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Clin Chem > Endocrine 2 > Flashcards

Endocrine 2 Flashcards

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1
Q

Why are e-lytes affected w/ Addison’s, not Cushings?

A

Addisons =GC + MC’s

Cushings =GC only

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2
Q

3 forms of Cushings

A 
1 - Pituitary dependent
       • ↑ ACTH production (dog)
2- Adrenal dependent
       •adrenocortical adenoma
3 - Iatrogenic
       • Adrenal atrophy
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3
Q

Signalment of Cushing’s dog

A
  • Middle aged / older dog
  • PU / PD / PP
  • bilateral alopecia
  • pot-belly
  • thin-skinned
  • Calcinosis cutis
  • Weak/lethargic
  • “old dog”
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4
Q

Signalment of Cushing’s cat

A
  • Extra thin Skin –> tearing
  • STRONG assoc w/ DM (75% of cushiness = DM)

• Mostly Pituitary origin

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5
Q

Signalment of Cushing’s horse

A

not the same pathogenesis (Adenoma of Pituitary Pars intermedia)
• Hirsutism

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6
Q

Erythron of Cushing’s patient

A

↑ androgens –> Stimulate polycythemia
• high Hct (may seem like dehydration, w/o other evidence)
• inappropriate polychromasia w/ nRBCs

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7
Q

Clin Chem changes assoc’d w/ Cushings

A 
• ↑ ALP (cALP)
       - mild ↑ ALT/GGT
• ↑ glucose (no glucouria)
• ↑ cholesterol / lipemia
• USG -- GC block ADH at kidney/central
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8
Q

What are atypical changes in liver enzymes for Cushings

A

Lg’er elevations in ALT / GGT / Bc
• more than drug induction
• indicate hepatopathy
- hydropic change (glycogen) –> swelling –> block canuliculi

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9
Q

What might you see in a Equine cushing’s patient that is diff than other species

A

Glucosuria

- due to higher levels of circulating glucose

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10
Q

Pathogenesis of Cushings to DM

A

GC anatagonist to insulin –> burn out –> DM

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11
Q

Why do you see ↑ cholesterol/ lipemia?

A

Antagonize insulin –> ↑ lipoprotein lipase activity –> ↓ lipoprotein breakdown –> prolong cholesterol +/- TG 1/2 life

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12
Q

Signalment & presenting signs of Addison’s

A
  • Young / middle aged dog (cat = rare)
  • Female
  • GI signs (vomiting)
  • Bradycardia (from ↑ K)
  • Addisonian crisis - cardiovascular collapse & shock
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13
Q

CBC/chem of Addison’s

A
  • Lack of stress response (w/ ill dog)
  • lymphs / eosins (maybe elevated)

• ↓ glucose (37%) - lack of basal GC
• ↑ K
• ↓ Na
• < 23:1 Na:K ratio (strongly suggestive)
• ↑ Ca possible
• Pre-renal azotemia (vomiting)
- ↓ Na –> 2° renal azotemia (medullary washout)

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14
Q

If you see ↑ K/ ↓ Na (ratio < 23:1) what are the possible ddx?

A

• Addisons!!
• Consider parameters individually
- GI sequestration + acidosis – could cause this too

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15
Q

Describe Thyroid hormone

A

• 80-90% secreted as T4
• 99% is protein bound
- free T3 = 3-5x’s&raquo_space; free T4 activity

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16
Q

What is ↓ protein’s affect on thyroid?

A

↓ total thyroid measure – in euthyroid animal

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17
Q

Signalment of hyperthyroid

A
  • older cat
  • hyperactive
  • thin
  • PP

( hyperplasia / adenoma )

18
Q

CBC/chem assoc’d w/ hyperthyroid

A
  • polycythemia (50%)
  • ↑ Heinz bodies

• ↑ ALT, ALP

  - 2/3 cases show enzyme ↑ -- reasons unclear
  - DON'T think these ONLY mean liver!
19
Q

Dz assoc’d w/ heinz bodies in cats

A

1 - Hyperthyroid
2- DM
3- Lymphosarcoma
4- Exogenous oxidants - acetaminophen, onion tox

• New methylene blue stain

20
Q

Signalment for Hypothyroid

A
  • Doberman / Dachshund / cocker
  • middle aged
  • Mid-sized
  • Heat-seeker & hypothermic W/O shivering
  • Obesity
  • Bilateral alopecia w/ dry skin

Glandular atrophy / lymphocytic thyroiditis

21
Q

What are clinical signs that are assoc’d w/ Critical condition hypothyroid?

