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Small Animal (Poppy) > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Thyroid action

A

Increases metabolism

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2
Q

Hyperthyroidism in dogs

A

Rare
Nutritional hypertyroidism (fresh thyroid given in raw feeding)

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3
Q

What causes this change in appearance?

A

Hyperthyroidism

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4
Q

Thyroid crisis

A

Severe tachycardia (>300bpm), tachypnoea, panting, respiratory distress, profound weakness, ventro-flexion, sudden blindness due to hypertension

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5
Q

What form of hyperthyroidism can cause poor appetite?

A

Apathetic hyperthyroidism/apathetic thyrotoxicosis

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6
Q

How does mild thyroid disease affect kidney parameters?

A

Improve mild kidney disease

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7
Q

Best initial test for hyperthyroidism

A

Total T4 (high TT4 and CS = diagnosis)

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8
Q

Follow up tests if TT4 is negative but there are clinical signs suggestive of hyperthyroidism

A

Free T4 and TSH

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9
Q

How can euthyroid sick syndrome be ruled out (non-thyroidal disease affecting thyroid hormone levels)?

A

Scintigraphy

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10
Q

Treatment of feline hyperthyroidism

A

Radioactive iodine (131 I), SC injection
Surgery (thyroidectomy)
Anti-thyroid medication (carbimazole ‘pro-drug’/methimazole, stop incorporation of iodine into protein associated with thyroid hormone)
Ultra-low iodine diet

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11
Q

Monitoring of hyperthyroidism that is non-negotiable in all cases

A

Clinical exam (BCS, MCS, fundic exam and blood pressure)
Weight check
Nutritional assessment

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12
Q

What hormones are produced by the adrenal medulla?

A

Catecholamines

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13
Q

What hormones are produced by the adrenal cortex?

A

Zona reticulus: androgens
Zona fasciculata: glucocorticoids
Zona glomerulosa: mineralocorticoids

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14
Q

Pituitary adrenal axis

A
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15
Q

Pituitary dependent hyperadrenocorticism

A

80-90%
Micro and macro adenomas/adenocarcinomas

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16
Q

Adrenal dependent hyperadrenocorticism

A

10-20%
Functional adrenal adenomas and carcinomas (50:50)

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17
Q

Iatrogenic hyperadrenocorticism

A

Exogenous steroids

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18
Q

Presentation in hyperadrenocorticism

A

Middle aged to old dogs
Females > males
PUPD (secondary diabetes insipidus)
Polyphagia
Muscle wasting/weakness/pot belly/panting
Skin thinning/calcinosis cutis/pigmentation/bruising
Symmetrical hair loss
Reproductive dysfunction

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19
Q

Abdominal radiograph findings with hyperadrenocorticism

A

Hepatomegaly
Pot-bellied appearance
Calcinosis cutis
Distended bladder

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20
Q

Thoracic radiograph findings with hyperadrenocorticism

A

Tracheal and bronchial wall mineralisation
Pulmonary metastasis
Osteoporosis

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21
Q

Haematology findings in hyperadrenocorticism

A

Stress leukogram (neutrophilia: mature, lymphopaenia, monocytosis, absolute eosinopaenia)

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22
Q

Clinical chemistry in hyperadrenocorticism

A

Increased ALP (steroid induced isoform)
Increased ALT (‘steroid hepatopathy’)
Hyperglycaemia
Increased cholesterol and triglyceride
Mildly abnormal bile acids

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23
Q

Urinalysis findings in hyperadrenocorticism

A

USG <1.030, mild dehydration
Mild glucosuria
Proteinuria
Positive urine culture (reduced immune function/glucosuria)

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24
Q

Diagnostic tests for hyperadrenocorticism

A

Low dose dexamethasone (3 samples at 0, 3-6, 8h)
ACTH response (samples at 0 and 1h)
Urinary cortisol:creatinine ratio (morning urine sample)
Steroid induced alkaline phosphatase

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25
Q

Meaning of positive response to low-dose dexamethasone

A

Pituitary dependent hyperadrenocorticism

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26
Q

When should you test for hyperadrenocorticism?

A

Dog in which you could believe a positive result

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27
Q

Treatment of hyperadrenocorticism

A

Medical: Trilostane (licenced)
Surgical: adrenalectomy for ADH, hypophysectomy for PDH

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28
Q

What adrenal medulla condition may be confused with hyperadrenocorticism?

A

Phaeochromocytoma

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29
Q

Treatment of phaeochromocytoma

A

Surgical
Medical: adrenoreceptor antagonists (sympatholytics), phenoxylbenzamine (alpha), propanolol (beta)

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30
Q

Activated calcium

A

Calcitriol

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31
Q

Effect of parathyroid hormone on blood calcium

A

Increase (from various sources)

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32
Q

Reasons for false high calcium result

A

Lipaemia
Icterus (jaundice)
Haemolysis

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33
Q

Effect of hypoalbuminaemia on calcium

A

Low (calcium binds to albumin)

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34
Q

Mechanism of renal secondary hyperparathyroidism

A

Renal disease affects phosphate levels = high/low total Calcium (PTH restoring balance?)

