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Endocrine Flashcards

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1
Q

Thyroid action

A

Increases metabolism

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2
Q

Hyperthyroidism in dogs

A

Rare
Nutritional hypertyroidism (fresh thyroid given in raw feeding)

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3
Q

What causes this change in appearance?

A

Hyperthyroidism

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4
Q

Thyroid crisis

A

Severe tachycardia (>300bpm), tachypnoea, panting, respiratory distress, profound weakness, ventro-flexion, sudden blindness due to hypertension

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5
Q

What form of hyperthyroidism can cause poor appetite?

A

Apathetic hyperthyroidism/apathetic thyrotoxicosis

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6
Q

How does mild thyroid disease affect kidney parameters?

A

Improve mild kidney disease

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7
Q

Best initial test for hyperthyroidism

A

Total T4 (high TT4 and CS = diagnosis)

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8
Q

Follow up tests if TT4 is negative but there are clinical signs suggestive of hyperthyroidism

A

Free T4 and TSH

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9
Q

How can euthyroid sick syndrome be ruled out (non-thyroidal disease affecting thyroid hormone levels)?

A

Scintigraphy

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10
Q

Treatment of feline hyperthyroidism

A

Radioactive iodine (131 I), SC injection
Surgery (thyroidectomy)
Anti-thyroid medication (carbimazole ‘pro-drug’/methimazole, stop incorporation of iodine into protein associated with thyroid hormone)
Ultra-low iodine diet

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11
Q

Monitoring of hyperthyroidism that is non-negotiable in all cases

A

Clinical exam (BCS, MCS, fundic exam and blood pressure)
Weight check
Nutritional assessment

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12
Q

What hormones are produced by the adrenal medulla?

A

Catecholamines

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13
Q

What hormones are produced by the adrenal cortex?

A

Zona reticulus: androgens
Zona fasciculata: glucocorticoids
Zona glomerulosa: mineralocorticoids

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14
Q

Pituitary adrenal axis

A
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15
Q

Pituitary dependent hyperadrenocorticism

A

80-90%
Micro and macro adenomas/adenocarcinomas

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16
Q

Adrenal dependent hyperadrenocorticism

A

10-20%
Functional adrenal adenomas and carcinomas (50:50)

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17
Q

Iatrogenic hyperadrenocorticism

A

Exogenous steroids

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18
Q

Presentation in hyperadrenocorticism

A

Middle aged to old dogs
Females > males
PUPD (secondary diabetes insipidus)
Polyphagia
Muscle wasting/weakness/pot belly/panting
Skin thinning/calcinosis cutis/pigmentation/bruising
Symmetrical hair loss
Reproductive dysfunction

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19
Q

Abdominal radiograph findings with hyperadrenocorticism

A

Hepatomegaly
Pot-bellied appearance
Calcinosis cutis
Distended bladder

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20
Q

Thoracic radiograph findings with hyperadrenocorticism

A

Tracheal and bronchial wall mineralisation
Pulmonary metastasis
Osteoporosis

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21
Q

Haematology findings in hyperadrenocorticism

A

Stress leukogram (neutrophilia: mature, lymphopaenia, monocytosis, absolute eosinopaenia)

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22
Q

Clinical chemistry in hyperadrenocorticism

A

Increased ALP (steroid induced isoform)
Increased ALT (‘steroid hepatopathy’)
Hyperglycaemia
Increased cholesterol and triglyceride
Mildly abnormal bile acids

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23
Q

Urinalysis findings in hyperadrenocorticism

A

USG <1.030, mild dehydration
Mild glucosuria
Proteinuria
Positive urine culture (reduced immune function/glucosuria)

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24
Q

Diagnostic tests for hyperadrenocorticism

A

Low dose dexamethasone (3 samples at 0, 3-6, 8h)
ACTH response (samples at 0 and 1h)
Urinary cortisol:creatinine ratio (morning urine sample)
Steroid induced alkaline phosphatase

