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!Small Animal Medicine > Pituitary and Parathyroid Disorders > Flashcards

Pituitary and Parathyroid Disorders Flashcards

(55 cards)

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1
Q

Adenohypophysis pituitary

A

ACTH, TSH, GH, FSH and prolactin

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2
Q

Neurohypophysis

A

Vasopression (anti-diuretic hormone)
Oxytocin

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3
Q

Hypersomatotropism (acromegaly) in dogs

A

Mid-age to older females
↑ progestins with Gh secretion from mammary tissue (endogenous)
Megesterol acetate (exogenous)

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4
Q

Hypersomatotropism (acromegaly) in cats

A

Older males (more in cats than dogs)
Pituitary macroadenoma (excess GH and insulin-like growth factor)

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5
Q

CS associated with Hypersomatotropism (acromegaly)

A

PU/PD, prognathism
Widened interdental spaces, face and foreheadand neck (stridor)
Dyspnea, abdominal swelling and weight gain

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6
Q

CS of Hypersomatotropism (acromegaly) in cats only

A

Clubbed paws and CNS signs
with other signs

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7
Q

How to dx Hypersomatotropism (acromegaly)

A

Hyperglycemia
Insulin- like growth factor 1 measurement
Thoracic rads (cardiomegaly)
CT/ MRI (pituitary mass)

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8
Q

How to tx Hypersomatotropism (acromegaly) in dogs

A

OHE and D/C progestins

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9
Q

How to tx Hypersomatotropism (acromegaly) in cats

A

Pituitary radiation (stereotactic/ gamma knife)
Hypophysectomy (supplement thyroid and glucos)
Pasireotide (somatostatin analog)

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10
Q

Pituitary dwarfism

A

Congenital growth hormone deficiency
Failure of complete pituitary genesis
Dx @ 2-5m of age

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11
Q

CS of pituitary dwarfism

A

Growth retardation
Fluffy haircoat, alopecia, hyperpigmentation, bilateral cryptorchidism (males), persistent anestrus (females)

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12
Q

Dx pituitary dwarfism

A

Clonidine Stimulation Test- GNRH stimulation test that measures GH (gold standard)
IGF-1 levels low

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13
Q

How to tx pituitary dwarfism

A

Porcine growth hormone
Progesterone
Thyroid supplementation
+/- glucos supplementation

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14
Q

Porcine growth hormone

A

Identical to K9 GH, expensive
Helps with long bone growth
Delay onset of renal dysfunction

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15
Q

Progesterone

A

↑ GH levels (OHE prior to prevent pyometra)
Helps with long bone growth
Delay onset of renal dysfunction

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16
Q

Central Diabetes Insipidis

A

Vasopressin deficiency
Complete or partial

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17
Q

Congenital nephrogenic DI

A

ADH receptor deficiency
Partial or complete

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18
Q

Acquired nephrogenic DI

A

ADH receptor blockage
Most common!

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19
Q

Primary polydipsia (psychogenic) DI

A

Non-vasopressin associated polydipsia
Behavioral or 2 degree central lesion/ head trauma

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20
Q

Dx of DI

A

Confirm patient really has PU/PD (measure water intake- 40-60 ml/kg/dy)
Rule out causes of nephrogenic DI prior to pursuing CDI v. 1 degree PD
Modified water deprivation test
Desmopressin trial

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21
Q

How do tx central DI

A

DDAVP (desmopressin)

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22
Q

How to tx first degree polydipsia

A

Behavior modification, limit water access
If 1st degree brain tumor is cause → radiation therapy

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23
Q

How to tx congenital nephrogenic DI

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A

Low sodium diet
Thiazide diuretics (rarely used)

24
Q

Parathyroid hormone (PTH)

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A

Synthesized, stored and secreted by chief cells
Binds to type1 receptors in target tissues regulating Ca fluxes across bone, kidney and intestines

