Adrenal Glands

Question 0

Hypercorticoidism

Pathophysiology

Answer 0

Hyper secretion of Cortisol

Primary- FAT - functional adrenal tumor

Secondary- PG tumor secreting too much ACTH

Iatrogenic- too much glucocorticoids

Question 1

Adrenal gland anatomy

Answer 1

Consists of an outer cortex and inner medulla

3 layers of the cortex
Outer - zona glomerulosa - produces aldosterone (mineralcorticoid = salt)

Middle - zona faciculata - produces cortisol (glucocorticoid = sugar)

Inner - zona reticularis - produces androgens (testoid = sex)

Question 2

Hypercorticoidism

Signalment

Answer 2

Dogs

Middle-aged to older

Dachshunds, terriers, poodles, and boxers

Question 3

Hypercorticoidism

Clinical signs/Physical exam

Answer 3

PU/PD, polyphagia, pot-bellied, wt gain, weakness, panting, hair loss

Question 4

Hypercorticoidism

Diagnostics

Answer 4

Increased ALP

ACTH stim

LDDST

Differentiating between PDH and FAT - LDDST - 4 hour concentration is < 1.4 or is < 50% of the basal cortisol, then it’s PDH

ultrasound

Question 5

Hypercorticoidism

Treatment

Answer 5

Medical therapy-
Mitotane- selective adrenocorticolysis
Trilostane- selectively inhibits the synthesis of the adrenal cortex hormones

FAT- adrenalectomy

Question 6

Hypercorticoidism

Prognosis

Answer 6

Good to excellent

Question 7

Hypocorticoidism

Pathophysiology

Answer 7

Primary- immune-mediated

Secondary- lesion of the hypothalamus or PG

Question 8

Hypocorticoidism

Signalment

Answer 8

Young-middle aged females

Standard poodles

Question 9

Hypocorticoidism

Clinical signs/Physical exam

Answer 9

Lethargy on and off, V, D, dehydration, PU/PD, muscle tremors, abd pain, shock, collapse

Addison’s crisis: lethargy, shock, hyponatremia, hyperkalemia

Question 10

Hypocorticoidism

Diagnostics

Answer 10

Sodium:potassium ratio less than 27:1

ACTH stim
Pre > 2 not Addison’s

Lack of stress leukogram or reverse stress leukogram (neutrophilia, lymphopenia, and eosinopenia)

Others: azotemia, hypoglycemia, elevated liver enzymes, hypercalcemia, hypoalbinemia, hyperphosphatemia

Question 11

Hypocorticoidism

Treatment

Answer 11

IVF

dexamethasone can be given before a stim test,

Maintenance: glucocorticoid therapy (prednisone) and mineralcorticoid therapy (percorten)

Question 12

Hypocorticoidism

Prognosis

Answer 12

Excellent

Question 13

Pheochromocytoma

Pathophysiology

Answer 13

Adrenal tumor that secretes catecholamines (epi, norepinephrine, and, dopamine)

Usually malignant

Metastasis common

Question 14

Pheochromocytoma

Signalment

Answer 14

Older dogs ~ 11 years

Rare in cats

Question 15

Pheochromocytoma

Clinical signs/physical exam

Answer 15

Intermittent collapse and weakness

Hypertensive crisis due to catecholamine release

Question 16

Pheochromocytoma

Diagnostics

Answer 16

BP- hypertension that can wax and wane

Rads- perirenal mass

Ultrasound- unilateral adrenomegaly and signs of metastasis

CT/MRI - mapping before surgery

ACTH STIM or LDDST

Question 17

Pheochromocytoma

Treatment

Answer 17

Adrenalectomy

Control hypertension before surgery- phenoxybenzamine (prazosin can also be used)

Radiation on inoperable tumors

Question 18

Pheochromocytoma

Prognosis

Answer 18

Depends on size, metastasis, concurrent diseases

Guarded to good