Dz of the Adrenals

Question 1

Adrenal gland cortex

Answer 1

Glomerulosa: aldosterone
Fasciculata: cortisol, sex hormones
Reticularis: androgen, some cortisol

Question 2

Function of the adrenal cortex

Answer 2

Glucocorticoid regulation (neg feedback regulation CRH and ACTH)
Aldosterone regulation (osmoreceptors, RAAS, K+ levels)

Question 3

Medulla

Answer 3

Catecholamines

Question 4

Primary hypoadrenocorticism

Answer 4

Immune-mediated destruction of adrenal cortices
Usually bilateral

Question 5

Drug induced hypoadrenocorticism

Answer 5

Mitotane and trilostane

Question 6

Other causes of hypoadrenocorticism

Answer 6

Iatrogenic
Thromboembolism/ loss of blood supply
Infiltrative neoplasia
Amyloidosis

Question 7

Signalment of hypoadrenocorticism

Answer 7

Young to middle-aged female dogs (intact>)
Poodles, collies, westie terriers, danes, rotties

Question 8

Hx of patients with hypoadrenocorticism

Answer 8

Waxing and waning (on and off)
+/- V/D responsive to fluids, abx and steroids
Weakness and leth

Question 9

CS associated with hypoadrenocorticism

Answer 9

Depression, leth, weakness, anorexia, dehy
PU/PD, bradycardia, abdominal pain, regurg. hypotension, acute collapse

Question 10

CBC of hypoadrenocorticism

Answer 10

Anemia of chr. dz
Marked anemia secondary to GI hemorrhage
+/- hyperproteinemia
Reverse stress leukogram

Question 11

Chemistry of hypoadrenocorticism

Answer 11

Hypo-natremia,-cholermia, -glycemia, -albuminemia
Hyper-kalemia, calcemia
Na:K <25:1
Azotemia (dehy/ hypotension- ↓ GFR, upper Gi hemorrhage)

Question 12

Atypical addison’s

Answer 12

Electrolyte changes won’t occur
Gluco deficient and normal aldosterone

Question 13

UA of hypoadrenocorticism

Answer 13

Low USG due to PU/PD
May ↑ with dehy (if medullary washout not occured)

Question 14

ECG changes with hypoadrenocorticism

Answer 14

Hyperkalemia induced changes →bradycardia, tall T waves, wide QRS, flat P waves → atrial standstill

Question 15

Diagnostic imaging of hypoadrenocorticism

Answer 15

Rads: hypovolemia maybe megaesophagus
U/S: adrenals small or poorly visualized

Question 16

ACTH stimulation test

Answer 16

Definitive for hypoadrenocorticism
If pre and post <1 = diagnostic
Not addison’s if 2x the baseline cortisol

Question 17

Tx for adrenocorticol crisis

Answer 17

Correct hyperkalemia and hypotension
Crystalloids @ shock dose (LRS)
Maintenance fluids with Na and dextrose
Dexamethasone

Question 18

Glucocorticoid supplementation

Answer 18

Hypoadrenocorticism maintenance therapy
Fludrocortisone acetate daily
Pred with DOCP therapy

Question 19

Mineralocorticoid supplementation

Answer 19

Hypoadrenocorticism maintenance therapy
Desoxycorticosterone pivalate (most common, q25d)
Fludrocortisone acetate daily

Question 20

Hyperadrenocorticism

Answer 20

Pituitary dependent 80-85% (most microadenomas)
Adrenal dependent 15-20% (50% malignant)

Question 21

Signalment for Hyperadrenocorticism

Answer 21

Middle aged to older dogs
Poodles, beagles, dascuhunds, cockers
Females >

Question 22

Rule of thumb for Hyperadrenocorticism

Answer 22

Small-medium breeds more likely to have PDH
Large breeds more likely to have adrenal dependent

Question 23

CS of Hyperadrenocorticism

Answer 23

Marked PU/PD, polyphagia, alopecia (rat tail)
Hyperpigmentation, thin skin, dermatits/ pyoderma, calcinosis cutis, panting, weight redistribution

Question 24

CBC/ chem for Hyperadrenocorticism

Answer 24

Stress leukogram and thrombocytosis
Markedly ↑ ALP, mild to moderate ↑ ALT
Hypercholesterolemia

Question 25

UA for Hyperadrenocorticism

Answer 25

USG <1.020 Proteinuria Subclinical UTI

Question 26

Radiograph findings of Hyperadrenocorticism

Answer 26

Markedly enlarged liver Distended urinary bladder +/- mineralized adrenals

Question 27

Screening test for Hyperadrenocorticism

Answer 27

Cortisol: creatinine ratio Sensitive, not specific (many false +) Low= no cushing's

Question 28

Low dexamethasone suppression test (Hyperadrenocorticism)

Answer 28

Collect baseline cortisol, 4hr cortisol then 8hr (>1.4= cushinoid) Normal: low PDH: 4 hr= low to ↑, 8hr = ↑ Adrenal dependent: 4 hr= ↑, 8hr = ↑

Question 29

Differentiating test for Hyperadrenocorticism

Answer 29

HDDS test (not used as much) PDH: 4 hr= low, 8hr = low to ↑ AD: 4 hr= ↑, 8hr = ↑

Question 30

When should a ACTH stimulation test be done for Hyperadrenocorticism

Answer 30

Concurrent illnesses Post-stim cortisol results >18-20 = HAC

Question 31

U/S for Hyperadrenocorticism

Answer 31

PDH: bilaterally symmetrically enlarged adrenals AD: one large, other small and not visualized Metastases and hyperechoic liver

Question 32

Tx for PDH Hyperadrenocorticism

Answer 32

Trilostane: inhibits 3b-hydroxysteroid dehydrogenase Mitostane: destroys fasciculata and reticularis

Question 33

Tx for AD Hyperadrenocorticism

Answer 33

Sx!! Has complications: pancreatitis, thromboembolism, DIC Other adrenal atrophied/ not functional (need gluco and mineral supplement)

Question 34

Monitoring for trilostane and mitotane therapy

Answer 34

T: ACTH stim levels @ wk 1,3,6,13 then q4-6m M: ACTH stim levels @ q3-6m

Question 35

Alopecia X

Answer 35

Pituitary hyperstimulation of reticularis layer of adrenals Overproduction of androgens instead of cortisol

Question 36

CS of Alopecia X

Answer 36

PU/PD/PP + similar signs as PDH Less marked elevation of ALP

Question 37

DX alopecia X

Answer 37

Androgen panel university of TN ACTH stim serum samples Elevated 17-hydroxyprogesterone, estradiol, other sex hormones

Question 38

Alopecia X tx

Answer 38

*therapies vary* Melatonin, flax seed oil Trilostane and mitotane (less success)

Question 39

Pheochromocytoma

Answer 39

Neoplasia of adrenal medulla: transient hypersecretion of catecholamines Older dogs, rare in cats

Question 40

CS of Pheochromocytoma

Answer 40

PU/PD, depression, leth., V/D Anxiety/ restlessness, exercise intolerance, sudden blindness, tachycardia and hypertension

Question 41

DX for Pheochromocytoma

Answer 41

U/S: one large (right) adrenal, other normal sized Dx with histopath CT/ MRI: determine extent of local involvement

Question 42

Tx for Pheochromocytoma

Answer 42

Sx resection Pre-sx stabilization: phenoxybenzamine (a-blockers) and atenolol (b-blocker)