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Addison's Disease Flashcards

1
Q

Which hormones are released from the anterior pituitary?

A
  1. LH
  2. GH
  3. ACTH
  4. TSH
  5. MSH
  6. Prolactin
  7. FSH
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2
Q

Which hormones are released from the posterior pituitary?

A
  1. Oxytocin

2. ADH

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3
Q

What are the 3 layers of the adrenal cortex from superficial to deep?

A
  1. Zona glomerulosa
  2. Zona fasciculata
  3. Zona reticularis
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4
Q

What is released from the zona glomerulosa?

A

Mineralocorticoids (aldosterone)

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5
Q

What is released from the zona fasciculata?

A

Glucocorticoids (cortisol)

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6
Q

What is released from the zona reticularis?

A

Anabolic and sex hormones

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7
Q

What is released from the adrenal medulla?

A

Catecholamines (epinephrine and norepinephrine)

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8
Q

What is the base molecule for aldosterone, cortisol, and estradiol?

A

Cholesterol

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9
Q

Hypoadrenocorticism is a deficiency in what?

A
  1. Aldosterone

2. Cortisone

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10
Q

Hyperadrenocorticism is an excess of what?

A

Cortisone

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11
Q

Hyperaldosteronism is an excess of what?

A

Aldosterone

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12
Q

What 4 changes trigger the secretion of aldosterone?

A
  1. Hyponatremia
  2. Hypotension
  3. Hypovolemia
  4. Hyperkalemia
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13
Q

What are aldosterone’s 2 main actions on the body?

A
  1. Renal conservation of Na

2. Renal excretion of K

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14
Q

From where is cortisol secreted?

A

Zona fasciculata

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15
Q

What is cortisol secreted in response to?

A

ACTH

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16
Q

What are the metabolic functions of glucocorticoids?

A
  1. Increase gluconeogenesis
  2. Increase fatty acid mobilization
  3. Decrease protein synthesis
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17
Q

How do glucocorticoids affect appetite?

A

Increase appetite

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18
Q

What are serum glucose levels with addison’s and cushing’s?

A

Addison’s = hypoglycemia

Cushing’s = hyperglycemia

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19
Q

What are blood pressures associated with addison’s and cushing’s?

A

Addison’s = hypotension

Cushing’s = hypertension

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20
Q

What is the most typical presentation of a dog with addison’s disease?

A
  1. Female
  2. Medium/large breed
  3. Mixed breed
  4. Young (2-7 years of age)
21
Q

Which 4 dog breeds are genetically predisposed to addison’s?

A
  1. Standard poodle
  2. Portuguese water dog
  3. Nova scotia duck tolling retriever
  4. Bearded collie
22
Q

What are some of the vague clinical signs associated with addison’s?

A
  1. Weight loss
  2. Vomiting & Diarrhea
  3. Polyuria
  4. Poor appetite
  5. Lethargy
  6. Weakness
23
Q

What would you find on physical exam of a dog with addison’s disease?

A
  1. Bradycardia
  2. Dehydration
  3. Poor peripheral pulses
  4. Hypothermia
  5. Melena/hematochezia
24
Q

What would you find on CBC associated with addison’s disease?

A
  1. LACK of stress leukogram
  2. Eosinophilia
  3. Lymphocytosis
25
What would you find on a chemistry profile associated with addison's disease?
1. Hyperkalemia 2. Hyponatremia 3. Hypercalemia 4. Azotemia 5. Hypoglycemia
26
Explain the sodium:potassium ratio associated with addison's disease...
Na:K <24:1
27
Other than addison's disease, what are 5 differentials for a low Na:K ratio?
1. Renal failure 2. Severe GI disease 3. Third space fluids (ascites, pleural effusion) 4. Late pregnancy 5. Akitas (K+ in RBCs)
28
What would you see on ECG with hyperkalemia?
1. Bradycardia 2. Loss of P wave 3. Peaked T wave 4. Wide QRS 5. Shortened QT interval
29
Explain the protocol for the ACTH stimulation test.
1. Collect baseline cortisol level 2. Inject ACTH 3. Collect 1 hour cortisol level
30
What is the typical result to the ACTH stimulation test when the animal has addison's disease?
Flatline
31
A basal cortisol of greater than ___ ug/dL helps rule-out hypoadrenocorticism.
> 2 ug/dL
32
If it is clinically necessary to administer corticosteroids prior to performing an ACTH stimulation test, which medication should be used?
Dexamethasone
33
Prior to performing an ACTH stimulation test, a patient must be weaned off prednisone because it will be measured as what?
Cortisol
34
The treatment of choice for hypoadrenocorticism is hormone replacement. Which drug can be used to replace glucocorticoids?
Prednisone
35
What is the physiologic dose of prednisone on which a patient is typically started?
0.1 - 0.22 mg/kg/day
36
Which drug provides both mineralocorticoid and glucocorticoid replacement?
Oral Florinef
37
What does Percoten replace within the body?
Only mineralocorticoids
38
What is the dosage protocol for Percorten?
2.2 mg/kg IM or SC every 25-31 days
39
Part of the monitoring and long-term maintenance of an addisonian patient involves decreasing the Percorten dose from what to what?
2.2 mg/kg --> 2.0 mg/kg --> 1.8 mg/kg
40
Also part of the monitoring and long-term maintenance of an addisonian patient involves increasing the dosing interval from what to what?
25 days --> 26 days --> 27 days --> 28 days --> 29 days --> eventually 30 days
41
What is the MOST important factor in long-term response to therapy in an addisonian patient?
Client education
42
An addisonian crisis is the result of what 5 physiologic abnormalities?
1. Hypotension 2. Dehydration 3. Hypoglycemia 4. Hyponatremia 5. Hyperkalemia
43
What is the most life-threatening component of an addisonian crisis?
Vascular collapse and shock
44
What is the most important component of therapy for an addisonian crisis?
IV fluid replacement
45
How do the doses of Dexamethasone and Prednisone differ?
The prednisone dose is 7 times that of Dexamethasone
46
What is a "typical" addisonian?
Deficient in glucocorticoids and mineralocorticoids.
47
What is an "atypical" addisonian?
Deficient in glucocorticoids alone.
48
What is the therapy for an "atypical" addisonian?
Glucocorticoid replacement

Small Animal Internal Medicine (36 decks)

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