Endocrine Articles All Testable Points/ Physio Questions Flashcards

Question

In a study evaluating serum and urinary cystatin C in cats with FIV and cats with hyperthyroidism (JFMS 2016)…

Answer 1

Included 30 cats with FIV 26 hyperthyroid cats 28 healthy cats Measured serum and urine cystatic C, and urinary cystatic C to creatinine ratio Routine renal variables (bun, creat, USG, UPCR) also recorded Cats with hyperthyroidism had significantly higher serum cystatin C and higher urinary cystatin C to creat ratios, lower serum creatinine, and higher UPC than healthy cats Based on the RR for serum cystatin C, hyperthyroid cats cannot be distinguished from healthy cats, suggesting that serum cystatin C might not be a riliable GFR marker in hyperthyroid cats Cats with FIV did not show a significantly higher serum cystatin C concentration but had a significantly higher serum creat and UPC than healthy cats Urinary cystatin C could only be detected in 4/30 cats with FIV

Answer 2

Low molecular mass protein responsible for intracellular catabolism of peptides and proteins Many properties for endogenous GFR markers apply to cystatin C Studies in humans and dogs have show that serum cystatin C may be better than creat at detecting early renal impairment, and urinary cystatin C can be used as a tubular marker

Answer 3

Looked at 55 cats with hyperthyroidism, 45 healthy cats, and 327 euthyroid cats with nonthyroidal disease ~80% of hyperthyroid cats and 20% of healthy cats and cats with non-thyroidal illness had a palpable thyroid gland Median thyroid palpation score in hyperthyroid cats was 2 (significantly higher compared to other groups) Thyroid size did not correlate with T4 Thyroid size was smaller (most <5mm) than previously reported Hyperthyroid cats with lower clinical scores had significantly higher T4 levels compared with hyperthyroid cats with higher scores Hyperthyroid cats were older and had lower body weight and BCS than other cats

Answer 4

Background- rebound hyperglycemia aka somogyi Looked at 10767 BG curves of 55 cats treated with glargine Biochemical hypoglycemia did occure frequently, but blood glucose curves consistent with rebound hyperglycemia with insulin resistance was confined to 4 single events in 4 different cats . (14/55 cats - 25%), with a median of 1.5% of BG curves were consistent with rebound hyperglycemia WITHOUT an insulin resistance component Represented 0.42% of BG curves in both affected and unaffected cats *** Somogyi Conclusion - rebound hypoglycemia is rare in cats treated with glargine on a protocol aimed at tight glycemic control. Insulin dose should not be reduced when there is hyperglycemia in the absence of biochemical or clinical evidence of hypoglycemia **note - Bg monitoring was intermittent and all cats were FED after hypoglycemia was noted, then this study likely under or overestimated occurrence of rebound hyperglycemia **

Answer 5

Recruited recently diagnosed diabetics treated with >/= 6 weeks of porcine lente insulin q 12 Assessed fructosamine, 24 h BG curve, and QOL assessment, and diabetic control score at enrollment and 2,4, and 12 weeks after transitioning to PZI at a starting dose of 0.2-0.7 U/kg q 12 22 cats recruited Median porcine lente insulin dose at enrollment was 0.5 U/kg q 12, equaling median PZI starting dose Transitioning insulin was followed by significant decrease in fructosamine, insulin dose, and diabetic control score and QOL score Mean BG did not alter significantly 5 cats (23%) achieved remission Hypoglycemia was noted in 30/190 12 hour BG curves (I.e. 16%), and 5/22 cats experienced clinical hypoglycemia (though proportion of hypoglycemic cats did not differ between porcine lente insulin treatment and PZI treatment 32 % of cats showed a short duration of action of porcine lente insulin, then went on to show duration of action >/= 9 hr on PZI 10.5% of cats showed short duration of PZI

Answer 6

Glargine Detemir Protamine zinc (PZI)

Answer 7

Cross sectional analysis of 2096 cats refered for radioiodine therapy Objective - to compared serum TT4 concentrations and thyroid scintigraphic characteristics of cats referred for I131 treatment based on disease duration Methods — Cats were divided into 5 groups based on time from diagnosis Each thyroid scintigraphic scan was evaluated for pattern (unilateral, bilateral, multifocal), location (cerivcal, thoracic inlet, chest), and size (small, med, large, huge) of the thyroid tumor, as well as features suggesting malignancy Median TT4 concentration increased with increasing disease duration Prevalence of unilateral disease decreaed with increasing duration, while multifocal disease increased Median tumor volume increased with increased disease duration Prevalence of large and huge thyroid tumors increased from 5.1% to 88.6% with increasing duration, while prevalence of intrathoracic tumor tissue increased from 3.4% to 33% Prevalence suspected thyroid carcinoma (characterized by severe hyperthyroidism refractory to methimazole, huge intrathoracic multifocal tumors, refractory to methimazole treatment) increased with increasing disease duration from 0.4% to 20%

Answer 8

Hyperthyroidism, 10% of geriatric cats 98% - benign thyroid adenomatous hyperplasia with ~70 % having bilateral disease <2% - thyroid carcinoma

Answer 9

Background - one factor that may influence outcome of radioiodine therapy in hyperthyroid cats is degree of activty of thyroid gland, represented byuptake of sodium pertechnetate or tracer activities of radioiodine by thyroid gland on scintigraphy. Thyroid gland pertechnetate update can be demonstrated by seiquantitative factors such as thyroid gland to salivary gland ratio and the thyroid to background ratio and the percentage technetium uptake by the thyroid glands 75 cats that had sodium pertechnetate thyroid scans ****Higher thyroid to salivary gland ratios were found to be significantly related to outcome of patient being persistently hyperthyroid. Threshold of 5.4 is a possible indicator of increased risk of persistent hyperthyroidism Other parameters evaluated (thyroid to background ratio and percentage technitium uptake) were not considered to be significant For low TT4 outcomes, no significant parameters were found

Answer 10

Aim - to evaluate the effect of determir therapy in diabetic cats in a general clinical setting 14 diabetic cats with follow up period of at least 3 months — dose 0.25-0.5 U/kg/BID) 13/14 cats 93% - moderate or excellent control of clinical symptoms within the initial 3 months of therapy, including 5 cats previously treated unsuccesfully with other insulins Clinical improvements were noted after 1 month and continued with time 3 cats (30%) achieved remission within 3 months, and non experienced a diabetic relapse during the study 1 cat achieve remission after 13 months Considered safe, with only 2 reported episodes of hypoglycemia

Answer 11

~8 hours (range 8-14 h)

Answer 12

Long acting isulin analogue, is slowly absorbed from the subcutaneous injection site and displays a prolonged action compared with other types of insulin Mechanisms of longer DOA - formation of dihexamers and binding of detemir to albumin In healthy cats - has similar pharmacokinetics to glargine

Answer 13

Objective - review characteristics of diabetic cats presenting for hypoglycemia and identify factors that may have contributed to hypoglycemic episodes, patient clinical signs, and lab findings, and response to therapy 28 cats presenting a total of 30 times Majority of cats presented with neurologic attributed to reduced ingestion or subsequent vomiting of a meal after insulin had been administered or accidental double dosing of insulin. Concurrent illnesses that may have affected insulin requirements were also common Cats that demonstrated clinical improvement within 12 hours of treatment were more likely to recover despite mental status and glucose level on presentation

Answer 14

Objective - to relate total thyroid volume calculated by a newly contructed formula for feline patients (0.438 x length x width ^2) to the outcome of i131 therapy 167 cats categorized by dose of I131 given and therapy outcome Study analysis showed no significant relationship between an increasing total thyroid volume and oddes for a final low TT4 or final hyperthyroid outcome Did find significant relationship between increased odds for hypothyroid outcome in patients with increased number of foci detected on the thyroid scan, but this was NOT true for a final hyperthyroid outcome Number of detected foci was associated with total thyroid volume Did find the largest thyroid volumes in the persistently hyperthyroid group, but no statistical significance Unlikely to be a testable study

Answer 15

Study design - prospective crossover Population - 12 healthy adult nonobese neutered cats enrolled and glucose assessed over 24 hours after feeding high and low carb diets with and without acarbose during single and multiple meal tests Testable points — cats fed high carb diet as a single meal had LOWER mean 24 h glucose concentrations when acarbose was given Mean glucose concentrations were lower in the first 12 h when acarbose was given ONCE daily, but no significant difference was observed in mean results from 12-24 hours — I.e. acarbose may be more effective if given before a meal and BID Acarbose had little effect in cats eating multiple meals or those being fed a low carb diet Compared with acarbose + high carb diet, cats fed the low carb diet ALONE had lower mean 24 hours peak glucose

Answer 16

Complex oligosaccharide of microbial origin Competitive alpha glucosidase and alpha amylase inhibitor (enzymes involved in digestion of comple carbs into monosaccharides at the brush border of the SI mucosa). It acts to delay absorption of glucose from the intestinal tract, and in people, reduces postprandial BG and insulin concentrations after a carbohydrate meal In dogs, helps to improve glycemic control

Answer 17

Measured screenin BG at presentation, then again after PE, then measured fasting BG after night of hospitalization RI for screeing BG was 189 mg/dL Mean screening BG was higher than mean fasting BG Breed, body weight, behavior score, fasting BG concentration, and aount of carbohydrate consumed before sampling collectively explained only a small proportion of the variability in screening BG. Screening BG at presentation should be considered, if >190 and if cat has risk factors for DM, consider additional investigation

Answer 18

Diet fed for 24 months (either limited iodine n=14 or conventional diet n=12). Performed chem, TT4, CBC, UA, thyroid ultrasound at baseline, 6,12,18,24 months Median serum concentrations of free and total T4 and TSH were WNL for both groups at all sampling intervals Median urine iodine concentrations in the limited iodine group declined significantly from baseline and were different from conventional iodine diet group Ultrasound revealed no significant change in median thyroid height in the limited iodine group at any time Results suggest that euthyroid cats can be exposed/ eat a limited iodine diet for an extended period of time and remain euthyroid

Answer 19

15 hyperthyroid and 10 healthy age matched controls CBC, Chem, T4, PT, PTT, fibrinogen, and TEG were performe in al cats before and 7 and 14 days after I131 therapy. Two weeks post I131, further comparisons were made between cats with normal T4 vs those with low TT4 14 days post successful I131, 7/15 cats had normal TT4, and 8/15 had low TT4 Thrombocytosis was noted in 40% Fibrinogen was higher and PT shorter in the hyperthyroid cats compared with healthy controls, and these changes persisted post I131 Persistent increases in fibrinogen, Pt, TEG MA and TEG clot rigidity occurred in cats that were euthyroid post therapy TEG k (time until preset amplitude of 20 mm is reached) and alpha angle (reflecting impaired fibrin cross linking ability prior to I131) significantly increased after therapy Overall - cats with hyperthyroidism were hypercoagulable compared to controls and had worsening parameters 14 days post treatment, suggesting potential radiation induced thyroiditis - questionable clinical relevance

