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Small Animal Year 4 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Where is AcTH produced?

A

Anterior pituitary gland

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2
Q

What is Cushings disease?

which sp/br mostly affected?

A

Hyperadrenocorticism

middle aged- older dogs
v rare in cats

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3
Q

Give 2 causes of hyperadrenocorticism

A

Spontaneous

  • pituitary gland tumour > pituitary dependent hyperadrenocorticism
  • adrenal gland cortex tumour> adrenal dependent hyperadrenocorticism

iatrogenic: from overuse of medication

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4
Q

Which of PDH and ADH is most likley found in small breeds?

A

PDH small breed dogs
ADH large breed dogs

remember: pituitary smaller< than adrenal

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5
Q

The overproduction of which substance leads to the majority of clinical signs in cushings in dogs?

A

Cortisol

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6
Q

A 8 year old dog has following clinical signs

PUPD, polyphagia, panting, abdominal distention, bilateral alopecia, muscle wasting and weakness, systemic hypertension, and bruising and poor healing

which endocrine disease is top of your ddx?

A

Hyperadrenocorticism- cushings

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7
Q

dog
Bloods: Stress leucogram, increased ALKP, ALT, hypercholestrolaemia hypertrigluceride, protein uria
radiograph: enlarged liver, full bladder

which endocrine condition is top ddx?

A

hyperadrenocorticism/ cushings

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8
Q

What are 2 good diagnostic test for cushings?

A

low dose dexmethasone suppression test (normally should suppress cortisol production)

AcTH stimulation test ( should produce cortisol in response)

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9
Q

how would the following cushing causing tumours present on AcTH stimulation test

a) pituitary tumour
b) adrenal tumour

normal dog

A

pituitary tumour> already producing loads of acth> HUGE AMOUNTS OF CORTISOL

adrenal tumour> varying cortisol. less reliable, as adrenal gland doesnt respond to AcTH stimulation.

normal: increased cortisol production then levels off

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10
Q

fill in the blanks

hypothalamus> ? anterior pituitary> ? adrenal gland> cortisol

A

hypothalamus> CRH anterior pituitary> AcTH adrenal gland> cortisol

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11
Q

how would a pituitary vs adrenal tumour vs normal dog respond to low dose dexamethasone test

A

pituitary tumour > suppresses levels then starts to creep back up
adrenal> no suppression whatsoever
normal> suppresses cortisol levels (-ve feedback)

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12
Q

how is a cortisol: creatine ratio used to diagnose cushings

A

useful to rule it out

low cortisol to creatine is v unlikely to be cushings

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13
Q

Which drugs are used in the tx of cushings?

A

trilostane: decreases production of cortisol
mitotane
pergolide: inhibits pituitary gland

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14
Q

when is surgery indicated in cushings treatment?

A

large adrenal tumours, not near caudal vena cava can eb removed
specialist: pituitary tumours can be removed

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15
Q

Why would you not treat a scottish terrier hepatopathy with trilostane?

A

they have abnormal cortisol, does not need suppressing, need correct cortisol

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16
Q

What is a phaeochromacytoma

A

tumour of adrenal medulla > increased catecholamines

cx: anxiety, tachycardia, tachyonoea, vomiting, diarrhoea, weight loss and hypertension

seen on radiography/ US, metanephrines (breakdown of catecholamines) in urine/ plasma

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17
Q

What is addisons disease

A

hypoadrenocorticism

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18
Q

what is the aetiology of addisons disease

A

autoimmune/ genetic > destruction of adrenal cortex> low cortisol

primary hypoadrenocorticism

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19
Q

what is a secondary cause of hypoadrenocorticism (ie not addisons causing it)

A

trauma/ injury> low AcTH production from pituitary> atrophy of adrenal cortex

can also get iatrogenic from sudden withdrawal from glucocorticoid drugs

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20
Q

reduced production of which substance is asc with addisons?

A

cortisol

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21
Q

dog
variety of clinical signs, waxing and waning malaise, vomiting +/- blood, diarrhoea +/- melena, lethargy + weakness, PUPD, abdominal pain, hypovolaemic collapse

top endocrine ddx?

A

Addisons- hypoadrenocorticism

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22
Q

what other ddx may you consider along side addisons?

