stimulation test and the cortisol-to-adrenocorticotrophic hormone ratio in canine babesiosis

Schoeman

Herrtage

2008

Veterinary Parasitology

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This prospective, interventional, case-controlled study sought to determine the association between adrenocortical function and mortality in dogs with naturally occurring Babesia rossi babesiosis. Sixty-eight dogs with canine babesiosis were studied and fifteen normal dogs were used as controls. Blood samples were obtained from the jugular vein in each dog prior to treatment, at admission to hospital, for the measurement of basal plasma ACTH (adrenocorticotrophic hormone) and serum cortisol concentrations. Immediately thereafter, each dog was injected intravenously with 5 g/kg of ACTH (tetracosactrin). A second blood sample was taken 1 h later for serum ACTH-stimulated cortisol measurement and the resultant calculation of delta cortisol by subtracting basal from ACTH-stimulated cortisol. Diagnosis of babesiosis was confirmed by polymerase chain reaction (PCR) and reverse line blot (RLB). Three outcomes were defined: hospitalization with subsequent death (n = 4); hospitalization followed by recovery (n = 48); and treatment as an outpatient (n = 16). Basal cortisol, but not ACTH-stimulated cortisol, was significantly higher in patients compared to control dogs. Basal-and ACTH-stimulated serum cortisol concentrations were significantly higher in the dogs that died, compared to hospitalized dogs that survived and compared to dogs treated as outpatients. There was no significant difference in delta cortisol concentrations or cortisol to ACTH ratios across outcome groups in dogs suffering from B. rossi babesiosis However, dogs with delta cortisol concentrations below 83 nmol/l had significantly higher cortisol to ACTH ratios compared to dogs with delta cortisol concentrations above 83 nmol/l. These findings of increased basal-and ACTH-stimulated cortisol and increased cortisol to ACTH ratios confirm the absence of adrenal insufficiency and concur with those in human malaria.

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Relative Adrenal Insufficiency in Dogs with Sepsis

Abstract: Delta-cortisol < or = 3 microg/dL after adrenocorticotropic hormone administration is associated with systemic hypotension and decreased survival in septic dogs.

Cited by 64 publications

References 42 publications

Hypothalamic‐Pituitary‐Adrenal Axis Dysfunction in Hospitalized Neonatal Foals

Hypothalamic‐Pituitary‐Adrenal Axis Dysfunction in Hospitalized Neonatal Foals

Fuel Oil–induced Adrenal Hypertrophy in Ranch Mink (Mustela Vison): Effects of Sex, Fuel Oil Weathering, and Response to Adrenocorticotropic Hormone

Adrenal response to the low dose ACTH stimulation test and the cortisol-to-adrenocorticotrophic hormone ratio in canine babesiosis

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