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ClinPath > Adrenal Diseases > Flashcards

Adrenal Diseases Flashcards

1
Q

What gland produces ACTH?

A

The anterior pituitary

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2
Q

What gland produces cortisol?

A

The adrenal gland

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3
Q

On what gland does ACTH act?

A

The adrenal gland

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4
Q

Canine hyperadrenocorticism CS

A

7-12 years old
PU/PD
Polyphagia
Pendulous abdomen
Panting
Hepatomegaly
Muscle weakness
Lethragy/Lameness
Endocrine alopecia
Pyoderma/Demodex
Calcinosis cutis

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5
Q

Canine Hyperadrenocorticism lab abnormalities

A

Stress leukogram: lymphopenia, neutrophilia, monocytosis
Increased ALP
Hypercholesterolemia
Hyperglycemia
USG < 1.020
Proteinuria

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6
Q

Canine hyperadrenocorticism pathogenesis

A

85%: pituitary dependent disease: production of excess ACTH, bilateral adrenocortical hyperplasia
15%: adrenal tumors: unregulated production of cortisol: unilateral adrenal enlargement
Or Iatrogenic: chronic steroid use, atrophy of adrenal

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7
Q

How do you differentiate between pituitary dependent and adrenocortical tumor?

A

High dose dexamthasone suppression test
Endogenous ACTH

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8
Q

What happens to the urine cortisol: creatinine ratio with hyperadrenocorticism?

A

It will be increased
Cortisol excretion increases as blood cortisol conc increases, but creatinine is excreted at a constant rate

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9
Q

Low Dose Dexamethason Suppression Test

A

Dex is a proxy for cortisol
Inhibits CRH/ACTH/Cortisol

Cortisol should be decreased in healthy animal

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10
Q

In a dog with Hyperadrenocorticism the LDDST should result in ___?

A

No change in cortisol

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11
Q

Can an adrenal tumor be suppressed with dex?

A

No
Adrenal tumors never suppress

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12
Q

LDDST interpretation

A

If the 8 hr cortisol is NOT suppressed: Cushings
If the 8hr cortisol is NOT suppressed but the 4 hr is: PDH
Lack of suppression: PDH or ADH

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13
Q

In a healthy animal, ACTH stim test should result in what?

A

A mild increased in cortisol

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14
Q

ACTH Stimulation Test protocol

A

ACTH stimulates production of cortisol
Draw base line blood
Administer ACTH
Redraw 1-2 hr later
Measure cortisol

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15
Q

With iatrogenic Cushings, the ACTH stim test should result in what?

A

No change in cortisol
The gland is too atrophied to produce

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16
Q

ACTH interpretation

A

Mild increase: normal
Exaggerated increase: Cushing’s
No Increase: Iatrogenic Cushing’s

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17
Q

A dog with Cushing’s has a low endogenous ACTH concentration. This is most consistent with what type?

A

Adrenal dependent hyperadrenocorticism

18
Q

A dog with Cushing’s has a high endogenous ACTH concentration. This is consistent with what type?

A

Pituitary dependent hyperadrenocorticism

19
Q

A dog with Cushing’s suppresses with a HDDST. This is consistent with what?

A

A pituitary dependent hyperadrenocorticism

20
Q

A dog with Cushing’s does not suppress with a HDDST. This is most consistent with what?

A

Hyperadrenocorticism but can’t tell what type.

21
Q

Equine Cushing’s Disease/Pituitary Pars Intermedia Dysfunction (PPID)

A

Most common equine endocrinopathy
CS:
Hirsutism/poor hair coat
Laminitis
Lethargy
PU/PD
muscle wasting
Increased appetite
Skin infections

22
Q

Equine Cushing’s lab abnormalities

A

Stress leukogram
anemia
hyperglycemia
hyperlipidemia
increased liver enzymes
glucosuria

23
Q

Feline Hyperadrenocorticism CS

A

Uncontrolled diabetes
PU/PD
Polyphagia
Weight loss
Lethargy
Weakness
Dermatopathies

24
Q

Feline Hyperadrenocorticism lab abnormalities

A

Stress leukogram
lack of consistent abnormalities

25
Q

Feline hyperadrenocorticism pathogenesis

A

80% =PDH
20% = ADH

26
Q

Feline hyperadrenocorticism diagnosis

A

Urine cortisol: creatinine
LDDST
ACTH stim not recommended

27
Q

Hypoadrenocorticism

A

Addison’s disease
Decreased glucocorticoid (cortisol)
Decreased mineralocorticoid (aldosterone)

28
Q

What normally stimulates cortisol production

A

ACTH

29
Q

What normally stimulates aldosterone production?

A

Reduced renal blood flow (RAAS)
Hypotension (carotid artery barorecetors)
Increased potassium

30
Q

Canine hypoadrenocorticism CS

A

4-5 year old
females > males
vague clinical signs
intermittent illness
ADDISONIAN CRISIS
abd pain/shaking
lethargy/anorexia
V/D, polyuria

31
Q

Canine hypoadrenocorticism lab abnormalities

A

Lack of stress leukogram in an ill dog
normocytic, normochromic anemia
Electrolyte abnormalities from decreased aldosterone
-Hyponatremia
-hypochloremia
-hyperkalemia
-Sodium: potassium <27:1
Prerenal azotemia
USG 1.015-1.030 (should be more concentrated)-can mimic renal failure
Hypercalcemia
Hyperalbuminemia
Hypoglycemia
Hypocholesterolemia

32
Q

Primary adrenocortical failure pathogenesis

A

most common cause of hypoadrenocorticism
Destruction of the adrenal cortex (immunemediated, neoplasia, infarct, idiopathic)

33
Q

Secondary adrenal insufficiency pathogenesis

A

Reduced ACTH from pituitary

34
Q

Idiopathic hypoadrenocorticism pathogenesis

A

Abrupt discontinuation of steroids (atrophied adrenals)

35
Q

Where is aldosterone produced?

A

Zona glomerulosa of the adrenals

36
Q

Where is cortisol produced?

A

Zona fasciculata of adrenals

37
Q

In a dog with Addison’s: ACTH stimulation causes what?

A

No response

38
Q

Canine hypoadrenocorticism diagnosis

A

ACTH stim test
(low cortisol post ACTH)

39
Q

What is the most common cause of hypoadrenocorticism in horses?

A

Discontinuation of chronic steroid use

40
Q

Is hypoadrenocorticism common in cats and horses?

A

No

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