Endocrinology Flashcards
Is there a noticeable difference in behavior for hypothroid dogs treated with thyroxine?
Yes - after 6 weeks
JVIM 2019
What overall percentagie of hypercortisolism may have concurrent pitutary and adrenal changes?
5% of dogs
10% of dexamethasone resistant dogs
(JVIM 2019)
What are the expected changes on CT and abdominal ultrasound in dogs with actue pancreatitis?
CT angiogram better id’d portal vein thrombosis
Pancreas w/ heterogenous contrast enhancement had longer hospitalziation, more relapse, more likely to have portal vein thrombosis
Heterogenous had increased spec cPL (JVIM 2019)
What is the expected lipid profile in dogs with diabetes mellitus?
Increased cholesterol, triglycerides
HDL, VLDL and LDL all sig higher in DM vs normal
JVIM 2018
What are the significant differences in the feline pancreas between DM and non DM noted on CT?
Pancreas in DM cats is enlarged compared to non-DM
There was a short time to peak portan enhancement
JVIM 2018
Is LDDST considered to be a sensitive test, or a specific test?
Sens: 96.5% vs spec 67%
JVIM 2018
What LDDST pattern has the highest PPV for diagnosing Cushing’s disease?
Lack of suppresion > partial > escape/inverse
JVIM 2018
What are the expected outcomes in blood glucose level after insulin induced hypoglycemia in deabetic cats?
25% had post hypoglycemic hyperglycemia (PHH)
Cats w/ PHH had:
higher daily insulin dose (1 u/kg vs .06 u/kg)
higher serum fructosamine
remission less frequent (10% vs 56%)
larger glycemic variability
JVIM 2018
Is post hypoglycemic hyperglycemia (PHH) replicable in healthy cats, or is it observed in DM cats alone?
PHH was not seen in healthy cats
25% DM cats had this
JVIM 2018
What is the correlation between growth hormone and hypothryoidism?
Basal GH sig higher in hypothyroid than nonthyroidal illness
GH increases after TRH stimulation in hypothyroid but not in NTI
TSH increases after TRH stimulation in an in NTI but not in hypothyroid dogs
JVIM 2018
How do GH and TSH levels respond in hypothyroid patients that have been administered TRH?
GH Increase in hypo t- not in nonthyroidal illness
TSH no change in hypo T, increased in NTI dogs
jvim 2018
Is an enteric coated micro-pelleted formulation of pancreatic enzymes a viable supplement to traditional powdered supplements?
Yes
JVIM 2018
What impact does EPI have on circulating blood levels of lipid soluble vitamins?
retinol and alpha-tocopherol sig lower
sig lower vit D
JVIM 2018
Is a variable dosing I131 protocol a viable treatment option?
Yes - comparable outcome to standard dosing
JVIM 2018
What was the presentation of 7 adult cats with spontaneous hypothyroidism
Routine blood work revealed hypot (total and free), azotemia, lethargy, poor hair coat. All ha high TSH
6/7 had goiter that improved after supplementation with thyroxine
jvim 2018
What is the percentage of cat with acute pancreatitis have abdominal ultrasound changes and what are they?
85% in a study of 157 cats Enalrged 81% hypoechoic 31% hyperechoic 14.8% extra-hepatic bile duct dilation (24%) increased peri-pancreatic echogenicity JVIM 2018
What are some prognostic indicators for survival in cats with acute pancreatitis?
Prolonged time to presentation
lethargy, pleural effusion, hypoglycemia, decreased iCa, azotemia
need for parententeral nutrition, persistent anorexia
These were not sig in multivaria
abx more common in survived cats
jvim 2018
Is low-dse ACTH simulation testing viable for diagnosis of Addison’s?
Yes
1 μg/kg versus before a 5 μg/kg dose of cosyntropin
Jvim 2018
Does administartion of TSH encourage radioiodine uptake?
No.
The goal was to increase uptake to lower needed dose
JVIM 2018
What is the optimal cut off for post stimulation cortisol in diagnosis for Addisons vs cushings?
26 ug/dL is most specific (100% spec and 81% sens)
jvim 2018
Is there a significant difference in survival in treated vs untreated dogs with PDH?
