Block 7 Flashcards
(516 cards)
1
Q
What is hyperadrenocorticism?
A
Cushings
2
Q
Is canine or feline cushings common?
A
Canine
3
Q
What does HAC mostly cause?
A
Hypercortisolemia
4
Q
What can HAC also cause?
A
Technically refers to overproduction of any adrenocortical hormone
Sex hormones
Aldosterone
5
Q
What are the layers of the cortex of the adrenal gland
A
Mineralcorticoids (salt)
Glucocorticoids (Sugar)
Androgens (Sex)
6
Q
What are 2 mineralcorticoids?
A
Aldosterone and corticosterone
7
Q
What are 2 glucocorticoids?
A
Cortisol and cortisone
8
Q
What are 2 androgens?
A
Testosterone and estrogen
9
Q
Where does steroid synthesis occur?
A
In adrenal cortex
10
Q
What does steroid synthesis begin with?
A
Cholesterol
11
Q
What are the 3 parts to the HPA axis?
A
Hypothalamus
Pituitary
Adrenal gland
12
Q
What is the negative feedback on BOTH the pituitary and the hypothalamus?
A
Cortisol
13
Q
What is released by the hypothalamus that stimulates the pituitary?
A
CRH (corticotropin releasing hormone)
14
Q
What is released by the pituitary that stimulates the adrenal glands?
A
ACTH (corticotropin)
15
Q
How many mechanisms of cortisol excess are there?
A
3
16
Q
What are the 3 mechanisms?
A
Pituitary dependent HAC (PDH)
Adrenal dependent HAC (ADH)
Iatrogenic
17
Q
What determines which mechanism it is?
A
Where the primary tumor is
18
Q
What percent of HAC is PDH?
A
85%W
19
Q
What type of tumor are most tumors?
A
Microadenomas
20
Q
What size are macroadenomas?
A
> 1cm
21
Q
What can macroadenomas cause?
A
Neurologic signs
22
Q
What is the signalment of dogs with Cushings?
A
Middle to older age dogs
23
Q
What percent of dogs are older than 6 yo?
A
100%
24
Q
What percent of dogs are older than 9 yo?
A
90%
25
What percent of dogs with PDH are <20kg?
75%
26
What are the clinical symptoms of Cushings?
***PPPP
PU/PD
Polyphagia
Pot belly
Panting
27
What does cortisol cause to muscles?
Causes muscle weakness
28
What happens to the liver in HAC?
Enlarged liver
29
What causes the pot belly appearance of HAC?
Muscles of abdomen weaken and the liver enlarges so the liver falls into the abdominal space
30
What is another harmful result of muscle weakness in HAC dogs?
Potential for cranial cruciate tears
31
What are 4 dermatologic changes wth HAC?
Alopecia (non-pruritic)
Comedones
Hyperpigmentation
Calcinosis cutis
32
What is normally seen on CBC for HAC?
Stress leukogram
Thrombocytosis
33
What things are increased on chem for HAC?
ALP
ALT
GGT
Cholesterol
34
What crystals may you find on a UA?
Calcium oxalate or struvite
35
Why will T4 be low in a HAC patient?
Cortisol suppresses T4 so it will be low!
Dont diagnose hypothyroid!!
36
What are the 3 screening tests of HCR?
UCCR - urine cortisol:creatinine ratio
ACTH stim
Low-dose dex suppression
37
What is UCCR good for?
Ruling disease out!
38
Where should urine for UCCR be taken?
At home as to not stress the dog out and in the morning
39
What is the synthetic cortisol given in ACTH stim?
cosyntropin
40
What are steps to ACTH stim?
Give cosyntropin
Take ACTH cortisol 1 hour after
41
What result would not be in line with HAC?
<17 increase
42
What result is borderline increase for HAC?
17-22
43
What result is in line with HAC?
>22
44
What can you not differentiate with a ACTH stim?
ADH vs PDH
45
How do you perform an LDDS?
Get a baseline cortisol
Administer dex
Obtain 4 hr levels
Obtain 8 hr levels
46
What is beneficial about LDDS?
It can differential between ADH and PDH
47
What do you look at first when reading an LDDS?
8 hr
48
Are there a lot of false negatives in LDDS?
No
49
What is a big con of LDDS?
Takes a long time
50
Are there a lot of false positives with LDDS?
Yes
51
What does LDDS test for?
PDH
52
What is another way besides LDDS to determine type of HAC?
Imagine (CT, US, MRI)
53
What is most important part of measuring the size of adrenal glands on ultrasound?
The thickness of the caudal poles?
54
Length doesn't provide much information
55
What is normal adrenal size of dog?
4-5mm
56
If dog has cortisol-secreting adrenal mass, other adrenal gland should be small
57
Should endogenous ACTH be low or high in ADH dogs?
Low
58
How do you collect blood for endogenous ACTH measurement?
INTO CHILLED TUBE!
59
Cushings disease is a ______ disease
Clinical (clinical signs + clinicopathologic findings)
60
In feline HAC, what steroids are elevated?
Cortisol and aldosterone
61
What are 2 clinical signs that are different in cats than dogs with HAC?
Can come from poorly regulated diabetes mellitus
Cat skin can be very fragile
62
What test should not be used to screen feline Cushings?
ACTH stim
63
What test is considered the best screening test for feline Cushings?
LDDS test
64
What are 2 affects of the increased aldosterone?
Hypokalemia
Hypertension
65
What is the scoring system for Cushings and owners?
ALIVE score
66
Is higher or lower better for the ALIVE score?
lower the better
67
What should you do if there is a high blood pressure?
Fundic exam
68
What will you see on a cushing CBC?
Stress leukogram and thrombocytosis
69
What is a stress leukogram?
lymphopenia
Eosinopenia
monocytosis
neutrophilia
70
What causes the high potassium in Cushing chems?
