Addison's

Question 1

Primary hypoadrenocorticism ____

secondary hypoadrenocorticism _____

Answer 1

adrenal glands

pituitary or hypothalamic malfunction

Question 2

CRH - ACTH - stim:

to release:

Aldosterone is a mineralocorticoid released from:

main purposes are to maintain:

Answer 2

zona fasciculata
zona reticularis

cortisol

zona glomerulosa
complex hormonal cascade that starts in the kidney

normovolemia
enhance potassium excretion

Question 3

aldosterone in released in response to:

Answer 3

< Cl- delivery to macula densa
> K
>AcTH

Question 4

macula densa, a group of specialized cells in ___

senses decreased filtrate (specifically ___) delivery:

macula densa then induces renin release from:

Renin cleaves the ___ hormone ____

ACE enzyme located in the lung, on endothelial cells, and in many other organs:

ATII stimulates release of ______

stimulates cells of the renal:

Na reabsorption leads to water retention and ECV

Answer 4

distal portion of the thick ascending LOH

chloride

juxtaglomerular cells of the afferent arteriole

circulating hormone angiotensinogen into angiotensin I

AT1 - ATII

aldosterone

CD reabsorb sodium and excrete potassium

Question 5

Dogs with atypical primary hypoadrenocorticism:

within months of initial diagnosis:

very rarely, mineralocorticoid deficiency may occur before glucocorticoid deficiency:

Do patients with secondary hypoadrenocorticism (steroid admin withdrawal) have the classic electrolyte abnormalities seen in patients with typical primary hypoadrenocorticism?

Answer 5

cortisol deficiency only

usually develop mineralocorticoid deficiency

before glucocorticoid deficiency

no aldosterone is mediated primarily by:
RAAS and K+

Question 6

Most common breeds:

mixed breeds:

cats:

Answer 6

Portugese Water Dog
Great Dane
West Highland White Terrier
Standard Poodle
Wheaton Terrier
Rottweiler

mixed breed dogs are more commonly affected than any individual breed

Most cats are young to middle aged, w. ages ranging from 1 to 14 years

Question 7

USG

other findings:

Answer 7

inappropriate low
N/K ration <27
anemia
lack stress leuk
eosinphilia
hypoglycemia - lack cort.

Question 8

azotemia why

Answer 8

lack ECV - don’t mistake for AKI

Question 9

non-reg anemia MoA:

Answer 9

lack of cortisol tropism at the level of the bone marrow

+ GI blood loss

Question 10

“reverse stress leukogram:”

can they have inflamm leuk?

Answer 10

neutropenia
lymphocytosis
eosinophilia

yes, neutrophilia and lymphopenia commonly seen with severe illness.

Question 11

hypoglycemia % and MoA:

low Ca MoA - unknown

Answer 11

38%

cortisol - glycogenolysis and gluconeogenesis

Question 12

most important feature of the basic clinicopathologic:

hook up ECG for hyperK***

Answer 12

highly variable

do not expect to find all classic changes in one animal

Question 13

baseline cortisol:

Answer 13

<1 mcg/dl high S&S

>1 mcg/dl highly unlikely Addisions

Question 14

ACTH stimulation test
250 mcg cosyntropin per dog
125 mcg cosyntropin per ca

WHat is cosyntropin?

Answer 14

IV or IM pre- 60 min post baseline cort. (30 and 60 in cats)

synthetic AcTH

Question 15

When is endogenous ACTH concentration particuarly useful?

If they have low endogenous ACTH concentration =

Answer 15

ddx. primary from secondary hypoadrenocorticism
particularly with atypical Addisonian (normal e-)

secondary hypoadrenocorticism 
(hypothalamic or pituitary malfunction) 
unlikely to develop mineralocorticoid deficiency

Question 16

study showed utility of ratios:
cortisol/ACTH ratio of ___ or less had primary addisons

aldosterone/renin activity may be used to distinguish between typical and atypical primary hypoadrenocorticism

aldosterone/renin activity ratio of ___ or less primary addisons

Answer 16

<0.17
ratios 0.79 or greater were healthy

<0.08
>0.09 or more healthy

Question 17

Tx:
Fluids #1

DexSP dose not interfer, dose:

which steroid is closest to cortisol?
dose:

Prednisolone:

Answer 17

1. with Na close to patients
2. 1mg/kg

hydrocortisone is closest to endogenous cortisol
1.25 mg/kg IV once- 0.5 to 1 mg/kg IV q6h on tape

1 to 2 mg/kg IV followed 0.5 to 1 mg/kg IV q8h on a taper

Question 18

After endogenous ACTH measurement and ACTH stimulation:
mineralocorticoid treatment should begin promptly:

desoxycorticosterone pivalate at a dosage:

fludrocortisone:

Answer 18

2.2 mg/kg IM or subcutaneously (SC) once every 25 days for the life

fludrocortisone can also be used, but it is available only in oral form and often is not tolerated during the initial crisis event because of GI disturbance

Question 19

cats response

Answer 19

3-5 days to respond - slow

Question 20

px:

primary hypoadrenocorticism sometimes can be controlled with:
most require glucocorticoid supplementation as well

Answer 20

good

mineralocorticoid therapy alone