Clinical Endocrinology (SA) Flashcards by julian ripley

What are the MOST common signs of Cushings?

PUPD
Polyphagia
Panting
Pot Belly
Alopecia
Hepatomegaly
Muscle Weakness
Hypertension

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What is raised on Haematology with cushings?

Neutrophils
Thrombocytes
Erythrocytes (mild)

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What is raised on Biochemistry with cushings?

ALP
ALT
Cholesterol
Triglycerides
Glucose

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On haematological assessment of a cushings patient, which values would you expect to be reduced?

Lymphocytes

Eosinophils

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What is the value for USG in cushings?

<1.018-1.020

+protein

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What is the best screening test for canine cushings?

LDDST - blood sample at 3 and 8h.

Don’t feed during test!

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What is the sens/spec of UPCR for cushings?

High sens, V low Spec.

Repeat 2d later. If still high - both sens and spec improved.

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How do you differentiate between PDH and ADH?

Measure ACTH - high indicates PDH.

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What drug is given to dogs with cushings?

Trilostane

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How can you Tx the hypertension associated with cushings? (1st and 2nd line)

1e: Benazepril
2e: Amlodipine

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Following Tx for cushings, you notice improved metabolic screens but the patient is more dull. Dx/Tx?

Macroadenoma - hypophysectomy + RT

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What are the causes for 1e and 2e hypoadrenocorticism?

1e: autoimmune destruction of adrenal cortex
2e: ACTH deficiency causing cortical atrophy

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What are the major signs of Addisons of clinical exam?

Weak Pulse/inc CRT
PUPD/dehydration
Bradycardia, lethargy
V+/D+ and malaise

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On haem/biochem of an Addisonian patient, which values would you expect to be reduced?

Non-regen anaemia

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On haem/biochem of an Addisonian patient, which values would you expect to be reduced?

Azotaemia
Lymphocytes
Eosinophils
Hyperkalaemia

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What changes would you see on an ECG with blood K+ between 5.5 and 6.5mmol/L?

T wave peak

Short QR

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What changes would you see on an ECG with blood K+ between 6.5 and 7mmol/L?

inc QRS duration

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What changes would you see on an ECG with blood K+ between 7 and 8.5mmol/L?

Dec P wave amplitude

Long PR interval

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What changes would you see on an ECG with blood K+ over 8.5mmol/L?

absent P wave

severe bradycardia

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How can you rule out addisons as a Ddx?

Single cortisol test - if normal, no addisons

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How can you confirm Addisons in a dog?

ACTH stim

If no change: Addisons

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How do you Tx a dog in Addisonian Crisis?

0.9% NaCl @ 60-80ml/kg/hr
Saline, Insulin and Dextrose
Hydrocortisone CRI (or Dex if cortisol assay not yet performed)

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What is the long term Tx protocol for a dog with addisons?

Fludrocortisone
Oral Prednisolone
DOCP

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What are the 1st 2 tests performed to diagnose hypothyroidism? (dog)

Tt4 and TSH

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What are the 2nd 2 tests performed to diagnose hypothyroidism? (dog)

Ft4 & TgAA

How is canine hypothyroidism treated?

Levothyroxine

What are the signs of feline hyperthyroidism?

``` PUPD Weight loss Coat changes Hyperactivity Tachycardia ```

What can be seen on a blood smear of feline hyperthyroid patients?

``` Heinz Bodies Inc PLT size Erythrocytosis Macrocytosis Leukocytosis ```

Which test diagnoses 90% of hyperthyroid cats?

tT4

What happens to a normal cats tT4 levels following a T3 suppression test with Tertroxin?

50% reduction Hyperthyroid = limited change

Which 3 anti-thyroid drugs are available to treat hyperthyroid cats?

Synthesis inhibitors: Thiamazole, Methimazole, Carbimazole

Which anti-thyroid drug has the lower rate of adverse reactions in cats?

Carbimazole

Why do cats with concurrent CKD and hyerthyroidism have normal creatinine levels?

Muscle loss | Glomerular hyperfiltration of creatinine

Which drugs are used to control the tachycardia/pnea, hypertension, and hyper-excitability associated w/hyperthyroidism?

Beta Blockers - Atenolol/propanolol

What are the 3 Tx options for hyperthyroidism?

Radioiodide Surgical Removal Medical Therapy

How does the Aetiology of DM differ in dogs and cats?

Dogs: Loss of Islets - insulin deficiency Cats: insulin resistance

What changes can be seen on haem/biochem in canine DM?

Hyperglycaemia Inc ALT/ALP Hypertrigllyceridaemia

What changes can be seen on urinalysis in canine DM?

Ketones Glucose Sediment Low USG (PUPD)

which diabetes medications are licenced for dogs and how long do they last?

Intermediate: Caninsulin Long: Prozinc

What is a normal protocol for diabetes Tx in the dog?

Feed 1/2 ration then administer insulin - twice daily!

Which diet changes should be made to cats/dogs with DM?

Cat: low CHO, High protein Dog: Fibre & complex CHO added

A DM+ dog sudden presents with ataxia, collapse and seizure - what happened? Tx?

OVERDOSE! give sugary substance under tongue and feed.

How should insulin dose be altered if an animal is not eating?

HALF DOSE - dont stop!

how often are samples taken for a glucose curve?

q2h

What is the max appropriate dose of insulin without SEs?