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25
Meaning of positive response to low-dose dexamethasone
Pituitary dependent hyperadrenocorticism
26
When should you test for hyperadrenocorticism?
Dog in which you could believe a positive result
27
Treatment of hyperadrenocorticism
Medical: Trilostane (licenced) Surgical: adrenalectomy for ADH, hypophysectomy for PDH
28
What adrenal medulla condition may be confused with hyperadrenocorticism?
Phaeochromocytoma
29
Treatment of phaeochromocytoma
Surgical Medical: adrenoreceptor antagonists (sympatholytics), phenoxylbenzamine (alpha), propanolol (beta)
30
Activated calcium
Calcitriol
31
Effect of parathyroid hormone on blood calcium
Increase (from various sources)
32
Reasons for false high calcium result
Lipaemia Icterus (jaundice) Haemolysis
33
Effect of hypoalbuminaemia on calcium
Low (calcium binds to albumin)
34
Mechanism of renal secondary hyperparathyroidism
Renal disease affects phosphate levels = high/low total Calcium (PTH restoring balance?)
35
Effect of hyperphosphataemia on calcium
Increased complex fraction
36
Affect of high calcium/phosphorous
Mineralisation of tissues e.g. kidneys, gastric mucosa (high levels complex/precipitate)
37
Causes of hypercalcaemia
HOGSINYARD Hyperparathyroidism Osteolysis Granulomatous disease Spurious (albumin) Idiopathic Neoplasia Young Addison's Renal disease (total Ca in horses)/Raisin toxicity D (Vit. D) toxicity
38
Most common causes of hypercalcaemia in dogs in practice
Malignancy Hypoadrenocorticism Primary hyperparathyroidism Chronic renal failure Vitamin D toxicosis Granulomatous disease
39
Most common causes of hyperparathyroidism in cats
Idiopathic hypercalcaemia Renal failure (total mainly, occasionally iCa) Malignancy (lymphoma and squamous cell carcinoma) Primary hyperparathyroidism
40
Test to differentiate PTH dependent/independent hypercalcaemia
PTH and iCa
41
When is parathyroid related peptide/PTHrP present?
Humoral hypercalcaemia of malignancy
42
Treatment of hypercalcaemia
Stabilise calcium urgently: fluids/diuresis, glucocorticoids, bisphosphonates Treatment of cause
43
Causes of hypocalcaemia
Parathyroid dependent/primary hypoparathyroidism (spontaneous immune mediated, functional hypomagnesaemic, post-surgical) Demand exceeds supply/mobilisation (periparturient tetany/eclampsia, nutritional deficiency of calcium/Vit. D, pancreatitis) (PTH and Calcitriol resistance syndromes)
44
How do hypocalcaemia cases present?
'Rubbing face' (Neuromuscular excitability, agitation)
45
Short term therapy/management of hypocalcaemia
IV calcium (gluconate, borogluconate, chloride) Monitor for bradycardia
46
Long term therapy for hypocalcaemia
Aim for subclinical/low normal Oral calcium supplement Vitamin D to promote calcium uptake (calcitriol short term, alfacidol/dihydrotachysterol long term)
47
Type 1 like diabetes in dogs
Insulin deficiency Common: immune mediated (antibodies in circulation against islet Ag) or B loss due to EPI/pancreatitis Rare: congenital B loss
48
Type 2 like diabetes in dogs
Insulin resistant Common: progesterone (metestrus), acromegaly, hyperadrenocorticism, exogenous corticosteroids Rare: IGF-1/GH excess (pituitary acromegaly)
49
Causes of type 1 diabetes in dogs
Pancreatectomy Pancreatitis Auto-immunity Islet cell hypoplasia Chemical toxicity
50
Causes of type 2 diabetes in dogs
Progesterone/agen Growth hormone Glucocorticoids Glucagon Catecholamines Thyroid Obesity
51
Are most diabetic dogs insulin dependent or not?
Insulin dependent (Exceptions are bitches in metoestrus and dogs with concurrent Cushings may/may not be)
52
Clinical presentation of diabetes mellitus in dogs
Older dogs (7-9y) Female > male 'Starvation amidst plenty' (polyphagia but losing weight) PUPD Quickly tired Diabetic cataracts Recurrent infections (e.g. UTI) 'Acetone' breath
53
Diabetic ketoacidosis
Acute Dull, depressed, weak, comatose? Vomiting Dehydrated IVFT/critical care
54
Monitoring diabetes mellitus in dogs
Blood glucose curves (can be done at home) Fructosamine (non-enzymatic binding of glucose to albumin) Glycated haemoglobin (glucose non-enzymatically bound to Hb) Urine testing
55
Somogyi
Low blood sugar (hypoglycemia) episode leads to high blood sugar (hyperglycemia) due to surge of hormones
56
Complications of insulin treatment of dogs with diabetes mellitus
