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Small Animal Year 4 > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

Where is AcTH produced?

A

Anterior pituitary gland

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2
Q

What is Cushings disease?

which sp/br mostly affected?

A

Hyperadrenocorticism

middle aged- older dogs
v rare in cats

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3
Q

Give 2 causes of hyperadrenocorticism

A

Spontaneous

  • pituitary gland tumour > pituitary dependent hyperadrenocorticism
  • adrenal gland cortex tumour> adrenal dependent hyperadrenocorticism

iatrogenic: from overuse of medication

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4
Q

Which of PDH and ADH is most likley found in small breeds?

A

PDH small breed dogs
ADH large breed dogs

remember: pituitary smaller< than adrenal

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5
Q

The overproduction of which substance leads to the majority of clinical signs in cushings in dogs?

A

Cortisol

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6
Q

A 8 year old dog has following clinical signs

PUPD, polyphagia, panting, abdominal distention, bilateral alopecia, muscle wasting and weakness, systemic hypertension, and bruising and poor healing

which endocrine disease is top of your ddx?

A

Hyperadrenocorticism- cushings

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7
Q

dog
Bloods: Stress leucogram, increased ALKP, ALT, hypercholestrolaemia hypertrigluceride, protein uria
radiograph: enlarged liver, full bladder

which endocrine condition is top ddx?

A

hyperadrenocorticism/ cushings

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8
Q

What are 2 good diagnostic test for cushings?

A

low dose dexmethasone suppression test (normally should suppress cortisol production)

AcTH stimulation test ( should produce cortisol in response)

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9
Q

how would the following cushing causing tumours present on AcTH stimulation test

a) pituitary tumour
b) adrenal tumour

normal dog

A

pituitary tumour> already producing loads of acth> HUGE AMOUNTS OF CORTISOL

adrenal tumour> varying cortisol. less reliable, as adrenal gland doesnt respond to AcTH stimulation.

normal: increased cortisol production then levels off

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10
Q

fill in the blanks

hypothalamus> ? anterior pituitary> ? adrenal gland> cortisol

A

hypothalamus> CRH anterior pituitary> AcTH adrenal gland> cortisol

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11
Q

how would a pituitary vs adrenal tumour vs normal dog respond to low dose dexamethasone test

A

pituitary tumour > suppresses levels then starts to creep back up
adrenal> no suppression whatsoever
normal> suppresses cortisol levels (-ve feedback)

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12
Q

how is a cortisol: creatine ratio used to diagnose cushings

A

useful to rule it out

low cortisol to creatine is v unlikely to be cushings

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13
Q

Which drugs are used in the tx of cushings?

A

trilostane: decreases production of cortisol
mitotane
pergolide: inhibits pituitary gland

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14
Q

when is surgery indicated in cushings treatment?

A

large adrenal tumours, not near caudal vena cava can eb removed
specialist: pituitary tumours can be removed

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15
Q

Why would you not treat a scottish terrier hepatopathy with trilostane?

A

they have abnormal cortisol, does not need suppressing, need correct cortisol

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16
Q

What is a phaeochromacytoma

A

tumour of adrenal medulla > increased catecholamines

cx: anxiety, tachycardia, tachyonoea, vomiting, diarrhoea, weight loss and hypertension

seen on radiography/ US, metanephrines (breakdown of catecholamines) in urine/ plasma

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17
Q

What is addisons disease

A

hypoadrenocorticism

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18
Q

what is the aetiology of addisons disease

A

autoimmune/ genetic > destruction of adrenal cortex> low cortisol

primary hypoadrenocorticism

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19
Q

what is a secondary cause of hypoadrenocorticism (ie not addisons causing it)

A

trauma/ injury> low AcTH production from pituitary> atrophy of adrenal cortex

can also get iatrogenic from sudden withdrawal from glucocorticoid drugs

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20
Q

reduced production of which substance is asc with addisons?

A

cortisol

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21
Q

dog
variety of clinical signs, waxing and waning malaise, vomiting +/- blood, diarrhoea +/- melena, lethargy + weakness, PUPD, abdominal pain, hypovolaemic collapse

top endocrine ddx?

