Endocrine Flashcards
What is adiponectin? Does it increase or decrease with obesity and what is the effect?
Anti-inflammatory and insulin sensitising hormone. Decreases with obesity and so contributes to insulin resistance. Produced by adipose tissue
Name an example of a sulfonylurea. What is their MOA? Adverse effects?
Glipizide. Stimulate insulin release by binding to beta cell ATPases. This closes K+ channels and leads to increase Ca2+ in the cell and therefore insulin release. AE: GI upset, liver enzyme elevations and jaundice
Name an example of a meglitinide. What is their MOA?
Nateglitinide. Closes ATP sensitive K+ channels and stimulate insulin release. Short acting.
Name an example of a biguanide. What is their MOA? Side effects?
Metformin. Insulin sensitiser in target tissues; increases glucose uptake in muscle and reduces hepatic glucose production. Lack of strong evidence for use, with only 1/5 cats exhibiting a response in one study and 1 cat died in a study testing it (unknown cause). Side effects: potential for lactic acidosis, GI upset
What is the POMC gene in Labradors associated with?
JVIM 2017: Associated with obesity and food motivation. No association found with diabetes
What is the association between PCV and point of care blood glucose?
JAVMA 2015: Lower HCT = high BG, higher HCT = lower BG. This paper developed a formula for correction
How can the accuracy of a POC blood glucose be improved?
JAVMA 2015: separating plasma or serum; difference in this study was 0.3/0.4 compared to 31 for whole blood
What is the average dose required for Detemir?
JAVMA 2015: 0.12iu/kg. Hypoglycemia in 22%, caution in small dogs
How did glargine compare to act rapid CRI for feline DKA management?
JVECC 2019: No difference in survival. Median times to resolution of ketonaemia were shorter in the glargine group, but was not statistically significant. Faster improvement in hyperglycaemia and faster discharge for glargine treated cats
What mode of inheritance is present for diabetes in American Eskimo dogs?
JVIM 2019: Polygenetic. Theoretically breeding program could address
What is the incidence of cPLI positivity in DKA dogs and what is the significance?
JVIM 2016: 73%. Did not affect duration of hospitalisation or survival
What are some indications for a somatostatin analogue? what is an example? what are some side effects?
Hypoglycemia (insulinoma), gastrinoma. Antagonises insulin release from beta cells and gastrin release from G cells. Eg Octreotide, an injectable. Need 2-3 injections per day. Side effects; GI upset, reduced biliary contraction
What is the reported accuracy for the freestyle libre?
JVIM 2016: 93% accurate at low BG but 99% accurate at other BGs. Mean difference from reference method was 2.3mg/dl (0.12)
What lipid fractions are increased in dogs with DM?
JVIM 2018: All fractions were, but the biggest were LDL-Cholesterols and non-HDL-cholesterol.
Is the CGM accurate in DKA in dogs?
JVIM 2019: found to be clinically but not analytically accurate. BCS, time wearing and metabolic variables did not affect accuracy
What is the incidence of relapse in cats with diabetic remission? What factors can predict this?
JVIM 2015: 30% relapse. Fasting BG 7.5+ and impaired glucose tolerance predicted; taking 5 hours to normalise or BG increasing to 14+
in a study based around an owner survey, feeding what sort of diet was associated with diabetes?
JVIM 2017: Dry food
In an uncontrolled JFMS study, what was the performance of Hills Metabolic in cats?
JFMS 2016: 83% lost weight and 14% reached ideal weight
Which was commonly increased in DM cats? T4, IGF or FPLI?
JFMS 2017: fPLI increased in 43%. T4 uncommonly increased 4.5%, and IGF >1000ng/ml in 17.8%
What is the effect of insulin treatment on IGF in cats and what is the significance?
JVIM 2018: Increased IGF and this was predictive of remission. Was associated with an increase in IGF complexes called ternary complexes (TCs) which is associated with IGF binding proteins.
What are the CT characteristics of cat pancreas’ with diabetes?
JVIM 2018: increased size and volume, increased peak portal enhancement time.
What is acarbose? What is the effect in healthy cats and is this diet dependent?
