Endocrinology - Cushings 2 Flashcards Preview

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Flashcards in Endocrinology - Cushings 2 Deck (40)
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How do you differentiate AT from PDH?

Diagnostic imaging, LDDST, HDDST, and endogenous ACTH concentrations


If you have a pituitary microadenoma, what does it secrete and how will the adrenal glands look?

It causes bilateral adrenomegaly due to excessive ACTH


Why is an ultrasound only a differentiating test for PDH?

Because adrenals with PDH can be a normal size


What do functional adrenal tumors do?

They secrete cortisol independent of pituitary control


Why is CT/MRI not a reliable differentiating test between FAT and PDH?

It can find a macroadenoma, but cannot differentiate all microadenomas from normal so it is not a reliable differentiating test


How do dogs react to a HDDST if they have a FAT?

There is not cortisol suppression


How do dogs react to a HDDST if they have PDH?

75% of dogs with PDH will suppress it at the 4 and/or 8 hour measurement


What is the disadvantage to a HDDST test?

It can never confirm the presence of a FAT


How do dogs with PDH react to endogenous ACTH?

They should have elevated ACTH levels


How do dogs with FAT react to endogenous ACTH?

They should have decreased levels due to negative feedback


How do you treat an adrenal tumor?



What complications are associated with removal of an adrenal tumor?

Hemorrhage, thromboembolism, pancreatitis, arrhythmias, and hypoadrenocorticism


How do you medically treat PDH?

Trilostane (FDA approved) or Mitotane


How does Trilostane work?

It blocks the steriodogenesis pathway therefore inhibits cortisol production


What is the recommended dosage of Trilostane?

1 mg/kg BID PO - Low dose protocol


What adverse effects are associate with Trilostane?

Possible adrenal necrosis, vomiting, diarrhea, hyperkalemia, and Addison's disease


Trilstane is effective in ______% of patients.

>90% .


How quickly will PU/PD/PP improve once Trilostane is started?

within 4 weeks


How quickly will skin improve once Trilostane has been started?

within 3 months


How do you monitor effectiveness of Trilostane? When should you?

Via ACTH stimulation 4-6 hours post pill administration


After you start Trilostane, when should you do your first ACTH stimulation and why?

At 10-14 days to make sure the patient isn't Addisonian - don't change dose unless cortisol is too low


After the initial ACTH stim, when do you want to do the next ones?

At 30 days, then every 10-14 days until controlled, and then at 30 days, 90 days, and every 3 months thereafter


What is the goal level for ACTH stimulation in patients treating for Trilostane?

To have the pre and post ACTH cortisol concentration between 1 and 5 micrograms/dl


What is the prognosis for dogs with Trilostane therapy?

Good - median survival with PDH is almost 2 years, and with AT is around 14 months


What type of drug is Mitotane and what does it do?

It is an adrenocorticolytic that causes Zona fasciculata and reticularis necrosis


When do you want to do a recheck for a patient that has begun Mitotane therapy?

Recheck in 8 days or when appetitie decreases


What should be done at the recheck appointment in a patient that is getting Mitotane therapy?

Perform an ACTH stimulation test and repeat every 7-10 days until adequate suppression


What are the potential adverse effects associated with Mitotane therapy?

Vomiting, diarrhea, inappetance, lethargym depression, adrenocorticol necrosis, and unmask concurrent diseases such as allergies, arthritis, and UTIs


What are the non-medical options for PDH treatment?

Surgical removal of pituitary mass, radiation therapy, and a bilateral adrenalectomy


What are the major complications of not treating hyperadrenocorticism?

Hypertension, hypercoagulability, calcium oxalate urinary stones, gallbladder mucocele, and infections

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