The thromobocytosis
71
What will you see on the chem of Cushings?
Thrombocytosis
High ALT and ALP
Hypercholestrolemia
Hyperglycemia
72
What may you see on a Urinalysis for Cushings?
Low SG, high proteins
73
What is normal value for UPC (urine protein:creatinine)
<0.5
74
What might you see in the gallbladder of a Cushing dog?
Mucocele
75
What can HAC do to the liver?
Enlargement
76
What is the reference range for "not consistent with" in ACTH stim?
Post-ACTH cortisol <22
77
What type of HAC does LDDS test for?
PDH
78
What is SDMA a marker for?
Marker of GFR (kidney function)
79
What are 4 things that cause PUPD?
CKD
Cushings
Hepatic encephalopathy
pyometra
80
What is the cut off for LDDS at 8 hrs to be considered for HAC?
1.3
81
In a CBC, should cholesterol be high or low in HAC dogs?
Hypercholesterolemia
82
Describe liver findings of a dog with HAC
Heptomegaly
Hyperechoic liver
83
What is the threshold for diagnosis of HAC?
At least 3 consistent clinical signs and/or physical exam findings
At least 2 consistent clinpath findings
84
What is the definition of hypoadrenocorticism?
Decreased production of one or more adrenocortical hormone
85
What is the most common pathophysiology of Addison's?
Primary immune mediated destruction of both adrenal glands
86
What is the more rare secondary pathophysiology of Addison's?
Rare destruction of pituitary gland
87
What is typical Addison's?
Glucocorticoid and mineralcorticoid deficiency
88
What is atypical Addison's?
Just glucocorticoid deficiency
89
What age dogs get Addison's?
Young to middle aged dogs
90
What is the median age of Addison's?
4 years old
91
What is the sex predisposition of Addison's?
Female (70%)
92
What are 2 breeds predisposed to heritable Addison's?
Standard poodle and Portuguese water dog
93
What may trigger an Addison's event?
A stressful event
94
What are some GI clinical signs of Addison's?
Vomiting, diarrhea, anorexia, lethargy, weight loss
95
What are additional clinical signs of Addison's?
Hypovolemic shock, collapse, NEVER PU/PD
96
What are some physical exam findings of Addison's?
Weight loss, dehydration, abdominal pain, melena, bradycardia, hypotension
97
Does Addison's have a stress leukogram?
NO!
98
***What is seen in the biochem?
Azotemia
Hypocholesterolemia
Hypoglycemia
Hypercalcemia
High globs, low albs
99
What occurs to liver enzymes with Addison's?
Mild elevation
100
***In typical Addison's, what additional chem values will you see?
Low bicarb
Hyponatermia
Hypochloremia
Hyperkalemia
101
What is a normal Na:K ratio?
27:1 - 40:1
102
What Na:K ratio is indicative (but not pathognomonic) of Addison's?
<27:1
103
What occurs to lymphocytes in Addisons?
They are normally high!
104
What can cause the hyperkalemia to be an artifact?
Thrombocytosis may cause a pseudohyperkalemia
105
If measured using plsma, platelets have granules with Potassium so if blood is put in red top tube, you rely on platelets to activate and form clots. Once activated they will release potassium. With potassium, there is no clot so potassium is not released causing the pseudohyperkalemia!
106
Lymphocytes can also be artifactually high from younger animals (<6m), infectious disease, and neoplasia
107
What is the screening process to rule out Addison's?
Basal or "resting" cortisol
Doesn't rule it in but will rule it out
108
Proceed to ACTH stim test if the resting cortisol is lower than ____?
<2 (>2 its unlikely Addison's)
109
How do you diagnose Addison's?
ACTH stim?
110
How do you perform ACTH stim?
Give Cortrosyn
Measure 1-hour post cortisol
111
How do you diagnose ACTH stim?
If after an hour the ACTH-cortisol is still <2
112
Do cats get Addison's?
NO (yes but very rare)
113
How do you determine typical vs atypical Addison's?
Look at Na:K ratio
114
If already determined that K was WNL, the Na:K ratio will determine if it is typical or atypical Addison's. What is typical, what is atypical?
Typical: <27 Na:K
Atypical: >27 Na:K
115
Can Addison's cause Megaesophagus?
YES!!!
116
Is Pu/PD a sign of hypothyroidism?
NO!
117
What are 3 clinical signs of hypothyroidism?
Alopecia, pyoderma, and lethargy
118
What percent of dogs have primary hyperthyroidism?
>95%
119
What is primary hypothyroidism caused by?
Lymphocytic plasmacytic thyroiditis or
idiopathic thyroid atrophy
120
What percent of the thyroid must be destroyed before clinical symptoms?
75%
121
What are 2 predisposed breeds for lymphocytic plasmacytic thyroiditis?
Beagles and borzois (BB)
122
Thyroid neoplasia is NOT a common cause of primary neoplasia
123
***Secondary hypothyroidism is very uncommon, what is most common cause of it?
Suppression of TSH by exogenous or endogenous glucocorticoids
124
What is the normal age range for hypothyroid dogs?
2-6 (middle to older dogs)
125
What breed of dog is hypothyroid rare in?
Toy breeds
German Shephards
126
What are 3 most common clinical findings of hypothyroid dogs?
Lethargy/inactivity
Weight gain w/o change in diet
Hyperkeratosis
127
What are the external physical exam findings "endocrine alopecia"?
Hyperkeratosis
Seborrhea (dandruff)
Thin hair
Rat tail
hyperpigmentation
128
What is a facial clinical sign?
"Tragic" facial expression due to myxedema (swelling of skin)
129
What is the main chem finding of hypothyroidism?
