Endocrine Cases Flashcards
CASE: 8 y/o FS Bichon Frise presented with a history of lethargy, depression, anorexia, PU/PD, and a slightly pendulous abdomen.
- Analyze the hematocrit.
- What does the leukogram indicate?
- hemoconcentration: dehydration (confirm with albumin/TP; unlikely in this case), poor renal oxygenation (chronic heart/lung disease)
- increased PCV seen with HAC
- decreased MCHC = likely artifactual since anemia is not present or clinically significant
neutrophilia without left shift, monocytosis, lymphopenia = STRESS LEUKOGRAM likely due to endogenous or exogenous steroids
CASE: 8 y/o FS Bichon Frise presented with a history of lethargy, depression, anorexia, PU/PD, and a slightly pendulous abdomen.
- What are some likely causes of the increased glucose?
- stress
- transient change in cases of Cushing’s (endogenous, exogenous steroids)
- cannot r/o DM, need serum fructokinase to differentiate from stress/Cushing’s
- glucocorticoids: increased gluconeogenesis and antagonize insulin, resulting in decreased uptake and utilization of glucose
CASE: 8 y/o FS Bichon Frise presented with a history of lethargy, depression, anorexia, PU/PD, and a slightly pendulous abdomen.
Which of the following can be responsible for the increased AST?
a. corticosteroids
b. hemolysis
c. hepatic lipidosis
d. all of the above
D
CASE: 8 y/o FS Bichon Frise presented with a history of lethargy, depression, anorexia, PU/PD, and a slightly pendulous abdomen.
Based on the biochemisty and history, what is the likely interpretation?
a. muscle injury
b. hepatocellular injury
c. corticosteroid hepatopathy
d. cardiac disease
C
- elevated ALT, AST, ALP, bilirubin, no info for CK = unlikely muscle injury
- hypercholesterolemia associated with hypothyroidism, HAC, and DM (+ cholestasis due to decreased clearance)
- marked increase in ALP within BILI increase = unlikely liver cause, likely steroid induction
- increased ALT and AST seen in slight hepatocellular damage, but ALT can be elevated permeability secondary to glucocorticoids and glycogen storage
- slight increase in sodium and decreased in potassium can be associated with HAC
CASE: 8 y/o FS Bichon Frise presented with a history of lethargy, depression, anorexia, PU/PD, and a slightly pendulous abdomen.
What 4 additional tests could you perform in order to confirm or exclude possible diagnosis?
- endocrine testing to r/o/i HAC
- serum fructosamine to r/o DM
- urine cortisol:creatinine ratio
- ACTH stim or LDDST required to r/o/i HAC, since increased basal cortisol level is not sufficient evidence of HAC
CASE: 8 y/o FS Bichon Frise presented with a history of lethargy, depression, anorexia, PU/PD, and a slightly pendulous abdomen.
What sample is required for fructosamine?
a. serum from fasted dog
b. heparinized serum
c. urine
d. urine sediment
A
CASE: 8 y/o FS Bichon Frise presented with a history of lethargy, depression, anorexia, PU/PD, and a slightly pendulous abdomen.
What are increased urine cortisol:creatinine ratio suggestive of?
a. healthy dog
b. stressed dog
c. HAC
C
it is seen in stressed dogs, but the history and biochemical findings are indicative of Cushing’s
CASE: 13 m/o Beagle presented with a long, vague history of intermittent lethargy, depression, possible PU/PD, and occasional diarrhea. The dog is fully vaccinated as dewormed regularly. According to the owner, he has never shown the exuberance of a normal puppy. PE showed slight bradycardia.
- What is the interpretation of the hematology?
- What parameters help assess dehydration?
normocytic, normochromic non-regenerative anemia: chronic inflammatory disease, renal disease, endocrinopathy, BM failure, immune response against marrow cells
albumin, plasma proteins, HCT, RBC count
CASE: 13 m/o Beagle presented with a long, vague history of intermittent lethargy, depression, possible PU/PD, and occasional diarrhea. The dog is fully vaccinated as dewormed regularly. According to the owner, he has never shown the exuberance of a normal puppy. PE showed slight bradycardia.
- How do you assess left shift?
- What do toxic neutrophils mean?
