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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
Q

What size cutoff is an adrenal tumor more likely to be a carcinoma in dogs?

A

> 2 cm

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26
Q

What percentage of adrenocortical carcinomas invade the phrenicoabdominal vein with extension into the renal v/ caudal vena cava?

A

20%

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27
Q

At time of diagnosis how many dogs with adrenocortical carcinoma have evidence of metastasis?

A

50%

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28
Q

What is the sensitivity of ACTH stim for adrenal dependent hyperadrenocorticism?

A

60%

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29
Q

What is the prognosis for dogs with ADH undergoing adrenalectomy after 4 weeks post op?

A

MST 3 yrs

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30
Q

What is the median survival time for dogs with adrenocorticocarcinoma undergoing adrenalectomy?

A

230 - 778 d (8 - 26 mos)

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31
Q

What is the median survival time for dogs with adrenal adenomas with surgery?

A

MST 688 days (23 mos)

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32
Q

With SRT, what is the median survival time of adrenocortical tumors with vascular invasion treated with external beam radiation?

A

1030 days (34 mos)

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33
Q

What is the mean survival time for dogs with functional adrenal tumors and no evidence of metastasis treated with mitotane?

A

16.4 mos

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34
Q

In a retrospective comparing mitotane to trilostane, what was the median survival time for each in the treatment of functional adrenal tumors?

A

Mitotane - 102 d (3 mos)
Trilostane - 353 d (~12 mos)

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35
Q

What is the survival time reported for functional adrenal tumors with metastatic disease treated with mitotane and trilostane?

A

Mitotane - 15.6 mos
Trilostane - 14 mos

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36
Q

What is Conn’s syndrome?

A

Primary hyperaldosteronism in cats

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37
Q

Are dog cortitroph adenomas functional or non-functional?

A

functional - produce adrenocorticotrophic hormone (ACTH)

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38
Q

Are feline somatotroph adenomas functional or non-functional?

A

functional - produce growth hormone

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39
Q

What percent of dog and cat HAC is pituitary dependent?

A

80-85%

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40
Q

What part of the pituitary gland do ACTH secreting tumors typically arise?

A

70-80% arise from pars distalis
Remainder from pars intermedia

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41
Q

Do dogs with PDH commonly have tumors that can be seen with CT/MRI?

A

40-50% are not visible
(note: so only 15-25% are at risk for developing neuro signs due to an enlarging tumor)

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42
Q

Which cells in the adrenal gland make up pheochromocytomas?

A

Chromaffin cells

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43
Q

What percentage of pheochromocytoma cases have metastasized at the time of diagnosis?

A

40%

44
Q

What percentage of pheochromocytomas have evidence of vascular invasion?

A

82%

45
Q

What is the prognosis for pheochromocytomas after surgical resection?

A

MST 374 d (12.5 mos)

46
Q

How does primary hyperparathyroidism cause hypercalcemia

A

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
Q

What treatment prior to surgery has been shown to significantly improve outcomes in dogs with pheochromocytomas?

A

Phenoxybenzamine

48
Q

In which type of adrenal tumor is caval thrombus more common?

A

Pheochromocytoma

49
Q

What is the perioperative mortality rate of adrenalectomy in dogs?

A

15-37%

50
Q

For cats undergoing adrenalectomy, what is the median survival time?

A

12 to 43 months

51
Q

MOA of Mitotane

A

Potent adrenocorticolytic agent that is cytotoxic to the adrenal cortex (particularly the zona fasciculata and zona reticularis)

52
Q

In a series of 11 cats undergoing laparascopic adrenalectomy, what was the median survival time?

A

803 d (27 mos)

53
Q

What percentage of dogs undergoing abdominal ultrasound are found to have incidental adrenal tumors?

A

4%

54
Q

What was the MST for dogs with non-cortisol secreting adrenal tumors without surgical intervention?

A

17.8 mos

55
Q

MOA of trilostane

A

synthetic corticosteroid analog that competitively inhibits 3-beta-hydroxysteroid dehydrogenase

This enzyme is essential for cortisol synethesis

56
Q

What percentage of dogs undergoing CT scan had an incidentally identified adrenal mass?

A

9.3%

57
Q

When should adrenalectomy be considered?

A

functional masses, >2.5 cm, locally invasive

58
Q

MOA of pasireotide

A

Somatostatin receptor analog that binds to receptors SST1, SST2, SS, and SST5

59
Q

whats the most common tumor type fo the parathyroid gland

A

adenoma > cystadenoma, carcinoma and hyperplasia
90% are single masses

60
Q

MOA of Selegiline

A

Inhibits degradation of dopamine which may inhibit ACTH secretion from the intermediate lobe of the pituitary gland

61
Q

what is the metastatic rate of parathyroid tumors

A

extremely rare

62
Q

clinical signs of hypercalcemia

A

pu/pd weakness, lethargy decreased appetite weight loss muscle wasting vomiting and trembling

63
Q

bloodwork findings in a patient with parathyroid tumors

A

hypercalcemia
hypophosphatemia
PTH can be high or withing the normal reference range - 73%

64
Q

Dow et al (1990) treated 6 dogs with pituitary macrotumors with RT (40gy in 10 fractions) - what was the MST?

