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Patient Care 2 > Endocrine system disorders > Flashcards

Endocrine system disorders Flashcards

1
Q

Where is the pituitary gland located and what is its role?

A
  • Sits at the base of the brain
  • Connects the endocrine system to the nervous system
  • Responds to the releasing of hormones secreted by the hypothalamus
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2
Q

What hormones do the anterior and posterior pituitary glands release?

A

Anterior:

  • ACTH
  • FSH
  • GH
  • LH
  • Prolactin
  • TSH

Posterior:

  • ADH
  • Oxytocin
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3
Q

What is hyperthyroidism?

A
  • Overactive thyroid gland (99% of cases are caused by benign adenoma)
  • Overproduction of triiodothyronine (T3) and thyroxine (T4) which increases metabolic rate
  • Results in multi system disease
  • Usually affects middle to old aged cats (rarely seen <10years), both male and female and all breeds (rare in pure breeds, especially siamese and himalayans)
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4
Q

What are some clinical signs with hyperthyroidism?

A
  • Polyphagia with weight loss
  • Palpable enlarged thyroid
  • Agression/hyperactivity
  • Heart murmur and tachycardia
  • Hypertension
  • Polyuria/polydipsia
  • V+ and D+
  • Blindness and retinal detachment
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5
Q

What diagnostics can be done for a patient with suspected hyperthyroidism?

A
  • Blood tests (biochemistry and haematology including T4)

- Thyroid scintigraphy

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6
Q

What treatment and nursing care can be done for a patient with hyperthyroidism?

A
  • Monitor vital signs
  • Assist VS with diagnostic testing
  • Reduce stress
  • Fresh water availability
  • Keep comfortable
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7
Q

What are the advantages and disadvantages of antithyroid drugs for hyperthyroidism?

A

Advantages:

  • Routinely available
  • Reversible
  • Spreads the cost

Disadvantages:

  • Not curative
  • Daily administration
  • Drug side effects
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7
Q

What are the advantages and disadvantages of antithyroid drugs for hyperthyroidism?

A

Advantages:

  • Routinely available
  • Reversible
  • Spreads the cost

Disadvantages:

  • Not a cure
  • Daily administration needed
  • Drug side effects
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8
Q

What are the advantages and disadvantages of limited-iodine food for hyperthyroidism?

A

Advantages:

  • Routinely available
  • Reversible
  • Spreads the cost

Disadvantages:

  • Not curative
  • Cat can only eat a single food
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9
Q

What are the advantages and disadvantages of limited-iodine food for hyperthyroidism?

A

Advantages:

  • Routinely available
  • Reversible
  • Spreads the cost

Disadvantages:

  • Not a cure
  • Cat can only eat a single food
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10
Q

What are the advantages and disadvantages of radioactive iodine for hyperthyroidism?

A

Advantages:

  • Cures current tumour
  • Single treatment
  • Effective for ectopic tissue
  • Side effects uncommon

Disadvantages:

  • High initial costs
  • Limited availability
  • Hospitalisation required
  • Irreversible (may negatively affect renal function in cats with kidney disease)
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11
Q

What are the advantages and disadvantages of thyroidectomy for hyperthyroidism?

A

Advantages:
-Cure current tumour

Disadvantages:

  • High initial cost
  • Requires anaesthesia and hospitalisation
  • Risk of postoperative hypocalaemia
  • Irreversible (may negatively affect renal function in cats with kidney disease)
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12
Q

What is hypothyroidism?

A
  • Underactive thyroid gland
  • Most commonly caused by auto-immune destruction of the thyroid gland
  • Results in decreased production of thyroxine (T4) and metabolic rate
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13
Q

What are some clinical signs that may be seen with hypothyroidism?

A
  • Lethargy/exercise intolerance
  • Obesity
  • Bradycardia
  • Dermatological abnormalities (alopecia, pyoderma, hyperpigmentation)
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14
Q

What diagnostics can be done for a patient with suspected hypothyroidism?

A
  • Blood tests (biochemistry and haematology)

- Total T4 and thyroid stimulating hormone (TSH) assay

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15
Q

What treatment and nursing care can be done for a patient with hypothyroidism?

A
  • Monitor vital signs
  • Assist VS with diagnostic tests
  • Fresh water available
  • Keep comfortable
  • Medication under VS direction (lifetime supplementation of thyroxine)
  • Suitable diet
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16
Q

Where are the adrenal glands located and what hormones do they produce?

