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Pituitary-adrenal function in dogs with acute critical illness

Linda G. MartinDepartment of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610.

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Reid P. GromanDepartment of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-6010.

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Daniel J. FletcherDepartment of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-6010.

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Ellen N. BehrendDepartments of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849-5523.

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Robert J. KemppainenAnatomy, Physiology, and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL 36849-5523.

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Valerie R. MoserDepartment of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610.

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Kathy C. HickeyDepartment of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610.

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Abstract

Objective—To evaluate pituitary-adrenal function in critically ill dogs with sepsis, severe trauma, and gastric dilatation-volvulus (GDV).

Design—Cohort study.

Animals—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.

Procedures—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 (Δ-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 Δ-cortisol ≤ 83 nmol/L were 5.7 times as likely to be receiving vasopressors as were dogs with Δ-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, Δ-cortisol, and baseline plasma ACTH concentrations.

Conclusions and Clinical Relevance—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 Δ-cortisol ≤ 83 nmol/L may be more likely to require vasopressors as part of the treatment plan.

Abstract

Objective—To evaluate pituitary-adrenal function in critically ill dogs with sepsis, severe trauma, and gastric dilatation-volvulus (GDV).

Design—Cohort study.

Animals—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.

Procedures—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 (Δ-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 Δ-cortisol ≤ 83 nmol/L were 5.7 times as likely to be receiving vasopressors as were dogs with Δ-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, Δ-cortisol, and baseline plasma ACTH concentrations.

Conclusions and Clinical Relevance—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 Δ-cortisol ≤ 83 nmol/L may be more likely to require vasopressors as part of the treatment plan.

Contributor Notes

Dr. Martin's present address is the Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849-5523.

Dr. Fletcher's present address is the Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401.

Dr. Moser's present address is Camelwest Animal Hospital, 5502 W Camelback Rd, Glendale, AZ 85301.

Dr. Hickey's present address is VCA Central Kitsap Animal Hospital, 10310 Central Valley Rd NE, Poulsbo, WA 98370.

Supported by a grant from the Morris Animal Foundation.

The authors thank Dr. Ann Busch for assistance with assays and Dr. Marc A. Evans for assistance with statistical analysis.

Address correspondence to Dr. Martin.