35
Q

Effect of hyperphosphataemia on calcium

A

Increased complex fraction

36
Q

Affect of high calcium/phosphorous

A

Mineralisation of tissues e.g. kidneys, gastric mucosa (high levels complex/precipitate)

37
Q

Causes of hypercalcaemia

A

HOGSINYARD
Hyperparathyroidism
Osteolysis
Granulomatous disease
Spurious (albumin)
Idiopathic
Neoplasia
Young
Addison’s
Renal disease (total Ca in horses)/Raisin toxicity
D (Vit. D) toxicity

38
Q

Most common causes of hypercalcaemia in dogs in practice

A

Malignancy
Hypoadrenocorticism
Primary hyperparathyroidism
Chronic renal failure
Vitamin D toxicosis
Granulomatous disease

39
Q

Most common causes of hyperparathyroidism in cats

A

Idiopathic hypercalcaemia
Renal failure (total mainly, occasionally iCa)
Malignancy (lymphoma and squamous cell carcinoma)
Primary hyperparathyroidism

40
Q

Test to differentiate PTH dependent/independent hypercalcaemia

A

PTH and iCa

41
Q

When is parathyroid related peptide/PTHrP present?

A

Humoral hypercalcaemia of malignancy

42
Q

Treatment of hypercalcaemia

A

Stabilise calcium urgently: fluids/diuresis, glucocorticoids, bisphosphonates
Treatment of cause

43
Q

Causes of hypocalcaemia

A

Parathyroid dependent/primary hypoparathyroidism (spontaneous immune mediated, functional hypomagnesaemic, post-surgical)
Demand exceeds supply/mobilisation (periparturient tetany/eclampsia, nutritional deficiency of calcium/Vit. D, pancreatitis)
(PTH and Calcitriol resistance syndromes)

44
Q

How do hypocalcaemia cases present?

A

‘Rubbing face’
(Neuromuscular excitability, agitation)

45
Q

Short term therapy/management of hypocalcaemia

A

IV calcium (gluconate, borogluconate, chloride)
Monitor for bradycardia

46
Q

Long term therapy for hypocalcaemia

A

Aim for subclinical/low normal
Oral calcium supplement
Vitamin D to promote calcium uptake (calcitriol short term, alfacidol/dihydrotachysterol long term)

47
Q

Type 1 like diabetes in dogs

A

Insulin deficiency
Common: immune mediated (antibodies in circulation against islet Ag) or B loss due to EPI/pancreatitis
Rare: congenital B loss

48
Q

Type 2 like diabetes in dogs

A

Insulin resistant
Common: progesterone (metestrus), acromegaly, hyperadrenocorticism, exogenous corticosteroids
Rare: IGF-1/GH excess (pituitary acromegaly)

49
Q

Causes of type 1 diabetes in dogs

A

Pancreatectomy
Pancreatitis
Auto-immunity
Islet cell hypoplasia
Chemical toxicity

50
Q

Causes of type 2 diabetes in dogs

A

Progesterone/agen
Growth hormone
Glucocorticoids
Glucagon
Catecholamines
Thyroid
Obesity

51
Q

Are most diabetic dogs insulin dependent or not?

A

Insulin dependent
(Exceptions are bitches in metoestrus and dogs with concurrent Cushings may/may not be)

52
Q

Clinical presentation of diabetes mellitus in dogs

A

Older dogs (7-9y)
Female > male
‘Starvation amidst plenty’ (polyphagia but losing weight)
PUPD
Quickly tired
Diabetic cataracts
Recurrent infections (e.g. UTI)
‘Acetone’ breath

53
Q

Diabetic ketoacidosis

A

Acute
Dull, depressed, weak, comatose?
Vomiting
Dehydrated
IVFT/critical care

54
Q

Monitoring diabetes mellitus in dogs

A

Blood glucose curves (can be done at home)
Fructosamine (non-enzymatic binding of glucose to albumin)
Glycated haemoglobin (glucose non-enzymatically bound to Hb)
Urine testing

55
Q

Somogyi

A

Low blood sugar (hypoglycemia) episode leads to high blood sugar (hyperglycemia) due to surge of hormones

56
Q

Complications of insulin treatment of dogs with diabetes mellitus

A

Hypoglycaemia
Pancreatitis
Keratoconjunctivitis
Cirrhosis
Neuropathy

57
Q

Treatment of canine diabetes

A

Daily routine of insulin injection, food and exercise (all at the same time)

