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Hematology > Cushings/Addisons > Flashcards

Cushings/Addisons Flashcards

1
Q

What does the cortex of the adrenal gland do

A

Produces the glucocorticoid cortisol and aldosterone

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2
Q

What does the cortex of the adrenal gland do

A

Produces the glucocorticoid cortisol and aldosterone

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3
Q

What does the medulla of the adrenal gland do

A

Secretes as epinephrine or adrenaline

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4
Q

What is the function of aldosterone

A

Aldosterone acts on renal tubes to preserve and reabsorb Sodium and excrete Potassium

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5
Q

What are the 3 types of cushion’s disease

A
  1. Pituitary tumor
  2. Adrenal gland tumor
  3. Iatrogenic
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6
Q

Why does a pituitary tumor cause cushings disease

A

Pituitary tumor (adenoma) produces excess ACTH  overstimulates the adrenal gland  xs cortisol

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7
Q

What does the hypothalamus produce

A

Corticotropin releasing factor

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8
Q

What does the corticotropin releasing factor do to the pituitary gland

A

Causes the pituitary to release ACTH.

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9
Q

What is ACTH

A

Adrenocorticotropic hormone

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10
Q

What does ACTH do in the body

A

Causes adrenal growth and secretion.

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11
Q

What does the adrenal gland produce

A

Cortisol (glucocorticoid)

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12
Q

What effect does cortisol have on the body

A

Inhibits CRF and ACTH by means of negative feedback

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13
Q

What are the hormones released by the Anterior pituitary gland

A

Thyroid, adrenal, ovary, teste

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14
Q

What are the hormone released by Posterior pituitary

A

Oxytocin, vasopressin (ADH)

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15
Q

What does a brain or pituitary tumor do

A

Causes excess ACTH –> Secondary bilateral adrenal hyperplasia –> excess cortisol

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16
Q

What does the adrenal gland tumor do

A

Other adrenal will become hypoplastic and unilateral,

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17
Q

What are the 3 types of excess cortisol hyperadrenocorticism

A
  1. Brain or pituitary tumor
  2. Adrenal gland tumor
  3. Iactrogenic
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18
Q

Describe pituitary dependant cushings disease

A

Up to 90% of all Cushing’s cases in dogs fall into this category.
It is slow growing cancer called an adenoma ( pituitary).
This causes secretion of excess ACTH.
The adrenal glands respond to this excess ACTH by enlarging and secreting excess cortisol.

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19
Q

Describe non-pituitary dependent cushings disease

A

In up to 15% of Cushing’s there is an actual tumor of one of the adrenal glands (sometimes both are involved). It enlarges and secretes excess cortisol in the bloodstream.
The benign version of this tumor occurs 50% of the time, and is called an adenoma.
The malignant version, which occurs the other 50% or the time, is called an adenocarcinoma. It can spread from the adrenal gland to the liver, lung, kidney, and lymph nodes.

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20
Q

Describe iatrogenic cushings disease

A

Long term use of supplemental cortisone, in oral, injectable, or even topical form, might cause an animal to have the symptoms of Cushing’s disease.
i.e. Long term use of Drug prednisone. will cause the adrenal glands to shrink in size. This is because the negative feedback loop tells the brain there is plenty of cortisol in the bloodstream, so the pituitary secretes less ACTH.

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21
Q

What does Iatrogenic hyperadrenocorticism

A

exogenous excess cortisone atrophied adrenal glands

Sudden withdrawal results in Addisonian crisis

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22
Q

What are the clinical signs of cushings disease

A

Polyphagia- excess appetite.
Polyuria/polydypsia (PU/PD)-
Pot bellied abdomen.

Thin skin and usually symmetrical hair loss along the trunk. The hair might grow in lighter in color or even be hyperpigmented. Secondary skin infections are common.
Other symptoms could include lethargy, muscle wasting, poor appetite, weakness, and behavioral changes.