A
  • Located dorsally and cranially to the kidneys
  • Two distinct areas each producing own set of hormones:
    1. Adrenal medulla = Adrenaline and noradrenaline (fight/flight response), controlled by sympathetic nervous system
    2. Adrenal cortex = glucocorticoids (eg cortisol), mineralocorticoids (eg aldosterone - regulates electrolytes and water), sex hormones
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17
Q

What is pituitary dependent hyperadrenocorticism?

A
  • Oversecretion of ACTH by pituitary gland (most likely due to tumour)
  • ACTH is hormone that stimulates the adrenal gland to produce glucocorticoids
  • Responsible for around 80% of canine Cushings cases
  • Compression of the base of the brain ad optic nerves
18
Q

What is adrenal-based hyperadrenocorticism?

A
  • Adrenal tumour causes over secretion of cortisol

- Responsible for around 20% of canine Cushings cases

19
Q

What is Iatrogenic Cushings?

A
  • Result of giving animal high dose of steroids

- Cushings symptoms will go once steroids have stopped

20
Q

What are some clinical signs of Cushings?

A
  • Polyuria/polydipsia
  • Polyphagia
  • Potbelly
  • Panting
  • Bilateral alopecia and skin changes (thin elastic skin)
  • Skin and other infections
  • Muscle atrophy and weakness
  • Neurological signs
21
Q

What diagnostics can be done for a patient with suspected Cushings?

A
  • Abdominal ultrasound and X-ray
  • MRI or CT
  • General blood tests
  • Specific blood tests
22
Q

What specific tests can be done for suspected canine Cushings?

A
  • ACTH stimulation = determines if adrenal glands are releasing too much cortisol
  • Low-dose Dexamethasone Suppression Test (LDDST) = decreases amount of ACTH released by pituitary gland decreasing amount of cortisol by adrenals, high levels of cortisol post injection suggest Cushings
  • High-dose Dexamethasone Suppression Test (HDDST) = Distinguishes between pituitary and non-pituitary dependent Cushings; low levels of cortisol post injections suggest pituitary dependent, high levels of cortisol post injection suggest non-pituitary dependent
  • Serum insulin levels = high levels suggest Cushings due to cortisol causing insulin resistance
23
Q

What treatment and nursing care can be done for a patient with Cushing’s?

A
  • Careful handling (haematomas/bruising common)
  • Fresh water available
  • Frequent toileting
  • Pituitary dependent HAC treated medically
  • Adrenal dependent HAC treated medically or surgically
  • Oral medication (trilostane most common for dogs)
24
Q

What is hypoadrenocortisim (Addisons disease)?

A
  • Atrophy of adrenal cortex resulting in decreased production of glucocorticoids and mineralocorticoids
  • Most commonly caused by auto-immune destruction of adrenal gland
25
Q

What does a lack of cortisol and aldosterone cause?

A

Cortisol:

  • Weakness
  • V+
  • Anorexia

Aldosterone:

  • Hyponatramia (low sodium)
  • Hyperkalaemia (high potassium)
26
Q

What are some clinical signs that may be present with Addisons disease?

A
  • May be vague
  • Lethargy/depression
  • Anorexia/weight loss
  • V+ and D+
  • PU/PD
  • Coat changes
  • May present in Addisonian crisis (arrhythmias eg bradycardia caused by hyperkalaemia, severe hypovolaemia, pre renal azotaemia, collapse)
27
Q

What diagnostics can be done for a patient with suspected Addisons disease?

A
  • Blood tests (haematology and biochemistry: low sodium, high potassium)
  • ACTH stimulation test
  • ECG
28
Q

What treatment and nursing care can be done for a patient with Addisons disease?

A
  • IVFT (usually 0.9% saline to treat hyponatraemia, shock doses in crisis)
  • Monitor vital signs (especially hydration)
  • Medication under VS direction (hydrocortisone or dexamethasone IV every 6 hours in crisis, dextrose and insulins to increase uptake of potassium by cells, Zycortal injection once monthly SC)
  • Stimulate appetite
  • Fresh water available
  • Frequent toileting (monitor urine output)
  • ECG
29
Q

What hormones do the Alpha, Beta and Delta cells release in the Islets of Langerhans in the pancreas and when are they stimulated?

