Endocrino

Question 1

What were the most common pituary lesions seen in dogs and cats during routine necropsy?
What was the prevalence of pituary neoplasia?
How is it possible to distinguish ACTH adenoma from hyperplastic nodules?
(Polledo, Vet Pathol, 2018)

Answer 1

They were cystic lesions approx. 13% in dogs and 12% in cats.
Pituary neoplasia in approx. 14% of middle aged dogs.
For ACTH adenoma- PAS (cytoplasmatic granules) and reticulin (loss of normal reticulin network)

Question 2

What was a suprising finding in a new IHC categorization of feline pituary tumors?
From the cats treated diagnosed with adenomas, which did better those recieving surgery or without?
(Miller, Vet Pathol, 2021)

Answer 2

11 melanotroph adenomas expressed MSH and ACTH, half of them had hypertcorticolism and half DM (usually cells are not stained for MSH if they are ACTH positive).
11 gonadotroph adenomas expressed either FSH or LH (not reported previously), no clinical signs
2 thyreotroph adenomas expressed TSH (not repoerted previously), no signs
Ki67 was higher in melanotroph adenomas

cats undergoing surgery for somatotroph or melanotrph adenomas lived sign. longer 899 days vs 173 days

Question 3

In a study evaluating canine pituary adenomas, which tumors were larger, more proliferative (higher ki67) and had a shorter ST?
What was recommended in that study?
(Miller, Vet PAthol, 2018)

Answer 3

Corticotroph adenomas vs. melanotroph (300 vs 793 days)

It was recommended that on PAS positive cells ACTH and MSH IHC should be performed and Ki67 as well.

Question 4

Was was the survival difference in dogs treated with SRT with 2 different protocols 1x 15Gy or 3x8 Gy?
(Hansen, VRU, 2018)

Answer 4

There was no difference in survival (311 vs 245 days)

However it was overall shorter then with definitive protocols (2-4 years)

Question 5

Whit what diagnostic modality was GTV larger, and were was the inter-observer variabilty greatest?
The protocol was 1x 16Gy, what was the MST?
(Gieger, VCO, 2020)

Answer 5

MRI for both

MST was 1 year. 9/13 improved neurologically.

Question 6

Is SRT for cats with acromegaly advisable? How was the outcome in comparison with standard fractionation?
(Wormhoudt, JVIM, 2018)

Answer 6

Yes, MST was alomost 3 years and 95% of cats had reduction in their insulin dosage, in 32% DM remission was noted.
The outcomes were better than with standard fractination. (1,5-2 years)

Question 7

How did cabergoline for the treatment of feline acromegaly effect the levels of IGF-1, fructosamine, insulin, and quality of life during 3 months of administartion?
Can it be recommended for treatment?
(Scudder, JFSM, 2021)

Answer 7

There was no change in the levels of IGF-1, fructosamine, insulin and QL.
According to the findings to this study it cannot be recommended (although in another study in 3 cats an effect was seen).

Question 8

What did the addition of pasireotide to trilostane therapy achieve? How did ACTH stimm test and endogenous ACTH levels change?
What is the conclusion of this study?
(Lottati, JAVMA, 2018)

Answer 8

It was well tolerated, no differences were seen in measured ACTH stimm test und ACTH levels.
The 6/9 macroadenomas decreased in size. Although 3 had increases.
It implies that maybe pasireotide can protetct from the development of neurological symptoms due to progressive tumor growth.
However some tumor may not express SST2 receptors.

Question 9

What were the outcomes of transsphenoidal hypophysectomy in cats in the UK study?
(Fenn, JVIM, 2021)

Answer 9

15% postoperative deaths, 95% improved control of DM (71% remission rate).
IGF-1 decreased
recurrence in 12% approx 8 months later
MST 2,3 years

Question 10

What were the outcomes of transsphenoidal hypophysectomy for cats in the Dutch study?
(Bokhorst, JVIM, 2021)

Answer 10

1 cat (5%) died posoperatively
IGF-1 decreased 22/23 cats, DM remission in 22/24 cats
MST almost 4 years
1-, 2-,3 year survival 76, 76, 52%

Question 11

In a study evaluting perioperive mortality in <3cm adrenal tumors withoout vascular invasion how many dogs survived the 14 day period?
What was the 1- and 2- year survival?
How many tumors smaller than <2cm were malignant?
(Cavalanti, VCO, 2021)

Answer 11

92% (4/51 dogs), surgery has a relative low risk
1- and 2- year ST 83% and 72%
54% (12/22) <2 cm were malignant! (do not automatically assume benign disesase)

Question 12

What is the purpose of the Utrecht score?
What factors were included?
(Sanders, VCO,2019)

Answer 12

It is evaluating the association between survival and histopathology in dogs with corticocosteroid-secreating tumors.
Ki67+ (4+ ) if more then 33% cytoplsma clear/vacuolated + (+3) necrosis

Score < 6 low risk of recurrance
Score 6-11 medium risk
Score >11 high-risk (survival 16 months)
High risk dogs might benefit from monitoring or adjuvant therapy

Question 13

Which 3 genes were associated with shortet survival in dogs with adrenal tumors?
(Sanders, VCO, 2019)

Answer 13

SF-1 (steroidgenic genic factor-1)
PTTG1 (pituary tumor transforming gene-1)
TOP2A (topoisomerase II alpha)

Question 14

What is Conns syndrome?

