Hypocortisolaemia és glükokorti koid-rezisztencia kritikus állapotú kutyákban Irodalmi összefoglaló

Abstract

SUMMARY Background: Activation of the hypothalamic-pituitary-adrenal- (HPA-) axis and the sympathetic nervous system are essentially involved in the acute phase response in critically ill patients. Inadequate elevation of endogenous cortisol level and/or impaired glucocorticoid sensitivity of target cells could contribute to unfavourable disease outcome. The pathomechanism of abnormal stress response is complex. All levels of the HPA-axis could be affected, including the peripheral target tissues. Glucocorticoid resistance is a pivotal question in human medicine, but we have limited knowledge about glucocorticoid sensitivity in dogs with various inflamma tory and neoplastic disorders. Identification and treatment of patients with altered stress response are serious challenges to clinicians, even in human medicine. Objectives: Summarize the current knowledge about critical illness-related corti costeroid insufficiency (CIRCI) in dogs focusing on pathogenesis, clinical and labora tory features. Brief review of the molecular background of glucocorticoid resistance in human beings and in canine patients is also discussed. Materials and Methods: Review articles, guidelines and case reports were stud ied from different scientific online databases and journals. Main keywords used for searches: dog, critical illness, hypocortisolaemia, cortisol resistance, glucocorticoid receptor. Results and Discussion: Determining the adrenal reverse capacity is a valuable additional test beyond the basic physical and laboratory examinations in critically ill dogs, for better estimation of the disease outcome. Examination of the glucocorti coid receptor profile on target cells is necessary to understand the phenomenon of peripheral glucocorticoid resistance in critically ill canine patients.