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23
Q

Describe the signalment of cushings diease

A

Cushing’s tends to be a problem that affects older dogs, usually greater than 10 years of age. The disease tends to have a slow and gradual onset, so the early symptoms are easily missed.

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24
Q

What are the breed dispositions of cushings disease

A 
Yorkshire Terrier 
Poodle 
Beagle 
Boston Terrier 
Boxer 
Dachshund
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25
Q

How do you diagnose cushings

A

CBC might show an increased WBC and an eosinopenia ( cortisol)
BIOCHEM
****elevated alkaline phosphatase (Alk Phos) **
maybe elevation Cholesterol
Urinalysis
Low sp .gravity often

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26
Q

What does the urine cortisol/creatinine ratio show

A

is a screening test for Cushing’s disease;
a positive test here does NOT confirm Cushing’s syndrome but a negative test DOES rule it out.
If there is a high ratio - a relatively high amount of cortisol being excreted - further testing is in order.
Ideally for this test the urine sample is collected at home so that cortisol secreted in response to the stress of visiting the vet’s office does not interfere with results.

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27
Q

Specific diagnostic tests for cushings

A

ACTH Stimulation test

Low Dose Dexamethasone Suppression Test (LDDS)

High Dose Dexamethasone Suppression Test (HDDS)

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28
Q

How do you treat a pituitary tumor

A

give drugs that will partially destroy or prevent the adreanal gland from secreting excess cortisone
Mitotane (o,p’-DDD) Lysodren,
L-Deprenyl (anipryl)
Ketaconazole

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29
Q

How do you treat an adrenal tumor

A

can do surgery or use above drugs

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30
Q

What is Hypoadrenocorticism
 or Addison’s dse

A

Cortisone and a mineralocorticoid deficiency (aldosterone)
Atrophy of adrenal cortex
Results in decrease of glucocorticoids (cortisone) and mineralocorticoids (aldosterone)

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31
Q

What are the clinical signs of addison disease

A
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32
Q

What are the clinical signs of addison disease

A
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33
Q

What does the medulla of the adrenal gland do

A

Secretes as epinephrine or adrenaline

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34
Q

What is the function of aldosterone

A

Aldosterone acts on renal tubes to preserve and reabsorb Sodium and excrete Potassium

How well did you know this?
1
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2
3
4
5
Perfectly
35
Q

What are the 3 types of cushion’s disease

A
  1. Pituitary tumor
  2. Adrenal gland tumor
  3. Iatrogenic
How well did you know this?
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36
Q

Why does a pituitary tumor cause cushings disease

A

Pituitary tumor (adenoma) produces excess ACTH  overstimulates the adrenal gland  xs cortisol

How well did you know this?
1
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2
3
4
5
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37
Q

What does the hypothalamus produce

A

Corticotropin releasing factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What does the corticotropin releasing factor do to the pituitary gland

A

Causes the pituitary to release ACTH.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is ACTH

A

Adrenocorticotropic hormone

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40
Q

What does ACTH do in the body

A

Causes adrenal growth and secretion.

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41
Q

What does the adrenal gland produce

A

Cortisol (glucocorticoid)

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42
Q

What effect does cortisol have on the body

A

Inhibits CRF and ACTH by means of negative feedback

43
Q

What are the hormones released by the Anterior pituitary gland

A

Thyroid, adrenal, ovary, teste

44
Q

What are the hormone released by Posterior pituitary

A

Oxytocin, vasopressin (ADH)

45
Q

What does a brain or pituitary tumor do

A

Causes excess ACTH –> Secondary bilateral adrenal hyperplasia –> excess cortisol

46
Q

What does the adrenal gland tumor do

A

Other adrenal will become hypoplastic and unilateral,

47
Q

What are the 3 types of excess cortisol hyperadrenocorticism

A
  1. Brain or pituitary tumor
  2. Adrenal gland tumor
  3. Iactrogenic
48
Q

Describe pituitary dependant cushings disease

A

Up to 90% of all Cushing’s cases in dogs fall into this category.
It is slow growing cancer called an adenoma ( pituitary).
This causes secretion of excess ACTH.
The adrenal glands respond to this excess ACTH by enlarging and secreting excess cortisol.

