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Clin path test 4 > Clinical Pathology in Endocrinopathies > Flashcards

Clinical Pathology in Endocrinopathies Flashcards

1
Q

Thyroid

A
  • Sets basal metabolic rate
  • req’d for growth/development of Skeletomuscular syst, and turnover for adults
  • Essential for Normal catecholamine actions
  • Maintenance of hair and coat, and sebaceous gland
  • Required for normal lipoprotein lipase activity
  • Maintains hepatic LDL receptor synthesis for rem of cholesterol from blood
  • Required for normal neural transduction
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2
Q

Hypothyroidism

about

A
  • Mostly dogs
  • Immune-mediated/idiopathic
  • Dec synth T3 and T4
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3
Q

Hypothyroidism

CS

A
  • Lethargy
  • Inactivity
  • Dullness
  • Weight gain w/o inc appetite

Other CS

  • alopecia
  • dull hair coat
  • seborrhea
  • cold intolerance
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4
Q

Hypothyroidism

Clin path

CBC

A
  • CBC
    • mild non-regenerative anemia (<50% dogs)
      • thyroid may have stim effect on EPO
      • Dec O2 consumption
    • May see codocytes (Target Cells)
      • Membrane change related to inc cholesterol
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5
Q

Hypothyroidism

Clin path

Chem

A
  • Fasting hypercholesterolemia (~75% dogs)
  • Fasting hypertriglyceridemia
  • Thyroid hormones stim lipid metabolism
  • Net effect of hypothyroidism: accumulation of plasma lipids
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6
Q

Hyperthyroidism

about

A
  • Most common in cats
  • hyperplasia or adenoma of thyroid tissue
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7
Q

Hyperthyroid

CS

A
  • Weight loss (92%)
  • Polyphagia (61%)
  • Polydipsia/polyuria (47%)
  • Inc activity/restlessness (40%)
  • GI (39%)
  • Vomiting (38%)
  • Skin changes (36%)
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8
Q

Hyperthyroid

PE findings

A
  • Palpable thyroid
  • Thin
  • Tachycardia
  • Hyperactivity/difficult to examine
  • Heart murmur
  • Skin changes
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9
Q

Hyperthyroid

CBC

A
  • RBC parameters can be normal
  • half may have MILD elevated PCV
    • stim EPO
    • Inc tis demand for O2
  • WBC: +/- stress leukogram
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10
Q

Hyperthyroid

Chem

A
  • Mild to moderate elevation of ALT and/or ALP
    • ​very common
    • both usually elevated, one almost always
  • Marked elevation in liver enzymes
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11
Q

Weight Loss despite good appetite

A
  • hyperthyroidism
  • Diabetes mellitus
  • Poor diet quality/starvation
  • GI dz
  • hyperadrenocorticism

*remember, Liver Dz not on this list, palpate THYROID

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12
Q

Hyperthyroidism

and Inc ALT

A
  • Possibly from hepatic hypoxia
    • inc O2 use in hyperthyroid state
    • concurrent heart dz and hepatic congestion possible
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13
Q

Hyperthyroidism

and Inc ALP

A
  • Inc ALP
    • some is from bone isoform
    • some may also be from liver (cholestasis)
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14
Q

Hyperthyroid

Other chem panel changes

A
  • Azotemia
    • hyperthyroidism inc renal blood flow and GFR
    • Could be due to concurrent underlying dz
      • chronic kidney dz
      • heart dz
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15
Q

Adrenal Glands

Layer nameses

A
  • Zona Glomerulosa (outside)
  • Zona Fasiculata
  • Zona Reticularis
  • Medulla
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16
Q

Adrenal glands

About the layerses

A
  • Zona Glomerulosa: SALT
    • secretes mineralocorticoids (aldosterone)
    • Na+, K+, and water homeostasis
  • Zona Fasiculata: SUGAR
    • Glucocorticoids (Cortisol)
    • Glucose homeostasis plus others
  • Zona Reticularis: SEX
    • secretes sex steroids (androgens)
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17
Q

Cushing’s

A
  • Hyperadrenocorticism
  • Overproduction of cortisol by adrenals
    • pituitary neoplasm
    • adrenal cortical neoplasm
  • CS due to excess cortisol
  • Most common in dogs
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18
Q

Glucocorticoid function

A
  • gluconeogenesis and glycogenesis
  • Insulin antagonist
  • Inc lipolysis
  • anti-inflammatory
  • inc appetite
  • dec neut migration => inc blood neuts
  • circulating lymphopenia and eosinopenia
  • maintains normal BP
  • inhibits wound healing
  • opposes ADH, dec release
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19
Q

Cushings dz manifestations

A
  • Thin skin
  • Bilateral, symmetrical alopecia
  • Acne
  • cutaneous hyperpigmentation
  • cacinosis cutis
  • Abdominal enlargement
  • muscle wasting of extremeties
  • hepatomegaly
  • Panting
  • bruising
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20
Q

Cortisol

CBC

A
  • RBC can be normal
  • Mild inc PCV (bone marrow stim)
  • WBC: Stress leukogram
  • +/- thrombocytosis (don’t know why)
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21
Q

