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Endocrine Neoplasia Flashcards

1
Q

If clinical signs are present with thyroid tumors, what are they?

A

dysphagia, voice change, laryngeal paralysis, Horner’s syndrome, dyspnea

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2
Q

What percentage of thyroid tumors in dogs are carcinomas/adenocarcinomas

A

90%

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3
Q

Potential complications of thyroid tumor removal in dogs?

A

hemorrhage, recurrent laryngeal nerve damage

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4
Q

Locations for ectopic thyroid carcinomas?

A

Base of tongue, hyoid apparatus, cranial mediastinum, right heart base

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5
Q

Prognosis for dogs with unilateral mobile thyroid carcinomas?

A

MST of 36 months; 70% 2 year survival rateR

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6
Q

Risk factors associated with hyperthyroidism in cats?

A

canned cat food, iodine content of cat food, indoor residence, use of litter, exposure to brominated flame retardants, flea control products

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7
Q

Clinical signs and PE findings hyperthyroidism in cats

A

Weight loss with polyphagia, hyperactivity, GI signs, PU/PD, palpable thyroid nodule, tachycardia, arrhythmia, heart murmur/gallop, poor hair coat

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8
Q

Potential side effects of methimazole

A

lethargy, anorexia, vomiting, facial excoriations, hepatotoxicity, bleeding diatheses, blood dyscrasias

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9
Q

Doses of I131 for feline hyperthyroidism

A

2 to 6 mCi

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10
Q

Outcome of I131 treatment for cats with hyperthyroidism?

A

95% of cats are euthyroid after one treatment

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11
Q

What is the difference between hypersomatotropism and acromegaly?

A

Hypersomatotropism - excess growth hormone

Acromegaly - clinical condition associated with excess GH

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12
Q

In a European study, what percentage of diabetic cats had elevated IGF-1 consistent with acromegaly?

A

18%

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13
Q

What is the prevalence of acromegaly in the average diabetic cat? In cats that are difficult to regulate?

A

Average - 10-15%
Difficult - 30%

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14
Q

Is there a sex predilection for acromegaly?

A

Males more common

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15
Q

What is one clinical finding that differs between poorly regulated diabetic cats and acromegalic cats?

A

Acromegalic cats gain weight vs poorly regulated diabetic cats lose weight

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16
Q

What test is performed in the US to test for acromegaly in cats?

A

Serum IGF-1 concentrations

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17
Q

What is the sensitivity and specificity of IGF-1 concentrations to test for acromegaly?

A

Sens - 84%
Spec - 92%

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18
Q

What is the recommended treatment of acromegaly in humans? In cats?

A

Humans - hypophysectomy (surgery)
Cats - Radiation therapy

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19
Q

What was the outcome of SRT administered in 3 or 4 doses to 53 acromegalic cats?

A

MST 1072 days (36 months)

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20
Q

What is a potential side effect to another endocrine system in acromegalic cats treated with SRT?

A

Hypothyroidism

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21
Q

What are the medical management options for acromegaly in cats?

A

Somatostatin analogs - octreotide, pasireotide ($$$)

Insulin management - 10 - 20 U or more per dose

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22
Q

What is the median survival time in general for cats with acromegaly without specific therapy?

A

MST 20.5 mos

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23
Q

What percentage of adrenal tumors are cortical? Medullary?

A

Cortical - 75%
Medullary - 23%

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24
Q

What percentage of adrenal tumors are carcinomas? Adenomas? Hyperplasia?