Hypoglycaemia Pancreatitis Keratoconjunctivitis Cirrhosis Neuropathy
57
Treatment of canine diabetes
Daily routine of insulin injection, food and exercise (all at the same time)
58
Pathophysiology of ketoacidosis
Reduced insulin > reduced glucose uptake into cells > metabolic deficit Glucagon > lipolysis > fatty acids > acetyl coA > ketones (acetoacetate, b-hydroxybutyrate, acetone) Acetoacetate and b-hydroxybutyrate acidic > metabolic acidosis > inappetence, nausea, reduced mentation, vomiting > dehydration, renal hypoperfusion and electrolyte derangements > death
59
Diagnosis of ketoacidosis
b-hydroxybutyrate (most abundant blood ketone) Blood gas (metabolic acidosis)
60
Stabilisation of patient with ketoacidosis
Hartmann's (monitor electrolytes closely, dehydration may cause pseudohyperkalaemia which is actually hypokalaemia, insulin therapy may drive K+ into cells) Electrolytes (potassium supplementation, rarely potassium phosphate for hypophosphataemia, correct glucose for hyponatraemia, correct hypocalcaemia if clinical sign, magnesium supplementation if not doing well) Analgesia (headache?) Anti-emetics (nausea) Concurrent disease
61
Hyperglycaemic hyperosmolar syndrome
Rare Pathogenesis similar to DKA but a small amount of insulin and hepatic glucagon resistance reduces lipolysis so ketones not elevated Diagnosis: BG >33mmol/L, no urinary ketones, serum osmolality >350mOsm/kg Treatment: fluid therapy, insulin therapy when normovolaemic
62
Glucose monitoring in DKA patient
Blood sampling by central venous catheter Freestyle Libra (easy to place, monitor via app, interstitial not blood)
63
Signalment for diabetes mellitus in cats
>7y M/MN>F/FN Obese Treatment with glucocorticoids or progestagens
64
Clinical signs of diabetes mellitus in cats
PUPD Weight loss Lethargy Polyphagia Less common: weakness, plantigrade stance, ventroflexion of neck, depression/anorexia (DKA)
65
If a cat with diabetes mellitus has abdominal pain what might you suspect?
Pancreatitis (triaditis?)
66
Type I diabetes in cats
Deficiency of insulin (pancreatic b cell loss)
67
Causes of b cell loss/destruction
Chronic pancreatitis +/- EPI Pancreatic amyloidosis Glucose toxicity Immune mediated disease Congenital lack of b cells
68
Type 2 diabetes in cats
Inability to respond to insulin (usually have functioning b cells at time of diagnosis) +/- relative insulin deficiency
69
How does glucose toxicity lead to insulin dependent diabetes mellitus?
70
Diagnostic plan for a cat with suspected diabetes mellitus
Document persistent hyperglycaemia and glucosuria (rule out stress hyperglycaemia) and appropriate clinical signs
71
Fructosamine
Irreversible reaction between glucose and plasma proteins Indicates average BG during preceding 1-3 weeks
72
Diabetic cat diet
High protein (gluconeogenesis provides consistent energy source) Restricted carbohydrate (relieve hyperglycaemia/glucose toxicity) Wet formulation (improves satiety and maintains hydration) Can graze but don't exceed daily calories (weight loss)
73
Insulin products
Lente insulin Protamine zinc insulin (Glargine) (Detemir)
74
Last resort for diabetes mellitus treatment in cats if owners will not consider insulin treatment
Glipizide Bexagliflozin (sodium-glucose cotransporter 2 inhibitor)
75
Causes of unstable diabetes in cats
Compliance issues UTI (may have no clinical signs) Pancreatitis Significant dental disease
76
Insulin resistance
No response to insuline at a dose of >2.2IU/kg/dose
77
Hypoglycaemia
BG <3-3.5mmol/l Mild hypoglycaemia well tolerated, severe hypoglycaemia is life threatening
78
Clinical signs of hypoglycaemia
Lethargy Muscle tremors Anorexia and vomiting Ataxia Recumbency Vocalisation Seizures
79
Treatment of hypoglycaemia
At home: honey/glucose on oral mucous membranes/feed Clinic: 25% dextrose solution slow IV, 5% dextrose CRI Monitor clinical signs and blood glucose
80
Biochemistry parameters raised in renal failure
Urea Creatinine
81
Electrolyte abnormality associated with refeeding syndrome
Hypophosphataemia
82
Electrolyte abnormality associated with hypervitaminosis D
Hyperphosphataemia
83
Treatment of inadequate hormone production from the zona glomerulosa of adrenal gland (in hypoadrenocorticism)
Fludrocortisone

Small Animal (Poppy) (20 decks)

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