TDK conference 2014

Defining the patient’s adrenal reverse capacity in the routine human intensive care medicine helps to predict the chance of survival. If the hypothalamic-pituitary-adrenal (HPA-) axis fails to be activated properly in critical ill patient that can contribute to poor prognosis. Critical illness-related corticosteroid insufficiency (CIRCI) also exists in dogs with acute, potentially fatal inflammatory/infectious disease or with immune-mediated and neoplastic disorders. The relative adrenal failure in critically ill patients is a dynamic and reversible alteration of the HPA-axis which is usually leads to hypocortisolaemia and/or cortisol resistance. The complex interactions between the neuroendocrine- and immune system play an essential role in the pathogenesis of CIRCI. Nowadays adrenal function testing in critically ill dogs is also emphasized in the veterinary medicine and it’s result should be taken account to determine the therapeutic plan and the prognosis.

In the current study we examined the adrenal reverse capacity with low dose ACTH-stimulation test of critically ill dogs (n=30) treated in the Small Animal Clinic of the Veterinary Faculty, Szent István University, Budapest and in the Clinic of Veterinary Hematology and Oncology, Budapest. Results were compared to routine laboratory (complete blood count, venous blood gas analysis, biochemical parameters) and clinical parameters (basic clinical parameters, SIRS criteria and values of APPLEfast scoring system). Dogs with acute, potentially fatal illness (e.g. infectious or inflammatory diseases), immune-mediated or neoplastic disorders were examined. Dogs, which were on glucocorticoid replacement 72 hour-period before the examination and those which have primary adrenal disorder were excluded from the study. Patients were devided in two groups (inflammatory disease and neoplastic disorder).

Based on our examination defining SIRS ciriteria or count the APPLEfast score of the patient do not help to predict the prognosis. Normal and near normal basal cortisol level or pronounced hypercortisolaemia tend to be associated with poor prognosis.

In critically ill patients testing the adrenal reverse capacity looks a valuable additional examination beyond the basic physical and laboratory examinations. Futher studies, including the examination of the peripherial cortisol resistance is necessary to determine the alterations of HPA-axis in critically ill dogs.