Ch 120 - Adrenal dependant cushings Flashcards

1
Q

What percentage of pituitary dependent cushinoid dogs will also fail to suppress on LDDST?

A

40% - Therefore if suppression occurs, can confirm it is pituitary dependent, however, if no suppression, cannot differentiate

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2
Q

What percentage of Cushinoid dogs have adrenal dependant cushing?

A

15-20%

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3
Q

What size is the contralateral adrenal gland in adrenal dependant cushings?

A

<3mm

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4
Q

List the layers of the adrenal cortex

A

zona glomerulosa, zona fasicularis, zona reticularis

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5
Q

Bilateral adrenalectomies require what medications indefinitely?

A

Prednisone and DOCP (desoxycorticosterone pivalate)

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6
Q

What is the peri-operative mortality of adrenocortical tumours?

A

13-60% (4-22% with recent improved peri-op management)

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7
Q

What is the MST of adrenocortical tumour treated with trilostane alone?

A

MST 15.4m

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8
Q

List perioperative management strategies which can reduce perioperative mortality

A
  • Pre-op treatment with trilostane for 2-3 weeks (goal is post-ACTH cortisol of 2-5mcg/dL and reduction of clinical signs)
  • Frequent short walks within 4 hours after surgery
  • Keeping anaesthesia as short as possible
  • Minimally invasiv techniques may help to decrease tissue trauma and have a faster return to ambulation
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9
Q

List some potential complications after adrenalectomy for a cortisol-secreting tumour

A
  • PTE
  • Hypoadrenocorticism (glucocorticoid +/- mineralocorticoid)
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10
Q

What might be expected on a blood-gas analysis of a patient with a PTE?

A
  • Hypoxaemia
  • Hypocapnia
  • Increased Aa gradient on room air
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11
Q

What treatments can be instituted to treat PTE?

A
  • Oxygen
  • Mechanical ventilaton may be needed
  • Unfractionated heparin
  • Judicious IVFT
  • Theophylline (bronchodilation, pulm vasodilation, increased diaphragmatic contractility)
  • Sildenafil - In documented pulm hypertension
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