Answer 20

30% of cats were <10 YO at diagnosis 24% had incidentally diagnosed hyperthyroidism Time betwen diagnosis and referral for I131 was significantly longer in cats with severe hyperthyroidism at the time of referral Increase in severity groups between time of diagnosis and referral occurred in ~40% of cats At referral 54% of cats with mild, 67% of cats with moderate, and 81% of cats with severe hyperthyroidism were unstable despite ongoing medical or dietary management Prevalence of ardiac abnormalities.was significantly increased in cats with severe hyperthyroidism No significant different in likelihood of renal disease or hypertension between groups Earlier I131 therapy should be considered- reduced comorbidities and dose requirements

Answer 21

85-95% for cure

Answer 22

Background - sexually intact females should have low serum LH concetrations until estrus, when it would increase. LH concentrations increase if there is no negative hormonal feedback from ovarian production of estrogen and progesterone inducing negative feedback on GNRH production. — I.e. high LH in ovariectomized females Cats or dogs in estrus may yield false positive results due to LH surge Time of testing relative to time of year can also affect result (cats are seasonally polyestrous increasing likelihood of false positive in the spring) Both males and females - Overall test sensitivity 90% Specificity 93% Accuracy 91% For differentiating intact vs neutered Analysis of spayed vs intact females 91% sensitivity, 92% specificity, 92% accuracy 10 intact queens had unexpected positive results, 2/10 were in estrus Analysis of intact vs neutered males 85% sensitivity 95% specificity 89% accuracy

Answer 23

74% (28/38) cats entered the home blood glucose monitoring group, and the majority considered it to be straightforward (89%) There was no significant difference between groups in overal qualityof life score or glycemic control parameters at any time point apart from maximal blood glucose at month 6 (max BG was lower in the home blood glucose monitoring group) Quality of life score (including indicators of owner worry about diabetes, worry about hypoglycemia and costs, and glycemic parameters) all improved at all time points within the home blood glucose monitoring groups but not within the NON-home blood glucose monitoring group Remission occurred in 32% of the home Bg monitoring group and 10% of the non home BG monitoring group - not statistically significant difference **home BG monitoring is practical and improves QOL of owner and cat with DM**

Answer 24

Retrospective case control study Control group of age matched cats included 24 cats were included in each group IGF1 concentrations in acromegaly group ranged from >148 - 638 nmol/L When compared with controls, acromegalic cats had increased median left and right kidney length, increased adrenal gland thickness, and increased pancreatic thickness Hepatomegaly (63%) and renomegaly (53%) reported in acromegalic cats and no controls Pancreatic abnormalities described in 88% of acromegalic cats and 8% of controls Overall - acromegalic cats tends to exhibit signs of organomegaly

Answer 25

Clinical syndrome that results from excessive secretion of growth hormone from a functional somatotrophic adenoma of the pars distalis of the pituitary gland Clinical signs of the disease are attributed to the catabolic effects of GH and the anabolic effects of IGF1, and space occupying effect of pituitary adenoma GH —> causes post receptor defect in action of insulin on target cells, leading to decreased carb use, reduced insulin sensitivity, and hyperglycemia GH also stimulates production of IGF1 from the liver mostly, resulting in increased protein synthesis and excessive tissue growth

Answer 26

Design - retrospective cross sectional study 266 dogs with nonadrenal illness Thickness of the caudal pole of the left and right adrenal glands was measured on longitudinal ultrasonographic images. Dogs were stratified into age and body weight categories to investigate assocations with adrenal thickness Testable point(S) — Adrenal thickness was significantly lower in dogs that weighed = 12 kg than in dogs that weight >12 kg Left adrenal thickness increased with age Both left and right adrenal thickness were larger in male than in female dogs that weighed > 12 and = 20 kg Left adrenal thickness was larger in male than in female dogs that weighed > 20 = 30 kg **body weight, age, and sex appear to be significantly associated with adrenal thickness, indicating that these variables should be considered when evaluating adrenal thickness in dgos with non adrenal gland illness and when developing RR for adrenal thickness in dogs** **Dogs that weigh =12kg should have Adrenal thickness no greater that 0.62 cm Dogs that weigh >12 kg should have an adrenal thickness no greater that 0.72 kg

Answer 27

Prospective case series with 602 bitches that had previously undergone OVH or ovariectomy AMH and progesterone were measureing in a single serum sample obtained from each dog, and results were classified as positive, negative or inconclusive 55 dogs underwent exploratory laparotomy, and 48 had histologically confirmed ovarian remnant syndrome 25/48 (52%) were positive for both progeseterone and AMH 23/48 (48%) were positive for AMH OR progesterone or test results were inconclusive No dogs with histologically confirmed ovarian remnant were negative for both AMH and progesterone 5 dogs that tested positive - no ovarian remnant tissue obtained at sx **combined measurement of AMH and progesteron in a single serum sample can be an effective diagnostic test for spayed dogs suspected to have ovarian remnant syndrome. Histologic examination of excised tissue is warranted**

Answer 28

Hormone that the ovaries secrete, and secretion is limited by granulosa cells of ovarian folicles Gonas are the sole source of AMH, so complete surgical removal of the ovaries should result in the absence of AMH in circulation **corpora lutea do not express AMH, so an ovarian remnant that is largely occupied by functional luteal tissue might not secrete a sufficient amount of AMH to be detectable, which is why measuring progesterone together with AMH to detect an ovarian remnant is beneficial

Answer 29

6 MC Australian shepher evaluated for persistent hypoglycemia with high serum insulin to glucose ratio No pancreatic lesion/ mass found on exlap, so partial left pancreatectomy and hepatic and local lymph node biopsies were performed Histologic exam revealed islet cell hypertrophy and hyperplasia, with no evidence of neoplasia Bartonella testing = negative on pancreatic tissue Clinical signs resolved post sx, and on follow up exasm 8 monthls later the dog was healthy and all b/w was WNL Consider nesidioblastosis as a ddx in a dog with signs suggestive of insulinoma

Answer 30

Neoformation or neodifferentiation of endocrine cells in the ductal epithelium of the exocrine pancreas. Results in hyperinsulinemic hypoglycemia Cause of onset is unknown in people, may be associated with gastric bypass surgery

Answer 31

9 dogs with PDH + macroadenoma where Cushings signs had been managed with adrenal directed treatment (trilostane/mitotane) — were concurrently given pasireotide (0.03 mg/kg SQ q12) for 6 months while adrenal directed treatment was continued. No dog developed neuro abnormalities or signs of adverse effects during study No differences from baseline were found in any clinicopathologic values, ACTH stim results, or plasma ACTH results at the 3 or 6 month post points ***After 6 months of pasireotide treatment, 6/9 dogs (67%) had decreases in MRI measured values, while 3 (33%) had increases in MRI measured values ** **no adverse effects of the drug were noted, further studies needed to determine if drug is effective in preventing development of neuro signs or improves outcome in dogs with pituitary macroadenomas**

Answer 32

0.2% per year

Answer 33

Somatostatin receptor ligand with high binding affinity for multiple receptor isoforms (SST 1, SST2, SST3, SST5) SST5 and SST2 isoforms are highly expressed in ACTH secreting pituitary adenomas (SST2 is most common in dogs) Pasireotide has been FDA approved in people with hyperadrenocorticism for whom pituitary surgery is not an options or has not been curative Previous use in dogs with PDH demonstrated a decrease in plasma ACTH,UCCR and pituitary adenoma size, along with improved clinical signs without adverse effects

Answer 34

Tumor that is > 1 cm in diameter, extends above the sella turcica, or as a pituitary:brain ratio >0.31

Answer 35

Inhibitor of 3 betahydroxysteroid dehydrogenase Blocks conversion of 3 beta hydroxysteroids into progesterone/ other steroid precursors to cortisol I.e. inhibits production of all classes of steroid hormones

Answer 36

Adrenlytic agent/ adrenal cortex inhibitor

Answer 37

Cat had been chronically treated with high dose steroisd Cat underwent staged wound closure with a combination of daily wound cleaning and debrisement, tension and appositional sutures and wet to dry and nonadherent dressings with triple antibiotic, then with mix of SSD and insulin Multiple additional lesions developed and were treated in the same way Complete closure and resolution of all lesions was achieve in 9 weeks Prognosis in cats that develop acquired skin fragility may be better than previously reported

Answer 38

Cholangiocarcinoma, cholangiohepatitis, hepatic lipidosis, disseminated histoplasmosis, pancreatic and hepatic carcinoma, FIP, multicentric follicular lymphoma, and spontaneous (most common) or iatrogenic hyperadrenocorticism

Answer 39

Epidermal thinning Severe dermal atrophy with wispy attenuated pale staining dermal collagen Adenexal atrophy, with most follicles in telogen phase

Answer 40

2.5 YO Mini american shepherd referred for 3 week hx of localized crusted skin lesion on the digital pad of digit 3 of the RHL Chem revealed severe hyperlipidemia Ultrasonography of the terminal aortal and other major arterial vessels revealed ateeriosclerotic change Patient was medically managed with atorvastatin calcium, low fat diet, and omega 3 FA, clopidogrel, pentoxifylline, clomipramine and trazodone, gabapentin Limb was eventually amputated Response to treatment was poor and patient was euthanized Necropsy - severe chronic intimal atherosclerosis + CNS changes

Answer 41

Mini schnauzers, Briards, rough collies, shetland sheepdogs, dobermans, rottweilers, and beagles

Answer 42

Retrospective and prospective case series 1 case of thyrotoxicosis was identified retrospectively, the others found prospectively, the remainder of dogs were fed meat based products suspected to cintain excessive thyroid hormone. TT4 measurement and scintigraphy were performed before and after food was discontinued TT4 was high in all dogs at initial evaluation (median 8.8 ug/dL), and scintigraphy revealed subjectively decreased thyroid gland radionuclide in all dogs At >/= 4 weeks after feeding was stopped, TT4 was within RR, and all signs associated with thyrotoxicosis if present resolved Diet analyses revealed median thyroxine concentration for suspected products of 1.52 mcg/g Commercial foods analyzed contained 0.38 mcg/g Thyrotoxicosis can occur secondary to consumption of meat based products contaminated by thyroid tissue and can be reversed by switching diets

Answer 43

Retrospective 24 dogs with hyperPTH that underwent 27 ultrasound guided ethanol ablation 3 dogs underwent a second treatment b/c of initial treatment failure of development of another nodule Hypercalcemia resolved after 23 out of 27 (85%) of procedures In the 23 treatments, 22 (96%) had resolution of hypercalcemia within 72 hours Hypocalcemia was noted in 6 (22%) different dogs at 2 (1 dog) 7 (3 dogs), 14 (1 dog), and 21 (1 dog) days after treatment. 5 had mild transient hypocalcemia and 1 developed c/s signs requiring calcium supplementation 2 dogs had delayed adverse effects, overall complication rate was 11% Long term follow up — sustained normocalcemia in 17/19 dogs May be beneficial treatment with low complication rate in dogs with significant comorbidities that can’t undergo prolonged anesthesia