A 
GI disease
renal failure
parasitic infection
urinary obstruction
chronic effusion 
pregnancy 
CHF
diabetes mellitus
chronic blood loss
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23
Q

which breeds/ sp most likely to get addisons disease?

A

uncommon but middle aged females
poodle, beardies, gt dane, portugese water dog, WHWT, st b,

particularly nova scotia duck- tolling retriever

affects siblings- family history

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24
Q

dog 8 years
bloods: mild non regen anaemia, mild hypercalcaemia, abnormal electrolytes- high K+
which endocrine disease is top ddx?

A

addisons

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25
Q

what endocrine test (s) would you do to diagnose addisons?

A

cortisol: creatine ration/ cortisol levels in blood
if normal then NOT addisons
if low then could be addisons
> further AcTH stimulation test> addisons dog would not respond to this as cant make cortisol

26
Q

How would you treat addisons

A

fluid therapy shock rates 0.9% NaCl initially
- hyperkalaemia: dextrose saline+insulin, calcium gluconate. K+ should rebalance once fluid therapy established anyway

dexamethasone sodium phosphate

once eating again can swap to oral prednisolone and fludrocortisone

life long therapy
monitor/ adjust tx

27
Q

the following are chronic complications of which endocrine disease?
ketoacidosis (due to increased fat mobilisation)
infections
lens induced uveitis
diabetic neuropathy
cataracts
diabetic retinopathy

A

diabetes mellitus

28
Q

what is the cause of diabetes mellitus in

  • dogs
  • cats
A

dogs: infection/ pancreatitis/ immune mediated/ hormona;/ drug antagonism–> loss of islet cells–> loss of insulin
cats: insulin resistance +/- deficiency, endocrinopathy, hyperlipaemia

29
Q

dog, obese
PUPD
polyphagia
weight loss
bloods: hyperglycaemia, high ALT, ALKP, hypertrigycidemia, urinary ketones
urinalysis: low USG, glycosuria, ketonuria, active sediment
which endocrine disease is top ddx

A

diabetes mellitus

30
Q

What does the following treat?

feed half ration, administer caninsulin, twice a day + consistent diet and exercise

A

diabetes mellitus in dog

31
Q

when would you use oral glipizide (sulfonylureas)

(rather that twice daily injection of caninsulin or prozinc (synthetic insulin) )

to treat diabetes mellitus in cat?

A

if the owner can not inject the cat themselves only. injection much preferred.

32
Q

what are signs of an insulin overdose

A

ataxia
collapse
seizure

33
Q

what is a glucose curve used for?

A

glucose curve = serial measurements of blood glucose during the duration of action of insulin.

1) inject insulin (twice daily)
2) skin prick every 2 hours - cat ear, dog lip/ear
3) measure blood glucose

34
Q

what should the following be on a normal glucose curve
- nadir

what is the
- duration of action of insulin

A

nadir= lowest point on curve, should be 4.5-9

duration= time from injection past nadir back to 14mM OR time from injection past nadir back to 7-% of basal level

35
Q

when doing a glucose curve, if the glucose has not returned to 14mM what should you do?

A

feed and monitor till reaches 14

36
Q

what should you do if insulin doesnt lower the blood glucose levels, and the patients insulin dose is currently:

a) <2IU/kg
b) >2IU/kg

A

<2IU/kg increase insulin dose

>2IU/kg, indicates insulin resistance

37
Q

a) if nadir is <4mmol on the glucose curve, what should you do?
b) if nadir is 8-9 mmol on the glucose curve, what should you do?

A

a) decrease dose - too much glucose being taken in out of blood
b) increase dose - not enough glucose being taken in

38
Q

which endocrine disease presents:

weakness, ataxia, seizures

bloods: persistant hypoglycaemia,
when fasted, insulin levels did not lower
US may have pancreatic mass?

A

insulinoma

39
Q

fill in the blanks

hypothalamus> ? > anterior pituitary> ? > thyroid glands> T3, T4 and calcitronin

A

hypothalamus> TRH > anterior pituitary> TSH > thyroid glands> T3, T4 and calcitronin

TRH= thyroid releaseing hormone 
TSH= thyroid stimulating hormone
40
Q

give 2 causes of hypothyroidism in dogs

A

congenital from iodine deficiency in mum/ v young:
thyroid hypoplasia, aplasia, dyshormonogenesis

acquired from drugs sulphonamides, prednisolone, thyroiditis, idiopathic atrophy, thyroid neoplasia

41
Q

where does the primary lesion lie in hypothyroidism in dogs

secondary lesions? tertiary ?