Hypercholesterolemia
130
What is the main cbc finding of hypothyroidism?
Non regenerative anemia
131
Hypothyroidism is a disease of clinical disorder. Patient needs clinical disorder and need something to improve to help monitor if there is improvement
132
What is sent to the pituitary from the hypothalamus?
TRH
133
What is sent to the thyroid from the pituitary?
TSH
134
What breed of dogs have lower T4 levels?
Sighthound
135
What is a Total T4 test used for?
To rule out hypothyroid (sensitive)
136
What is the most accurate thyroid test for diagnosis?
Free T4 ED (equilibrium dialysis)
137
What does the TSH test confirm?
Primary hypothyroidism
138
Should you use TSH test by itself?
NO!
139
What will be the result of the TSH test if its primary hypothyroidism?
High TSH and low T4
140
What does high autoantibodies suggest?
Primary hypothyroidism
141
What is the gold standard test for hypothyroidism?
TSH response test
142
With the TSH response test, prior treatment with T4 can fuck up results for 2 months after so do it right the first time
143
What results do you see with TSH response test if its hypothyroidism (administer TSH and check for response)
No response to TSH after 6 hours
144
Dogs get _____ Cats get ______
Dogs get hypothyroidism, cats get hyperthyroidism
145
What sex of cat gets hyperthyroidism more?
No sex predolection
146
What age cats get it more often?
Older cats
147
What is the #1 clinical sign of hyperthyroidism?
Weight loss
148
***What are other clinical signs of hyperthyroidism?
Polyphagia with weight loss
PU/PD
GI issues
Increased activity
149
People are often happy that their elderly cat is running around and acting like a kitten again
150
What is the apathetic form with hyperthyroidism?
Cat looks and feels ill
May be associated with concurrent disease
151
What clinical signs are there with apathetic form?
Lethargic, decreased activity and appetite, weakness
152
what are physical exam findings of hyperthyroid?
Thyroid slip
Thin
Poor hair coat
Systolic murmur
Tachycardia
Hyperactivity
Hypertension
153
What is an important step when you have a hyperthyroid cat with hypertension?
Fundic exam
154
What is a reliable screening test for Hyperthyroid/
Total T4
155
What are the 2 most reliable things seen on chem of hyperthyroid cats?
***Liver enzyme increase - ALT!
Azotemia
156
***What can be masked due to hypertension and increased GFR in old cats?
Kidney disease
157
What should you always run for hyperthyroid cats to unmask CKD?
UA (<1.035 is concerning)
158
What can you run to get an early detection that is not affected by muscle mass in hyperthyroidism?
SDMA
159
What is the best test to look for masked CKD (SDMA or USG)?
USG <1.035
160
You should use both the USG and SDMA values to increase the likelihood that you are correctly diagnosing masked CKD
161
What may be seen on CBC for hyperthyroid cats?
Increased PCV and MCV
162
What may be seen on radiographs of a cat with hyperthyroidism?
Cardiomegaly
163
What is the best test to use for diagnosing hyperthyroidism?
increasing T4 with baseline
164
What is most affected by illness severity?
T4
165
What is a radiological approach to diagnosis?
Nuclear scintigraphy
166
What are the thyroids compared to in nuclear scintigraphy?
The salivary gland
167
What ratio indicates hyperthyroid in nuclear scintigraphy?
>2:1 with the salivary glands
168
What will happen in normal physiology with administration of T3?
A decrease in TT4
169
What happens if you administer T3 to a hyperthyroid cat?
TT4 will remain the same "T3 suppression test"
170
What 4 drugs have the potential to affect thyroid function?
Glucocorticoids
Phenobarbitals
Sulfonamides
NSAIDs
171
What is a functional pituitary neoplasm
Tumor that causes an overproduction of hormones
172
What is a nonfunctional pituitary neoplasm?
Tumor that doesnt cause a release of hormones
173
What 2 domestic species most frequently devlope pituitary neoplasms?
Dogs and horses
174
What are the clinical signs of PPID primarily caused by?
Compression of normal pituitary/hypothalamus
175
For horses it is the pituitary adenoma of the pars ______
Intermedia
176
For dogs it is the pituitary adenoma of the pars _____
distalis
177
What is the ACTH secreting adenoma/
Pars distalis
178
What is adenoma of the pars distalis called?
Canine cushings
179
What is adenoma of the pars intermedia called in horses?
Equine cushings
180
In rats with an adenoma of the pars distalis, what hormone is increased?
Prolactin
181
What does the increased prolactin levels in the rat cause?
Potential for increased mammary neoplasias
182
Of the adrenal gland, what is the negative feedback to the pituitary gland?
Glucocorticoids
183
An adenoma in the pituitary may increase the ACTH secretion causing an increase in glucocorticoids and will not respond to the negative feedback
184
What is nodular hyperplasia
Masses in the adrenal cortex that doesnt cause disease
185
What is adrenal cortical hyperplasia?
Unlike nodular hyperplasia, this is diffuse thickening and always due to ACTH-secreting pituitary tumor
186
What are teh most ACTH responsive regions of the adrenal cortex?
Zona fasiculata and zona reticularis
187
What is the malignant tumor of the adrenal cortex?
Adrenal carcinoma
188
Where may the adrenal carcinoma invade?
Vena cava
189
What percent of ferrets will develop an adrenal-associated endocrinopathy?
70%
190
Spay/neuter of ferrets disrupt negative feedback of GnRH which increases luteinizing hormone, causing a stimulation of sex-steroid producing adrenal cells with overproduction
191
What hormones are increased in ferrets with adrenal disease?
GnRH and luteinizing hormone
192
What region of the adrenal gland is overproduced?
Hyperestrogenism
193
What are the clinical signs of ferret adrenal disease?