Answer 44

85% parathyroid adenomas 12 % parathyroid hyperplasia 5% parathyroid carcinoma

Answer 45

Bark change, cough

Answer 46

10 Dogs were treated with detemir SQ q 12h for 6 months Follow up evaluations were done at 1,2,4,12, and 24 weeks and included evaluation of clinical signs and measurement of BG curves and fructosamine Determir resulted in signficant decrease in BG and fructosamine concentration at 6 months compared with pretreatment values Median insulin dose at study end was 0.12 U/kg (range 0.05-0.34 U/kg) hypoglycemia was noted in 22% of BG curvesm and 6 episodes of clinical hypoglycemia were noted in 4 dogs Subjective clinical improvement in all dogs was noted Based on clinical improvement, efficacy of detemir was considered good in 5 dogs, moderate in 3, and poor in 2 Detemir is more potent in dogs

Answer 47

22 dogs with PDH were retrospectively included 109 ACTH stimulation tests were performed for 22 dogs Baseline corticsol concentration was >/= 3.2 predicted that ACTH stimulated cortisol concentration would be >/= 2 with 100% certainty 14/64 (22%) tests with a baselin cortisol concentration of >3.2 mcg/dL had an ACTH stimulated cortisol concentration of = 3.2, which suggested inadequate adrenal reserve There was no correlation between baseline cortisol dose and the subsequent trilostane dose adjustment **baseline cortisol concentration should not be used as the sole monitoring tool for management of dogs with PDH treated with trilosatne BID ** ACTH stim should be used in conjunction with history and PE to monitor dogs with PDH that are receiving trilostane

Answer 48

Evaluate agreement of an ELISA and precision for measurement of serum cortisol. — agreement between ELISA and 2 validated chemluminescent assays assessed. Evaluated clinical implications of bias associated with ELISA when measuring Serum cortisol in dogs 75 stored frozen samples There was a high correlation between ELISA results for all samples combined and the 2 assays used for comparison Constant and proportional biases between ELISA and the chemiluminescent assays were present at all concentrations Clinically important disagreement between ELISA and the other assays occurred in 16/63 (25%) of samples, particularly with LOW and HIGH serum cortisol **results suggest that equivocally low or high results obtained by ELISA be confirmed at a reference lab**

Answer 49

Retrospective case series of 270 client owned dogs that underwent abdominal CT Incidental adrenal gland masses were detected in 25/270 (9.3%) of dogs Dogs with incidental adrenal gland masses were significantly older (median 12 YO) than dogs without Dogs examined for neoplsaia were significantly more likely to have an incidental adrenal gland mass (16%) than were dogs examined for any other reason (2.3%) No other risk factors found Histologic exam only performed in 3/25 dogs, with 2 having an adenoma, and 1 having a pheo +cortical adenoma Patient with incidental adrenal mass < 2 cm in any dimension with no c/s - careful monitoring is reasonable q 2-3 months Patient with incidental mass > 2 cm or <2 cm AND clinical signs or evidence of vascular invasion or contrast enhancement on CT, further testing recommended / consider adrenalectomy

Answer 50

7 dogs with pheochromocytoma 10 dogs with hypercortisolism 14 dogs with nonadrenal disease 10 healthy dogs Dogs with pheochromocytoma had significantly higher urinary normetanephrine and metanephrin:creatinine ratios and significantly higher plasma total and free normetanephrine and plasma free metanephrines concentrations compared to the 3 other groups There were no overlapping results of urinary normetanephrines concentrations between pheo and other groups, and only ONE pheo dog had plasma normetanephrine concentratations in the range of dogs with hypercortisolism and nonadrenal disease Overlap of epinephrine and norepinrphine results between groups was large **measurement of normetanephrines is preferred for pheochromocytoma diagnosis and urine is better than plamsa as a sample ** Nonadrenal illness can increase production of catecholamines and metanephrines, so cutoff values of 3-4x normal can be used

Answer 51

Catecholamine producing tumors Arise from the chromaffin cells in the adrenal medulla

Answer 52

O-methoxylated metabolites of catecholamines

Answer 53

12 cats with ionized hypercalcemia Treated with dose of 5-20 mg/cat PO q 7 days - pill followed by 6 ml water on butter Serum iCa was measured before, and 1,3,6 months of treatment. Dose was adjusted according iCa Alendronate treatment resulted in a decrease in iCa in all cats Median % change in iCa was -13.2%, -15.9%, -18.1% at the 1, 3, and 6 month time points Baseline iCa was significantly different from 1 month, 3, month and 6 months Median iCa decreased of -0.34 mmolL 8 cats had iCa decrease to within RR at some point during treatment 4 cats did not respond or iCa did not decrease by 20% Results suggest that increased bone resorption may play a role in idiopathic hypercalcemia No adverse effects reported Alendronate was well tolerated and decreased iCa in most cats in 6 months

Answer 54

Diet change to nonacidifying, high fiber diet to decrease calcium absorption from the GI tract Prednisolone to promote lowering of serum calcium concentration

Answer 55

Nitrogen containing bisphosphonate Inhibit osteoclast function by inhibition of enzyme farnesyl diphosphate synthase in the HMG-CoA reductase pathway The end products of this pathway are required for normal intracellular signaling and cytoskeletal functions requiredfor hydroxyapatite crystal dissolution Metabolism of nitrogen biosphosphonates also result in the production of an intracellular ATP analog APPPI, which is believed to directly induce apoptosis of osteoclasts

Answer 56

112 dogs with PDH that underwent transsphenoidal hypophysectomy Hormone concentrations were measured preoperatively and 1-5 hours post Median follow up and disease free period was 1096 days and 896 days respectively 28% of patients had recurrence, with median disease free period of these patients at 588 days Absolute and posoperative cortisol concentrations were significantly higher in dogs with recurrence than in dogs without recurrence High ACTH 5 hours after surgery, high cortisol 1 and 4 hours post surgery, high normalized ACTH 3 hours post surgiery, high normalized cortisol 4 hours post surgery and random slope of cortisol were associated with a shorter disease free period No cutoff point could be found, so need combine individual perioperative hormone curves with other variables like pituitary height/brain ratio, etc

Answer 57

25 % recurrence Large pituitary size

Answer 58

10 healthy dogs, 7 dogs with PDH, 8 dogs with atypical hyperadrenocorticism Hourly and sum cortisol concentrations differed significantly between controls and atypical hyperadrenocorticism and PDH dogs Only hourly cortisol and not sum cortisol was higher in PDH dogs in comparison to atypical hyperadrenocorticism **Hypercortisolism may play a role in the pathogenesis of atypical HAC** Average transverse adrenal gland diameter was significantly less ( 0.53 cm) compared to dogs with PDH (0.64 cm) and atypical hyperadrenocorticism (0.72cm ) Adrenal gland diameter did not differ between dogs with atypical hyperadrenocorticism and those with PDH Serum cortisol in dogs with atpypical Cush is increased in comparison to healthy dogs, but lower than dogs with PDH, while adrenal gland diameter is similar between dogs with PDH and atypical cushings.

Answer 59

When dogs have clinical signs of hypercortisolemia, no evidence of sex hormone secreting adrenal tumor, and HAC screening test results are WNL Adrenal panel - Tenessee Reveals alterations in concentrations of adrenocortical precursor hormones before and after ACTH stim - e.g. 17- hydroxyprogesterone

Answer 60

12 cats with IGF >1000 ng/mL by RIA and pituitary enlargement IGF1 decreased in all 12 cats that completed the study (median decreased by ~1000) Insulin dose was lower on day 5 than on day 1 (median dose reduction of 1.5 U/kg) Product of insulin dose and area under the BG curve was lower on day 5 than day 1 No clinically relevant adverse effects - small bowel diarrhea (25%), non-symptomatic hypoglycemia (42%) **overall - short acting Pasireotide decreased IGF1 and insulin requirement in cats with hypersomatotropism and DM**

Answer 61

Case of congenital hypothyroidism with goiter in a 9mo french bulldog with signs of cretinism Thyroid tissue and blood from a CHG-French bulldog and 4 normal controls and buccal brush samples of 125 french bulldogs was studied The dog had signs of cretinism at 9 mo with otherwise normal skeletal maturation - did well with increasing doses of t4 supplementation Enlarged thyroid gland had noninflamatory fibrosis and aberrant follicular organization TPO activity and immunocrossreactive protein were undetectable

Answer 62

What is it? : multifunctional enzyme required for thyroid hromone synthesis Lack of TPO causes failure of iodide incorporation into thyroglobulin aka organification defect. This results in failure of thyroid hormone synthesis/ dyshormonogenesis, thus leading to excess TSH stimulation and diffuse thyroid follicular epithelial cell hyperplasia aka goiter Most common cause of congenital hypothyroidism with goiter in people

Answer 63

30 cats with newly diagnosed DM without clinical signs of pancreatitis on admission Prospective study - at admission, 2, and 6 months later, measured spec fPL, and DGGR lipase and pancreas was ultrasounded Pancreatitis was suspected if serum markers were increased and >/= 2 ultrasound abnormalities noted Subclinical pancreatitis at the time of diagnosis was suspected in 33,50, and 31% of cats based on spec fPLI, DGGR lipase, and ultrasound respectively Suspected in 60% of cats when diagnostics combined During follow up period, suspected pancreatitis developed in additional 17-30 % of cats 17/30 (57%) of cats achieved diabetic remission Frequency of abnormal fPl, DGGR, and ultrasound did not differ in cats that achieved remission and those that didn’t Cats that achieved remission had lower spec fPL at 2 months Many cats with DM have subclinical pancreatitis. Cats with high fPL might have reduced change of diabetic remission.

Answer 64

Background - in adrenal carcinomas in people, activation of phosphatidylinositol 3 kinase (PI3K) signaling pathway by IGF signaling or ERBB2 (dimer of epidermal growth factor) represents a promising therapeutic target 36 canine cortisol secreting tumors (11 adenomas, 25 carcinomas) and 15 normal adrenal glands of dogs Target gene expression indicated PI3K activation in carcinomas, but no adenomas No amino acid changing mutations were found in genes encoding PTEN or PIK3 catalytic subunit (PIK3ACA) No significant alterations in IGFII or IGF receptor I expression were detected In carcinomas, ERBB2 expression tended to be higher than in normal adrenal glands, and higher expression of inhibitor of differentiation 1 and 2 (ID1 and ID2) and IGFBP 5, and lower expression of SGK1 was found in carcinomas with recurrence within 2.5 years post adrenalectomy ERBB2 expression might be a promising therapeutic target in adrenal tumors in dgogs. ID1 and ID2 might be valuable prognostic markers and therapeutic targets.