A 
Alpha = produce glucagon, stimulated by low glucose concentration or stress
Beta = produce insulin, stimulated by high glucose levels
Delta = produce somatostatin, regulatory role inhibiting the release of both glucagon and insulin
30
Q

Outline diabetes mellitus in cats

A
  • Diabetes Mellitus II
  • Insulin resistance due to obesity
  • Reversible if treated quickly enough
  • Result in hyperglycaemia
  • Eventually patients breakdown fat store resulting in raised ketone levels
31
Q

Outline diabetes mellitus in dogs

A
  • Diabetes Mellitus I:
  • Insulin deficiency
  • Auto-immune destruction of beta cells of the pancreas
  • Irreversible but with appropriate control can live a healthy and normal life

Diabetes Mellitus II:

  • Insulin resistance
  • Resistance caused by obesity

Both:

  • Result in hyperglycaemia
  • Eventually patients breakdown fat store resulting in raised ketone levels
32
Q

What are some clinical signs of diabetes mellitus?

A
  • Polyuria/polydipsia
  • Polyphagia with weight loss
  • Plantigrade posture in cats
  • Cataracts
  • Urinary tract infections
  • Hypertension
  • Glaucoma
  • DKA (serious) -> V+, D+, anorexia, collapse, acetone breath
33
Q

What diagnostics can be done for a patient with suspected diabetes mellitus?

A
  • Bloods (haematology, biochemistry and fructosamine levels)

- Urinalysis

34
Q

What treatment and nursing care can be done for a patient with diabetes mellitus?

A
  • Client/outpatient support
  • Fresh water availability
  • Patients with type 2 diabetes may enter remission from diet and exercise alone
  • Insulin administration under direction (SID vs BID)
  • Glucose curves in and out of practice
  • Monitor blood glucose levels at home
  • Low carb diet (strict times if on insulin)
  • Patients on insulin require strict exercise routine
35
Q

What support can be given from an inpatient with DKA (diabetic ketoacidosis)?

A
  • Monitor blood glucose and electrolyte levels
  • Supplement IVFT as required
  • Stimulate appetite
  • IV glucose/insulin under VS direction
36
Q

What clinical signs may be present with insulin overdose?

A

Causes hypoglycaemia

  • Altered mentation
  • Syncope and weakness
  • Tremors and seizures
  • Collapse
37
Q

What is diabetes insipitus (DI)?

A

-ADH usually released in the pituitary gland and acts on the distal convoluted tubule to retain water
-Large volume of dilute urine produced
-“Water diabetes”
TWO FORMS:
-Central DI = decrease in ADH produced by the pituitary
-Nephrogenic DI = collecting tubules in the nephrons fail to respond to ADH

38
Q

What are some clinical signs associated with diabetes insipitus?

A
  • PU/PD
  • V+ (after drinking ++)
  • Weight loss (poor appetite due to constant thirst)
39
Q

What diagnostics can be done for a patient with suspected diabetes insipitus?

A
  • Haematology and biochemistry (both usually normal)
  • Urinalysis (SG <1.009)
  • Water deprivation test
  • Trial of ADH
40
Q

Explain how to perform a water deprivation test

A

NOTE: patient should be well hydrated, have normal blood urea level and be closely monitored throughout procedure

  1. Empty the bladder and measure SG
  2. Weigh animal and calculate 5% of its BW
  3. Put away with no access to food or water
  4. Empty bladder every hour, check SG and weigh the animal
  5. Once 5% of the BW has been lost stop the test
  6. Normal result: SG >1.025, if SG <1.020 suspect DI

Once rehydrated, repeat but give ADH injections or drops

  • If increased SG = central DI
  • No change in SG = nephrogenic DI
41
Q

What treatment can be given for central and nephrogenic DI?

A

Central DI:
-Desmopressin acetate (DDAVP) nassal/eye drops = synthetic ADH

Nephrogenic DI:
-Chlorothiazide diuretics (hydrosaluric)

42
Q

What nursing care can be done for a patient with DI?

A
  • Monitor hydration status
  • Assisting with diagnostics
  • Fresh water available (unless performing deprivation test)
  • Frequent toileting
  • Administer medication under VS direction

Patient Care 2 (13 decks)

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