Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul;33(4):1766-1774.
doi: 10.1111/jvim.15527. Epub 2019 May 20.

Multiple adrenocortical steroid response to administration of exogenous adrenocorticotropic hormone to hospitalized foals

Katarzyna A Dembek  1 , Lindsey M Johnson  2 , Kathryn J Timko  2 , Jillian S Minuto  2 , Kelsey A Hart  3 , Bonnie S Barr  4 , Ramiro E Toribio  2
Affiliations

Multiple adrenocortical steroid response to administration of exogenous adrenocorticotropic hormone to hospitalized foals

Katarzyna A Dembek et al. J Vet Intern Med. 2019 Jul.

Abstract

Background: The hypothalamic-pituitary-adrenal axis regulates the response to sepsis-associated stress. Relative adrenal insufficiency or adrenocorticotropic hormone (ACTH):cortisol imbalance, defined as a poor cortisol response to administration of ACTH, is common and associated with death in hospitalized foals. However, information on other adrenal steroid response to ACTH stimulation in sick foals is minimal.

Objective: To investigate the response of multiple adrenocortical steroids to administration of ACTH in foals.

Animals: Hospitalized (n = 34) and healthy (n = 13) foals.

Methods: In this prospective study, hospitalized foals were categorized into 2 groups using cluster analysis based on adrenal steroids response to ACTH stimulation: Cluster 1 (n = 11) and Cluster 2 (n = 23). After baseline blood sample collection, foals received 10 μg of ACTH with additional samples collected at 30 and 90 minutes after ACTH. Steroid and ACTH concentrations were determined by immunoassays. The area under the curve (AUC) and Delta0-30 were calculated for each hormone.

Results: The AUC for cortisol, aldosterone, androstenedione, pregnenolone, 17α-OH-progesterone, and progesterone were higher in critically ill (Cluster 1) compared to healthy foals (P < .01). Delta0-30 for cortisol and 17α-OH-progesterone was lower in Cluster 1 (24%, 26.7%) and Cluster 2 (16%, 11.2%) compared to healthy foals (125%, 71%), respectively (P < .05). Foals that died had increased AUC for endogenous ACTH (269 versus 76.4 pg/mL/h, P < .05) accompanied by a low AUC for cortisol (5.5 versus 15.5 μg/dL/h, P < .05), suggesting adrenocortical dysfunction.

Conclusion and clinical importance: The 17α-OH-progesterone response to administration of ACTH was a good predictor of disease severity and death in hospitalized foals.

Keywords: adrenal insufficiency; cortisol; equine; sepsis.

PubMed Disclaimer

Conflict of interest statement

Authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Hormone concentrations in Clusters 1 (n = 11), 2 (n = 23), and healthy (n = 13) foals at 0, 30, and 90 minutes after ACTH stimulation (median and interquartiles). Letters “a” indicates compared to healthy and “b” indicates compared to Cluster 2; “#” indicates compared to Time 0. ACTH, adrenocorticotropic hormone; DHEAS, dehydroepiandrosterone sulfate. *P < .05; **P < .01
Figure 2
Figure 2
Receiver operating characteristic curve for Delta0‐30 17α‐OH‐progesterone to predict non‐survival in neonatal foals. A cutoff value of (−19%) maximized sensitivity (87%) and specificity (70%) to predict death. AUC, area under the curve
See this image and copyright information in PMC

References

    1. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165‐228. - PMC - PubMed
    1. Dembek KA, Onasch K, Hurcombe SD, et al. Renin‐angiotensin‐aldosterone system and hypothalamic‐pituitary‐adrenal axis in hospitalized newborn foals. J Vet Intern Med. 2013;27:331‐338. - PubMed
    1. Hart KA, Slovis NM, Barton MH. Hypothalamic‐pituitary‐adrenal axis dysfunction in hospitalized neonatal foals. J Vet Intern Med. 2009;23:901‐912. - PubMed
    1. Marik PE, Pastores SM, Annane D, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008;36:1937‐1949. - PubMed
    1. Hart KA, Barton MH. Adrenocortical insufficiency in horses and foals. Vet Clin North Am Equine Pract. 2011;27:19‐34. - PMC - PubMed

Substances