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!Small Animal Medicine > Dz of the Adrenals > Flashcards

Dz of the Adrenals Flashcards

1
Q

Adrenal gland cortex

A

Glomerulosa: aldosterone
Fasciculata: cortisol, sex hormones
Reticularis: androgen, some cortisol

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2
Q

Function of the adrenal cortex

A

Glucocorticoid regulation (neg feedback regulation CRH and ACTH)
Aldosterone regulation (osmoreceptors, RAAS, K+ levels)

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3
Q

Medulla

A

Catecholamines

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4
Q

Primary hypoadrenocorticism

A

Immune-mediated destruction of adrenal cortices
Usually bilateral

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5
Q

Drug induced hypoadrenocorticism

A

Mitotane and trilostane

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6
Q

Other causes of hypoadrenocorticism

A

Iatrogenic
Thromboembolism/ loss of blood supply
Infiltrative neoplasia
Amyloidosis

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7
Q

Signalment of hypoadrenocorticism

A

Young to middle-aged female dogs (intact>)
Poodles, collies, westie terriers, danes, rotties

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8
Q

Hx of patients with hypoadrenocorticism

A

Waxing and waning (on and off)
+/- V/D responsive to fluids, abx and steroids
Weakness and leth

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9
Q

CS associated with hypoadrenocorticism

A

Depression, leth, weakness, anorexia, dehy
PU/PD, bradycardia, abdominal pain, regurg. hypotension, acute collapse

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10
Q

CBC of hypoadrenocorticism

A

Anemia of chr. dz
Marked anemia secondary to GI hemorrhage
+/- hyperproteinemia
Reverse stress leukogram

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11
Q

Chemistry of hypoadrenocorticism

A

Hypo-natremia,-cholermia, -glycemia, -albuminemia
Hyper-kalemia, calcemia
Na:K <25:1
Azotemia (dehy/ hypotension- ↓ GFR, upper Gi hemorrhage)

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12
Q

Atypical addison’s

A

Electrolyte changes won’t occur
Gluco deficient and normal aldosterone

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13
Q

UA of hypoadrenocorticism

A

Low USG due to PU/PD
May ↑ with dehy (if medullary washout not occured)

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14
Q

ECG changes with hypoadrenocorticism

A

Hyperkalemia induced changes →bradycardia, tall T waves, wide QRS, flat P waves → atrial standstill

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15
Q

Diagnostic imaging of hypoadrenocorticism

A

Rads: hypovolemia maybe megaesophagus
U/S: adrenals small or poorly visualized

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16
Q

ACTH stimulation test (definitive forhypoadrenocorticism)

A

If pre and post <1 = diagnostic
Not addison’s if 2x the baseline cortisol

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17
Q

Tx for adrenocorticol crisis

A

Correct hyperkalemia and hypotension
Crystalloids @ shock dose (LRS)
Maintenance fluids with Na and dextrose
Dexamethasone

18
Q

Glucocorticoid supplementation (hypoadrenocorticism maintenance therapy)

A

Fludrocortisone acetate daily
Pred with DOCP therapy

19
Q

Mineralocorticoid supplementation (hypoadrenocorticism maintenance therapy)

A

Desoxycorticosterone pivalate (most common, q25d
Fludrocortisone acetate daily

20
Q

Hyperadrenocorticism

A

Pituitary dependent 80-85% (most microadenomas)
Adrenal dependent 15-20% (50% malignant)

21
Q

Signalment for Hyperadrenocorticism

A

Middle aged to older dogs
Poodles, beagles, dascuhunds, cockers
Females >

22
Q

Rule of thumb for Hyperadrenocorticism

A

Small-medium breeds more likely to have PDH
Large breeds more likely to have adrenal dependent

23
Q

CS of Hyperadrenocorticism

A

Marked PU/PD, polyphagia, alopecia (rat tail)
Hyperpigmentation, thin skin, dermatits/ pyoderma, calcinosis cutis, panting, weight redistribution

24
Q

CBC/ chem for Hyperadrenocorticism

A

Stress leukogram and thrombocytosis
Markedly ↑ ALP, mild to moderate ↑ ALT
Hypercholesterolemia

25
Q

UA for Hyperadrenocorticism

A

USG <1.020
Proteinuria
Subclinical UTI

26
Q

Radiograph findings of Hyperadrenocorticism

A

Markedly enlarged liver
Distended urinary bladder
+/- mineralized adrenals

27
Q

Screening test for Hyperadrenocorticism

A

Cortisol: creatinine ratio
Sensitive, not specific (many false +)
Low= no cushing’s

28
Q

Low dexamethasone suppression test (Hyperadrenocorticism)

A

Collect baseline cortisol, 4hr cortisol then 8hr (>1.4= cushinoid)
Normal: low
PDH: 4 hr= low to ↑, 8hr = ↑
Adrenal dependent: 4 hr= ↑, 8hr = ↑

29
Q

Differentiating test for Hyperadrenocorticism

A

HDDS test (not used as much)
PDH: 4 hr= low, 8hr = low to ↑
AD: 4 hr= ↑, 8hr = ↑

30
Q

When should a ACTH stimulation test be done for Hyperadrenocorticism

A

Concurrent illnesses
Post-stim cortisol results >18-20 = HAC

31
Q

U/S

A

PDH: bilaterally symmetrically enlarged adrenals
AD: one large, other small and not visualized
Metastases and hyperechoic liver

32
Q

Tx for PDH Hyperadrenocorticism

A

Trilostane: inhibits 3b-hydroxysteroid dehydrogenase
Mitostane: destroys fasciculata and reticularis

33
Q

Tx for AD Hyperadrenocorticism

A

Sx!!
Has complications: pancreatitis, thromboembolism, DIC
Other adrenal atrophied/ not functional (need gluco and mineral supplement)

34
Q

Monitoring for trilostane and mitotane therapy

A

T: ACTH stim levels @ wk 1,3,6,13 then q4-6m
M: ACTH stim levels @ q3-6m

35
Q

Alopecia X

A

Pituitary hyperstimulation of reticularis layer of adrenals
Overproduction of androgens instead of cortisol

36
Q

CS of Alopecia X

A

PU/PD/PP
Less marked elevation of ALP

37
Q

DX alopecia X

A

Androgen panel university of TN
ACTH stim serum samples
Elevated 17-hydroxyprogesterone, estradiol, other sex hormones

38
Q

Alopecia X tx

A

therapies vary
Melatonin, flax seed oil
Trilostane and mitotane (less success)

39
Q

Pheochromocytoma

A

Neoplasia of adrenal medulla: transient hypersecretion of catecholamines
Older dogs, rare in cats

40
Q

CS of Pheochromocytoma

A

PU/PD, depression, leth., V/D
Anxiety/ restlessness, exercise intolerance, sudden blindness, tachycardia and hypertension

41
Q

DX for Pheochromocytoma

A

U/S: one large (right) adrenal, other normal sized
Dx with histopath
CT/ MRI: determine extent of local involvement

42
Q

Tx for Pheochromocytoma

A

Sx resection
Pre-sx stabilization: phenoxybenzamine (a-blockers) and atenolol (b-blocker)

!Small Animal Medicine (32 decks)

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