Endocrine Flashcards
In the endocrine pancreas, what do the Alpha and Beta cells secrete?
A: Glucagon in response to hypoglycemia
B: Insulin in response to hyperglycemia
How does insulin affect glucose, lipids, protein, and ketone levels in the body?
Insulin will decrease glucose, decrease lipolysis, decreased proteolysis, decreased ketogenesis, and decreased gluconeogenesis. Iti will increase glucose oxidation, increase glycogenesis, and increased lipogenesis.
How does glucagon affect glucose, lipids, protein and ketone levels in the body?
Glucagon will increase lipolysis, proteolysis, ketogenesis. It will decrease
Type I Diabetes Mellitus
No insulin is produced by beta cells due to degeneration of islet cell and hypoplasia usually because of an autoimmune condition.
Type II Diabetes Mellitus
Insulin is still produced, but the receptors are desensitized. These are on cells that allow glucose to be brought into cells to be used as energy . Insulin antagonism and anti-insulin antibodies can also play role.
Hyperglucagonemia in diabetes mellitus
This is characterized by excess glucagon production/secretion by the alpha cells of the pancreas. It can increae the oxidation of fatty acid in hepatocytes leading to ketoacidosis.
How could deficiencies in islet cells be created?
- Immune mediated disease
- Neoplasia
- Pancreatitis
Which hormones can act as insulin antagonizer in type II diabetes mellitus?
- Growth hormone
- Glucagon
- Glucocorticoids
In diabetic cats, what is a common accumulation in the pancreatic islets of their pancreas?
Amyloid derived from islet amyloid polypeptide (IAPP)
In diabetic dogs, what clinical sign occurs with the eyes and why?
Cataracts due to glucose being converted to sorbitol and fructose in the lens leading to swelling and degeneration of the lens fibers.
Emphysematous cystitis in diabetic dogs, what is it and what is happening?
It is an infection of the bladder wall caused by gas-forming bacteria or fungi. Diabetes dogs are suffering from hyperglycemia which causes the body to want to excrete as much glucose as possible in the urine leading to glucosuria. Glucose fermenting bacteria appear in the bladder and form gas which damages the wall.
What is insulinoma and what clinicopathologic finding is usually seen in a patient with this?
An insulinoma is a functional tumor ( if benign= adenoma, if malignant= adenocarcinoma) in the pancreas that affects the beta cells and causes an excess of insulin to be produced/secreted. This can lead to hypoglycemia which can manifest into collapse and/or seizures.
If a ferret has an insulinoma, what would the gross appearance of the pancreas be? Why?
Nodular hyperplasia. The current theory is that when they are fed diets high in carbohydrates, the blood sugar continually spikes causing overstimulation of the beta cells=hyperplasia.
What is the best way to diagnose an insulinoma?
There will be hypoglycemia even with normal to increased blood levels of insulin.
What is a gastrinoma and what lesion commonly accompanies it?
A gastrinoma is a rare invasive tumor in the pancreatic islets that affects the gastrin secreting G cells. This causes hypersecretion of gastric acid in the stomach leading to the development of peptic/gastric ulcers. Also called ““Zollinger-Ellison syndrome”
What are chemoreceptors and where are they?
These detect fluctuations in oxygen, carbon dioxide, and pH levels in the blood. They are located in the aortic arch (aortic body) and near the bifurcation of the carotid arteries (carotid body).
What is a chemodectoma and what gross appearance will it have?
It is a tumor of either the aortic or carotid body. In animals, it is most commonly of the aortic variety in dogs, especially brachycephalic breeds. It presents as a solid white mass surrounding the aorta in the pericardial sac and it indistinguishable from a thyroid carcinoma.
What are the major differences between aortic body and carotid body chemodectomas?
Aortic chemodectomas are non-functional and usually adenomas, but take up space and can cause pressure on the atria/vena cava.
Carotid chemodectomas are also non-functional, slow growing, unilateral, adenocarcinomas or adenomas. They can invade certain cranial nerves and the external jugular vein.
What is the etiology of chemodectomas?
The current theory is that brachycephalic dog breeds are in a constant state of hypoxia leading to hyperplasia of the aortic/carotid bodies.
What are the two functional cell types in the thyroid gland and what do they secrete?
- Thyroid follicular cells: Thyroxine ( T4) and Triiodothyronine(T3)
- Thyroid C cells (parafollicular): calcitonin
How are the thyroid hormones regulated by the adenohypophysis?
The thyrotroph basophil cells of the adenohypophysis (pars distalis) release thyroid stimulating hormone (TSH) after the hypothalamus releases thyrotropin releasing hormone (TRH). The TSH from the adenohypophysis stimulates thyroid follicular cells to release T3 and T4 which usually raise increases the body’s metabolism.