A 
1= thyroid
2= pituitary 
3= hypothalamis
42
Q

which endocrinopathy is commonly seen in
middle age- old dogs, english cocker spaniels,golden retrievers, dobermans,
dogs which train extensively

A

hypothyroidism

43
Q

what causes the pathology in hypothyroidism

A

deficiency of T3 and T4

44
Q

dog
lethargy, obesity+ weight gain, exercise and cold intolerance, hair thinning + dry coat of poor quality - pyoderma.
bloods: hyperlipidaemia (>atherosclerosis),
US: GB mucocoele

A

hypothyroidism

45
Q

which endocrinopathy causes disproportionate dwarfism

A

pituitary dwarfism- hypothyroidism

46
Q

which blood test is best to diagnose hypothyroidism?

A

low free T4

+ high TSH indicates primary hypothyroidism

47
Q

what does TgAA in blood mean

A

Thyroid globulin antibodies> indication of thyroiditits

48
Q

how to treat hypothyroidism

A

Levothyroxine (t4) for life

tablets= thyforon
solution= leventa
49
Q

what is the most common cause of hypothyroidism in cats

still v rare in cats

A

iatrogenic- overdose of antithyroid medication etc

50
Q

what endocrinopathy is this
12 year old cat
palpable thyroid glands- both lobes
weight loss, PUPD, hyperactivity, GI signs, tachycardia, heart murmur, hypertension, skin and hair changes

sometimes presents in apethetic form: anorexia, depression, lethargy

A

hyperthyroidism

51
Q

which blood test and dynamic test can be used to diagnose hyperthyroidism

A

blood: total t4- high

t3 suppression test

  • take basal t3/4
  • give t3orally every 8 hours for 7 doses
  • measure t4 (and t3 to ensure tablets being taken)
  • normal cat should reduce its t3 and t4
  • hyperthyroid cat will keep producing loads t3 and t4
52
Q

bloods: increased heinz bodies, increased platelet size, mild to mod erythrocytosis and macrocytosis, leukocytosis, increased ALP, ALT, AST, LDH, hypokalaemia and hyperphosphataemia

which endocrinopathy?

A

hyperthyroidism

53
Q

how to treat hyperthyroidism?

A

medical:

thiamazole (methimazole) - most commonly used
carbimazole

radioactive iodine> taken in by hyperfunctioning thyroid tissue is tx of choice
thyroidectomy also poss but risk

54
Q

how many pairs of parathyroid glands are there

A

2 pairs (external and internal)

55
Q

where are the adrenal glands located

A

left: adjacent to aorta, medial to cranial of left kidney
right: adhered to caudal vena cava, medial to cranial of left kidney

56
Q

5 ddx PUPD

A 
diabetes insipidus 
osmotic diuresis
iatrogenic eg glucocorticoids
renal medullary washout
primary polydipsia
57
Q

very dilute urine, PUPD, trauma in posterior pituitary

which endocrinopathy?

A

diabetes insupidus- ADH deficiency, cant concentrate urine

treat with hypophysectomy

58
Q

insulin resistant DM, excessive growth of extremeties, prognathism, wide interdental space, elevated IGF1, liver enzymes

in bitch treated with OVH
queen hypophysectomy, radiation

A

acromegaly= excessive growth hormone due to

cats: pituitary tumour
bitch: comes from mammary tissue in luteal phase

59
Q

hypercalcaemia, PUPD, dehydration, dystrophic clacification, renal dmaage, fibrous osteodystrophy

bloods: high total calcium and iCa
mass in thyroid area

A

primary: hyperparathyroidism due to parathyroid tumour
secondary: imbalanced diet

pseudohyperparathyroidism= tumour secreting PTH-rp

60
Q

hypoparathyroidism sees which signs

A

hypocalcaemia: anxiety, muscle spasm, tetant, weakness, ataxia, seisures, tachycardia

Small Animal Year 4 (6 decks)

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