- What are the 3 main causes of neutrophilia?
increased neutrophil count with the presence of band neutrophils and toxic changes in neutrophils
cytoplasmic basophilia, cytoplasmic vacuilation, Dohle bodies, ring/band nuclei —> maturation under conditions that intensely stimulate neutrophil production and shorten the maturation time in marrow
- inflammation - left shift
- steroid (stress response) - lymphopenia
- excitement (EPI) - lymphocytosis
CASE: 13 m/o Beagle presented with a long, vague history of intermittent lethargy, depression, possible PU/PD, and occasional diarrhea. The dog is fully vaccinated as dewormed regularly. According to the owner, he has never shown the exuberance of a normal puppy. PE showed slight bradycardia.
- What is the leukogram showing? What is this suggestive of?
- What should be considered with the lymphocyte and eosinophil counts?
neutrophilia, monocytosis, lymphocytosis, eosinophilia —> inflammation (mild)
OPPOSITE of a stress leukogram, even though this dog is sick, which is indicative of hypoadrenocorticism (Addison’s)
- Ddx: Ag stimulation, EPI, Ehrlichiosis, hypersensitivity, allergy, paradsites
CASE: 13 m/o Beagle presented with a long, vague history of intermittent lethargy, depression, possible PU/PD, and occasional diarrhea. The dog is fully vaccinated as dewormed regularly. According to the owner, he has never shown the exuberance of a normal puppy. PE showed slight bradycardia.
- What is the biochemistry profile indicative of?
hyponatremia, hyperkalemia, hypochloremia, Na:K ratio < 27
- ratio = hypoadrenocorticism, but not in all cases (not seen with glucocorticoid deficiencies)
- ratio can be breed related (Akitas, Shiba Inus, and Shar Peis have RBCs rich in potassium)
- hyponatremia and hyperkalemia is seen in oliguric or anuric renal disease
RESPONSE TO ACTH STIM WOULD HELP DISTINGUISH
CASE: 13 m/o Beagle presented with a long, vague history of intermittent lethargy, depression, possible PU/PD, and occasional diarrhea. The dog is fully vaccinated as dewormed regularly. According to the owner, he has never shown the exuberance of a normal puppy. PE showed slight bradycardia.
- What acid-base pattern is seen?
- Interpret the anion gap.
metabolic acidosis (TCO2) —> blood gas profile is needed to evaluate respiratory acid-base disturbances or compensation
elevated TCO2 + elevated AG = titrational metabolic acidosis, likely due to the presence of unmeasured anions, like uremic and lactic acids associated with decreased tissue perfusion secondary to hypotension seen in aldosterone deficiencies
CASE: 13 m/o Beagle presented with a long, vague history of intermittent lethargy, depression, possible PU/PD, and occasional diarrhea. The dog is fully vaccinated as dewormed regularly. According to the owner, he has never shown the exuberance of a normal puppy. PE showed slight bradycardia.
- Interpret the urinalysis.
- Interpret the urine sediment.
low USG, but not isosthenuric (1.008-1.012), meaning the kidneys are still somewhat concentrating the urine
normal - blood is likely due to collection technique
CASE: 13 m/o Beagle presented with a long, vague history of intermittent lethargy, depression, possible PU/PD, and occasional diarrhea. The dog is fully vaccinated as dewormed regularly. According to the owner, he has never shown the exuberance of a normal puppy. PE showed slight bradycardia.
- What is the increased phosphorus indicative of?
- What additional tests could be performed to confirm/exclude possible diagnosis of hypoadrenocorticism?
decreased GFR = decreased excretion
ACTH stim test - atrophy = no production of cortisol despite ACTH stimulation
(LDDST and HDDST are used for hyperadrenocorticism)
CASE: 13 m/o Beagle presented with a long, vague history of intermittent lethargy, depression, possible PU/PD, and occasional diarrhea. The dog is fully vaccinated as dewormed regularly. According to the owner, he has never shown the exuberance of a normal puppy. PE showed slight bradycardia.
- What does the ACTH stimulation test indicate?
lack of ACTH stimulation, hyponatremia, hypochloremia, and hyperkalemia confirm hypoadrenocorticism
(decreased basal serum cortisol does not increase with ACTH stimulation)
