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Clinical Pathology > Lecture 19: Endocrine system II > Flashcards

Lecture 19: Endocrine system II Flashcards

(68 cards)

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1
Q

What does the zona glomerulosa release

A

mineralcorticoids (aldosterone)

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2
Q

what does zona fasciculata release

A

glucocorticoids

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3
Q

what does zona reticularis release

A

sex hormones (adrogens)

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4
Q

what does medulla release

A

catecholamines- epi/NE

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5
Q

how does stress, hypoglycemia and exercise affect cortisol

A

increase CRH—> ACTH—> cortisol

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6
Q

what 3 functions is cortisol important for

A
  1. Hepatic gluconeogenesis—> hyperglycemia
  2. Increase protein and fat catabolism
  3. Important to maintain BP
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7
Q

What is the function of aldosterone

A

increase Na+ and Cl- retention and increase potassium secretion

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8
Q

what are the 3 categories of addisons

A
  1. Primary
  2. Atypical primary
  3. Secondary
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9
Q

what is cause of primary hypoadrenocorticism

A

complete destruction of all 3 layers of adrenal cortex
Causes: lymphocytic inflammation, neoplasia, granulomatous inflammation, infarction, iatrogenic

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10
Q

__% destruction of both adrenal cortices needed before clinical signs of addisons

A

75-90%

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11
Q

what is atypical primary addisons

A

adrenal destruction limited to ZF (glucocorticoid deficiency)

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12
Q

how would sodium and potassium concentrations be in atypical primary addisons

A

normal

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13
Q

what are the two subcategories for secondary addisons

A
  1. Pituitary lesion
  2. Iatrogenic from exogenous corticosteroids
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14
Q

what is pathophysiology of pituitary lesion causing secondary addisons

A
  1. Tumor/ cyst/ inflamamtion/ head trauma
  2. Destruction of corticotrophs
  3. Decrease ACTH
  4. Atrophy of ZF and ZR
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15
Q

what dog breeds are predisposed to Addisons

A

standard poodles, Great Danes, westies, Nova Scotia duck tolling retriever

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16
Q

what are some signs associated with glucocorticoid deficiency

A

lethargy, weakness, vomiting, diarrhea, anorexia, abdominal pain

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17
Q

what are some signs associated with mineralcorticoid deficiency

A

bradycardia, PU/PD, microcardia

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18
Q

what are some CBC abnormalities with addisons related to corticosteroid deficiency

A
  1. Lack of stress leukon in sick patient
  2. +/- mild eosinophilia
  3. +/- mild, non-regenerative anemia
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19
Q

what electrolyte abnormalities are seen with addisons

A
  1. Hyponatremia
  2. Hyperkalemia
  3. Hypochloremia
  4. Decreased Na:K ratio
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20
Q

if you see hyponatremia, hyperkalemia and hypochloremia is that related to glucocorticoid or mineralcorticoid deficiency in addisons

A

mineralcorticoid

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21
Q

what renal abnormalities are seen with addisons

A

azotemia (pre-renal d/t dehydration)

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22
Q

how is phosphate affected by addisons and what is cause

A

hyper phosphate is—> decrease GFR d/t dehydration

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23
Q

how is calcium and BG affected in addisons patients

A
  1. Hypercalcemia
  2. Hypoglycemia
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24
Q