A

743 days

65
Q

Kent et al (2007) - retrospective of RT for pituitary masses - MST for treated vs non-treated dogs?

A

Treated (19 dogs) - 1405 days (47 mos, 4 yrs)
Non-treated (27 dogs) - 551 days (18 mos)

66
Q

imaging for parathyroid tumors

A

ultrasound
scintigraphy has not been useful

67
Q

how does hyper calcemia lead to an AKI

A

altered glomerular permeability
reduced renal blood flow
mineralization of the kidenys
when calcium x phosphorus product >70 the risk of mineralization is increased

68
Q

methods for treatment of parathyroid tumors

A

surgery
ultrasound guided ablation (radiofrequency and ethanol have been reported)

69
Q

how many parathyroid glands can safely be removed

A

3/4 without risk of hypoparathyroidism

70
Q

preferred treatment for hypocalcemia

A

calcitriol - rapid onset and short half life
oral calcium is not sufficient

71
Q

success of radiofrequency ablation

A

8/11 responded with one or two treatments
3/11 were unsuccessful
another paper showed persistent or recurrent disease in 31%

72
Q

Ultrasound-guided ethanol ablation success

A

85% resolved hypercalcemia

73
Q

when comparing surgery to RFA to US ethanol ablation - what is the success of hypercalcemic control

A

94% OF PARATHYROIDECTOMY
72% of ethanol ablation
90% RFA

74
Q

what % of dogs experience recurrence after treatment of parathyroid tumor

A

10%
long term prognosis is very good

75
Q

insulinoma hallmark on bloodwork

A

increased insulin levels and low glucose levels

76
Q

feline insulinoma cells express what abnormal enzymes that contribute to increased glucose sensitivity and abnormal insulin secretion

A

glucokinase and hexokinase

77
Q

hormones associated with insulinomas

A

insulin, glucagon, somatostatin, pancreatic polypeptide, GH, IGF1 and gastrin

78
Q

what % of canine insulinomas are metastatic

A

50% - most commonly to liver and LN
pulmonary mets are rare
most are malignant

79
Q

how does hormone expression differ in metastatic insulinoma lesions

A

higher expression of GH and IGF1 in mets
less somatostatin in met sites and therefor increase GH

80
Q

highly metastatic insulinomas have been shown to have what gene expression profile

A

genes for acinar enzymes are down regulated
down regulates dna repair and cell cycle regulation pathways

81
Q

tumor prognostic factors for insulinomas

A

tumor size, TNM stage, ki67, necrosis, nuclear atypia, stromal fibrosis

82
Q

common breeds for insulinomas

A

labs, goldens, GSD, pointers, irish setter, boxers, mbd , westies

83
Q

neuropathy and insulinoma

A

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
Q

what is the success of ultrasonography of insulinomas

A

miss 50% of pancreatic masses
low sensitivity and specificity for the detection of metastatic lesions

85
Q

what is the best imaging for pancreatic insulinomas

A

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
Q

treatment of insulinomas

A

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
Q

streptozotocin toxicity

A

nephrotoxic - mitigated with fluid diuresis
vomiting during administration, diabetes mellitus, hypoglycemia, increase liver enzymes, mild hematologic changes

88
Q

how does prednisone treat hypoglycemia

A

antagonizes insulin
gluconeogenic
glycolytic

89
Q

how does diazoxide treat insulinomas and whats the RR

A

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
Q

diazoxide SE

A

ptyalism, vomiting, anorexia, and diarrhea.
VERY EXPENSIVE

91
Q

diazoxide dose

A

5mg/kg PO BID - increased up to 30 mg/kg daily

92
Q

how does octreotide work and whats the RR

A

somatostatin receptor ligand
inhibits insulin secretion
RR 50%

93
Q

octreotide dose

A

10-50 ug SQ 2-3 times daily

94
Q

insulinoma prognosis with partial pancreatectomy

A

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
Q

prognosis of insulinoma with medical management alone

A

196 day (6.5 months)

96
Q

how does the use of medical therapy after surgery affect survival

A

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
Q

insulinomas in cats st with surgery

A

1-32 mths

98
Q

what is zollinger -ellison syndrome

A

non beta cell neuroendocrine tumor in the pancreas, hypergastrinemia, and GI ulceration

occurs with gastrinomas

99
Q

gastrinoma location

A

pancreas one report of duodenum

100
Q

gastrinoma metastasis

A

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
Q

how to diagnose gastrinoma

A

cs or evidence of gi ulceration
CT
US - limited to find tumor
elevated serum gastrin
scintigraphy with radiolabeled pentetreotide

102
Q

treatment of gastrinoma

A

surgery - even with mets surgical debulking
reduces the gastrin secretory capacity and enhances the efficacy of medical management

ppi and sucralfate
octreotide reported

103
Q

survival of gastrinomas in dogs and cats

A

1-26 months

104
Q

what skin condition do glucagonomas cause

A

crusting dermatologic condition termed necrolytic migratory erythema (NME)

105
Q

signs of glucagonoma

A

skin lesions, hyperglycemia or overt diabetes mellitus, hypoaminoacidemia, and increased liver enzyme activity

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