A

Carcinoma - 57%
Adenoma - 39%
Hyperplastic - 4%

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25
What size cutoff is an adrenal tumor more likely to be a carcinoma in dogs?
>2 cm
26
What percentage of adrenocortical carcinomas invade the phrenicoabdominal vein with extension into the renal v/ caudal vena cava?
20%
27
At time of diagnosis how many dogs with adrenocortical carcinoma have evidence of metastasis?
50%
28
What is the sensitivity of ACTH stim for adrenal dependent hyperadrenocorticism?
60%
29
What is the prognosis for dogs with ADH undergoing adrenalectomy after 4 weeks post op?
MST 3 yrs
30
What is the median survival time for dogs with adrenocorticocarcinoma undergoing adrenalectomy?
230 - 778 d (8 - 26 mos)
31
What is the median survival time for dogs with adrenal adenomas with surgery?
MST 688 days (23 mos)
32
With SRT, what is the median survival time of adrenocortical tumors with vascular invasion treated with external beam radiation?
1030 days (34 mos)
33
What is the mean survival time for dogs with functional adrenal tumors and no evidence of metastasis treated with mitotane?
16.4 mos
34
In a retrospective comparing mitotane to trilostane, what was the median survival time for each in the treatment of functional adrenal tumors?
Mitotane - 102 d (3 mos) Trilostane - 353 d (~12 mos)
35
What is the survival time reported for functional adrenal tumors with metastatic disease treated with mitotane and trilostane?
Mitotane - 15.6 mos Trilostane - 14 mos
36
What is Conn's syndrome?
Primary hyperaldosteronism in cats
37
Are dog cortitroph adenomas functional or non-functional?
functional - produce adrenocorticotrophic hormone (ACTH)
38
Are feline somatotroph adenomas functional or non-functional?
functional - produce growth hormone
39
What percent of dog and cat HAC is pituitary dependent?
80-85%
40
What part of the pituitary gland do ACTH secreting tumors typically arise?
70-80% arise from pars distalis Remainder from pars intermedia
41
Do dogs with PDH commonly have tumors that can be seen with CT/MRI?
40-50% are not visible (note: so only 15-25% are at risk for developing neuro signs due to an enlarging tumor)
42
Which cells in the adrenal gland make up pheochromocytomas?
Chromaffin cells
43
What percentage of pheochromocytoma cases have metastasized at the time of diagnosis?
40%
44
What percentage of pheochromocytomas have evidence of vascular invasion?
82%
45
What is the prognosis for pheochromocytomas after surgical resection?
MST 374 d (12.5 mos)
46
How does primary hyperparathyroidism cause hypercalcemia
PTH is released in excess PTH causes directed affects through increased resorption of calcium from the bone ( increased bone turnover) and decreased calcium excretion ( increased reabsorption of ca and increased excretion of phosphorus) from the kidneys and increased production of Vitamin D indirectly that vitamin D increases calcium absorption from the intestines
47
What treatment prior to surgery has been shown to significantly improve outcomes in dogs with pheochromocytomas?
Phenoxybenzamine
48
In which type of adrenal tumor is caval thrombus more common?
Pheochromocytoma
49
What is the perioperative mortality rate of adrenalectomy in dogs?
15-37%
50
For cats undergoing adrenalectomy, what is the median survival time?
12 to 43 months
51
MOA of Mitotane
Potent adrenocorticolytic agent that is cytotoxic to the adrenal cortex (particularly the zona fasciculata and zona reticularis)
52
In a series of 11 cats undergoing laparascopic adrenalectomy, what was the median survival time?
803 d (27 mos)
53
What percentage of dogs undergoing abdominal ultrasound are found to have incidental adrenal tumors?
4%
54
What was the MST for dogs with non-cortisol secreting adrenal tumors without surgical intervention?
17.8 mos
55
MOA of trilostane
synthetic corticosteroid analog that competitively inhibits 3-beta-hydroxysteroid dehydrogenase This enzyme is essential for cortisol synethesis
56
What percentage of dogs undergoing CT scan had an incidentally identified adrenal mass?
9.3%
57
When should adrenalectomy be considered?
functional masses, >2.5 cm, locally invasive
58
MOA of pasireotide
Somatostatin receptor analog that binds to receptors SST1, SST2, SS, and SST5
59
whats the most common tumor type fo the parathyroid gland
adenoma > cystadenoma, carcinoma and hyperplasia 90% are single masses
60
MOA of Selegiline
Inhibits degradation of dopamine which may inhibit ACTH secretion from the intermediate lobe of the pituitary gland
61
what is the metastatic rate of parathyroid tumors
extremely rare
62
clinical signs of hypercalcemia
pu/pd weakness, lethargy decreased appetite weight loss muscle wasting vomiting and trembling
63
bloodwork findings in a patient with parathyroid tumors
hypercalcemia hypophosphatemia PTH can be high or withing the normal reference range - 73%
64
Dow et al (1990) treated 6 dogs with pituitary macrotumors with RT (40gy in 10 fractions) - what was the MST?
743 days
65
Kent et al (2007) - retrospective of RT for pituitary masses - MST for treated vs non-treated dogs?
Treated (19 dogs) - 1405 days (47 mos, 4 yrs) Non-treated (27 dogs) - 551 days (18 mos)
66
imaging for parathyroid tumors
ultrasound scintigraphy has not been useful
67
how does hyper calcemia lead to an AKI