Alopecia
Enlarged vulva and mammary hyperplasia
Urinary obstruction, prostatic hyperplasia
194
What does paraganglioma mean?
Umbrella term for tumors derived from neural crest cells
195
Adrenal medulla is derived from neural crest cells which is different from the adrenal cortex!!!
196
What are tumors derived from teh adrenal medullary called?
Pheochromocytomas
197
What type of tumor is formed from alpha cells?
Glucagonoma
198
What type of tumor is formed from beta cells?
Insulinoma
199
What is the most common islet-origin tumor?
Insulinoma
200
Do insulinomas tend to be carcinomas?
Yes
201
What is caused by the increase in insulin produced by the insulinoma?
Hypoglycemia
202
What is a clinical sign of the insulinoma that causes hypoglycemia?
seizures
203
Ferrets will also get adenomas of the endocrine pancreas
204
What is likely a major cause of diabetes mellitus in dogs and cats?
pancreatic hypofunction
205
What causes the pancreatic hypofunction?
Secondary loss of beta cells by recurrent pancreatitis/chronic pancreatitis
206
What are 3 secondary lesions associated with diabetes mellitus?
Cachexia
Cataract
hepatic lipidosis
207
What is a common cause of islet degeneration in cats?
Islet amyloidosis
208
What percent of cats have islet amyloidosis?
20%
209
What percent of DM cats have islet amyloidosis?
60%
210
What species is islet amyloidosis most common in?
Cats
211
What is uniform, bilateral enlargement of thyroid gland called?
Goiter
212
What may cause goiter?
Excess iodine
Iodine deficiency
Goitrogenic compound plants
213
Who usually has goiter?
Fetuses/young food animals and horses that are born with it
214
Why do the young have goiter?
Dam either is grazing on goitrogenic plants
Dam has iodine deficient diet
Iodine excess
215
What plants are goitrogenic?
Brassicaceae family
216
What does fetal goiter cause?
Abortion, stillbirth, prolonged gestation, dystocia, neonatal death
217
Why would a dam have iodine excess?
Mares eating dry seaweed
218
High iodine in fetal circulation interferes with thyroid hormone synthesis goiter
219
After correction of the iodine in goiter, what is it called?
Colloid goiter
220
What are the 4 major players of calcium-regulating hormones?
PTH, calcitriol, calcitonin, FGF23
221
What is another name for vitamin D3?
Cholecalciferol
222
What is the active form of cholecalciferol?
calcitriol
223
What is the role of vitamin D in the intestin?
Facilitates intestinal absorption of calcium (calcium binding protein)
Inhibits PTH synthesis and secretion
224
When is PTH released?
When there is low calcium
225
What is needed to activate vitamin D?
UV light (sheep more susceptible because fiber)
226
What is rickets?
Defective vitamin D metabolism at sites of endochondral ossification
227
What is osteomalacia?
Defective vitamin D metabolism at site of skeletal remodeling
228
What causes rickets and osteomalacia?
Dietary deficiency in either vitamin D or phosphorus
229
Where do the lesions most commonly occur for rickets?
Sites of rapid growth
230
What are 3 reasons for primary hyperparathyroidism?
Parathyroid nodular hyperplasia, adenoma, carcinoma
231
What are 2 reasons that may cause secondary hyperparathyroidism?
Chronic renal disease and dietary imbalances
232
CKD causes hyperparathyroidism because the decreased GFR causes an increased blood phosphate. The increased phosphate causes an increased FGF23, decreased calcitriol production. Chief cell hyperplasia is a result and increases PTH production
233
What is the primary cause of fibrous osteodystrophy?
Nutritional secondary hypercalcemia
234
What is fibrous osteodystrophy?
Osteoclastic resorption of bone causing swelling, pliability, and fractured bone
235
What are the 3 hypercalcemias secondary to neoplasia?
Humoral hypercalcemia of malignancy (HHM)
Metastasis to bone
Hematologic malignancies localized to bone
236
What does PTHrP stand for?
Parathyroid hormone-related protein
237
What does elevated PTHrP indicate?
Elevated values indicate neoplasia
238
What 3 things is elevated PTHrP indicative of?
Apocrine gland adrenocarcinoma of the anal sac
T cell lymphoma
Multiple myeloma
239
PTHrP has a very similar affect on the body as PTHrP
240
What is the most common pituitary tumor in dogs?
Corticotrophs
241
What is the most common pituitary tumor in cats?
Somatotrophs
242
Can pituitary tumors be defined as carcinomas through histo alone?
No, only by metastasis
243
What is the most common form of spontaneous hyperadrenocorticism?
Canine pituitary-dependent hyperadernocortisism (85%)
244
HAC due to the pituitary gland will cause BILATERAL adrenal hyperplasia
245
Are clinical signs the same if its adenoma vs adenocarcinoma?
YES!
246
_______% of dogs have pituitary tumors not visible on CT or MRI
40-50%
247
How is pituitary enlargement diagnosed on CT/MRI?
Pituitary height:brain ratio
248
What is the threshold ratio consistent with enlargment?
>0.31
249
What is the mean age for feline pituitary-dependent HAC?
10years
250
What is the most common tumor in feline HAC?
Adenomas
251
How do cats present with HAC compared to dogs?
Sicker
252
Feline patients presenting with HAC, what is it not uncommon to see as well?
Insulin-resistant diabetes mellitus
253
What is seen on blood work for HAC??
Elevated ALP, ALT, hypercholesterolemia, azotemia, and low USG
Concurrent hyperglycemia, glycosuria
254
What percent of adrenocarcinomas invade the renal vena cava?
20%
255
What percent of adrenocortical carcinomas are metastatic?
50%
256
What 2 spots do the adrenocortical carcinomas usually invade?