Answer 65

Frequently activated pathway in cancers in people Pathway activation initiated by receptor tyrosine kinases (e.g. IGF1, IGFR1) or dimers of epidermal growth factor (ECG) receptor family (ECFG, ERBB2-4) and counteracted by competitied PI3K inhibitor phosphatase and tensin homolog (PTEN) Upon activation of the PI3K pathway, phosphorylated AKT and downstream effectors stimulate cell proliferation, survival and growth by transcriptional and posttranslational mechanisms

Answer 66

Overal incidence rate of DM in the cohort of 504688 cats was 11.6 cases per 10,000 cat years at risk Male cats had 2x higher incidence rate than femalse DSH at higher risk than purebred High risk purebreeds: Burmese, Russian Blue, Norwegian forest cat, and Abyssinian No sex predilection among burmese cats

Answer 67

21 cats in diabetic remission, 28 healthy controls Of the 21 cats in remission, 19% had impaired fasting glucose concentration and 76% had impaired glucose tolerance Of cats followed up for 9 months after testing, 30% had relapsed and required insulin treatment Fasting blood glucose concentration >135 mg/dL and severely impaired glucose tolerance (> 5 hrs to return to normal BG) were significantly associated with relapse - 13 X higher odds of relapse BG concentration at 3 hrs was significantly assocaited with relapse Cats with normal fasting BGF and normal glucose tolerance have low risk of relapse Consider cats in remission as prediabetic long term, most have impaired glucose tolerance

Answer 68

13 dogs - each had comprehensive thyroid profile consistent with hypothyroidism For detection of hypothyroidism, sensitivities of the chemiluminescent assays for FT4human and FT4 vet were 62% and 75% respectively compared to FT4 by ED 38% of dogs had FT4h and 25% of dogs had FT4 v concentrations by chemiluminescent assay that were increased or within RR Percentage of false negative test results by FT4 by chemiluminescent assay compared to ED was significantly higher than hypothesized false negative rate of 0%. 25-38% of dogs with thyroiglobulin antibodies that are hypothyroid have FT4 concentrations by CLIA that do NOT support a diagnosis of hypothyroidism

Answer 69

125 serum samples of hyperthyroid cats receiving methimazole and TT4 concentrations <3.9 were included 33% of cats had increased TSH Of cats with TT4 and FT4 below RR, 68% and 73% respectively had TSH above the RR 18% of cats with normal TSH had increased serum creatinine as compared to 39% of those with increased TSH Free T4 by ED does not identify more cats with potential iatrogenic hypothyroidism as compared to TT4 The prevalence of iatrogenic hypothyroidism was approximately 20% Measure of TSH may be helpful in indicating that azotemia, if present is at least in part related to iatrogenic hyperthyroidism

Answer 70

23 dogs with Addisons, 79 dogs with diseases mimicking addisons, and 30 healthy dogs Plasma ACTH and baseline Cortisol were measured before 5 mcg/kg ACTH in all dogs Cortisol to ACTH ratio was calculated and the diagnostic performance of ACTH, baseline cortisol, cortisol to ACTH ratio, and sodium to potassium ratios was assessed The cortisol to ACTH ratio was significantly lower in dogs with hypoadrenocorticism compared to that in healthy dogs and those with diseases mimicking Addisons There was an overlap between dogs with hypoadrenocorticism and those with addison’s mimicking diseases, but cortisol to ACTH ratio was still the best parameter for diagnosing hypoadrenocorticism, then ACTH concentration, basal cortisol, and Na/Kratio. **With a cortisol to ACTH ratio of >0.01, the diagnostic sensitivity and specificity were 100% and 99%** **Calculation of the Cortisol to ACTH ratio is a useful screening test, but given the overlap with disease that mimics addison’s can run the risk of misdiagnosis Unknown reliability of diagnosing secondary hypoadrenocorticism

Answer 71

Objective - investigate the usefulness of cTSH as a diagnostic test in cats with hyperthyroidism 917 cats with untreated hyperthyroidism, 32 euthyroid cats suspected of hyperthyroidism, 131 clinically normal cats Cats had TT4, FT4, T3 and TSH measured. Scintigraphy was used as gold tandard to confirm or exclude hyperthyroidism Median TSH concentrations in hyperthyroid cats were significantly lower than clinically normal or euthyroid cats with suspected disease Only 18 (2%) of cats had measurable TSH concentrations 70% of euthyroid cats with suspected disease had detectable concentrations **Combining TSH with TT4 or fT4 concentrations lowered sensitivity of TSH from 98 to 97% but increased the spcificity from 70 to 99% **the TSH assay does a bad job at differentiating low normal TSH from abnormally low TSH **Serum TSH is suppressed in 98% of hyperthyroid cats, but concentrations are measurable in a few cats with mild to moderate disease. TSH measurement is a sensitive but not specific test for hyperthyroidism diagnosis and is best combined with TT4 and fT4

Answer 72

Ghrelin is a GH secretagogue that is down regulated in people with hypersomatotropism and increases after treatment. Also seems to be decreased in people with DM. 20 cats with DM, 20 cats with hypersomatotropism and DM (13 underwent RT), and 20 healthy age matched controls Retrospective cross sectional study. Differences in serum ghrelin, fructosamine, IGF1 and insulin were evaluated * *Ghrelin was higher in controls compared to HSDM and DM cats * *Ghrelin in the HSDM and DM groups was similar - indicates that it should NOT be used as a differentiating diagnostic * *After RT in the HSDM group, ghrelin increased significantly and post RT ghrelin was not significantly different from controls, indicating that it may be a good marker of treatment success **Serum IGF1 did not significantly change in the HSDM cats after RT, despite significant decreases in fructosamine and insulin dose requirement. **ghrelin assay had good analytical performance

Answer 73

49 client owned cats with spontaneous hyperthyroidism Retrospective case series, cats were fed a commercially available iodine restricted diet, and clinical response was assessed by weight cahnge, HR and TT4, BUN, creatinine, at various times during diet management (21-60 day, 60-180 days) **Serum TT4 normalized in 42% of cats at 21-60 day time point and 83% of cats at the 61-180 day time point Cats in which TT4 was still above RR at days 21-60 had significantly higher starting TT4 Body weight did not significantly increase nor did HR disease There was a significant decrease in creatinine (1.8 to 1.5) Cats in the low RR for serum TT4 did not have a significant increase in body weight nor creatinine when compared to those with high RR **Iodine restricted diets were effective at maintaining serum TT4 concentrations within RR for a majority of cats, though not all c/s of hyperthyroidism improved — retrospective, cats also had other diseases

Answer 74

0.17 -0.28 ppm (mcg/kg) - has been shown to decrease TT4

Answer 75

8 cats with hyperthyroidism - prospective study where cats were fed y/d for 6 months. Clinical signes were evaluated and TT4, fT4 were measured during consumption of the diet. I123 uptake was determined before and 8-16 weeks after diet consumption. **Clinical signs of hyperthyroidism resolved in all cats, but there was no significant increase in body weight TT4 and fT4 decreased into the RR by 8-16 weeks (9.7 mean at start to 3.1 at finish) Scientigraphy revealed unilateral isotope uptake in 5 cats and bilateral uptake in 3 cats Mean percentage of uptake of I123 at 8 hours post isotope was 16.2% before and 34.6 % post diet consumption. Percentage increase was variable between cats **Limited iodine diets increase iodine uptake in autonomous thyroid glands, which could possibly affect sensitivity of thyroid gland to I131 treatment. — I.e. limited iodine diet could be used to decrease dose of I131 needed/ glands may become more ssensitive, may also increase risk of iatrogenic hypothyroidism. Stop limited iodine diets for 2 weeks prior to I131**

Answer 76

Objective - to evaluate the poststimulation peak cortisol concentrations and the duration of the stimulatory effect of a depot ACTH preparation in dogs. Population - 22 healthy, 10 dogs with suspected hypoadrenocorticism, 15 dogs with suspected hyperadrenocorticism Prospective study - ACTH stim performed using synthetic depot IM 5 mcg/kg injection was performed. Samples for cortisol were taken before, and 1,2,3,4,6,24 hours post Peak cortisol concentrations were reached at 2-4 hours in all dogs Cortisol concentrations 1 hr post were >9 in all healthy dogs and >5 in all dogs in which hypoadrenocorticism was excluded None of the dogs with hypoadrenocorticism showed a cortisol increase above the detection limit of the assay After 6 hrs, cortisol concentrations had decreased in the healthy and hyperadrenocorticism groups, and were at baseline in 24 hours * *Can use depot formulation in place of short acting ACTH. Blood for peak cortisol concentrations should be drawn at 3 hours post in cases where hyperadrenocorticism is suspected * * In hypoadrenocorticism cases, blood can be pulled at 1 hour post b/c there should not be a detectable response

Answer 77

Background - no guidelines for ogs with clinically well regulated hyperadrenocorticism where serum cortisol pre and post stim performed 3-6 hours post trilostane are <2 Objective - deteremine if serum cortisol measured pre/post at 3-6 hours post pill is lower than cortisol measured 9-12 hours post pill pre/post 13 dogs with clinically well regulated Cushings **Cortisol concentrations before and after first stimulation were significantly lower than cortisol before second stim. Cortisol concentration before the first stim was also significantly lower than cortisol after second stim. **In dogs with clinically well regulated trilostane treated cushings and cortisol concentrations <2 before and after first stim, a second stim performed 9-12 hours post pill can result in higher cortisol concentrations that could support continued trilostane treatment *. This indicates that it is safe to continue trilostane w/o dose reduction in dogs with clinically well controlled disease. If the dog has low Na/K ratio or no stress leuk, consider ACTH 9-12 hours post to support plan to NOT change dose** 31% of dogs in this study had an NA/K ratio <27

Answer 78

Objective - to identifyh prevalence of concurrent intraabdominal disease using AUS in hyperthyroid cats referred for radioactive iodine treatment and to determine whether requirement for pretreatment ultrasound is indicated 534 cats with hyperthyroidism Retrospective Overall prevalence of concurrent disease: 37% — 23% had renal disease, 2.4 % had neoplasia Significant differences in USG and BUN were found in cats with abnormal vs normal kidneys on AUS 2.2% of cats were not treated as a result of AUS findings **indicates that pretreatment AUS not needed**

Answer 79

306 dogs with PDH Survival and disease free fractions were evaluated related to pituitary size, dogs with and without recurrence were compared 4 weeks post — 91% of dogs were alive and remission was confirmed in 92% of dogs median survival time 781 days Median disease free interval 951 days 27% of dogs developed recurrence of hypercortisolism after median period of 555 days * *Dogs with disease recurrence had significantly higher pituitary heigh/brain area (P/B ratio) and preoperative basal UCCR than dogs without recurrence — important preoperative prognosticator * *dogs with a P/B ratio >0.31 have 2x the chance of early death **survival time and disease free interval of dogs with enlarged pituitary glands was significantly shorter than that of dogs with non-enlarged pituitary. Outcome with larger tumors improved over time**

Answer 80

Background - NTerminal type III procollagen propeptide (PIIINP) is a biomarker of soft tissue proliferation. During collagen synthesis, propeptides are cleaved and released into circulation. Hypersomatotropism is associated with ST proliferation - study was done to see if PIINP decreases with treatment of hypersomatotropism **Serum PIINP concentrations were significantly higher in hypersomatotropism cats compared to DM cats. Cut off of 10.5 ng/mL allowed differentiation between DM and hypersomatotropism with 87% sensitivity and 100% specificity **After RT, PIIINP INCREASE significantly, with no significant changes in IGF1 concentrations **After hypophysectomy, serum PIIINP and IGF1 concentrations DECREASED significantly in most hypersomatotropism cats