altered glomerular permeability reduced renal blood flow mineralization of the kidenys when calcium x phosphorus product >70 the risk of mineralization is increased
68
methods for treatment of parathyroid tumors
surgery ultrasound guided ablation (radiofrequency and ethanol have been reported)
69
how many parathyroid glands can safely be removed
3/4 without risk of hypoparathyroidism
70
preferred treatment for hypocalcemia
calcitriol - rapid onset and short half life oral calcium is not sufficient
71
success of radiofrequency ablation
8/11 responded with one or two treatments 3/11 were unsuccessful another paper showed persistent or recurrent disease in 31%
72
Ultrasound-guided ethanol ablation success
85% resolved hypercalcemia
73
when comparing surgery to RFA to US ethanol ablation - what is the success of hypercalcemic control
94% OF PARATHYROIDECTOMY 72% of ethanol ablation 90% RFA
74
what % of dogs experience recurrence after treatment of parathyroid tumor
10% long term prognosis is very good
75
insulinoma hallmark on bloodwork
increased insulin levels and low glucose levels
76
feline insulinoma cells express what abnormal enzymes that contribute to increased glucose sensitivity and abnormal insulin secretion
glucokinase and hexokinase
77
hormones associated with insulinomas
insulin, glucagon, somatostatin, pancreatic polypeptide, GH, IGF1 and gastrin
78
what % of canine insulinomas are metastatic
50% - most commonly to liver and LN pulmonary mets are rare most are malignant
79
how does hormone expression differ in metastatic insulinoma lesions
higher expression of GH and IGF1 in mets less somatostatin in met sites and therefor increase GH
80
highly metastatic insulinomas have been shown to have what gene expression profile
genes for acinar enzymes are down regulated down regulates dna repair and cell cycle regulation pathways
81
tumor prognostic factors for insulinomas
tumor size, TNM stage, ki67, necrosis, nuclear atypia, stromal fibrosis
82
common breeds for insulinomas
labs, goldens, GSD, pointers, irish setter, boxers, mbd , westies
83
neuropathy and insulinoma
paraneoplastic peripheral neuropathy has been described in dogs with insulinoma. This is rare, although sub-clinical neuropathies may be present and undetected and dogs rarely have brain lesions
84
what is the success of ultrasonography of insulinomas
miss 50% of pancreatic masses low sensitivity and specificity for the detection of metastatic lesions
85
what is the best imaging for pancreatic insulinomas
contrast US CT - 3 phase single photon emission ct (SPECT) with octreotide (50% SN) Somatostain receptor scintigraphy - indium IN111 pentetreotide PET CT - only in people
86
treatment of insulinomas
surgery of mass and mets streptozotocin diet - frequent small meals high in fat protein complex carbs prednisone- 0.25mg/kg bid diazoxide octreotide palladia
87
streptozotocin toxicity
nephrotoxic - mitigated with fluid diuresis vomiting during administration, diabetes mellitus, hypoglycemia, increase liver enzymes, mild hematologic changes
88
how does prednisone treat hypoglycemia
antagonizes insulin gluconeogenic glycolytic
89
how does diazoxide treat insulinomas and whats the RR
nondiuretic benzothiadiazine suppresses insulin from beta cells stimulates hepatic gluconeogenesis and glycogenolysis and inhibits cellular uptake of glucose NOT CYTOTOXIC does not inhibit insulin synthesis 70% RR
90
diazoxide SE
ptyalism, vomiting, anorexia, and diarrhea. VERY EXPENSIVE
91
diazoxide dose
5mg/kg PO BID - increased up to 30 mg/kg daily
92
how does octreotide work and whats the RR
somatostatin receptor ligand inhibits insulin secretion RR 50%
93
octreotide dose
10-50 ug SQ 2-3 times daily
94
insulinoma prognosis with partial pancreatectomy
good short term poor longterm MSTs after partial pancreatectomy range from 12 to 14 months - newer study showed 26 month (785 d) survival 50% of dogs with mets are dead at 6 months
95
prognosis of insulinoma with medical management alone
196 day (6.5 months)
96
how does the use of medical therapy after surgery affect survival
subset of P MST 1316 d ( 44 mths) use of post of medical treatment in another study inc survival to 452 d (15 mths)
97
insulinomas in cats st with surgery
1-32 mths
98
what is zollinger -ellison syndrome
non beta cell neuroendocrine tumor in the pancreas, hypergastrinemia, and GI ulceration occurs with gastrinomas
99
gastrinoma location
pancreas one report of duodenum
100
gastrinoma metastasis
highly metastatic liver, regional lymph nodes, spleen, peritoneum, small intestine, omentum, or mesentery identified in 85% of dogs and cats at the time of initial diagnosis
101
how to diagnose gastrinoma
cs or evidence of gi ulceration CT US - limited to find tumor elevated serum gastrin scintigraphy with radiolabeled pentetreotide
102
treatment of gastrinoma
surgery - even with mets surgical debulking reduces the gastrin secretory capacity and enhances the efficacy of medical management ppi and sucralfate octreotide reported
103
survival of gastrinomas in dogs and cats
1-26 months
104
what skin condition do glucagonomas cause
crusting dermatologic condition termed necrolytic migratory erythema (NME)
105
signs of glucagonoma
skin lesions, hyperglycemia or overt diabetes mellitus, hypoaminoacidemia, and increased liver enzyme activity

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