Liver
Lungs
257
What can be a side effect and presenting complaint of invasion into the vena cava?
Hemoabdomen
258
What is a go-to method for extent and invasion of a tumor?
CT
259
What is the adrenal medullary tumor of the chromaffin cells?
Pheochromocytoma
260
What do pheochromocytoma (chromaffin cells) secrete?
Catecholamines
261
What is the metastatic rate of pheochromocytomas?
40%
262
What are the common sites for metastasis of pheochromocytomas?
Liver, spleen, regional LN, and bone
263
What is the vascular invasion rate of pheochromocytoma?
80%
264
What is the best diagnostic approach for pheochromocytomas?
Abdominal ultrasound and CT
Plasma and urine catecholamine level
Histology: Chromogrenin A
265
What are the 4 subgroups of thyroid tumors?
Follicular, compound, papillary, anaplastic
266
What are the 2 most common subgroups of thyroid tumors in dogs?
Follicular and compound
267
Are thyroid tumors usually benign or malignant?
Malignant
268
What is an increasing risk factor for malignant thyroid tumor?
Bilateral involvement
269
What is a syndrome related to the face that can be caused by thyroid tumors?
Horner's syndrome
270
What locations are the most likely area to metastasize to?
Lungs or retropharyngeal lymph nodes
271
What are the top 2 diagnostic approaches for thyroid tumors?
CT
Ultrasound guided FNA
272
What should you be aware with ultrasound guided FNA?
High vascular structure!
273
What is an insulinoma?
Neoplasia of beta cells
274
What does an insulinoma cause?
Upregulation of insulin
275
What are the clinical signs of insulinomas?
Seizures
Collapse
Weakness
276
What is serum test that will help confirm insulinoma?
Low blood glucose paired high insulin
277
What is diabetes mellitus characterized by?
Hyperglycemia that results from defects in insulin secretion or insulin sensitivity in target tissues or both
278
What is type I diabetes diabetes mellitus a result of?
Beta cell loss or destruction
279
What is type II diabetes mellitus a result of?
Abnormal beta cell function
280
What type of diabetes mellitus do dogs get?
Type I
281
What type of diabetes mellitus do cats get?
Type II
282
What is the threshold for cortical blood glucose in dogs?
180
283
What is the threshold for cortical blood glucose in cats?
280
284
***What are the 3 clinical signs of diabetes mellitus?
PU/PD
Polyphagia
Weight loss
285
What is the pathophys of glucosuria in diabetes mellitus?
As blood glucose concentrations rise, there is too much glucose in the blood for the glomerular ultrafiltrate to resorb
286
What causes the polyuria in diabetes patients?
Glycosuria creates an osmotic diuresis drawing urine into the tubules
287
What causes polyphagia and weight loss?
The lack of insulin in diabetes causes little uptake of glucose into cells which is required to trigger satiety so body continuously wants to eat. Without peripheral tissue utilization, body loses a lot of glucose via urine
288
What type of diabetes is unexpected weight loss more common?
Type I
289
What is a common breed to get diabetes?
Miniature schnauzers
290
In dogs, which sex is more likely to get DM?
Females
291
What is a common presenting complain of DM?
Acute blindness
292
In cats, which sex is more likely to get DM?
Neutered males
293
What is an eye issue that may make you suspicious of diabetes?
Acute cataracts
293
What is seen on CBC with DM?
No much
294
What is seen on UA with DM?
Glucosuria
Proteinuria
Bacteriuria
295
What is seen on chem with DM?
Hyperglycemia, Increased ALT and ALP, hypercholesterolemia
296
Why do you see mildly increased liver values on chem?
The decreased insulin causes lipid mobilization which causes the liver to become inflamed and release some enzymes
297
How do you document persistence of DM?
Fructosamine
298
What is considered hypoglycemic?
BG less than 60
299
What is Whipple's triad of hypoglycemia?
Consistent clinical signs
Hypoglycemia
Response to treatment
300
What do you expect to see in the chem of a dog with an insulinoma?
hypoglycemia
301
What are the 4 main suspects of true insulin resistance
Bacterial infection
Organ failure
Pancreatitis
Concurrent endrocrinopathies (Cushing/Addisons)
302
What is another iatrogenic cause of "insulin resistance"
Owners just not giving insulin correctly
303
What is the Somogyi phenomenon?
Counter regulatory pattern of insulin induced hypoglycemia followed by hyperglycemia phase
304
What causes insulin-induced hyperglycemia?
Too much insulin that stresses the animal and causes a counter-regulatory release of stress hormones
305
What is acromegaly?
excessive release of GH
306
What causes acromegaly?
Pituitary adenoma
307
What does acromegaly cause?
Insulin resistance
IGF-1 release and bony and soft tissue overgrowth
308
Are cats with acromegaly always diabetic?
YES!
309
What is a clinical sign that is not seen in cats with acromegaly despite uncontrolled DM?
Weight loss
310
What are the 2 diagnostics for acromegaly/
Measure of IGF-1
Brain imaging to confirm
311
Will high IGF-1 always mean acromegaly?
No, there is some variation but will almost always mean that diabetes is not under control
312
What will DM cause when screening for HAC?
False positives
313
How do you test a HAC with DM?
Glucosuria, increased blood glucose, fructosamine
314
What are the 3 ketone bodies?
Acetoacetate, BHB, acetone
315
What causes sickness from DKA?
Ketones cause a high anion gap metabolic acidosis
316
What are the common things seen on UA for DKA?
Ketones, uremic toxins, lactic acid, or salicylates
317
How do you calculate anion gap?
(Na+K) - (Cl + HCO3)
318
What must always be asked when a patient undergoes DKA?
Why did it
319
Why do diabetics get DKA?
Lower insulin allows lipolysis, increasing availability of fatty acids.