what is USG in addisons patients

A

decreased <1.030

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25
what is the #1 disease that addisons mimics
renal disease
26
how would you classify effects on USG from addisons
extra-renal effects on USG
27
besides addisons what other diseases can cause decrease Na:K+ ratio
1. Oliguric or anuric renal failure 2. Uroabdomen 3. Diarrhea (whipworms, salmonella) 4. Repeated drainage of chylous effusions
28
what dx test is used to exclude addisons
basal cortisol concentration
29
if basal cortisol concentration >2ugldL then __ if <2ug/dl then __
>: rule out addisons <: not enough to rule in addisons
30
what steroid is the only one that does not cross-react with cortisol assay. So if you need to give steroids to stabilize suspected addisons patient before running cortisol tests give this
dexamethasone
31
what is gold standard test to dx addisons
ACTH stim
32
both primary and secondary hypoadrenocorticisim will fail to respond to __ACTH with stim test
exogenous
33
t or f: ACTH stim test differentiates primary vs secondary addisons
false
34
what findings on ACTH stim are consistent with addisons
both pre- and post- ACTH cortisol <2ug/dL
35
if post ACTH cortisol >2ug/dl then __
not consistent with addisons
36
what test is used to differentiate atypical primary addisons vs secondary addisons
endogenous ACTH levels
37
what addisons patient do you not need to test endogenous ACTH levels
patietn dx via ACTH stim test with concurrent hyponatremia and hyperkalemia (because primary)
38
if patient has increase ACTH levels with endogenous ACTH test then __
atypical primary addisons
39
if patient has low/normal ACTH levels after endogenous ACTH test then __
secondary addisons
40
what are type categories of cushings
1. Pituitary dependent 2. Adrenal dependent
41
ferrets with cushings have increase in __hormones accounting for signs of alopecia and vulvar enlargement
sex hormones
42
what is cause and pathogenesis of pituitary dependent cushings
cause: functional pituitary tumors (adenoma) Secrete ACTH—> bilateral adrenal cortical hyperplasia—> increased cortisol
43
what is cause and pathogenesis of adrenal dependent cushings
Cause: functional adrenal tumor Secretes excess cortisol—> decrease ACTH—> atrophy of contralateral adrenal cortex
44
What happens to adrenal cortex with iatrogenic hyperadrenocorticism
bilateral adrenocortical atrophy
45
what dog breeds is cushings common in
poodles, boxers, dachshunds
46
what are some signs of cushings
1. PU/PD 2. Derm 3. Pendulous abdomen 4. Polyphagia 5. Panting 6. Hepatomegaly
47
what are some common cBC findings for cushings
1. Stress leukon 2. Erythrocytosis 3. Thrombocytosis
48
what are some common urinalysis findings in cushings
1. Decrease USG <1.020 2. Proteinuria 3. UTI
49
What are some common biochemistry findings in dogs with cushings
increase ALP- increase C-ALP
50
when do you test for cushings
if patient is clinical
51
when do you not test for cushings
no clinical signs, concurrent non-adrenal illness
52
what are the screening tests for cushings
1. ACTH stim 2. LDDST 3. Urine cortisol: urine creatinine ratio
53
what are the discriminatory tests for cushings used for
differentiate PDH and adrenal tumors
54
what are the discriminatory tests for cushings
1. HDDST 2. Endogenous ACTH 3. Advanced imaging
55
56
t or f: dogs with iatrogenic cushings will have inadequate response to ACTH stim
true
57
t or f: a negative ACTH stim test can rule out cushings
false- can miss a lot of cases with adrenal tumors
58
what is result of LDDST in healthy dog
dexamethasone—> decrease ACTH—> decrease cortisol (suppression) Remains suppressed for 24-48hrs
59
what is result of LDDST in dog with cushings
will not respond to negative feedback, no suppression/decreas cortisol at 8hr time point
60
Suppression at 4hr time point with an escape of suppression at 8hr time point supports what type of cushings
pituitary dependent cushings
61
If urine cortisol: urine creatinine ratio is low or WRI then you can __
rule out cushings
62
if urine cortisol: urine creatinine ratio is high then __
proceed to ACTH stim or LDDST
63
discriminatory tests for cushings are only used __
after diagnosis of cushings is made
64
what is discriminatory test for cushings helpful for
1. Treatment options 2. Medication choice 3. Prognosis: better survival rate with PDH
65
What would results be of HDDST in dog with PDH
suppress ACTH production at 8hr time point
66
what is result of HDSST in dog with ADH
ACTH already really low so unlikely to suppress further
67
what is best test to discriminate PDH vs adrenal tumor
endogenous ACTH
68
if endogenous ACTH is high consistent with __, if low consistent with __
PDH, AT

Clinical Pathology (19 decks)

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