49
Q

Describe non-pituitary dependent cushings disease

A

In up to 15% of Cushing’s there is an actual tumor of one of the adrenal glands (sometimes both are involved). It enlarges and secretes excess cortisol in the bloodstream.
The benign version of this tumor occurs 50% of the time, and is called an adenoma.
The malignant version, which occurs the other 50% or the time, is called an adenocarcinoma. It can spread from the adrenal gland to the liver, lung, kidney, and lymph nodes.

50
Q

Describe iatrogenic cushings disease

A

Long term use of supplemental cortisone, in oral, injectable, or even topical form, might cause an animal to have the symptoms of Cushing’s disease.
i.e. Long term use of Drug prednisone. will cause the adrenal glands to shrink in size. This is because the negative feedback loop tells the brain there is plenty of cortisol in the bloodstream, so the pituitary secretes less ACTH.

51
Q

What does hypothyroidism do

A

inadequate active thyroid hormone
most common hormone imbalance of the dog.
In Dogs:
T3 is the active form
T4 is the inactive form
When T4 is absorbed into tissue cells, it is converted into T3

52
Q

What are the clinical signs of cushings disease

A

Polyphagia- excess appetite.
Polyuria/polydypsia (PU/PD)-
Pot bellied abdomen.

Thin skin and usually symmetrical hair loss along the trunk. The hair might grow in lighter in color or even be hyperpigmented. Secondary skin infections are common.
Other symptoms could include lethargy, muscle wasting, poor appetite, weakness, and behavioral changes.

53
Q

Describe the signalment of cushings diease

A

Cushing’s tends to be a problem that affects older dogs, usually greater than 10 years of age. The disease tends to have a slow and gradual onset, so the early symptoms are easily missed.

54
Q

What are the breed dispositions of cushings disease

A 
Yorkshire Terrier 
Poodle 
Beagle 
Boston Terrier 
Boxer 
Dachshund
55
Q

How do you diagnose cushings

A

CBC might show an increased WBC and an eosinopenia ( cortisol)
BIOCHEM
****elevated alkaline phosphatase (Alk Phos) **
maybe elevation Cholesterol
Urinalysis
Low sp .gravity often

56
Q

What does the urine cortisol/creatinine ratio show

A

is a screening test for Cushing’s disease;
a positive test here does NOT confirm Cushing’s syndrome but a negative test DOES rule it out.
If there is a high ratio - a relatively high amount of cortisol being excreted - further testing is in order.
Ideally for this test the urine sample is collected at home so that cortisol secreted in response to the stress of visiting the vet’s office does not interfere with results.

57
Q

Specific diagnostic tests for cushings

A

ACTH Stimulation test

Low Dose Dexamethasone Suppression Test (LDDS)

High Dose Dexamethasone Suppression Test (HDDS)

58
Q

How do you treat a pituitary tumor

A

give drugs that will partially destroy or prevent the adreanal gland from secreting excess cortisone
Mitotane (o,p’-DDD) Lysodren,
L-Deprenyl (anipryl)
Ketaconazole

59
Q

How do you treat an adrenal tumor

A

can do surgery or use above drugs

60
Q

What is Hypoadrenocorticism
 or Addison’s dse

A

Cortisone and a mineralocorticoid deficiency (aldosterone)
Atrophy of adrenal cortex
Results in decrease of glucocorticoids (cortisone) and mineralocorticoids (aldosterone)

61
Q

What is the free T4

A

Most of the circulating T4 is carried by blood proteins and is not available for tissue absorption;
the portion that is not carried by proteins (the so-called “free T4”)
free T4 is the portion that is able to enter tissues for activation