320
What are clinical signs of a dog in DKA?
Vomiting, dehydration, severe illness
321
What things will be seen on diagnostics for DKA?
D - hyperglycemia / glycosuria
K - ketonemia / ketonurea
A - acidosis
322
What specifically are you looking for in the urine of a DKA animal for diagnostics?
Acetone
323
What comes from somatotropic cells in the anterior pituitary?
GH
324
What contains receptors for GH to release IGF-1?
Liver
325
GH has effects that can be characterized into which 2 categories?
Anabolic
Catabolic
326
What does the catabolic affect do?
Increases insulin resistance
327
What does the anabolic affect do?
IGF-1 leads to bone, fibrous, etc. growth
328
What is the one difference in diabetes that acromegaly cats will present with?
Weight gain instead of loss
329
Acromegaly cats can also present with some neurological signs
330
So I know a previous answer to this was brain imaging and IGF but this is different... What is a one time measurement that can be used to diagnose acromegaly?
IGF-1
331
Why does GH need to be measured at multiple time points with acromegaly?
There can be GH spikes
332
What does MED stand for?
Multiple endocrine diseases
333
What is the test of choice when you have multiple endocrinopathies present?
ACTH stim
334
Which 2 diseasese have similar mechanisms?
Diabetes mellitus
Hypothyroidism
335
What are essentially the same thing for large animals in terms of ketones?
Ketosis and pregnancy toxemia?W
336
Who gets pregnancy toxemia and when?
Small ruminants before partuition
337
Who gets ketosis and when?
Cattle after parturition
338
What can be a consequence of chronic ketosis or pregnancy toxemia?
Hepatic lipidosis
339
What is the transition period?
3w before and 3w after
340
What are 3 things that change for ruminants in transition period?
Feed, social structure, daily routine
341
When is peak milk production for a cow?
4-6 weeks
342
When is peak feed consumption?
7-8 weeks
343
"Lake gestation fetus steals space from rumen"
344
What happens when there is a negative energy balance during transition period?
Mobilize NEFAs
345
What is the site of gluconeogenesis and ketone production?
Liver
346
What is the primary NEFA?
BHB
347
What is primary ketosis?
Lactation energy demands are too high
348
What is secondary ketosis?
Decreased feed consumption
349
Which ketosis type has a higher risk for hepatic liposis?
Type II
350
What is type I ketosis?
Peak lactation / high production cow
351
What is type II ketosis?
Early lactation, overweight cow in dry period
352
What do NEFAs and BHB increase activation of?
Pro-inflammatory (NF-KB)
353
When is peak incidence of hyperketonemia?
5 days in milk
354
What is the gold standard for determining ketosis?
Blood BHB
355
What is the clinic threshold for ketosis?
>3
356
What are the 3 tests you can run to measure ketosis?
Urine
Blood
Milk
357
What is the median time of resolution of ketosis?
5 days
358
What is the prognosis of pregnancy toxemia?
Poor
359
pregnancy toxemia can occur in beef cows
360
When does pregnancy toxemia occur?
Final 4-6 weeks of pregnancy
361
Why dont small ruminants eat more in late gestation?
Increased uterus makes it physically unable to consume more
362
What inhibits the normal circulation of the kreb cycle?
Oxaloacetate
363
What is a common clinical department of pregnancy toxemia?
Nervous system
364
What is gold standard diagnostic for pregnancy toxemia?
BHB
365
What is clinical pregnancy toxemia BHB levels?
>2.6
366
What are the 2 scenarios in which you may see a sudden drop in BHB?
Treatment is working
Lamb/kid dies
367
What is a large contributing factor to hepatic lipidosis?
Overconditioned in dry period
368
All high producing dairy cows have some degree of increased fat in liver
369
What is mortality of hepatic lipidosis/
>25%
370
What is the gold standard to diagnose hepatic lipidosis?
Liver biopsy
371
What hormones do camelids produce a lot more of than other domestic species?
T3 and T4
372
Is normal blood glucose higher in camelids than ruminants?
YES! Like 2x higher
373
Camelids have a _______ insulin production?
Low
374
Camelids are very sensitive to insuline diseases becuase of their low production
375
NEFAs, BHB, and triglycerides should all be ________ in fed state?
LOW
376
With hyperlipidemia in camelids, unlike cattle, what level of BHBs will you see in camelids?
Low
377
Are clinical changes severe or mild in camelids with hyperlipidemia?
More severe
378
What is a large contributing factor to ketosis in camelids?
Stress
379
Since camelids release very low insulin, stress will cause cortisol release causing increased levels of gluconeogenesis and thus glucose resulting in hyperglycemia
380
Camelids are known as the what of large animals?
Cats
381
*** What 5 effects do NEFAs have?
Pro-inflammatory
Cytotoxic
Inhibit hepatic glycogen storage
Inhibit glucose uptake
Increase insulin resistance
382
What 2 things may cause hepatic lipidosis in camelids?
Hypoglycemia
Hyperglycemia
"Feast or famine"
383
What level of BHBs are indicative of hepatic lipidosis in camelids/
>2.5
384
What is the blood glucose renal threshold?
>200
385
What is the main clinical sign of hyperglycemia in camelids?
PU/PD
386
Is diabetes mellitus rare in camelids?
YES
387
What are the clinical signs of diabetes mellitus in camels?
PU/PD
Ocular changes
Ulcerative foot lesions
388
How much total calcium is lost in 24 hours during partuition?
46-48g
389
What 3 things contribute to the loss of calcium during partuition?
Maintenance
Fetal skeleton
Milk/colostrum
390
What are 4 risk factors for milk fever?
Older cows
Periparturient diseases
Breed
Alkalosis
391
What are the 3 diet risk factors for milk fever?