A
  • Weakness
  • NON-pitting edema
  • Serous cavity effusion

• Myxedema w/ stupor = rare life-threatening

22
Q

CBC assoc’d w/ Hypothyroid

A

• Mild non-regenerative anemia
- ↓ oxidative metabolism – body is good at ↓ Hct
• usually no stress leukogram

– differentiated it from cushings!

23
Q

Chemistry assoc’d w/ hypothyroidism

A

• ↑ cholesterol

- > 500 = strongly suggests hypothyroid

24
Q

Ddx for ↑ cholesterol

A 
1 - Hypothyroid ( >500)
2- Pancreatitis
3- Cholestasis
4- DM
5- Renal failure (nephrotic syndrome)
25
Q

What is “Sick Euthyroid Syndrome”?

Should you supplement T4?

A

Degree of ↓ correlated w/ degree of sickness (ICU patients)

  • protective mechanism to ↓ metabolism during Negative nitrogen balance
  • Do not give T4 – will correct itself
26
Q

Dz / Drugs assoc’d w/ Sick Euthyroid Syndrome

A 
Dz
• Cushings / Addisons
• DM
• Chronic renal failure
• Liver dz
• Pyoderma
Drug
• Anesthetics
• Glucocorticoids
• NSAIDs
• Furosemide
• Anti-convulsants
  • resolve 1° condition
27
Q

Hormones that regulate Ca++

A

PTH
- ↑ Ca ↓ P

Calcitonin
- ↓ Ca ↓ P

Vitamin D
- ↑ Ca ↑ P

28
Q

Ddx of hypercalcemia

A
  • 1° hyperparathyroidism
  • Humoral hypercalciemia of malignancy
  • Hypervitaminosis D
  • addisons
  • granulomatous dz involving bone

Horse
• Renal dz

29
Q

Classic pattern of 1° hyperparathyroidism

A

↑ Ca / ↓ P

↑ Ca –> deposits in tubules –> renal failure
• Phos may be normal if renal failure (due to ↑ retention)

30
Q

Most common cause of significant hypercalcemia

A

Humoral hypercalcemia of Malignancy
• Lymphosarcoma
• Anal sac adenoma

31
Q

Classic pattern hypervitaminosis D

A

↑ Ca / normal to ↑ Phos (even w/o azotemia)

• if there is azotemia –> you may want to interpret it as ↑ Phos due to azotemia, but should be thinking about ↑ Vit D too!

32
Q

Differentiate btwn 1° renal failure & hypercalcemia-induced renal failure, using ↑ Ca

A

1° renal failure
–> mild ↑ in Ca

Hypercalcemia induced renal failure
• ↑ ↑ ↑ Ca –> renal failure

33
Q

1 cause for Hypocalcemia

A

Hypoalbuminemia

- mild change

34
Q

Causes for hypocalcemia

A 
1 - hypoalbuminemia
2- Renal failure (non-equine)
         - esp. Ethylene glycol tox
3- Hypoparathyroidism
4- Pancreatitis
5- Parturient paresis
6- Hypomagnesemia
7- Blister beetles
8- Mercurial skin compound (horse)
35
Q

Hypoparathyroid

A

↓ Ca ↑ Phos

• measure PTH during hypocalcemia
- if low during this time = hypocalcemia

36
Q

Parturient paresis

A

Milk fever = cow
↓ Ca –> ↓ Ach release –> flaccid paralysis
Eclampsia = Bitch & mare
↓ Ca –> ↓ membrane stability –> ↑ firing –> Puerperal tetany

37
Q

Hypomagnesemia

A
  • Grass tetany
  • Seasonal/winter tetany
  • calves on whole milk for extended time
38
Q

Clinical signs of hypomagnesemia

A
  • hyper-excitability
  • Twitching
  • staggering
  • paresis
  • tetany
  • convulsion
39
Q

what ion is assoc’d with Mg? What does it do with hypomagnesemia?

A

Ca
• Mg required for PTH release
• may contribute to clinical signs

Phos
• mild ↓

40
Q

What is the toxin assoc’d w/ blister beetles?

What are the assoc’d lesions?

A

Cantharidin
• often find them in alfalfa

** Combined GI symptoms, Renal dysfunction, ↓ Ca

Clin Chem (12 decks)

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