62
Q

What are the clinical signs of addison disease

A
63
Q

What is an addison crisis

A

Medical Emergency—
Presents with sudden weakness, vomiting, diarrhea
Low Na- causes a drastic drop in Blood pressure
High K - heart problems
Hypovolumemic – symptoms of shock

64
Q

How do you treat an addison crisis

A 
Crisis-  fluids– Normal Saline
Replace Na    (do not want K)

Cortisone- prednisone or dexamethasone

65
Q

What is the treatment for addisons

A

Percoten V - monthly injections,

Florinef- tablets

66
Q

How do you diagnose addison disease

A

Pre treatment Blood work: electrolyte imbalance
Na:K – less than 27:1
Often pre renal increase in BUN CREAT
High BUN in absence of Kidney dse

67
Q

How do you confirm the diagnosis of addison disease

A

ACTH stimulation test to confirm addisons

68
Q

What is an ACTH sim test used for

A

used To dx Addison’s or Cushing’s

Evaluates the degree of adrenal response to exogenous ACTH

69
Q

What hyperplastic adrenal gland do

A

Exaggerated response indicates cushings

70
Q

What does a hypo plastic adrenal gland do

A

Diminished response indicates addisons

71
Q

What is Low dose dexamethasone Suppression test

A

Replaces the ACTH test - to diagnose cushings

72
Q

What is High dose Dex. Suppression test

A

helps to distinguish if it’s a pituitary or adrenal tumor

73
Q

What dexamethasone suppression test is used for cats

A

use only in the high dose test

74
Q

What is the LDDST Protocol

A

Patient fasted before collection.

i) Collect blood into a plain or SST for a baseline cortisol
ii) Administer 0.01 mg/kg off dexamethasone IV

iii) Collect post-dexamethasone blood into a plain or SST at both 4 hours and 8 hours post-dexamethasone administration

75
Q

What are the results of LDDST

A

In the normal animal blood cortisol level will drop after a tiny dose of dexamethasone is given
If there is a pituitary tumor, it will not turn off its stimulatory message and it ignores the dexamethasone. There is No drop in cortisol level is seen at the end of eight hours
Adrenal tumor will not suppress either

76
Q

How does the low dose/high dose work

A

Normally dexamethasone  suppress ACTH decreased cortisol
Pituitary tumor does not suppress to a low dose dex, but will suppress to a high dose dex– ( results in lower cortisol levels)
Adrenal gland tumor pumps out cortisol regardless of ACTH  NO Suppression by large dose dex
High dose dex suppression test will distinguish between the adrenal and pituitary cause of cushing’s

77
Q

Why can’t we measure ACTH

A

Very labile protein– requires special handling for sample—and immediate freezing of the plasma

78
Q

What does a pituitary tumor cause

A

HIGH ACTH

79
Q

What does an adrenal tumor

A

LOW ACTH

80
Q

What does the thyroid gland produces

A

T4 Thyroxine

T3 Tri-iodothyronine

81
Q

What do T3 and T4

A

These hormones regulate metabolism of all tissues and organs

82
Q

What does hypothyroidism do

A

inadequate active thyroid hormone
most common hormone imbalance of the dog.
In Dogs:
T3 is the active form
T4 is the inactive form
When T4 is absorbed into tissue cells, it is converted into T3

83
Q

What causes hypothyroidism

A

immune-mediated destruction of the thyroid gland,
natural atrophy of the gland,
dietary iodine deficiency, (Goiter)
a congenital problem

84
Q

What are the breeds predisposed to hypothyroidism

A 
the Doberman pinscher, 
the Golden retriever,
 the Irish Setter,
 the Great Dane,
 the Dachshund, 
 the Boxer
85
Q

What are the clinical signs of hypothyroidism

A

Weight gain without an increase in appetite
Lethargy and lack of desire to exercise
Cold intolerance (gets cold easily)
Dry, dull hair with excessive shedding and flaking
Very thin to nearly bald hair coat
Increased dark pigmentation in the skin
Increased susceptibility and occurrence of skin and ear infections
Failure to re-grow hair after clipping or shaving
High blood cholesterol
Slow heart rate