High cations, low magnesium, high phosphorus
392
What does a high cation diet cause?
Alkalinizing effect
393
What is a non-lactating cause of hypocalcemia?
Oxalate-containing plants
394
/What is stage I hypocalcemia?
Tremors, head open, tongue extended
395
What is stage II hypocalcemia/
Sternal recumbancy, still able to stand, hypothermia, S curve neck
396
What is stage III hypocalcemia?
Flaccid muscles, lateral recumbancy, bloat
397
Dogs and cows act differnetly with calcium... Dogs: lower ionized calcium causes acetylcholine release causing inctact muscles resulting in hyperthermia and tetany. Cows: lower ionized calcium causes acetylcholine release inhibiting muscles and causing hypothermia and flaccid paralysis.
398
What is the key role in immune cell signaling and activation?
Calcium
399
What are 3 risk factors of hypocalcemia in small ruminants?
Older
Multiple fetuses
High milk production
400
What 2 things cause the release of PTH?
Low Ca and Low Mg
401
What does PTH do to phosphorus?
Decreases levels
402
What are 4 risk factors for low vitamin D?
Fall born
Dark coat
Heavy fleece
Rapid growth
403
Why does hyperphosphatemia occur a lot?
Poor diets high in phosphorus low in calcium
404
What does hyperphosphatemia do to the parathyroid gland?
hyperplasia
405
What is hypocalcemia of pigs called?
Eclampsia
406
How much is too much calcium to give to a hypocalcemic cow?
1-2 bottles
407
What is almost always associated with hypervitaminosis?
Hypercalcemia and hyperphosphatemia
408
What is the difference between hyperlipidemia and hyperlipemia
Hyperlipemia is a disease state
409
What is hyperlipemia?
Hypertriglyceridemia in horses
410
What is the level typically resulting in hyperlipemia?
>500
411
What are 3 risk factors of hyperlipemia?
Late gestation
Lactation
Heavy work
412
Hyperlipemia is increased triglyceridemia that results in disease most commonly caused by increased metabolic demands and mobilization of lipids
413
What are predisposed breeds to hyperlipemia?
Small, stocky thangs OR overweight horses brought into negative energy balance
414
What is hormone sensitive lipase sensitive to?
Insulin
415
What are the 3 main tissues responsive to insulin?
Muscle
Liver
Fat
416
What is a nearly pathogneumonic lesion of hyperlipemia?
Plaque of ventral edema
417
***Assume hyperlipemia is present in any ill equid of a predisposed species and test for it in others
418
What may you see to diagnose hyperlipemia in serum?
Increased triglycerides in serum
419
What special stains should be done to diagnose hepatic lipidosis?
Oil Red O
PAS
420
What effect does lipid have on total protein?
Lipid causes an increased tp on refractometer
421
Hyperlipidemia causes errors in clinical chemistry assessments via several mechanisms (pseudohyponatremia, pseudohypokalemia, pseudohypochloridemia)
422
What is the complete inability to sweat when physiologically appropriate?
Anhidrosis
423
What is the insufficient sweat under same conditions?
Hypohidrosis
424
What is a clinical sign of anhidrosis?
Tachycardiac
Exercise intolerance
Hyperthermia
425
What is the diagnosis for anhidrosis?
Intradermal sweat test
426
Is hypocalcemia or hypercalcemia more common?
Hypercalcemia
427
____________ hypoparathyroidism and ____________ hyperparathyroidism cause hypocalcemia
Primary, secondary
428
What are the 5 top differential for hypoparathyroidisim?
Hypoparathyroidism
Eclampsia
Malabsorption
Pancreatitis
Nutritional hyperparathyroidism
429
What level should PTH be when total calcium/ionized calcium is low?
PTH should be above reference interval
430
What is the most common reason for primary hypoparathyroidism?
Immune-mediated
431
What are classic signs of hypoPTH?
Facial rubbing
Tremors
Seizures
432
If calcium is low, which direction is phosphorus usually?
high
433
What 2 tests do you need to make the definitive diagnostic for hypoPTH?
Paired PTH and ionized calcium
434
What is eclampsia?
Puerperal tetany
435
What increases likelihood of a dog getting eclampsia
Small dogs with large litters (first 3 weeks of lactation)
436
What are 2 causes of secondary hyperparathyroidism?
Renal and nutritional
437
Can you differentiate secondayr and primary hypocalcemia on a paired inionzed and PTH panel alone?
NO!
438
Chronic kidney disease may wash out all of the Calcium in the body causing a cycle of resorption of bone leading to demineralization of the body
439
With low calcium, what other values do you see?
High phosphorus and low vitamin D
440
What significant values do you see in CKD?
Low vitamin D
441
What nutrients will cause secondary hyperparathyroidism?
Diets low in Ca
Diets low in Vit D
Diets high in P
442
What is the ration of Ca:P that is bad?
Ca:P < 1
443
What is the orthopedic sign seen with nutritional hyperPTH?
Fibrous osteodystrophy
444
What are the clinical signs of nutritional hypoPTH?
Orthopedic issues (lameness, limb deformities)
445
Who do you see nutritional hypoPTH in the most?
Young growing animals
446
Can serum Ca and P be normla in a nutritional hypoPTH animal?
YES!!
447
What is another name for PPID?
Equine cushings
448
PPID's pathophysiology is similar to what human disease?
Parkinson's
449
What part of the pituitary do humans not really have?
Pars intermedia
450
Where is the lesion causing PPID?
Pars intermedia
451
What does PPID stand for?
Pituitary pars intermedia dysfunction
452
Where is ACTH made?
Pars distalis
453
When is ACTH secreted normally?
In the fall for a winter coat
454
What occurs with PPID?