Cushing’s

Chem

A
  • Inc alk phos (can be extreme)
    • steroid induced isoform DOG ONLY THING
    • some possibly from hepatopathy
  • Inc ALT (markedly less than ALP)
    • some leakage from liver if steroid hepatopathy
  • Inc cholesterol
    • cortisol imp in lipid metabolism
  • Inc fasting blood glucose
    • cortisol = insulin resistance
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22
Q

Cushing’s

UA

A
  • Proteinuria
    • mild
    • may be glomerular
    • May be due to UTI (culture urine)
  • UTI (silent UTIs)
    • immunosuppression
    • dilute urine
    • urine retention
    • may not see WBC inc
  • Dilute urine
    • cortisol interferes with ADH
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23
Q

Addison’s

A
  • Hypoadrenocorticism
  • Destructino of adrenal cortex
    • Immune-mediated
    • Idiopathic
  • Clinical signs from lack of
    • glucocorticoids (cortisol)
    • mineralocorticoids (aldosterone)
  • Most common in Dog
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24
Q

Mineralocorticoids

functions

A
  • aldosterone
    • produced by zona glomerulosa of adrenal cortex
    • produced in response to
      • stim of renin-angiotensin system
      • hyperkalemia
      • inc ACTH
    • promotes renal reabsorption of sodium and chloride
    • promotes excretion of potassium
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25
Addison's CS
* related to lack of cortisol * often waxes and wanes * Lethargy, weakness * Vomiting, diarrhea, GI bleeding * Polyuria/Polydipsia * **Addisonian crisis** * Hypobolemic/dehydrated * bradycardia
26
Addison's CBC
* RBC parameters may be normal * Possible mild to moderate anemia * dec glucocorticoid stim on bone marrow * +/- GI blood loss (glucocorticoids imp for GI) * May have inc PCV: dehydration * can't pull water back into body * not holding onto Na and Cl * **WBC: lack of stress leukogram in sick patient**
27
Addison's Chem
* **Azotemia, Low Na and Cl, high K** * lack of aldosterone * inability to conserve Na and Cl and excrete K in kidney * Less total body Na =\> less water conservation * dehydration * hypovolemic * Gi blood loss may contribute to inc BUN
28
Dec sodium to potassium ratio dDx
* Na/K * Oliguric/anuric renal failure * Post-renal aotemia * DX (esp with whipworm infestation...pseudoaddisons) * Diabetes mellitus
29
In acidosis, K moves
Out side of cell
30
Addison's Other Chem values
* Hypoglycemia (mild to moderate) * less cortisol = less insulin antagonism * Hypocholesterolemia * less cortisol (imp in lipid metabolism) * Hypercalcemia * ? inc renal conservation ?
31
Addison's UA
* USG not as concentrated as expected * despite azotemia and dehydration
32
**when unconcentrated urine + azotema** **Doesn't = renal disease**
* Things that interfere with ADH * hypercalcemia * hypercortisolemia * Concentration gradient * medullary washout * liver failure/dec function (low urea) * hypoadrenocorticism (low sodium) * osmotic diuresis * diabetes mellitus
33
Endocrine pancreas
* Diabetes mellitus most common dz * relative/absolute def of insulin secretion by beta cells * insulin def causes * dec tissue utilization of glucose, amino acids, and fatty acids * accelerated hepatic glycogenolysis and gluconeogenesis * accumulation of glucose in circulation =\> hyperglycemia
34
Diabetes mellitus Classic signs DX
* PU/PD * Polyphagia * Weight loss DX * Clinical signs + * persistent hyperglycemia + * glucosuria
35
Diabetes mellitus CBC
* uncomplicated diabetic =\> mild inc PCV if dehydrated * if inflammatory leukogram =\> worry about concurrent dz
36
Diabetes Mellitus Chem
* Uncomplicated diabetic * hyperglycemia * possible hepatic lipidosis * hypercholesterolemia * elevated ALP (mild-mod) * elevated ALT (mild-mod) * **ALP or ALT \> 500 IU/L worry about concurrent dz** * **​*think hyperadrenocorticism*** * *_​_***Pancreatitis another common concurrent dz (*look out for chem changes*)**
37
Dz that likes to accompany diabetes
Hyperadrenocorticism (Cushings)
38
Diabetes Mellitus UA
* UA * glucosuria * hyperglycemia exceeds renal threshold * Dog: \> 180 mg/dL * Cat: \> 280 mg/dL in cat * May have inappropriately conc urine for hydration state * osmotic diuresis due to glucosuria * +/- Ketonuria (if ketosis or ketoacidosis) * +/- UTI * may see proteinuria, Bacteriuria, WBC, RBC * **culture urine!!!!**
39
Normal Blood Glucose plus persistent glucosuria
Tubule problem
40
Diabetic Ketoacidosis
* Other diseases often make diabetes worse * insulin deficiency + insulin resistance * Increased mobilization of fats for energy =\> more ketones * **Ketones contribute to acidosis (high anion gap)** * ​makes you feel crummy * neg charged, will bind Na and maybe K * **Ketones worsen osmotic diuresis and electrolyte depletion**
