Critical illness-related corticosteroid insufficiency in small animals.

Critical illness-related corticosteroid insufficiency (CIRCI) describes endocrine abnormalities associated with illness. CIRCI is characterized by an inadequate production of cortisol in relation to an increased demand during periods of severe stress, particularly in critical illnesses such as sepsis or septic shock. A hallmark sign of CIRCI is hypotension refractory to fluid resuscitation, requiring vasopressor therapy. Corticosteroid treatment can be indicated in patients with CIRCI. This article reviews the physiology and pathophysiology of the corticosteroid response to critical illness and the incidence, clinical features, diagnosis, and treatment of CIRCI.