A

Addisons- hypoadrenocorticism

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22
Q

what other ddx may you consider along side addisons?

A 
GI disease
renal failure
parasitic infection
urinary obstruction
chronic effusion 
pregnancy 
CHF
diabetes mellitus
chronic blood loss
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23
Q

which breeds/ sp most likely to get addisons disease?

A

uncommon but middle aged females
poodle, beardies, gt dane, portugese water dog, WHWT, st b,

particularly nova scotia duck- tolling retriever

affects siblings- family history

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24
Q

dog 8 years
bloods: mild non regen anaemia, mild hypercalcaemia, abnormal electrolytes- high K+
which endocrine disease is top ddx?

A

addisons

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25
what endocrine test (s) would you do to diagnose addisons?
cortisol: creatine ration/ cortisol levels in blood if normal then NOT addisons if low then could be addisons > further AcTH stimulation test> addisons dog would not respond to this as cant make cortisol
26
How would you treat addisons
fluid therapy shock rates 0.9% NaCl initially - hyperkalaemia: dextrose saline+insulin, calcium gluconate. K+ should rebalance once fluid therapy established anyway dexamethasone sodium phosphate once eating again can swap to oral prednisolone and fludrocortisone life long therapy monitor/ adjust tx
27
the following are chronic complications of which endocrine disease? ketoacidosis (due to increased fat mobilisation) infections lens induced uveitis diabetic neuropathy cataracts diabetic retinopathy
diabetes mellitus
28
what is the cause of diabetes mellitus in - dogs - cats
dogs: infection/ pancreatitis/ immune mediated/ hormona;/ drug antagonism--> loss of islet cells--> loss of insulin cats: insulin resistance +/- deficiency, endocrinopathy, hyperlipaemia
29
dog, obese PUPD polyphagia weight loss bloods: hyperglycaemia, high ALT, ALKP, hypertrigycidemia, urinary ketones urinalysis: low USG, glycosuria, ketonuria, active sediment which endocrine disease is top ddx
diabetes mellitus
30
What does the following treat? feed half ration, administer caninsulin, twice a day + consistent diet and exercise
diabetes mellitus in dog
31
when would you use oral glipizide (sulfonylureas) (rather that twice daily injection of caninsulin or prozinc (synthetic insulin) ) to treat diabetes mellitus in cat?
if the owner can not inject the cat themselves only. injection much preferred.
32
what are signs of an insulin overdose
ataxia collapse seizure
33
what is a glucose curve used for?
glucose curve = serial measurements of blood glucose during the duration of action of insulin. 1) inject insulin (twice daily) 2) skin prick every 2 hours - cat ear, dog lip/ear 3) measure blood glucose
34
what should the following be on a normal glucose curve - nadir what is the - duration of action of insulin
nadir= lowest point on curve, should be 4.5-9 duration= time from injection past nadir back to 14mM OR time from injection past nadir back to 7-% of basal level
35
when doing a glucose curve, if the glucose has not returned to 14mM what should you do?
feed and monitor till reaches 14
36
what should you do if insulin doesnt lower the blood glucose levels, and the patients insulin dose is currently: a) <2IU/kg b) >2IU/kg
<2IU/kg increase insulin dose | >2IU/kg, indicates insulin resistance
37
a) if nadir is <4mmol on the glucose curve, what should you do? b) if nadir is 8-9 mmol on the glucose curve, what should you do?
a) decrease dose - too much glucose being taken in out of blood b) increase dose - not enough glucose being taken in
38
which endocrine disease presents: weakness, ataxia, seizures bloods: persistant hypoglycaemia, when fasted, insulin levels did not lower US may have pancreatic mass?
insulinoma
39