Answer 14

Primary aldosteronism

Question 15

Is SPECT reliable method for the detection of thoracic mets in dogs with thyroid tumors?
(Berg, JVIM, 2020)

Answer 15

Yes, however the lesion were not confirmed

Question 16

What was the outcome of a study evaluating surgically resected solely functional thyroid tumors?
(Frederick, JAVMA, 2020)

Answer 16

The MST was about 3 years, comparable with non-funcional tumors
Mets only in 1 dog (4%)
No diff. in survival between adenomas and carcinomas

Question 17

According to 2 recent studies what were the most common presenting signs of dogs with functional thyroid tumors?
What similar conclusions did the 2 studies have?
(Scharp,JSAP,2020 &Fredrick, JAVMA, 2020)

Answer 17

PU/PD, weight loss
the MST was approx. 3 years
there were adenomas 13-15% (higher than previously thought)
metastatic rate was low (3-4%), probably earlier detection due to the clinical signs

Question 18

For unilateral thyreoidectomy what was the perioperative mortality, complication rate, survival?
Which were the most common complications?
(Reagen, JAVMA, 2019)

Answer 18

mortality 2%
complications 20%, bleeding and aspiration pneumonia
MST was about 3 years

Question 19

In a study concerning invasive thyroid tumors, what was the periopertaive complication rate, recurrence, metastasis and MST?
What was the interesting fact about this study?
(Latifi, VCO, 2021)

Answer 19

The perioperative mortality was 23%, mostly minor, 2 dogs died
10% recurrence median 8 months
12% metastasis median 1 year
MST 621 days

50% of the invasive tumors were missed on CT
recurrence and metastasis occured late, possible slow doubling time of the tumor (questions the usefullness of adjuvant chemo or RT)
in people intermediate or high risk differentiated tumors radioiodine therapy

Question 20

Where do ectopic thyroid tumors usually occur and what was seen in a recent study with radioionide?
What was the outcome in this study?

Answer 20

Sublingual, heart (+pharynx)
All had a decrease in their T4 level, and clinical sings improved
the dog with metastatic disease lived 3 months, the others 7-50 months and died of unrelated causes

Radioiodine is a feasable option in dogs with ectopic thyroid tumors

Question 21

What was the MST of dogs with thyroid carcinoma recieving SRBT?
Was there any difference between dogs having metastatic disease at the time of diagnosis?
What was an important factor for longer surival?
(Lee, VCO, 2020)

Answer 21

The MST was approx. 1 year
At presentation almost half of the dogs had metastatic disease, but there was no diff. in ST.
Response to therapy was an important factor, responders lived much longer (15 months vs. 3 months)

Question 22

In dogs recieving palladia either in naive or post treatment setting for thyroid carcinoma what was the clinical benefit and MST?
Which dogs did poorer?
(Sheppard, VCO, 2020)

Answer 22

cinical benefit was 83% for the whole population
MST 1,5 years for the naive and 3 years for the already treated dogs
asympotomatic, naive dogs did poorer!

Question 23

What to thyroid parameters changed over time in dogs recieving Palladia?
(Hume, JVIM, 2017)

Answer 23

both remained in between the limits, but fT4 decreased and TSH increased slightly after 90 days

Question 24

In a prospective study evaluating thyroid function with palladia, what were the outcomes?
(Harper, VCO, 2019)

Answer 24

There was no differece in the baseline of TT4 and TSH.
On 12 occasions TSH was elevated without TT4 decrease

Monitoring is advised

Question 25

What were the most common clinical sings associated with insulinoma in a recent study?
Which dogs did better ?
(Ryan,JSAP, 2021)

Answer 25

Weakness, epileptic seizures and obtunded mentation.
The clinical sings were generally seen sooner then historically reported, but was in accordance with 2 recent studies.
The dogs undergoin surgery did better (20 vs 8months for medical)
Presence of metastasis was approx. 50%, and these dogs had worse outcomes.

Question 26

According to a recent study what is an important factor in prolonged survival in dogs with insulinoma?
(Cleland, VCO, 2019)

Answer 26

Resolution of hypoglycemia, MST 2 years vs. overall MST 1,5 years

Question 27

In a recent study what was the most common complication and what affecetd negatively survival in dogs undergoing surgical excision for insulinoma?
(Del Busto, JVIM, 2020)

Answer 27

Development of transient and permanent hyperglycemia (33%, 20% DM), pancreatitis second most common
negative factors were stage: I-652 vs II-III 320 days, and persistant hypoglycemia