Yes - not reached vs 506 in not treated group
Cause of death in untreated group were more likely to be related to this disease vs dogs that were treated
Dogs treated more likely to die d/t cancer etc….
jvim 2017
What is the clinical relationship between cholestatic disease and PDH in dogs?
Dogs w/ increased GGT, higher cortisol post ACTH stim and serum cholesterol were more likely to have a GBM or cholestasis compared to normal.
Baseline cortisol levels to not correlated w/
Higher dose of trilostane correlated with increased risk for GBM or cholestasis
GBM
JVIM 2017
Does extravasation of cortrosyn affect ACTH stimulation testing results?
No
JVIM 2017
Which dose of cortrosyn is necessary to monitor response to Trilostane therapy?
1 mcg/kg and 5 mcg both allow for accurate interpretation
jvim 2016
What baseline cortisol level is most consistent with a diagnosis of hypoadrenocortisim?
2 mg/dL - sn 99 spec 96%
jvim 2016
What gene in the adrenal glands is responsibel for synthesizing aldosterone and cortisol?
CYP11B
CYP17 is specific to each zone and is responsible for zone specific manufacturing of aldosterone vs cortisol
JVIM 2016
What are the expected outcomes in dogs after transsphenoidal hypophysectomy?
91% of dogs survive
92% undergo remission
MST 781 days - median disease-free interval 951
27% developed recurrence of hypercortisolism - 555 days mean - these dogs had a higher pituitay height/brain ratio and pre-oeprative basal urinary corticoid-to-creatinine ratio
survival time and disease-free interval of dogs with enlarge pituiary based on P/B ratio
JVIM 2016
Is there cinical rational to perform a second ACTH timulation test in patients that have adequate clinical control of Cushing’s disease but low pre and post ACTH stimulations at 3-6 hours
Possibe - ACTH stimulation 9-12 afters after trilostane are sig higher and may support continued use of Trilostane at prescribed doses
JVIM 2015
How should ACTH stimulation testing be interpreted if a depo formulation is used?
For HA - if cortisol is less than 5 ug/dL by 1 hour post, confirms
For HC - wait 3 hhours - peak concentration of cortisol is 2-4 hours.
24 hours ACTH is metabolized
ACIM 2015
What is phosphatidylinositol 3 kinase (PI3K)
A signaling pathway activated in adrenoal carcionmas but not adenomas
JVIM 2015
What mRNA markers are present in adrenal carcinomas?
ERBB2 higher - may be a therapeutic target
Id1 and Id2 increased - may be a prognostic marker - detected in patients w/ recurrence
JVIM 2015
What is atypical Cushing’s disease?
Atypical hyperadrenocorticism (AHAC) is considered when dogs have clinical signs of hypercortisolemia, no evidence of a sex hormone‐secreting adrenal tumor, and HAC screening test results within the normal reference interval. Cortisol levels are higher than normal dog and adrenal gland size is similar to PDH JVIM 2015
What changes to ACTH and cortisol profile are supportive of possible disease recurrence after transsphenoidal hypophysectomy in dogs with corticotroph adenomas?
c. High ACTH post-op, high cortisol post-op, high normalized ACTH post-op, and high normalized cortisol post-op were associated with a shorter disease-free period
No cut off - consider all abnormalities collectively
JVIM 2015
Which of the following is the superior test for diagnosing a pheochromocyoma in dogs? Urine epi Urine norepi Plasma epi Plasma norepi
Urine norepi
Jvim 205
What is the reported epidemiology of HAC in the UK?
Overall prevalence - 0.28% Bichon frise 6.5x more likely Heavier dogs 1.7 X more likely > 12 yrs 5.7 x more likely JSAP 2016
What is the reported signalment and outcome for cats with adrenal neoplasia?
c/s: weakness, resp distess, blindness, GI
biochemical: hypokalemia, alkalemia, elevated CK, azotemia
Hypertension in 40%
76% had functional adrenal - hyperaldosteronism most common
77% survived 2 weeks post-op
Female negatively associated w/ survival post-adrenalectomy
Is baseline cortisol a viable monitoring technique for HAC and trilostane?
No
Baseline >3.2 ug/dL predicted post >/= 2.0 - 22% of animals had a post 2.0-3.2 which may suggest inadequate cortisol reserve
JAVMA 2016