JFMS 2015: Oral hypoglycemic agent affecting glucose absorption. inhibits pancreatic amylase and alpha-glucosidase. Reduced BG in cats fed a high CHO diet but not a low CHO diet. A low CHO diet was more effective than using this medication with a high CHO diet. Best used in cats that eat all their food at once, may be less effective with
What is the recommended CHO content of feline DM food?
JFMS consensus: <12-15%/ME
What is the relevance of chromium and vanadium in diabetes?
Cofactor for insulin function. Chromium has improved glucose tolerance in healthy cats and vanadium has improved CSx and fructosamine in cats with DM
What is an incretin? Name an example and how it is degraded. What is its MOA?
GI hormone, such as glucagon like peptide (exenatide). Cleaved by DPP-4 (another drug target; inhibitors). GLP-1 promotes insulin release in response to glucose, inhibit beta cell apoptosis, inhibits glucagon release and delays gastric emptying. Relies on glucose being present. In DM cats also on insulin a long acting exenatide formulation was associated with reduced insulin requirement and higher remission.
What was the impact of exenatide on newly diagnosed DM cats?
JVIM 2016: Reduced appetite and lack of weight gain. Remission in 40% and good control in 89%, compared to 20/58% in placebo group, not statistically significant
What is the benefit of home glucose monitoring in cats?
JFMS 2018: Higher rate of remission 32% vs 10% (though not statistically significant) and improved QOL
What sort of insulin is lispro? how did it compare to regular insulin for DKA in cats?
JVIM 2019: Human analogue insulin, short acting. In this paper found to be safe and in the dose used normalised BG faster than regular insulin.
What % of dogs having abdominal CT had an incidental adrenal mass identified? What were risk factors for this?
JAVMA 2016: 9.3%. Associated with screening for neoplasia and increased age
What was the level of disagreement between a cortisol ELISA and chemilumescent assays?
JAVMA 2018: Clinically important disagreement in 25% of samples, particularly when high or low
What is pasireotide? What is the effect of this drug in conjunction with trilostane or mitotane in PD Cushings?
JAVMA 2018: Somatostatin analogue. PD tumours may express somatostatin receptors (and dopamine receptors). These may be inhibitory.
In this study, pasireotide did NOT improve clinical variables, ACTH stim or plasma ACTH levels. some dogs had increases in PD size and some had decreases
What is the % recurrence of PD in dogs after hypophysectomy? can any post operative variables be used to predict?
JVIM 2015: 28%. Post op cortisol, ACTH were associated with a shorter disease free period but no single cut off could be identified
What dose of ACTH has been recommended for monitoring vs diagnosis
JVIM 2016: 1ug/kg could be used for monitoring (85-108% equivalent to 5ug/kg). Couldn’t be used for diagnosis though, only 73-92% equivalent. Clinical interpretations would have been different for 23% of the dogs
What limitations of the ACTH stimulation test was seen via evaluating it in healthy dogs?
JVIM 2017: Intermediate IoI value, which is a marker of inter-individual variability. This means reference interval may not reflect true normal in all dogs. Cortisol was higher in males. Cd (critical difference for interpretation) was 93
What was the incidence of reported AE in FNA of adrenal masses?
JSAP 2019: only 1/19 dogs had Vtach.
What is the preferred test for Phaeochromocytoma?
JVIM 2015: Urinary normetanephrin:creatinine ratio. No overlap with HAC or healthy dogs
What receptor has been found to be expressed more in adrenal carcinomas?
JVIM 2015: ERBB2 (potential therapeutic target)
What is the Sn and Sp of the LDDST? What pattern of suppression has the highest PPV and which has the second highest?
JVIM 2018: Sn 96 and Sp 67. Lack of suppression had a PPV of 94, followed by partial 67%
How did dogs with atypical HAC differ from control dogs?
JVIM 2015: They had significantly higher hourly and sum cortisol concentrations compared to healthy dogs. Adrenal diameter did not differ between atypical and PDH dogs.
What is the significance of the P/B ratio and UCCr prior to hypophysectomy?
JVIM 2016: Higher of either associated with recurrence. P/B ratio of 0.31+ was associated with significantly shorter survival.
What is the contribution of the basal cortisol to the ACTH stim?
JVIM 2018: Redundant. Post stim cortisol had good discriminatory ability, comparable to the difference in concentration between values. Baseline was redundant.