41
3 principle signs DKA
diabetic panel with * 1) high anion gap * 2) metabolic acidosis * 3) ketonuria
42
Causes of Hypercholesterolemia dDx
* Diabetes mellitus * Hyperadrenocorticism * Hypothyroidism * Cholestasis * Pancreatitis * Nephrotic syndrome * Post prandial (mild increase) * Breed related (schnauzer and others)
43
Causes of Hypocholesterolemia dDx
* Malabsorption/Maldigestion * Dec liver function or failure * Hypoadrenocorticism
44
Addisons case ## Footnote 1. Why does this dog have erythrocytosis? 2. What is best interpretation of the leukogram
1) Erythrocytosis suggests dehydration 2) Unusual lymphocytosis, rather than lymphopenia normally seen in sick, stressed patients, indicates lack of a stress leukogram
45
Addison's Case * 1) calculate Na: K ratio and interpret electrolyte and acid/base changes.
* 1) Na:K ration is 19.8, well below normal. Consistent with hypoadrenocorticism * other things cause low Na:K ration too tho
46
Addison's case ## Footnote 1) Why is this dog azotemic?
1) This is likely pre-renal azotemia likely with dx of hypoadrenocorticism. * Probs medullary washout and can't conc urine * Always look for other causes of dilute urine before dxing a patient with *true renal azotemia*
47
Addison's case * 1) explain other chem panel abnormalities.
* Hypercalcemia can be seen in dogs with hypoadrenocorticism * mild inc in ALT could reflect low level hepatocellular injury (from hypovolemia maybe)
48
Addison's case * Things we didn't see but could have....(2 things)
* Hypoglycemia * Hypocholesterolemia
49
Most common cause of normochromic, normocytic, mild, non-regenerative anemia
anemia of chronic inflammatory dz
50
microcytic, hypochromic, non-regenerative, fragmentation morphologies, and 50% of the time reactive thrombocytosis
* iron deficiency anemai * look for the slow bleed (probs upper GI)
51
**Super high ALP..... =\>**
**Maybe think Cushings...**
52
High PTHrp worry about...
* Neoplasia * lymphoma * anal sac carcinoma * mulitple myeloma * some cat carcinomas
53
Renal Chronic renal dz case Renal dz and Ca...
It can do whatever it wants to Ca!
54
Chronic renal dz case Two things that affect phosphorus in opposite ways...
* 1) Decreased GFR =\> promotes hyperphosphatemia and inc PTH * 2) Increased PTH promotes greater excretion of phosphorus in urine
55
**Calcium Panels** ## Footnote **Total Ca : INC** **Ionized Ca: INC** **PTH: N/INC** **PTHrP: norm** **\*Test Question**
* **Primary Hyperparathyroidism**
56
**Calcium Panels** ## Footnote **Total Ca: INC** **Ionized Ca: INC** **PTH: L** **PTHrP: INC** **\*Test Question**
* **Neoplasia hunt**
57
**Calcium Panels** ## Footnote **Total Ca: DEC** **Ionized Ca: DEC** **PTH: N/DEC** **PTHrP: Norm** **\*Test Question**
* Hypoparathyroidism
58
**Calcium Panels** ## Footnote **Total Ca: INC/N/DEC** **Ionized Ca: N/DEC** **PTH: INC** **PTHrP: Norm** **\*Test Question**
* **Renal disease (2 hyperparathyroidism)** * **Horses often hypercalcemic with renal disease** * **Lots of different stuff can happen**
59
presurgical BW on 8 month old great dane whos in for a spay and pexy... ## Footnote **ALP: INC** **Ca: INC** **Phosphorous: INC** **\*Test Question**
* Normal for a puppy * ALP coming from bone isophorm, Ca, and P also bone growth
60
* High ALT, ALP, and Cholesterol.... * 1) What are the most likely sources of patient's elevated ALP? * 2) What is the most likely cause of this patient's hypercholesterolemia \***Test Question**
* 1) Liver and steroid induced isoforms * 2) Hyperadrenocorticism \*possibly pancreatitis if other cholestatic markers present: inc bili, GGT
61
New patient seen for peripheral lymphadenopathy..... * Inc BUN, Creatinine, Albumin, Globulin, very high Ca * Spec Grav 1.010 Most likely cause of inappropriately concentrated urine? \***Test Question**
* Inhibition of ADH
62
Run a chemistry on a 5yo MC boston terrier presenting for weight loss and diarrhea * Low Ca, Albumin, and Globulin Likely cause of the hypocalcemia? Are clinical signs likely to develop? \***Test Question**
* Hypoalbuminemia * No b/c hypoalbuminemia dec total Ca but ionized Ca should be normal
63
Bloodwork from a 5yo FS DSH, what is your top differential for the hypocalcemia? * Inc: Glucose, BUN, Creatinine * Dec: Ca (1.0) * Inc: K (11), Phosphorus * Dec: ALP, ALP * USG: 1.050
* Spurious =\> contaminated with EDTA * Ca of 1.0 is not compatible with life * K of 11 is crazy high * **rerun this panel....Ca is used by the machine to do other analyses**

Clin path test 4 (9 decks)

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