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Small Animal Internal Medicine > Addison's Disease > Flashcards

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
Q

What would you find on a chemistry profile associated with addison’s disease?

A
  1. Hyperkalemia
  2. Hyponatremia
  3. Hypercalemia
  4. Azotemia
  5. Hypoglycemia
26
Q

Explain the sodium:potassium ratio associated with addison’s disease…

A

Na:K

<24:1

27
Q

Other than addison’s disease, what are 5 differentials for a low Na:K ratio?

A
  1. Renal failure
  2. Severe GI disease
  3. Third space fluids (ascites, pleural effusion)
  4. Late pregnancy
  5. Akitas (K+ in RBCs)
28
Q

What would you see on ECG with hyperkalemia?

A
  1. Bradycardia
  2. Loss of P wave
  3. Peaked T wave
  4. Wide QRS
  5. Shortened QT interval
29
Q

Explain the protocol for the ACTH stimulation test.

A
  1. Collect baseline cortisol level
  2. Inject ACTH
  3. Collect 1 hour cortisol level
30
Q

What is the typical result to the ACTH stimulation test when the animal has addison’s disease?

A

Flatline

31
Q

A basal cortisol of greater than ___ ug/dL helps rule-out hypoadrenocorticism.

A

> 2 ug/dL

32
Q

If it is clinically necessary to administer corticosteroids prior to performing an ACTH stimulation test, which medication should be used?

A

Dexamethasone

33
Q

Prior to performing an ACTH stimulation test, a patient must be weaned off prednisone because it will be measured as what?

A

Cortisol

34
Q

The treatment of choice for hypoadrenocorticism is hormone replacement. Which drug can be used to replace glucocorticoids?

A

Prednisone

35
Q

What is the physiologic dose of prednisone on which a patient is typically started?

A

0.1 - 0.22 mg/kg/day

36
Q

Which drug provides both mineralocorticoid and glucocorticoid replacement?

A

Oral Florinef

37
Q

What does Percoten replace within the body?

A

Only mineralocorticoids

38
Q

What is the dosage protocol for Percorten?

A

2.2 mg/kg IM or SC every 25-31 days

39
Q

Part of the monitoring and long-term maintenance of an addisonian patient involves decreasing the Percorten dose from what to what?

A

2.2 mg/kg –> 2.0 mg/kg –> 1.8 mg/kg

40
Q

Also part of the monitoring and long-term maintenance of an addisonian patient involves increasing the dosing interval from what to what?

A

25 days –> 26 days –> 27 days –> 28 days –> 29 days –> eventually 30 days

41
Q

What is the MOST important factor in long-term response to therapy in an addisonian patient?

A

Client education

42
Q

An addisonian crisis is the result of what 5 physiologic abnormalities?

A
  1. Hypotension
  2. Dehydration
  3. Hypoglycemia
  4. Hyponatremia
  5. Hyperkalemia
43
Q

What is the most life-threatening component of an addisonian crisis?

A

Vascular collapse and shock

44
Q

What is the most important component of therapy for an addisonian crisis?

A

IV fluid replacement

45
Q

How do the doses of Dexamethasone and Prednisone differ?

A

The prednisone dose is 7 times that of Dexamethasone

46
Q

What is a “typical” addisonian?

A

Deficient in glucocorticoids and mineralocorticoids.

47
Q

What is an “atypical” addisonian?

A

Deficient in glucocorticoids alone.

48
Q

What is the therapy for an “atypical” addisonian?

A

Glucocorticoid replacement

Small Animal Internal Medicine (36 decks)

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