58
Q

Pathophysiology of ketoacidosis

A

Reduced insulin > reduced glucose uptake into cells > metabolic deficit
Glucagon > lipolysis > fatty acids > acetyl coA > ketones (acetoacetate, b-hydroxybutyrate, acetone)
Acetoacetate and b-hydroxybutyrate acidic > metabolic acidosis > inappetence, nausea, reduced mentation, vomiting > dehydration, renal hypoperfusion and electrolyte derangements > death

59
Q

Diagnosis of ketoacidosis

A

b-hydroxybutyrate (most abundant blood ketone)
Blood gas (metabolic acidosis)

60
Q

Stabilisation of patient with ketoacidosis

A

Hartmann’s (monitor electrolytes closely, dehydration may cause pseudohyperkalaemia which is actually hypokalaemia, insulin therapy may drive K+ into cells)
Electrolytes (potassium supplementation, rarely potassium phosphate for hypophosphataemia, correct glucose for hyponatraemia, correct hypocalcaemia if clinical sign, magnesium supplementation if not doing well)
Analgesia (headache?)
Anti-emetics (nausea)
Concurrent disease

61
Q

Hyperglycaemic hyperosmolar syndrome

A

Rare
Pathogenesis similar to DKA but a small amount of insulin and hepatic glucagon resistance reduces lipolysis so ketones not elevated
Diagnosis: BG >33mmol/L, no urinary ketones, serum osmolality >350mOsm/kg
Treatment: fluid therapy, insulin therapy when normovolaemic

62
Q

Glucose monitoring in DKA patient

A

Blood sampling by central venous catheter
Freestyle Libra (easy to place, monitor via app, interstitial not blood)

63
Q

Signalment for diabetes mellitus in cats

A

> 7y
M/MN>F/FN
Obese
Treatment with glucocorticoids or progestagens

64
Q

Clinical signs of diabetes mellitus in cats

A

PUPD
Weight loss
Lethargy
Polyphagia
Less common: weakness, plantigrade stance, ventroflexion of neck, depression/anorexia (DKA)

65
Q

If a cat with diabetes mellitus has abdominal pain what might you suspect?

A

Pancreatitis (triaditis?)

66
Q

Type I diabetes in cats

A

Deficiency of insulin (pancreatic b cell loss)

67
Q

Causes of b cell loss/destruction

A

Chronic pancreatitis
+/- EPI
Pancreatic amyloidosis
Glucose toxicity
Immune mediated disease
Congenital lack of b cells

68
Q

Type 2 diabetes in cats

A

Inability to respond to insulin (usually have functioning b cells at time of diagnosis)
+/- relative insulin deficiency

69
Q

How does glucose toxicity lead to insulin dependent diabetes mellitus?

A
70
Q

Diagnostic plan for a cat with suspected diabetes mellitus

A

Document persistent hyperglycaemia and glucosuria (rule out stress hyperglycaemia) and appropriate clinical signs

71
Q

Fructosamine

A

Irreversible reaction between glucose and plasma proteins
Indicates average BG during preceding 1-3 weeks

72
Q

Diabetic cat diet

A

High protein (gluconeogenesis provides consistent energy source)
Restricted carbohydrate (relieve hyperglycaemia/glucose toxicity)
Wet formulation (improves satiety and maintains hydration)
Can graze but don’t exceed daily calories (weight loss)

73
Q

Insulin products

A

Lente insulin
Protamine zinc insulin
(Glargine)
(Detemir)

74
Q

Last resort for diabetes mellitus treatment in cats if owners will not consider insulin treatment

A

Glipizide
Bexagliflozin (sodium-glucose cotransporter 2 inhibitor)

75
Q

Causes of unstable diabetes in cats

A

Compliance issues
UTI (may have no clinical signs)
Pancreatitis
Significant dental disease

76
Q

Insulin resistance

A

No response to insuline at a dose of >2.2IU/kg/dose

77
Q

Hypoglycaemia

A

BG <3-3.5mmol/l
Mild hypoglycaemia well tolerated, severe hypoglycaemia is life threatening

78
Q

Clinical signs of hypoglycaemia

A

Lethargy
Muscle tremors
Anorexia and vomiting
Ataxia
Recumbency
Vocalisation
Seizures

79
Q

Treatment of hypoglycaemia

A

At home: honey/glucose on oral mucous membranes/feed
Clinic: 25% dextrose solution slow IV, 5% dextrose CRI
Monitor clinical signs and blood glucose

80
Q

Biochemistry parameters raised in renal failure

A

Urea
Creatinine

81
Q

Electrolyte abnormality associated with refeeding syndrome

A

Hypophosphataemia

82
Q

Electrolyte abnormality associated with hypervitaminosis D

A

Hyperphosphataemia

83
Q

Treatment of inadequate hormone production from the zona glomerulosa of adrenal gland (in hypoadrenocorticism)

A

Fludrocortisone

Small Animal (Poppy) (20 decks)

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