The ACTH signals are constantly sent
455
What are the retained hairs from PPID called?
Guard hairs
456
What are 6 main clinical signs of PPID?
Hypertrichosis
Weight loss/muscle loss
Laminitis
Secondary infection (endoparasites)
PU/PD
Hyperhidrosis
457
What clinical sign is associated with the weight loss?
Dropped abdomen
458
Is PPID primarily cortisol driven?
No
459
Some other clinical signs to think about: Regional adiposity (supraorbital fossae, delayed wound healing, seizure / neuro issues)
460
What is the only risk factor for PPID?
Age
461
What is considered (but not that accurate) gold standard for PPID?
Histopathology of Pars intermedia
462
What is the recommendation for diagnosing PPID?
Use multiple diagnostic tests
463
What are the 2 current tests to be used for diagnosing PPID?
endogenous ACTH
TRH - Stimulation test
464
When is the e-ACTH test most sensitive?
Fall!
465
When is teh TRH stim test most senestive?
Fall!
466
How do you do the TRH stim test?
Get 1mL baseline blood sample, give TRH, measure ATCH at 10 min and 30 min
467
What do owners usually report as laminitis associated with green pasture?
Seasonal lameness
468
Why does green pasture cause laminitis/
Acute increase in carbs triggering inflammatory cytokines
469
What are the 3 risk factors of EMS?
Obesity
Insulin dysregulation
History or current lameness
470
Where is the regional fat for EMS usually found?
Neck and tail head
471
What is laminitis?
Disease/disruption of the digital lamellae
472
What are cases with rotation or distal displacement of the coffin bone?
Founder
473
***Who is predisposed to EMS?
Ponies
Donkeys
Mules
(Gaited Horses)
American Saddlebreds
Tennessee Walking Horses
Morgans
Paso Finos
Arabians
474
What are the 3 current tests for EMS?
Basal insulin and glucose concentration
Oral sugar test
IV insulin tolerance test
475
You need to do all 3 tests for diagnosis. If just one tests positive, EMS is likely
476
Most hypocalcemic disorders are ______
acute
477
Most hypercalcemic disorders are ______
chronic
478
What does sepsis do to calcium?
Hypocalcemic
479
What is the cause of primary hypothyroidism in horses?
Idiological
480
What kind of calcium do striated muscles need?
Intracellular Ca
481
What kind of calcium do neurons and smooth muscle need?
Extracellular Ca
482
What are types of secondary hypoparathyroidism?
Sepsis, low magnesium
483
What is a clinical sign of hypocalcemia associated with breathing?
Synchronous diaphragmatic flutter
484
What causes impaired thyroid gland dysfunction?
Cytokines
485
Why does diarrhea cause hypocalcemia?
Lost in intestines
486
Acidosis or alkalosis leads to signs of hypocalcemia?
Alkalosis
487
Acidosis or alkalosis falsely elevated Ca?
Acidosis
488
Why do horses with anterior enteritis get hypocalcemic?
Horses lose Cl- and replaced by HCO3 causing alkalosis -> hypocalcemia
489
What is a C-cell adenoma?
Adenoma of the thyroid gland
490
Non-functional C-cell adenomas are majority compared to functional c-cell adenomas
491
What do functional C-cell adenomas secrete?
Calcitonin
492
What are 4 causes of hypercalcemic disorders in horses?
Hyperparathyroidism
Chronic renal failure
Vitamin D intoxication
Cancer - HHM
493
What are the 3 reasons that hypercalcemia causes PU/PD
High Ca blocks electrolyte and water reabsorption, inducing diuresis
High Ca blocks the actions of antidiuretic hormone (ADH)
High Ca acts like Lasix blocking electrolyte reabsorption
494
What are 2 causes of secondary hyperparathyroidism?
Renal disease
Nutritional
495
What are 3 reasons a horse can have hypervitaminosis D
Iatrogenic
toxic plants
Rodenticides
496
Increased vitamin D equals....?
Increased Ca, increased P
497
How can you tell if a horse has vitamin D toxicity?
Both high Ca and P
498
What is hypercalcemia of malignancy?
HHM
499
What are the laboratory findigns of HHM?
Hypercalcemia, Hypophosphatemia, high PTHrP, low PTH
500
Chronic renal failure can cause hypercalcemia
501
What cause hypercalcemia in chronic renal failure?
Less renal Ca excretion
502
What is the main cause (most common) of hypercalcemia in horses?
Chronic renal failure
503
Hypocalcemia and hypomagnesemia are frequent in critically ill horses
504
What panel do you run for PTH and calcium?
Malignancy panel
505
What is the average age of dogs with primary hyperparathyroidism?
10 years old
506
*****Why are hypercalcemic animals PuPD?
Calcium interferes with antidiuretic hormone (ADH) hypercalcemia also causes nephrogenic diabetes inspidus (NDI)
507
What should you think if you see mild to moderate hypercalcemia in a young cat?
Idiopathic hypercalcemia
508
What are the 3 causes of hypercalcemia with cancer?
Humoral hypercalcemia with cancer (PTHrP)
Cancer in the bone marrow
Tumor metastasis to bone
509
Which disases are hte most common causes of hypercalcemia in cats?
Neoplasia, renal disease, hyperparathyroidism, Addison's disease
510
Which diseases are the most common causes of hypercalcemia in dogs?
Neoplasia, renal disease, urolithiasis
511
What are 3 humoral hypercalcemia of malignancy?
Lymphoma
Anal sac adenocarcinoma
Squamous cell carcinoma
512
What are 2 cancers of bone marrow?
Lymphoma
Multiple myeloma
513
What are 2 solid tumors of the bone?
Mammary carcinomas
Squamous cell carcinoma
514
Does osteosarcoma induce hypercalcemia?
NO!!!
515