86
Q

What is hypothyroidism

A

biochemistry panel might show an elevated cholesterol ( 75% of time)

CBC mild non responsive anemia

May see target cells due to cholesterol deposits on RBC membrane

87
Q

What is the physiology of hypothyroidism

A

(Hypothalmus)  TRF  pituitary (TSH) - thyroid gland  T3 +T4 (triiodothyronine and thyroxine)

All of the T4 is produced by thyroid
T4 can be converted to converted to T3 at the tissue level
Most T4 + T3 in blood is protein bound
fT4 freeT4 enters the cell and is converted to T3

88
Q

Describe the Pituitary gland

A

pituitary gland –. TSH
When T4 levels are dropping, the pituitary gland sends out TSH–stimulates the thyroid gland to make and release more T4.

You expect to have a high TSH in a hypothyroid dog

89
Q

What is the total T4 screening test

A

Often part of a geriatric profile

90
Q

What is the free T4 by equilibrium dialysis

A

Can be a more specific test

91
Q

Do we ever do TSH and T4 together

A

Yes

92
Q

What is the free T4

A

Most of the circulating T4 is carried by blood proteins and is not available for tissue absorption;
the portion that is not carried by proteins (the so-called “free T4”)
free T4 is the portion that is able to enter tissues for activation

93
Q

What is Euthyroid sick

A

Many chronic illnesses will cause an animal to have a low T4 and he is not hypothyroid

94
Q

What is the TSH response test

A

Many diseases and drugs can suppress T4 levels– this test is more sensitive

95
Q

How do you do the TSH response test

A

Draw Pre-test blood sample
– give TSH
Draw post-test blood samples 4-6 hrs later
Normal dogs or euthryoid sick dogs should show increased T4
Hypothyroid dog shows no increase

96
Q

What are the two other hypothyroid tests

A

TRH- thyrotropin –Releasing Hormone Response test

Triiodothyronine Suppression test

97
Q

Monitoring thyroid treatment

A

Monitoring with T4

Monitoring with +/- TSH level

98
Q

How do you know if diagnosis correct

A

to repeat test:

thyroid hormone supplementation must be discontinued at least 2 months for blood testing to be valid

99
Q

What is hyperthyroidism

A

Caused by benign tumor (adenoma) on the thyroid gland excess of amounts of T3 and T4.

These adenomas are not under the control of TSH

100
Q

What are the clinical signs of hyperthyroidism

A 
Weight loss 
Excess appetite (polyphagia) 
Decreased appetite (anorexia) 
Nervousness , vocalization 
Muscle weakness 
Vomiting (emesis) 
Diarrhea 
Excess drinking and urinating (polyuria and polydipsia) 
Poor hair coat 
High heart rate (tachycardia) ( 200-300bpm) -  gallop rhythm 
Labored breathing (dyspnea)
101
Q

What are the secondary complications of hyperthyroidism

A

thyrotoxic cardiomyopathy

Hypertension (high blood pressure)
If left untreated there are significant complications that can develop. Blindness can occur due to retinal detachment from high blood pressure.
Long term kidney damage and non-stop diarrhea might also be consequences, along with heart failure and death.

102
Q

What are the elevated enzymes in a biochem panel

A

Elevated liver enzymes on biochem panel- ALT AST

103
Q

How do you diagnose hyperthyroidism

A

Routine geriatric biochemistry

Total T4 is very elevated

Sometimes if T4 is normal and Hyperthyroidism is suspected the free T4 by equilibrium dialysis will be done

104
Q

What are the 4 treatment hyperthyroidism

A

Radioactive Iodine

Tapazole (Methimazole) - monitor T4 levels

Surgery (thyroidectomy)

Y/D diet from Hills ( has no iodine)- monitor T4 levels

Hematology (15 decks)

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