Explain the main functions of T3, T4, and reverse T3.
T3 is responsible for most of the biologic effects in the body and has a longer half-life than T4.
T4 is the primary hormone secreted by the thyroid.
Reverse T3 is biologically inactive or protein bound hormone and represents the majority of hormone in the body, The free hormone levels in the blood represent the true thyroid status of the patient.
What happens to T4 when a patient is suffering from renal disease or has protein restriction in a neonate?
It will be preferentially mono deiodinated to reverse T3.
In early hypothyroidism, why would serum T3 levels sometimes be within normal limits?
There is a possibility that the disease has not progressed enough to lower the serum levels, however, the T3 levels in the tissues may be lower than normal therefore not providing those tissue with enough hormone to function properly.
If there is chronic TSH stimulation, what gross and histologic appearance will the thyroid gland have?
TSH is released from the adenohypophysis and will stimulate the thyroid to secrete T3 and T4. In excess, this would overstimulate the thyroid causing hyperplasia and reduced luminal colloid.
If there is reduced TSH stimulation, what gross/histologic appearance will the thyroid gland have?
The thyroid gland will not be secreting as much T3 and T4 and will result in atrophy of the gland with increased luminal colloid as more T3/T4 is stored
If there is chronic thyroxine (T4) administration, what will the thyroid gland look like grossly/histologically?
This will cause there to be a decrease in T4 secretion which will cause atrophy of the thyroid gland and an increase in appearance of colloid due to more storage of T4.
If there is an iodine deficiency, what will the thyroid gland look like grossly/histologically?
Iodine is required for the synthesis of T3 and T4. There will be a decrease in T3 and T4 which will cause the pituitary gland to ramp up (negative feedback lost) and release more TSH to stimulate the thyroid to produce more T3 and T4. Chronic stimulation of TSH will cause follicular hyperplasia of the thyroid gland and there would be decreased colloid because the cells are not making any T3/T4 to be stored.
If there is an excess in iodine, what will the thyroid gland look like grossly and histologically?
Too much iodine means that there will be a reduction of T3/T4 synthesis in the thyroid gland. Because there is less T3/T4 in the blood, the adenohypophysis will start to release more TSH and stimulate the thyroid gland in excess leading the follicular hyperplasia and reduced luminal colloid.
Why would decreased total serum T4 levels not confirm a diagnosis of hypothyroidism?
There is a disease called euthyroid sick syndrome which can decrease the T3/T4 levels without there being hypothyroidism. You would want to test FREE T4 levels as it is more sensitive and specific. Testing for high TSH concentration along with low to borderline serum T4 levels is diagnostic.
In a dog with clinical hypothyroidism, what could the gross appearance of the thryoid gland be?
- Idiopathic follicular collapse and luymphocytic thyroiditis= thyroid atrophy
- Thryoid ademona/carcinoma with iodine defeciency/excess= Thryoid hyperplasia
- Secondary hypothryoisim due to a pituiary proglme = thryoid gland atorphy
What are the common cutaneous changes in a dog with hypothyroidism?
- Bilateral alopecia
- Hyperkeratosis
- Hyperpigmentation
- Myxedema
What vascular disease may accompany hypothyroidism in dogs?
Atherosclerosis: Thyroid hormones are important for maintaining cholesterol levels, blood pressure, c reactive protein levels, and the renin-angiotensinogen system. Less of these hormones tend to increase cholestrol levels, blood pressure, and crp levels while decreasing vasodilatory substeances and inhibition of angiotensinogen Ii receptors. This can all lead to increase risk of atherosclerosis.
In cats with clinical hyperthyroidism what will the gross appearance of the thyroid glands be?
Bilateral (usually) nodular, multifocal, hyperplasia with a possible adenoma or carcinoma.
In feline hyperthyroidism, what cardiac lesion is usually present? Why?
Hypertrophic cardiomyopathy due to the elevated thyroid hormones that stimulate the heart to pump faster and more forcefully in order to keep up with the increased metabolic needs, requiring more blood to be pumped to maintain the same HR and blood pressure.
What are four differential diagnoses for goiter ( or enlarged, hyperplastic thyroid gland that is non neoplastic and non inflammatory) in neonatal sheep?
- Iodine dificient diet
- Excess dietar iodine
- INgetion of goitrogenic compounds
- Congenital dyshormonogenic goiter ( a defect in thyroglobulin synthesis)
What is the difference between hyperplastic and colloid goiter?
Hyperplastic goiter: There is excessive TSH stimulation
Colloid goiter There is diminished TSH stimulation
What are two differential diagnosis for a mass surrounding the aorta in a dog?
- Chemodectoma
2. Ectopic thyroid carcinoma