Answer 81

Background - hyperthyroidism has been associated with low seurm cobalamin concentrations. Unclear if functional cobalamin deficiency 39 hyperthyroid cats, prospective observational study — serum cobalamin, methlmalonic acid and clinical scores determined for each cat at enrollement and when euthyroid (60 days post tx) * *5/39 (13%) had low serum cobalamin, which normalized in 2 cats once euthyroid * *None of the hyperthyroid/hypocobalaminemic cats had increased serum, methylmalonic acid concentrations In cats with clinical and biochemical hyperthyroidism, there was no correlation between serum cobalamin concentrations with TT4 concentrationor clinical scores including body weight and BCS **overall prevalence of hypocobalaminemia was low in this population. Hypocobalaminemia is NOT a functional deficiency requiring supplementation in hyperthyroid cats without GI disease. Investigate for GI disease if hypocobalaminemia persistent once euthyroid **

Answer 82

Role in cellular functions involving DNA synthesis and amino acid production Cofactor required in many enzymatic reactions, including conversion of methylmalonyl-coenzyme A to succinyl coenzyme A and conversion of homocysteine to methionine Decreased activity of these enzymes leads to increased serum methlmalonic acid (MMA) and homocysteine concentrations Increased MMA and homocysteine reflect cellular/ functional cobalamin deficiency in people

Answer 83

Based on serum PLI activity 45 (73%) of dogs with DKA had evidence of concurrent pancreatic injury — ** pancreatic injury is common in dogs with DKA Median TCO2 was lower in all dogs with increased PLI compared to dogs with normal PLI Fair agreement between PLI and AUS. Pancreatic injury was NOT associated with longer hospital stay (though panc dogs did stay slightly longer) and did not influence short term outcome

Answer 84

Characterized by hyperglycemia, hyperketonemia or ketonuria and metabolic acidosis Prolonged absolute or relative insulin deficiency results in accelerated lipolysis, hypertriglyceridemia and ketone body production When ketone production exceeds peripheral utilization, the associated hydrogen ions overwhelm body’s buffering systems and severe metabolic acidosis and electrolyte imbalances ensue

Answer 85

Background — current undertanding of adrenal steroidogenesis is that production of aldosterone or cortisol depends on expression of aldosterone synthase (CYP11B2) and 11beta-hydroxylase cytochromic P450 (CYP11B1). In dogs/ other species, a single CYP11B catalyzes both cortisol and aldosterone formation. Analysis of the canine genome provides data of a single CYP11B gene known as CYP11B2, and a large sequence gap exists near the CYPB11B2 gene. Equal expression of the CYP11B2 was gound in the zona glomerulosa and zona fasciculata - single gene found. Expression of 17 alpha hydroxylase/ 17, 20 lyase (CYP17) was significantly higher in the zona fasciculata compared with the zona glomerulosa **There is only one CYP11B gene in canine adrenals based on RT-qPCR (aldosterone synthase or CYP11B2) in the zona glomerulosa and fasciculata. The zone specific production of aldosterone and cortisol is probably due to zone specific CYP17 expression, making it an attractive target for selective inhibition of cortisol syntehsis ithout affecting mineralocorticoid production in the zona glomerulosa

Answer 86

Zona glomerulosa - mineralocorticoid/aldosterone production (Regulated by plasma potassium, angiotensin II, and ACTH Zona fasciculata - functions with reticularis as a unit and are the main source of glucocorticoid, which is strictly regulated by the HPA axis Zona reticularis - also produces androgens like dehydroepiandrosterone and androstenedione Uses cholesterol as a uniform precursor, zone dependent enzyme production is needed for distinct steroid production

Answer 87

Objective - to investigate the epidemiological characteristics of naturally occuring adrenocortical insufficiency in a large population of insured dogs Retrospective cohort study - incidence rates, prevalences and relative risks for dogs iwth naturally occuring adrenocortical insufficiency Total 534 dogs identified Overall incidence - 2.3 cases per 10,000 dog years at risk (DYAR) Relative risk of disease - significantly higher in portuguese water dog, standard poodle, bearded collie, cairn terrier, and cocker spaniel Female at highter risk than males Relative risk of death in addisonian dogs - 1.9 x higher than in dogs overally

Answer 88

Objective - to investigate post prandial metabolic and hormonal responses to a high fat mixed meal in dogs and responses of lean vs overweight dogs Prospective observational study - 12 lean dogs, 10 slightly overweight, 6 overweight. Overnight fasted, collected urine and blood, then fed high fat mixed meal and blood was collected hourly for 4 hours and urine after 3 hours, Post prandial concentrations of insulin and glucagon were increased at 1 hour, triglycerides at 2 hrs, and glucose at 3 hrs - all remained increase throughout feeding challenge for all groups Post prandial UCCR was higher than fasting values There was an overall higher triglyceride response in overweight compared to lean and slightly overweight groups. Overweight dogs also had higher fasting UCCR **all dogs responded to high fat meal by increase in triglyceride concentrations, but response was higher in overweight dogs (other metabolic and hormonal variables didn’t differ between groups except fasting UCCR being higher in overweight dogs) Increased TG concentrations may suggest metabolic alterations **

Answer 89

Retrospective case series describing 150 cats with EPI ``` Median age 7.7 YO Median BCS 3/9 77% - hypocobalaminemia 47% - hyperfolatemia 5% - hypofolatemia Clinical signs: 91% weight loss, 62% unformed feces, 50% poor hair coat, 45% anorexia, 42% increased appetite, 40% lethargy, 28% watery diarrhea, 19% vomiting, 58% had concurrent disease ``` 60% had good treatment response, 27% had partial, and 13% had poor response TLI <4 was assocaited with a positive treatment response, and cobalamin supplementation improved response to treatment

Answer 90

Objective - to investigate body weighy, BCS and muscle condition in hyperthyroid cats Prospective cross sectional and before/after studies Pretreatment body weight was lower than premorbid body weight recorded 1-2 years pre-diagnosis 36% of cats were thin or emaciated, 77% had loss of muscle mass Cats showed increases in body weight, BCS, and MCS after treatment, but mild to moderate muscle wasting persisted in 45% of treated cats **most hyperthyroid cats lose body weight but maintai an ideal or overweight BCS with only 1/3rd being underweight. Weight loss is generally associated with muscle wasting rather than fat loss (affects >75%) of hyperthyroid cats. Successful treatment leads to weight gain and increase of BCs in most cats, but almost 50% fail to regain normal muscle mass **

Answer 91

Population - 522 dogs: 163 with hypoadrenocorticism, 351 with nonadrenal gland illness, 8 dogs with equivocal results At a cortisol cut point of 0.8 mcg/dL, sensitivity and specificitry were 97% and 96% respectively Basal cortisol = 2 - sensitivity 99.4%, specificity 67% **Basal cortisol = 0.19 mcg/dL resulted in a specificity of 99.1% **, sensitivity 82% * *similar to previous studies, cortisol >2 ruled out addisons. Lower cut points improved the specificity and PPV for Addison’s disease** * *Test performance was not influenced by normal/abnormal electrolyte concentrations **

Answer 92

Objective - to estimate the prevalence and identify risk factors for DM ibn a large population of cats in primary care practices Of 1128 DM cases found among 194563 (period prevalence of 0.58%) Tonkinese (4.1 x risk), Norwegian forest cats (3.5x risk) , and Burmese (3xrisk) had increased odds of DM compared with crossbred cats DM odds increased as bodyweight increased above 4 kg, in cats >6 YO, and insured cats Sex was not significantly associated with DM Unlikely to be testable

Answer 93

Exenatide extended release is a glucagon like peptide analogue that increases insulin secretion, inhibits glucagon secretion and induces satiation in humans with type II DM. Exenatide was found to be safe in healthy cats Prospective placebo controlled clinical trial of 30 cats with DM - cats treated with exenatide ER or saline given SQ once weekly, and both groups received glargine insulin and low carb diet. Exenatide ER was given SQ for 16 weeks. IF cats achieved remission it was given for 4 weeks after discontiuning sinulin. Cats in both groups had transient adverse signs of decreased appetite (60% exenatide group, 20% placebo) and vomiting (53% exenatide, 40 % placebo) Body weight increased in the placebo group but not in the exenatide group ** 40% of cats in exenatide group achieved remission ** 89% achieve good metabolic control** 20% of placebo cats achieved remission 58% achieved good metabolic control Study suggests that rate of remission in diabetic cats is ~20%, rate of good metabolic control is ~30% **

Answer 94

Gastrointestinal hormones such as glucagon like peptide 1 (GLP1) and glucose dependent insulinotropic polypeptide (GIP) released in response to food intake that increase glucose dependent insulin secretion Have been shown to stimulate pancreatic beta cell proliferation in rats Also inhibit glucagon secretion, slow gastric emptying, induce satiation and promote weight loss

Answer 95

Population - looked at 531 healthy dogs of 9 different breeds Prospective observational study - measured circulating concentrations of endothelin1 and cortisol, renin activity Key results - median endothelin 1 concentration was 1.29 pg/ml Median cortisol concentration was 46 nmol/L Median renin activity was 0.73 ng/ml/h Breed differences were found in endothelin 1 and cortisol concentrations and renin activity 67% breed variation — Newfoundlands had the highest median endothelin 1 (3x higher than CKCS, Doberman, and DAchshunds) - ** most prominent difference here, differences in other values were less prominent ** Median renin was highest in DAchshunds Median cortisol was highest in Finnish Lapphunds ** breed variation may be important when interpreting lap results **

Answer 96

Decrease in BP —> activates SNS, RAAS, and vasopressin (ADH) —> vasoconstriction Angiotensin II can stimulate the release of endothelin I = potent vasoconstrictor that is released from vascular endothelium Endothelin can stimulate the release of norepinephrine, angiotensin II and vasopressin RAAs and vasopressin stimulate sodium and fluid retention

Answer 97

Objective - compared cortisol response to 1 and 5 mcg/kg cosyntropin IV in dogs being screened for hyperadrenocorticism and in dogs receiving trilostane or mitotane that have PDH In dogs being treated for PDH with trilostane or mitotane, the 2 doses were pharmacodynamically equivalent Dogs with suspected hyperadrenocorticism - doses were NOT pharmacodynamically equivalent, and in 23% of the dogs, clinical interpretation of test results was different between doses **For dogs suspected of having hyperadrenocorticism, 5 mcg/kg cosyntropic IV is still recommended for ACTH stimulation testing, but for monitoring while on trilostane/mitotane, 1 mcg/kg is sufficient making monitoring cheaper **

Answer 98

In healthy dogs, 1 mcg/kg provides the same maximal adrenocortical stimulation

Answer 99

Objective - to describe the occurrence and clinical presentation of central hypothyroidism in mini schnauzers. Possible role of TSH releasing hormone receptor gene and tSH beta gene were investigated Central hypothyroidism was diagnosed in 7 mini schnauzers based on TSH or TRH stimulation test. Three/seven dogs had disproportionate dwarfism and at least one had combined deficiency of TSH and prolactin. CT showed no abnormalities Scintigraphy showed minimal 99m Technetium uptake in the thyroid No disease causing mutations were found in TSHB genes and exons of the TRHR gene of schnauzers **Central hypothyroidism could be underdiagnosed in mini schnauzers with hypothyroidism, especially those with normal stature. Could have genetic background in mini schnauzers **

Answer 100

Thyroid glands not affected, but are deprived of TSH. Rare compared to primary hypothyroidism. ``` Pituitary tumor Lymphocytic adenohypophysitis Head trauma Non-traumatic intracranial hemorhage Hypophysectomy ```

Answer 101

Prospective observational study. FSL was placed on the neck of 10 client owned diabetic dogs for up to 14 days. During the 1st-2nd, 6-7th, and 13-14th days from application, interstitial glucose was compared with plasma EDTA glucose **FSL application was well tolerated. 50% dogs had mild erythema at application site. Good correlation between interstitial and plasma glucose was found (rho 0.94). The FSL was 93,99 and 99% accurate at low, normal, and high BG concentrations.