25
Regulation of PTH
Secretion regulated by Ca concentrations (high= inhibits, low=stimulates) Hypophosphatemia: inhibit PTH secretion Vit D and ↑ plasma: inhibits PTH
26
Net affect of ↑ PTH
↑ Ca and ↓ P Mobilizes Ca from bone and kidney, delayed effect on mobilizing Ca from GI tract
27
Primary hyperparathyroidism
Hyperplasia (adenoma, adenomatous hyperplasia) Carcinoma
28
Hypercalcemia
↑ PTH → ↑ vit. D →↑ Ca++ from GI ↑ Osteoclastic activity ↑ resorption of Ca++ from DRT
29
Signalment for hyperparathyroidism
Old dogs (large breeds) Keeshond (autosomal dominant gene)
30
CS of hyperparathyroidism
Leth, PU/PD, urinary continence, muscle weakness/ wasting, anorexia, depression, UB stones Shivering, UT signs, C, constipation, mental dullness, coma/ CNS signs
31
Lab findings of hyperparathyroidism
Hypercalcemia, fasting, persistent Low to normal P Poorly concentrated urine Ca oxalate or Ca phophate urolithiasis Genetic testing
32
Humoral hypercalcemia of malignancy
Production of PTH realted protein (PTH-rP):mimics PTH and binds PTH receptors
33
What causes hypercalcemia of malignancy
Lymphosarcoma Multiple myeloma Apocrine gland adenocarcinoma of the anal sac Thymoma
34
Diagnostic imaging of hyperparathyroidism
Rads: mineralization of vessels and other ST urinary calculi U/S: parathyroid nodules
35
Acute (emergency) therapy for hyperparathyroidism
Diuresis (0.9% NaCl, 0.45% NaCl + 5% dextrose or loos diuretics- furosemide) Glucos Salmon calcitonin Parathyroidectomy Parathyroid ablation
36
Glucocorticoid therapy for hyperparathyroidism
↓ osteoclastic formation and activity PU/ ↑ Ca excretion in urine Lympholytic
37
Salmon calcitonin
Inhibits bone resorption ↑ Ca++ excretion in urine
38
Hypoparathyroidism
Immune-mediated and iatrogenic Causes hypocalcemia Middle aged female dogs (mini poodles, schaunzer and dachshunds)
39
CS for hypoglycemia
Twitching of facial muscles Pawing @ face Muscle fasciculations Stiff/Stiled gait *
40
Lab findings of hypoparathyroidism
Total and ionized hypocalcemia Mild hyperphosphatemia Low PTH levels Definitive: atrophied parathyroids on histopath
41
Emergency therapy for hypoparathyroidism
Calcium gluconate 10% IV slowly Monitor ECG for bradycardia, short QT interval, sudden elevation of ST segment, VPCs
42
Therapy for hypoparathyroidism is stailized
Ionized Ca Elemental Ca (gluconate or chloride) Ca++ gluconate
43
Maintenance therapy for hypoparathyroidism
Calcitriol (dihydroxycholecalciferol)- not in hyperphosphatemic patients (t first with oral Ca carbonate) Feed reg diet with oral Ca++ carbonate
44
Hyperaldosteronism
Conn's dz or primary aldosteronism From ↑ secretion of aldosterone from adrenal gland
45
Primary hyperaldosteronism
Independent of RAAS Most commonly caused by unilateral adrenal neoplasia or bilat adrenal neoplasia Cause of hypokalemia or hypertension
46
Secondary Hyperaldosteronism
Occurs in response to RAAS Dehydration, hypertension, ↓ renal perfusion or Na deficiency
47
Signalment for Hyperaldosteronism
Middle age to older
48
Hyperaldosteronism hallmarks
Primary: hypokalemia, hypertension, ↑ serum aldosterone Secondary: ↑ aldosterone due to ↑ renin
49
Hypokalemic myopathy (hyperaldosteronism)
Most common for adrenal hyperplasia Muscle dysfunction, dysphagia, collapse, ataxia, etc Weakness most common then central ventroflexion
50
Other CS of hyperaldosteronism
Acute onset blindness due to retinal detachment or intraocular hemorrhage from hypertension
51
Lab findings of hyperaldosteronism
Hypokalemia, low phosphorus, met. alk Azotemia and proteinuria
52
Dx for hyperaldosteronism
Plasma aldosterone (plasma renin activity) *: aldosterone  ↑ with low renin Plasma aldosterone concentration (PAC): ↑ aldosterone with low K
53
Medical tx for hyperaldosteronism
Goal: control hypokalemia and hypertension- K gluconate Amlodipine for hypertension Spironolactone for hypokalemia and hypertension
54
Sx tx for hyperaldosteronism
Adrenalectomy (unilateral tumors) Post-op fludrocortisone for hyperkalemia
55
Most common cause of death with hyperaldosteronism
CKD or thromboembolism if medically managed

!Small Animal Medicine (37 decks)

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