2IU/kg

Below what nadir should insulin dose be decreased?

<4mmol/L

Above what nadir should insulin dose be increased?

>8-9mmol/L

What should be done if DOA too short?

Switch to longer acting insulin

What are the signs of DKA?

``` V+ Dehydration Weakness Tachypnoea Depression ```

What 2 ions should be supplemented in DKA?

Phosphate | K+

After stabilisation with insulin in an acute DKA episode, glucose reaches <16mmol/L - what are your next steps?

insulin q4-6h Dextrose 5% infusion Monitor q1h still! MAINTAIN until patient eating then start lente

What water intake classes as PUPD?

>100ml/kg/day

If you have run haem/biochem/T4/urinalysis on a PUPD patient and everything is normal, what 4 DDx are you left with?

HyperAC Central DI 1e NDI 1e PD

What is the DDAVP test used to test for?

Diabetes Inspidus: give dDACP q8h 1w - if SG inc and PUPD resolves - was DI.

How is CDI treated?

DDAVP drops in conjuncitva SID/BID

Which breed of dogs commonly suffer form pituitary dwarfism?

GSD

Pituitary dwarfism Tx?

Progestagens GH for skin Check thyroid & supplement if needed.

What is the cause and sequelae of acromegaly in cats?

Cause: pituitary tumour Seq: Insulin resistant DM

How is feline acromegaly tx?

Control DM | RT pituitary mass - or Sx

How is 1e HyperPTH treated?

``` IV NaCl then frusemide Preds Calcitonin Bisphosphonates Surgical Excision ```

What are the signs of hyperPTH?

PUPD, calcification, renal damage Hypercalcaemia Normal/Low PO4 High PTH

How is renal hyperPTH managed?

Remove cause, inc Ca, dec PO4 | Phosphate binders i.e. Aluminium Hydroxide

How is hyperfunctional thyroid tissue detected in the cat?

Scintigraphy (technetium 99)

Which drugs can be used against hyperthyroidism?

Carbimazole (SID) | Methimazole (BID)

What are the potential side effects of anti-thyroid medication?

Anorexia/V+ Facial/cervical excoriation Bleeding eyes/nose Hepatopathy

Which haem/biochem changes are caused by anti-thyroid medication?

Dec: leukocytes, thrombocytes Inc: lymphocytes, eosinophils

What is the gold std Tx for feline hyperthyroidism?

Radioiodine therapy

When is thyroidectomy indicated in feline hyperthyroidism?

Cat doesn't tolerate meds | Radioiodide not available

How must the patient be positioned for a thyroidectomy?

Extend neck - ventral midline incision

Which 2 sets of muscles must be incised to access the thyroid glands?

Sternothyroideus | Sternohyoideus

How does a thyroid adenoma differ visually from a normal gland?

Normal: Pale tan Adenoma: brown/red

Which nerves are located closely to the thyroid gland?

Recurrent layrngeal | Vagosympathetic Trunk

Which blood vessels are located close to the thyroid gland?

Cartoid Sheath - common carotid, internal jugular vein

How can you tell if thyroid Dz is unilateral?

"normal" thyroid gland will be atrophied

What is an extracapsular thryoidectomy?

Thyroid removed in capsule, no attempt to preserve PT gland

What is 1 advantage and 1 disadvantage to an extracapsular thryoidectomy?

Low recurrence | HypoCa

What is an intracapsular thyroidectomy?

capsule left in situ to preserve cranial PT gland

What is 1 advantage and 1 disadvantage to an intracapsular thyroidectomy?

Inc recurrence | Low chance of HypoCa

What is a modified extracapsular thryoidectomy?

thyroid capsule incised around cranial PT gland

What is 1 advantage and 1 disadvantage to a modified extracapsular thryoidectomy?

Low recurrence | Lower risk of hypoCa

What is a modified intracapsular thyroidectomy?

removal of thyroid from within capsule, preserving PTH

What is 1 advantage and 1 disadvantage to a modified intracapsular thryoidectomy?

Low recurrence Lower risk of hypoCa similar to other modified technique

What can be done if the blood supply is interrupted to the PT gland during thyroidectomy?

Insert PT into sternothyroideus/ sternohyoideus - in 7-21d it will be revascularised

How are 4 potential complications of thyroidectomy?

Hypocalcaemia Recurrence of hyperT4 Laryngeal paralysis Hypothyroidism

What can be done to treat a cat with acute post-op hypoCa?

10% CaGluconate + CRI Stable: oral vit D and Ca

What is the best Tx for ectopic thyroid tissue?

I131 (radioactive iodine)

Which breed of dog is at the greatest risk of 1e hyperPT?

Keeshond

How are the cranial and caudal parathyroid glands removed?

Cranial: dissected from thyroid Caudal: partial thyroidectomy; guillotine technique

Which structures may canine thyroid carcinomas involve?

Jugular Vein Carotid Artery Vagosympathetic Trunk Recurrent Laryngeal Nerve

What do phaeochromocytomas secrete?

Catecholamines (adrenaline)

What is the Tx of choice for a hormonally active adrenal adenoma/carcinoma?

Adrenalectomy

What should your surgical approach be for an adrenalectomy?

Ventral Midline

Which vascular structure may some adrenal tumours involve?

Caudal Vena Cava