Answer 102

Prospective randomized masked placebo controlled study - dogs with OA were treated with 2 mg/kg galliprant or placebo and owners completed a survey describing perceived pain level throughout study **Galliprant/ grapiprant treatment improved pain compared to placebo on day 28 compared to placebo (48% galliprant, 31.3% pacebo treatment success) Pain interference score and pain severity score improved in the galliprant group compared to placebo. Veterinary assessments were significantly better in the galliprant treated dogs. **Galliprant was well tolerated, but 17% of dogs had occasional vomiting as compared to 6% of placebo group **Galliprant results in owner and veterinary assessed improvement of clinical signs in dogs with OA treated for ~28 days. Minimal adverse events were seen, even in dogs with comorbidities **

Answer 103

Potent specific antagonist of the prostaglandin E2 (PGE2) and EP4 receptor. Member of the piprant drug class, that block prostagland receptors Used for analgesia Different from NSAIDs b/c NSAIDs act by inhibiting cyclooxygenase enzymes. EP4 recepto antagonists do not inhibit the production of prostanoids, which are important in a variety of physiological functions and maintain normal homeostatic functions

Answer 104

Objective - to report distinguishing clinical features and treatment responses of cats with thyroid cysts - 40 client owned cats were retrospectively evaluated 40 cats Cats ranged from 8YO to 20 YO, no breed or sex predilection 93% of cats were hyperthyroid and the majority had long standing hyperthyroidism, remainder had nonfunctional thyroid tumors Majority of masses (60%) were larger than 8 cm No association between cystic and serum TT4 Clinical findings: 100% had palpable neck mass, 38% had weight loss, 20% had dysphagia, 13% decreased appetite, 10% dyspnea Small cysts 40%, large 60% 25 cats treated with I131 - 92% became euthyroid, thyroid cysts resolved in 50%. I131 resolved small cysts in 62% of cats and large cysts in 36% of cats. 8 cats (including 2 euthyroid cats, underwent thyroid cystectomy. 3 with bilateral thyroid involvement euthanized due to hypocalcemia. Excised thyroid masses were identified as cystadenoma and carcinoma Cystectomy can be considered in cases of unilateral cyst where euthyroid or if I131 does not resolve cyst

Answer 105

Prospective uncontrolled clinical trial. Dogs were treated with bezafibrate SID using 200 mg tablets (dose range 4-10 mg/kg depending on body weight) for one month 35% of dogs had primary hyperlipidemia 65% of dogs had secondary hyperlipidemia (including hyperadrenocorticism and dogs chronically treated with glucocorticoids) No difference in baseline triglyceride concentration between the primary and secondary hyperlipidemia group * *Resulted in normalization of triglycerides in 91% of dogs and cholesterol in 67% WITHOUT raising CK or ALT levels * *The decrease in triglyceride concentration after treatment was greater in the primary hyperlipidemia group * *No adverse events observed, but ALT activity decreased significantly after 30 days of treatment

Answer 106

Fibric acid derivative (other examples - fenofibrate, gemfibrozil) Used as a lipid lowering drug, specifically effective in treating hypertriglyceridemia Fibrates are mediated by peroxisome proliferator activated receptor (PPAR) alpha —> induce hepatic fatty acid uptake and decrease hepatic triglyceride and very low density lipoproteins (VLDL) synthesis, increase activity of lipoprotrein lipase, increase gall bladder excertion of hepatic cholesterol, and increase production of high density lipoproteins Adverse effects: muscle pain, vomiting, diarrhea, increased CK and ALT, predisposition to form gallstones

Answer 107

Background - no genetic predisposition for DM in labradors has been found. A deletion in the pro-opiomelanocortin gene (POMC) in labs is assocaited with increased appetite and risk fo obesity 61 non-diabetic labs aged >6 YO and 57 labs with DM - case control genotyping study to compare the frequency of the POMC deletion in dogs with and without DM **14 base pair deletion was confirmed and localized to exon 3 of the canine POMC gene. PCR based test for the deletion was successfully developed. There was no association between the presence of the POMC deletion mutation and DM in this population of labs. ** **14 base pair deletion is likely to cause a frameshift in the protein. **little evidence directly linking obesity and DM in dogs restriction fragment length polymorphism based genotyping of the mutation can be don using PCR, apaI or Sac II enzyme digestion

Answer 108

Difference in a single DNA building block/nucleotide. Can act as biological markers and allow for identification of genes that are associated with disease, When they occur within a gene or in a regulatory region near a gene, they may play a more direct role in disease by affecting the gene’s function

Answer 109

Certain haplotypes of the canine major histocompatibility complex, polymoprhisms in several other immune response and cytokine genes (e.g. genes encoding IFN gamma, IL10, IL12 beta, IL6, IL4, PTPN22, TNFa)

Answer 110

14 cats with hypersomatotropism diagnosed based on DM, pituitary enlargement, and IGF1 >1000 Uncontrolled prospective cohort study. Cats received long acting release pasireotide 6-8 mg/kg SQ once monthly for 6 months. 8 cats completed the trial 3 cats entered diabetic remission - 37% Median IGF1, median insulin resistance index (fructosamine x insulin dose) decreased significantly Median insulin dose requirement significantly decreased (1.5 U/kg decreased to 0.3 U/kg) No significant change was found in mean fructosamine or mean blood glucose despite significant decreased in median insulin dose. Adverse events: diarrhea (80%), hypoglycemia, worsening polyphagia

Answer 111

Objective - to evaluate renal perfusion in hyperthyroid cats with contrast enhanced ultrasoubnd 42 hyperthyroid cats included and were evaluated one month before and 1 month after I131 treatment Renal perfusion was evaluated through contrast enhanced ultrasound and creation of time intensity curves Increase in multiple time related perfusion parameters was seen following I131 treatment, indicating decreased blood velocity after hyperthyroidism was treated. Small post treatment decrease in peak enhancement was present in renal medulla, suggesting lower medullar blood volume. **reduced renal blood flow following I131 treatment and return to euthyroid state**

Answer 112

Increased TT4 causes decreased vsacular resistance and increased cardiac output, leading to increased renal blood flow

Answer 113

Risk factors for DM: Indoor confinement, being a greedy eater, and being overweight In cats assessed by owners as being a normal weight, there was an association between eating predominantly dry food and increase risk of DM (odds ratio 3.8)

Answer 114

Objective - to compare efficacy and short term outcomes of low dose I11 vs high standard dose I 131 as treatment for hyperthyroidism 189 hyperthyroid cats with mild to moderate hyperthyroidism (TT4 >4 <13) **No significant difference in prevalence of cats with persistent hyperthyroidism between standard and low dose treatment groups at 3 (0% high dose, 5.3% low dos) and 6 (0 % high dose, 3.3 % low dose) months post Overt (18% high dose vs 1% low dose) or subclinical (46% high dose and 21% low dose) hypothyroidism was more common in cats at 6 months after standard dose No difference in incidence of azotemia was noted between groups, but cats treated with standard 4 mCi dose had higher creatinine concentrations and higher percent rises in creatinine (77% high dose vs 50% low dose) **97% cure rate of cats treated with low dose, and lower frequency of iatrogenic hypothyroidism and azotemia ** **high TSH together with normal (usually low normal T4) is relatively common in hyperthyroid cats after treatment

Answer 115

Background: - chronic levothyroxine supplementation can suppress the HPA axis and make it difficult to assess thyroid function after withdrawal of levothyroxine 28 euthyroid dogs - prospective randomized study administering levothyroxine (0.026 mg/kg SID) to euthyroid dogs for 8 weeks or 16 weeks. Performed thyroid panels q 4 weeks during supplementation and weekly for 16 weeks once levo stopped Mean TT4 was higher and TSH was lower during supplementation Sean serum TT4, fT4, TSH in both groups, starting 1 week post stopping levo wass different compared to values during levothyroxine administration but not compared to baseline **8 to 16 weeks of treatment, then stopping can result in return to baseline approx 1 week after stopping treatment

Answer 116

What happens if cosyntropic is injected outside a vessel? Prospective study - each of 20 dogs underwent 2 different ACTH stims (either given perivascular or IV) No significant difference in results was noted when comparing serum cortisol after IV and perivascular ACTH administration in all 20 dogs No significant difference was noted when comparing serum cortisol after IV and perivascular ACTH in the 10 healthy dogs OR in the 10 hyperadrenocorticism dogs ***Perivascular administration of ACTH does not significantly alter stimulation test results in healthy dogs or those with hyperadrenocorticism undergoing trilostane therapy

Answer 117

53 dogs with primary hypoadrenocorticism - 24 newly diagnosed, 29 treated Prospective multicenter clinical trial - DOCP was administered and NA and K concentrations were measured until the dog developed hyponatremia or hyperkalemia or had c/s of electrolyte derangements - defined DOCP duration of action Individualized dosing interval - DOCP duration of action - 7 days ``` Duration of action of DOCP in dogs with newly treated hypoadrenocorticism ranged from 32-94 days (median 62 days) Phase II (applying IDI) - mean IDI 58 days (38-90 days) Phase III (IDI long term) - no reduction needed Duration of action of DOCP of previously treated dogs - 41-124 days (median 67 days) ``` Final DOCP dosing interval for all dogs that completed phase II ranged from 38 to 90 days No dog that completes phase III required reduction in the individual dosing interval Median drug cost reduction using individual dosing interval was ~56% per year **individual dosing interval can be evaluated by measuring plasma sodium and potassium concentrations weekly starting 25-30 days post DOCP to ID duration of action. IDI = duration of action - 7 days

Answer 118

Retrospective cohort study of 43 dogs diagnosed with PDH - 17 trilostane treated and 26 untreated - survival analysis at 2 years post diagnosis was performed Median survival time for the trilostane group was not reached and was significantly longer than the median survival time of the untreated group of 506 days Only variable identified associated with increased risk of mortality was being untreated for hyperadrenocorticism **not treating dogs for PDH might be associated with higher risk of death

