addisons

Question 1

incidence

Answer 1

5 years or less, cats not as common. females more common? autoimmune diseases more common in females. in dogs, addisons is autoimmune adrenolitis. 3-5years more common

Question 2

causes

Answer 2

iatrogenic exogenous glucocorticoid induced atrophy. infiltrative disease- cancer, mycosis, tuberculosis. infarction or hemorrhage. pituitary insufficiency secondary addisons. opddd induced destruction. indiopathic. autoimmune destruction. cosyntropin rare.

Question 3

relative hypoadrenocorticism/addisons

Answer 3

septic shock. cytokines in septic shock can impair glucocorticoid output from adrenal glands. respond to steroids

Question 4

glomerulosa, fasciculata

Answer 4

aldosterone and cortisol get taken out. no sodium is saved, potassium is high. cortisol low. hyperkalemia, hyponatremia

Question 5

atrophic fasciculata

Answer 5

low cortisol- low gluconeogen, less vessel sensitivty to catecholamines, low water diuresis, low appetite, high eos, lymphs, mentally dull because cortisol is neuro stimulant

Question 6

pathophysoilogy z. glomerulosa

Answer 6

decreased vascular volume because sodium fixes low blood pressure. decreased CO, BP, GFR, high K, muscle weakness, abnormal cardiac exccitation and conduction, low CL

Question 7

diagnose addisons

Answer 7

hx and clin findings, ecg, clin path. if have a dog in shock decreased capilarry refill, low pulses, bradycardia, think addisons. heart should normally increase blood pressure if low output

Question 8

acute addisons crisis

Answer 8

weight loss, lethargy, decreased appetite, GI signs. weak/ complete collapse. bradycardia while hypotensive, weak femoral pulse. mentally dull. look uremic (decreased renal perfusion). low neuts, high eos, high lymphs. high k low sodium increased bun low bicarb, low glucose. low album, low chlroide, high calcium

Question 9

low na and high k

Answer 9

psuedoaddisons. renal disease, gi disease, DKA, HNKD. chylothorax.

Question 10

lab dx

Answer 10

acth stimulation test- gold standard. will be flat line. renin ratio.

Question 11

plasma aldosteron

Answer 11

low in most addisons.

Question 12

immediate emergnecy treatment

Answer 12

dexamethasone. isn’t picked up on cortisol assay

Question 13

addisonian rx

Answer 13

restore volume, provide glucocroticoid, provide mineralocorticoid, reversed hyperkalemia. dex or prednisone. insulin-dextrose lowers k, bicarb, cal glu

Question 14

maitenance treatment

Answer 14

florinef- mineral, glucocorticoids, more if stressed. oral NaCl. prednisone- needed with DOCP- mineral only!!. use gluco with it. DOCP overdose– hypok mypothay.

Question 15

atypical addions

Answer 15

chronic theragy, weakness, poor appetite, weight loss, normal serum na, and k despite low aldosterone. absent to minimal acth induced cortisol response

Question 16

if lytes normal

Answer 16

pred only. if lytes abnormal- give pred with mineralocorticorid. docp only mineral, florinef- both

Question 17

stress to addisonian

Answer 17

use of significant supplemental doses of glucocorticoids

Question 18

addisons take home

Answer 18

typically low na high k. treatment: acute iv nacl, prednisolone, florinef, docp. maintain: florinef, docp plus pred. keep alert for atypical addisons