Creedon Jamie M Burkitt
Critical Consultations, Wichita Falls, Texas.
J Vet Emerg Crit Care (San Antonio). 2015 Jan-Feb;25(1):107-12. doi: 10.1111/vec.12270. Epub 2014 Dec 16.
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.
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.
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.
Low-dose hydrocortisone is the treatment of choice for patients with CIRCI.
If the patient survives the critical illness, prognosis for resolution of CIRCI and hydrocortisone dependence is very good.
描述与危重病相关的皮质类固醇功能不全（CIRCI）以及在危重病患者中使用氢化可的松所引发的争议，并介绍已发表的伴侣动物诊断和治疗策略。
与危重病相关的皮质类固醇功能不全可能是由于下丘脑 - 垂体 - 肾上腺（HPA）轴功能障碍、皮质醇与血浆蛋白结合的改变、靶细胞酶变化、糖皮质激素受体（GR）功能改变，或危重病期间这些因素或其他因素的组合所致。
尚无用于诊断CIRCI的合适检测方法。目前人类的诊断基于对氢化可的松治疗的反应。目前在兽医物种中对于合适的诊断特征尚无共识。
低剂量氢化可的松是CIRCI患者的首选治疗方法。
如果患者在危重病中存活下来，CIRCI缓解及氢化可的松依赖消除的预后非常好。