Answer 119

Retrospective observational case series of 65 dogs with PDH - each dog treated with trilostane for 3 months before the study. Dogs were separated into three groups based on AUS: normal, cholestasis, gall bladder mucocele Mucocele group had more severe clinical signs and significantly different total serum cholesterol concentration and post ACTH stim cortisol concentration at diagnosis Dogs that weighed <6 kg had a significantly higher prevalence of cholestatic disease than other dogs Optimal trilostane dose for gallbladder mucocele and cholestasis groups were 2.5 x and 1.5 x higher than the normal ultrasound group **gallbladder mucoceles are a complication of PDH and are related to severity of disease. Dogs with PDH and mucoeles have more severe clnical signs and higher post ACTH stim cortisol concentrations than those without GB mucocele Pathophysiology of mucocele formation with PDH may include breed, genetic and female sex predisposition, which may be associated with cholesterol metabolism and bile secretion. The significant difference in required trilostane dosing between groups likely because of lipid soluble charcteristic of trilostane

Answer 120

Breeds at DECREASED risk of hyperthyroidism compared to DSH: Burmese, Tonkinese, Persion, Siamese, Abyssinian, and British Shorthair Domestic longhair - INCREASED risk (odds ratio 1.3) Coat color and pattern was NOT associated with hyperthyroidism in non-purebred cats

Answer 121

Objectives - to report the biological and analytical variability components in serum cortisol concentration post acth stim in healthy dogs **Index of individuality was equal to 1.1 (indicator of within and between individual variability) Critical difference between measurements was 3.3 Number of measurements required to assess homeostatic set points of cortisol with a confidence interval of 90 and 95% were 3 and 15 respectively Mean cortisol concentration was higher in males than in females Treatment with cortisone acetate resulted in a dose dependent suppression of cortisol concentration **false negative test results in hypercortisolism could occur when cortisol concentration is outside of the individual’s homeostatic set point and within the RR The largest critical difference between sequential measurements emphasizes the iportance of assesing clinically relevant parameters in the diagnosis and monitoring of hyperadrenocorticism **post ACTH cortisol level has intermiediate individuality that may accound for some false negatives.

Answer 122

54 dogs with primary hyperparathyroidism - enrolled with hypercalcemia and no prior calcitriol treatment leading up to sx. All dogs were treated with parathyroidectomy or percutaneous ultrasound guided heat ablation There was moderate correlation between before treatment hypercalcemia and after treatment hypocalcemia All dogs were placed into groups according to their pretreatment iCa After treatment, the mean lowest iCa was lowest in the group with the highest pretreatment iCa (>1.81 mmol/L) There was significant association betwween higher group and proportion of dogs with iCa <1 mmol/L There was no association between PTH concentration or duration of disease before treatment on development of hypocalcemia post op **there are studies that contradict this so it is unlikely to be testable**

Answer 123

Background - TSH can be increased in people with primary hypoadrenocorticism before glucocorticoid treatment. Increases in TSH is a typical finding of primary hypothyroidism and both disease can occur together in people TSH concentrations were increased in 11/30 37% of dogs with hypoadrenocorticism and 0% of dogs with nonadrenal illness. No of the dogs with reduced TSH had low TT4. There was no difference in TT4 between dogs with increased TSH compared to those with normal TSH and controls After starting treatment, TSH normalized after 2-4 weeks in 9 dogs and after 3and 4 months in 2 dogs without levothyroxine supplemnentation Treat hypoadrenocorticism first prior to thyroid function testing

Answer 124

Objective - to characterize the use of IVCRI lispro at an initial dose of 0.09 U/kg/hr and the use of NaCl for resusciation. 12 cats with DKA Randomized controlled blinded study, 6 cats randomized into each group - lispro group and regular insulin group All cats received IVCRI fluid resuscitation with NaCl, and solutions with higher than previous electrolyte concentations were used to treat electrolyte deficiencies **Duration of hospitlization and time time to first SQ insulin injection did not differ betwen groups ** **Median time to blood glucose concentration <250 was shorter in the lispro group (median 7hrS) than in the regular insulin group (median 12.5 hours)** Two cats had nonclinical hypoglycemia **Low concentrations of serum sodium, potassium, phosphate, and magnesium were over 3x more common than above normal electrolyte concentrations, despite supplementation with fluids of high electrolyte concentrations , and most rapid sodium change recorded was 0.7 mmol/L/hr - sodium rich fluids are safe to use in DKA**

Answer 125

Objective - to investigate heritability and mode of inheritance of DM in the american eskimo dog Heritability of DM in american eskimo dogs was estimated at 0.62 Predicted DM probability for neutered females was 0.76, intact females 0.11, neutered males 0.63, and intact males 0.12 There was no overlap between 95% posterior intervals of disease probability in any sex/neuter status Analysis suggested that mode of interitance of DM in american eskimo is polygenic, with no evidence of single gene of large effect Estimated heritability of DM in American eskimo is high but has low precision. DM transmission appears to follow polygenic mode of inheritance.

Answer 126

Prospective study, 17 dogs with addisons - 12 newly diagnosed, 5 previously treated with florinef Dogs with newly diagnosed addison’s were treated with a starting dose of 1.5 mg/kg Dogs previously treated with florinef were started at 1-1.8 mg/kg SQ Re-evaluations performed at regular intervals for a min of three months. DOCP dose was adjusted to obtain an injection interval of 28-30 days and to keep serum electrolyte concentrations within the reference interval The starting dose was sufficient in all but 2 dogs, and had to be decreased after 2-3 months to a median dose of 1.1 mg/kg Dogs = 3 YO needed higher doses compared to older dogs. No dogs needed the listed 2.2 mg/kg SQ THEY USED ZYCORTAL in this study NOT Percorten **starting dose of 1.5 mg/kg SQ is effective in controlling c/s and serum electrolyte concentrations in the majority of dogs (88%) Additional dose reduction is often needed to maintain an injection interval of 28-30 days.

Answer 127

Parenteral long acting mineralocorticoid with no glucocorticoid activity

Answer 128

Looked at 40 dogs with hypothyroidism and 20 healthy dogs Prospective cohort study Hypothyroid dogs had significantly decreased median or mean HR, P wave amplitude, and T wave amplitude and E point to septal separation normalized to body weight (EPSSn) and transmitral E wave velocity (Emax) at time 0 compared to control dogs At time 60, significantly increased median or mean HR, P wave amplitude, fractional shortening, and E max and significantly decreased left ventricular and end diastolic volume index, and normalized systolic diameter and EPSSn were found. **overall -hypothyroidism induces some modification of the electromechanical cardiac function in affected dogs, but these changes are usually mild and reversible with treatment. None of the hypothyroid dogs had c/s of heart disease OR echocardiographic features mimicking DCM phenotype. MPI or myocardial performance index (echocariographic index of combined systolic and diastolic function) does not seem to be a useful variable to ID cardiac dysfunction in dogs with spontaneous hypothyroidism**

Answer 129

Sum of isovolumetric contractino time plus relaxation time divided by ejection time

Answer 130

Objective - to predict serum iCa concentration from signalment, biochemistry profile, and T4 and compared predicted iCa to tCa Cross sectional study - attempted to create model by using various variables for 1701 cats to calculate predicted iCa For hypercalcemia - predicted iCa was highly specific 99% (in hospital), 97% (external set/ out of hospital) but poorly sensitive (in hospital/ test set 30.4%), 43% (External set/ outside hospital) For hypocalcemia, predictive iCa was highly specific (82% in hospital/test, 99.6% external), but poorly sensitive (58% test/in hospital, 0% external) These diagnostic performances were comparable to those of tCa. Upper and lower limits of predicted iCa prediction interval had high sensitivity for detecting ionized hypercalcemia and hypocalcemia. **Model created is useful for ruling IN ionized hyper/hypocalcemia, may get some false negatives**

Answer 131

To develop a novel health related quality of life tool to aid assessment of dogs with Cushings and to evaluate factors that impact on dogs living with Cushings 210 dogs with Cushings and 617 dogs without Cushings 19 question tool was developed with good internal consistency Owners related questions to owner impact (Ie. impact on bond with their pet and how much they worry about their future) as more important than those related to demeanor There was a positive correlation between tool score of dogs with Cushings and their owner’s assessment of their dog’s QOL Dogs currently on treatment with trilostane had statistically better QOL scores than those NOT on trilostane.

Answer 132

Objective - to determine how often concurrent pitutiary and adrenal lesions are present in dogs with spontaneous hypercortisolism In dogs with dexamethasone suppressible hypercortisolism (PDH - 122/201) - 64% had an enlarged pituitary gland (mean P/B ratio 0.43). 2 of these dogs (2%) had concurrent adrenal lesions In the remaining dogs with PDH based on LDDST (44/122 or 36%), the pituitary gland was NOT enlarged. In the dexamethasone resistant group (79/201), the pituitary gland was enlarged in 47 (59% - P/B ratio of 0.57). 17% of these dogs had concurrent adrenal lesions In the remaining dexamethasone resistant dogs (41%), the pituitary gland was not enlarged. 27 of these 32 (84%) had adrenal lesions and suppressed ACTH concentrations consistent with adrenal dependent hypercortisolism and 5 dogs were diagnosed with PDH Concurrent pituitary and adrenal lesions were present in 5% of all dogs with hypercortisolism and 10% of dogs that did not suppress at all on their LDDST. An enlarged pituitary gland (P/B >0.31) was noted in 70% of dogs with PDH. Diagnostic imaging of both pituitary and adrenal glands should be included in the evaluation of every dog with Cushings to obtain information needed for estimation of prognosis and choosing the optimal treatment

Answer 133

15 dogs with spontaneous SARDS (median time of vision loss 18 days), 14 normal dogs, 13 dogs with confirmed PDH Prospective case control study ELISA on samples obtained in the morning for measurement of plasma melatonin and dopamine, serum esrotonin, urine 6-sulfatoxymelatonin (MT6) and creatinine There were no significant differences in circulating melatonin, serotonin, or dopamine concentrations between the 3 groups, though the study was underpowered for detection of significant differences in serotonin Urine MT6:creatinine ratio was higher in dogs with PDH compared with dogs with SARDS, but not compared with normal dogs

Answer 134

Reflects more than 70% of melatonin secretion, breakdown product of melatonin, represents accumulated amounts of systemic melatonin over several horus and less affected by fluctuations in circulating concentatinos

Answer 135

Retrospective cross sectional study assessing thyroid hormone concentrations of 68 cats within 6 months of surgery. Longitudinal study of thyroid status in 23 cats with >18 months follow up post thyroidectomy 68 cats had follow up within 6 months. 22% of cats had persistent or recurrent hyperthyroidism. 33 (49%) were hypothyroid. 23/33 (70%) of the euthyroid/hypothyroid cats had long term follow up. — 4 (17%) remained hypothyroid, 19 (83%) were euthyroid (often transiently) and 9/23 (44%) developed recurrent hyperthyroidism. SDMA and creatinine were linearly associated, but hyperthyroid cats had higher SDMA concentrations relative to creatinine **Cats have changes in thyroid function for years after bilateral thyroidectomy, with a high incidence of recurrent hyperthyrooidism. Both SDMA and creatinine are affected by thyroxine concentrations, and the effect is greater in hyperthyroid cats

