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Flashcards in Pituitary Disease and Insulinoma Deck (17)
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1

1/3 of middle to old age, uncontrolled diabetic cats have a tumor on the pars distalis that causes an excess of growth hormone. What disease does this cause? 

Acromegaly

2

How does an increase in growth hormone affect diabetics?

Further decreases tissue insulin sensitivity

Further decreases glucose transport

3

A 14 year old MN diabetic cat named Georgey presents for recent onset of seizures. You can feel the liver on abdominal palpation and you detect stridor on auscultation of the trachea. Oral exam is as pictured. What diagnostics would you like to do?

CT/MRI of the brain

Insulin-like growth factor-1 level

Ultrasound changes

 

4

You perform an ultrasound on Georgey and find the adrenals, kidneys, and pancreas to be enlarged. Based on the clinical presentation and ultrasound findings in the abdomen, what do you expect to see when you ultrasound the heart?

Cardiac hypertrophy

 

5

What 2 clinical findings in acromegaly cats significantly reduce survival time?

Arrhythmias

Hypertension

6

What are the treatment options for Georgey?

Radiotherapy

Surgery

Medical (most common)

7

Medical management of cats with acromegaly involves what drugs?

Insulin - no more than 5U BID

ACE inhibitors - proteinuria (kidney dz)

Diuretics - heart failure

B Blockers - dysrrhythmias

8

Georgey didn't have hypertension or arrhythmia on exam. What is his MST?

2-3 years

9

You are examining a 5 year old F Labrdor who is being treated with progestagens. Based on her clinical signs you suspect acromegaly, which IGF-1 level confirms. What is the treatment for this dog? 

Discontinue progestagens

Spay

10

The anterior pituitary is responsible for synthesizing which 6 hormones?

GH

TSH

PRL

FSH & LH

ACTH

11

A client brings in a German Shepherd puppy they just adopted from a shelter. The paper from the shelter states that the animal is 5 months old, but you estimare him to be at least 2 years old. Deciduous teeth are retained, along with the adult teeth that have grown in. The coat is sparse and consists of only guard hairs, and the skin is dark. Tesicles are not palpable. There is no response to pituitary stimulation test (TRH stimulation) and the T4 is low. What is the diagnosis in this patient?

Pituitary Dwarfism

 

*Low TSH, GH, FSH, LH

*German Shepherds retain normal ACTH levels

12

You tell the client that with treatment, these animals can live longer than 5 years, and she agrees to try medicating the dog. What medications will you send her home with?

Levothyroxine

Porcine GH

13

A 6 year old dog presents with a history of collapse. BP is 120mmHg [120-150]. You do a spot glucose and the level is extremely low at 15mg/dL. You also measure an insulin level, and the insulin:glucose ratio is 4.5. What is this diagnostic for in this patient?

Insulinoma

 

*Insulin levels should be low when the BG is that low. Normal or high insulin levels, or an insulin:glucose ratio greater than 4.2 is diagnostic. 

14

You perform a CT on the dog with suspected insulinoma. What are you looking for?

Pancreatic mass

 

*most are located in the left lobe

15

In patients with insulinomas, what is the first line of treatment?

Surgery!

16

What disease can patients develop after surgical resection of an insulinoma?

Diabetes mellitus

17

For insulinoma patients who won't be having the mass surgically removed, what is the medical treatment?

Prednisone (inhibits insulin, stimulates glycogenolysis)

Diazoxide (inhibits insulin secretion)

OR
Octreotide (inhibits insulin synthesis)

 

Can try dietary control but it doesn't go very well