# fill in the blanks hypothalamus> ? > anterior pituitary> ? > thyroid glands> T3, T4 and calcitronin
hypothalamus> TRH > anterior pituitary> TSH > thyroid glands> T3, T4 and calcitronin ``` TRH= thyroid releaseing hormone TSH= thyroid stimulating hormone ```
40
give 2 causes of hypothyroidism in dogs
congenital from iodine deficiency in mum/ v young: thyroid hypoplasia, aplasia, dyshormonogenesis acquired from drugs sulphonamides, prednisolone, thyroiditis, idiopathic atrophy, thyroid neoplasia
41
where does the primary lesion lie in hypothyroidism in dogs | secondary lesions? tertiary ?
``` 1= thyroid 2= pituitary 3= hypothalamis ```
42
which endocrinopathy is commonly seen in middle age- old dogs, english cocker spaniels,golden retrievers, dobermans, dogs which train extensively
hypothyroidism
43
what causes the pathology in hypothyroidism
deficiency of T3 and T4
44
dog lethargy, obesity+ weight gain, exercise and cold intolerance, hair thinning + dry coat of poor quality - pyoderma. bloods: hyperlipidaemia (>atherosclerosis), US: GB mucocoele
hypothyroidism
45
which endocrinopathy causes disproportionate dwarfism
pituitary dwarfism- hypothyroidism
46
which blood test is best to diagnose hypothyroidism?
low free T4 | + high TSH indicates primary hypothyroidism
47
what does TgAA in blood mean
Thyroid globulin antibodies> indication of thyroiditits
48
how to treat hypothyroidism
Levothyroxine (t4) for life ``` tablets= thyforon solution= leventa ```
49
what is the most common cause of hypothyroidism in cats | still v rare in cats
iatrogenic- overdose of antithyroid medication etc
50
what endocrinopathy is this 12 year old cat palpable thyroid glands- both lobes weight loss, PUPD, hyperactivity, GI signs, tachycardia, heart murmur, hypertension, skin and hair changes sometimes presents in apethetic form: anorexia, depression, lethargy
hyperthyroidism
51
which blood test and dynamic test can be used to diagnose hyperthyroidism
blood: total t4- high t3 suppression test - take basal t3/4 - give t3orally every 8 hours for 7 doses - measure t4 (and t3 to ensure tablets being taken) - normal cat should reduce its t3 and t4 - hyperthyroid cat will keep producing loads t3 and t4
52
bloods: increased heinz bodies, increased platelet size, mild to mod erythrocytosis and macrocytosis, leukocytosis, increased ALP, ALT, AST, LDH, hypokalaemia and hyperphosphataemia which endocrinopathy?
hyperthyroidism
53
how to treat hyperthyroidism?
medical: thiamazole (methimazole) - most commonly used carbimazole radioactive iodine> taken in by hyperfunctioning thyroid tissue is tx of choice thyroidectomy also poss but risk
54
how many pairs of parathyroid glands are there
2 pairs (external and internal)
55
where are the adrenal glands located
left: adjacent to aorta, medial to cranial of left kidney right: adhered to caudal vena cava, medial to cranial of left kidney
56
5 ddx PUPD
``` diabetes insipidus osmotic diuresis iatrogenic eg glucocorticoids renal medullary washout primary polydipsia ```
57
very dilute urine, PUPD, trauma in posterior pituitary | which endocrinopathy?
diabetes insupidus- ADH deficiency, cant concentrate urine treat with hypophysectomy
58
insulin resistant DM, excessive growth of extremeties, prognathism, wide interdental space, elevated IGF1, liver enzymes in bitch treated with OVH queen hypophysectomy, radiation
acromegaly= excessive growth hormone due to cats: pituitary tumour bitch: comes from mammary tissue in luteal phase
59
hypercalcaemia, PUPD, dehydration, dystrophic clacification, renal dmaage, fibrous osteodystrophy bloods: high total calcium and iCa mass in thyroid area
primary: hyperparathyroidism due to parathyroid tumour secondary: imbalanced diet pseudohyperparathyroidism= tumour secreting PTH-rp
60
hypoparathyroidism sees which signs
hypocalcaemia: anxiety, muscle spasm, tetant, weakness, ataxia, seisures, tachycardia

Small Animal Year 4 (6 decks)

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