Answer 136

20 hypothyroid dogs - behavior evaluated at presentation, after 6 weeks, and after 6 months of treatment with levothyroxine (starting dose 0.01 mcg/kg Q12). At each period, circulating serotonin and prolactin were evaluated After 6 weeks of levothyroxine, behavioral scores significantly improved. No significant change in behavioral scores was observed after 6 months of treatment. No significant difference in circulating concentrations of serotonin and prolactin were noted at any time point

Answer 137

Objective - to assess the association between diabetes and CKD In a population of adult cats — 516 cats 12% of cats had CKD 2.9% of cats had DM 60 cats without DM (11%) had CKD 7 cats with DM (44%) had CKD - both conditions were diagnosed simultaneously in 6/7 cases (86%), DM preceded CKD in the other case Multivariate analysis showed that D< was significantly associated with CKD (odds 4.47) Other variables associated with CKD were age and mixed breed

Answer 138

Hyperglycemia, advanced glycation products, oxidative stress, inflammatory cytokines, and profibrotic growth factors are involved in renal injury

Answer 139

Objective - to evaluate SDMA as a biomarker of renal function in hyperthyroid cats before T0 and 1 month post I131 treatment (T1) 47 hyperthyroid nonazotemic cats - measured creat and SDMA pre and post treatment, and estimated GFR by using plasma exogenous crewatinine clearance test SDMA was elevated in 6/47. (13%) cats at T0 and normalized after treatment in 4 of those cats All cats remained nonazotemic after treatment In 10/47 cats (21%) where GFR was measured, correlation between GFR and sSDMA was low and not significant, whereas correlatino between GFR and creatinine was moderate and significant. **careful interpretation of mildly increased SDMA with normal creat in hyperthyroid cats is warranted, as SDMA values might not normalize after resolution of hyperthyroidism in some cats. SDMA was poorly correlated with GFR in this study. **

Answer 140

Symmetric dimethylarginine - byproduct of protein methylation, is minimally protein bound and is freely filtered through the glomerulus. In people > 90% of SDMA is eliminated by renal clearance, and has been found to be closely correlated with GFR in healthy cats and older cats with CKD Sensitivity and specificity of SDMA to ID decreased renal function in cats with CKD is 100% sens, 91% specific

Answer 141

Background: a low plasma TT4 in combination with a TSH within RI does not distinguish between hypothyroidism and non thyroidal illness. Hypothyroidism is associated with TSH releasing hormone (TRH) induced increased release of GH. population - 21 dogs with signs consistent with hypothyroidism, low TT4, and TSH within RI Thyroid scintigraphy was performed to classify dogs with hypothyroidism or non thyroidal illness. All dogs underwent a TRH stimulation test with GH and TSH measurement before, 30min, and 45 min post IV injection of TRH 11/21 (52%) of dogs were hypothyroid - basal GH in hypothyroid dogs (3.2) was higher than in non thyroidal illness dogs (0.73), with minimal overlap GH increased after TRH stimulation test in hypothyroid dogs but didnt change in the non thyroidal illness dogs plasma TSH did not change significantly in TRH stimulated hypothyroid dogs, while it increased in non thyroidal illness dogs. 10 had non thyroidal illness **measuring GH and GH + TSH concentrations following TRH stimulation can help differentiate dogs with hypothyroidism and nonthyroidal illness

Answer 142

population - 54 dogs with suspected hyperadrenocorticism assessed diagnostic performance of: baseline cortisol (BC), post stimulation serum cortisol (PC), post to baseline cortisol concentration (deltaC), and quotient (RatioC) for the diagnosis of hyperadrenocorticism post cortisol performed best/ AUC was significantly higher than AUCs of BC, and RatioC post cortisol AUC did not significantly differ from AUC of DeltaC an Optimal cutoff value of 24.8 mcg/dL for post cortisol yielded sensitivity of 86% and a specificity of 94%. Post cortisol cutoff of 26 yielded specificity of 100% with 81% sensitivity for diagnosis of pituitary dependent HAC PC was comparable to deltaC for the diagnosis of hyperadrenocorticism. Baseline cortisol and quotient of BC and PC were ineffective. Recommendation for obtaining a baseline cortisol may be redundant when looking to diagnose HAC

Answer 143

prospective case series cats ranged from 3.5 - 11 YO, with no apparent breed prediction 6/7 cats were male (85%) 2/7 cats were initially tested b/c of signs of hypothyroidism (hair coat changes, lethargy, obesity) 4/7 were azotemic (57%) 6/7 cats had low TT4 and fT4 7/7 had elevated TSH 6/7 cats - thyroid scintigraphy showed bilateral goiter with intense uptake 1/7 - no radio nucleotide uptake/ no thyroid tissue After levothyroxine treatment, ft4 and TT4 increased, TSH fell, and azotemia resolved in azotemic cats repeat imaging showed reduction in goiter size

Answer 144

Objective - to determine lipoprotein lipid content of plasma of dogs with DM and to compare lipoprotein lipid content in diabetic and healthy dogs, and to quantify apolipoprotein B100 in dogs with DM population - 22 dogs with DM and 9 healthy dogs Median triglycerides (122) total cholesterol (343.5), HDL-cholesterol (200), VLDL cholesterol (27) LDL cholesterol (68) and non-HDL-cholesterol (114) and ApoB (320) were significantly higher in dogs with DM compared to healthy dogs A significant association was found between ApoB and LDL cholesterol) and ApoB and non-HDL cholesterol **dyslipidemia of dogs with DM is characterized by pronounced increases of LDL cholesterol and nonHDL cholesterol concentrations, although ALL lipoprotein fractions are significantly increased** Statins are typically used in people to lower them in ppl with DM, as LDLC and nonHDLC increase risk of heart disease

Answer 145

Background - in humans, EPI is associated with deficiencies in lipid soluble vitamins. This study compared serum concentrations of retinol, 25-hydrocholecalciferol, and alpha tocopherol in dogs with EPI, those with subclinical EPI, and healthy dogs serum retinol (vitamin A) and alpha tocopherol (vitamin E) was lower in dogs with EPI and dogs with subclinical EPI compared with healthy dogs dogs with weight loss had significantly lower calcidiol level than dogs with stable weight

Answer 146

vision loss, decreased bone density, coagulopathies

Answer 147

In dogs with EPI, there was no difference in percent fecal fat (low value indicates normal fat digestion) between dogs given the enteric coated and standard pancreatic supplement - this may also be due to low power of the study (only 11 dogs with EPI in study)

Answer 148

less oral bleeding | coating may also reduce inactivation of enzymes in the stomach by gastric acid and proteases

Answer 149

10 hyperthyroid cats cats were given either a placebo, 50 mcg TSH, and 100 mcg TSH in randomized crossover design with treatments separated by 10 days scintigraphy was performed after each treatment - with 123I and assessing uptake 8 and 24 hours post. T 4 was measured at each visit **thyroid percent iodine uptakes were not different between placebo and the two doses. Independent of TSH administration, percent iodine uptakes were positively correlated with serum T4 concentrations

Answer 150

population - 31 dogs with suspected hypoadrenocorticism prospective study, dogs had ACTH stimulation done using 1 mcg/kg cosyntropin for the first ACTH stir, and the second test was performed 4 hours later and dogs received 5 mcg/kg. Endogenous ACTH was measured at the time of initial blood collection **No significant difference was observed in basal cortisol concentration before 1 mcg/kg or before 5 mcg/kg For dogs with suspected Addisons, the ACTH stimulated cortisol in response to both doses of ACTH were equivalent. No cases with partial ACTH deficiency were conclusively identified. Timing of post sample is crucial (exactly 60 min post, cannot use IM/ efficacy unknown)

Answer 151

objective - to compare a method of radio iodine dose determination that used thyroid scintigraphy with a standard fixed se for treatment of hyperthyroidism ** No difference in outcome was found between the variable dosing plan based on scintigraphy or fixed dosing. Euthyroidism developed in 61% of the variable dosing and 58% of the fixed dosing hypothyroidism developed in 30% of variable and 26% of fixed dosing persistent hyperthyroidism was noted in 9% of variable and 16% of fixed dosing group ** rates of post treatment hypothyroidism and persistent hyperthyroidism were higher than those founding in other studies investigating modified fixed dosing methods

Answer 152

population of 6 healthy and 133 diabetic cats PZI and degludec insulin was administered and BG curves were performed, and % curves with post hypoglycemic hyperglycemia were documented in healthy cats, all insulin doses caused hypoglycemia, but post hypoglycemic hyperglycemia was not seen. Glycemic variability did not differ between insulin preparations. Among diabetic cats 25% had post hypoglycemic hyperglycemia, the remainder did not. PHH cats had higher insulin doses than cats that did not have PHH. They also had higher serum fructosamine, less frequent remission, and higher glycemic variability

Answer 153

the pancreas in cats with chronic DM was significantly larger, had higher volume, had higher volume to body weight ratio, and shorter time to peak portal enhancement on CT angiogram when compared to normal cats. These variables can potentially be used to differentiate normal sedated cats from those with chronic DM.

Answer 154

prospective study - IGF1, glucose, fructosamine, IGFBP all determined in 14 diabetic and 13 healthy cats IGF median pre insulin was 300 IGF1 was positively associated with ternary complexes and endogenous insulin and was negatively associated with fructosamine Median IGF was higher 2-4 weeks after start of insulin treatment compared with baseline and predicted future remission. In cats that went into remission, the amount of ternary complexes and IGFBP3 increased, suggesting increase in IGF1 is dependent on Ternary complex formation

Answer 155

serial postoperative iCa concentrations measured at 12 hour intervals for 2 days post were positively associated with prep iCA concentrations. The effect of preoperative iCa concentrations on postoperative iCA concentrations decreased as time elapsed. Prophylactic calcitriol administration was NOT found to be significantly associated with post iCa concentrations or its rate of decrease after parathyroidecomy ** No protective value was found in administering calcitriol prophylactically to prevent hypocalcemia in the immediate postoperative period (48 hours) after parathyroidectomy. Preoperative iCa concentration had a significant positive association with post iCA concentration throughout the monitoring period

Answer 156

Objective - to assess the current features of HAC and evaluate if the diagnostic test performance of individual LDDST result patterns differ 48% of dogs had HAC 52% of dogs had non adrenal illness sensitivity of the LDDST was 96.6% specificity was 67.2% PPV 73.1% NPV 95.6% Lack of suppression pattern had the highest PPV (94%), followed by partial suppression pattern (68%) and escape or inverse pattern **I.e. overall LDDST performance remains similar to previously described

Answer 157

262 hyperthyroid cats and 206 age matched controls no hyperthyroid cats were azotemic before treatment 16% became azotemic when rechecked at 4-8 months after I131. Of these 16%, 33% of them had high SDMA concentrations before treatment. As a diagnostic test for pre-azotemic/masked CKd in untreated hyperthyroid cats, SDMa showed a sensitivity of 33.3% and specificity of 97.7 % **Finding a high serum SDMA pretreatment can help predict development of azotemia post. pre-treatment USG <1.035 had the highest sensitivity as a predictor of masked azotemia

Answer 158

40% reduction