Adrenal Gland

Question 1

whats the thing to remember what is made by each area of the adrenal gland, starting with the cortex

Answer 1

salt, sugar, sex, stress

Question 2

what are the 3 main types of hypoadrenocorticism?

Answer 2

1. primary hypoadrenocorticism: immune mediated destruction of all 3 layers of the cortex (small percentage are corticosteroid deficient ONLY)
2. secondary hypoadrenocorticism: destruction of the pituitary or hypothalamus
3. iatrogenic: like a dog treated with steroids and then goes off of them

Question 3

what are some signs of addisons disease?

Answer 3

• waxing/waning GI signs, lethargy, inappetence, PUPD, melena or hematochezia

Question 4

30% of patients with addisons present in acute crisis, which looks like…

Answer 4

hypovolemic chock, bradycardia, collapse, hypothermia, weak pulses, poor CRT

Question 5

what is your biggest clue on CBC that there is addisons disease? other less important clues?

Answer 5

lack of a stress lymphopenia***
a normocytic and normochromic anemia (bone marrow suppression), can be from GI ulceration and hemorhage, dark tar feces.

Question 6

what is the classic electrolyte abnormality in regards to addisons?

Answer 6

• decreased Na, increased K because there is a decrease in aldosterone

Question 7

what is the Na:K ratio and why do we use it?

Answer 7

used to diagnose/support addisons disease. addidions will be lower than 27:1, the lower the more likely it is addisons, but this is not a confirmatory test

Question 8

with addisons youll see a mtabolic acidosis due to a gain of acid. why?

Answer 8

hypoaldosteronism impairs renal tubular hydrogen ion secretion. hypovolemia=lacticacid, and decreased renal perfusion=uremic acids

Question 9

in what ways can addisons look like kidney disease?

Answer 9

• they will have an azotemia (mostly pre renal in nature but can become renal if chronic)
• they will have a low USG, cannot concentrate urine
• PUPD: medullary washout due to lack of solutes

***renal disease WILL have a stress lymphopenia tho

Question 10

how can you tell liver disease from addisons?

Answer 10

• both will have hypoglycemia, hypoalbuminemia, and hypocholesterolemia
• ONLY LIVER DISEASE will have a stress lymphopenia

Question 11

what is the gold standard test for addisons?

Answer 11

ACTH stim test, dogs with a post ACTH sample lower than 30nmol/L will have addisons

Question 12

baseline cortisol of more than 55nmol/L tells you…what about if it’s between 55 and 30?

Answer 12

addisons can be ruled out
cannot confirm nor deny if they dog has it

Question 13

what is hyperaldosteronism and who gets it? what are the main two causes?

Answer 13

excessive aldosterone, cats get it
primary(idiopathic): adrenal ademona, carcinoma, hyperplasia
secondary: in response to decreased renal blood flow and activation of the RAAS system

Question 14

clinical signs of hyperaldosteronism?

Answer 14

• hypokalemia os less than 2.5, or systemic hypertension

Question 15

what is a pheochromocytoma?

Answer 15

catecholamine productin endocrine tumor originating in the medulla, too much Ep & NE, released episodically. wont see nothin on CBC, biochem, and UA. have to analysize catecholamines in plasma or urine