Endocrinology Flashcards
1
Q
Is there a noticeable difference in behavior for hypothroid dogs treated with thyroxine?
A
Yes - after 6 weeks
JVIM 2019
2
Q
What overall percentagie of hypercortisolism may have concurrent pitutary and adrenal changes?
A
5% of dogs
10% of dexamethasone resistant dogs
(JVIM 2019)
3
Q
What are the expected changes on CT and abdominal ultrasound in dogs with actue pancreatitis?
A
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)
4
Q
What is the expected lipid profile in dogs with diabetes mellitus?
A
Increased cholesterol, triglycerides
HDL, VLDL and LDL all sig higher in DM vs normal
JVIM 2018
5
Q
What are the significant differences in the feline pancreas between DM and non DM noted on CT?
A
Pancreas in DM cats is enlarged compared to non-DM
There was a short time to peak portan enhancement
JVIM 2018
6
Q
Is LDDST considered to be a sensitive test, or a specific test?
A
Sens: 96.5% vs spec 67%
JVIM 2018
7
Q
What LDDST pattern has the highest PPV for diagnosing Cushing’s disease?
A
Lack of suppresion > partial > escape/inverse
JVIM 2018
8
Q
What are the expected outcomes in blood glucose level after insulin induced hypoglycemia in deabetic cats?
A
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
9
Q
Is post hypoglycemic hyperglycemia (PHH) replicable in healthy cats, or is it observed in DM cats alone?
A
PHH was not seen in healthy cats
25% DM cats had this
JVIM 2018
10
Q
What is the correlation between growth hormone and hypothryoidism?
A
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
11
Q
How do GH and TSH levels respond in hypothyroid patients that have been administered TRH?
A
GH Increase in hypo t- not in nonthyroidal illness
TSH no change in hypo T, increased in NTI dogs
jvim 2018
12
Q
Is an enteric coated micro-pelleted formulation of pancreatic enzymes a viable supplement to traditional powdered supplements?
A
Yes
JVIM 2018
13
Q
What impact does EPI have on circulating blood levels of lipid soluble vitamins?
A
retinol and alpha-tocopherol sig lower
sig lower vit D
JVIM 2018
14
Q
Is a variable dosing I131 protocol a viable treatment option?
A
Yes - comparable outcome to standard dosing
JVIM 2018
15
Q
What was the presentation of 7 adult cats with spontaneous hypothyroidism
A
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
16
Q
What is the percentage of cat with acute pancreatitis have abdominal ultrasound changes and what are they?
A
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
17
Q
What are some prognostic indicators for survival in cats with acute pancreatitis?
A
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
18
Q
Is low-dse ACTH simulation testing viable for diagnosis of Addison’s?
A
Yes
1 μg/kg versus before a 5 μg/kg dose of cosyntropin
Jvim 2018
19
Q
Does administartion of TSH encourage radioiodine uptake?
A
No.
The goal was to increase uptake to lower needed dose
JVIM 2018
20
Q
What is the optimal cut off for post stimulation cortisol in diagnosis for Addisons vs cushings?
A
26 ug/dL is most specific (100% spec and 81% sens)
jvim 2018
21
Q
Is there a significant difference in survival in treated vs untreated dogs with PDH?
A
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
22
Q
What is the clinical relationship between cholestatic disease and PDH in dogs?
A
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
23
Q
Does extravasation of cortrosyn affect ACTH stimulation testing results?
A
No
JVIM 2017
24
Q
Which dose of cortrosyn is necessary to monitor response to Trilostane therapy?
A
1 mcg/kg and 5 mcg both allow for accurate interpretation
jvim 2016
25
What baseline cortisol level is most consistent with a diagnosis of hypoadrenocortisim?
2 mg/dL - sn 99 spec 96%
jvim 2016
26
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
27
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
28
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
29
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
30
What is phosphatidylinositol 3 kinase (PI3K)
A signaling pathway activated in adrenoal carcionmas but not adenomas
JVIM 2015
31
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
32
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
```
33
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
34
```
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
35
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
```
36
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
37
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
38
What are the important differences between low dose (2-milicurie) vs standard dose (4-milicurie) treatment for I131
Standard less likely to by euthyroid at 3 and 6 months
Overt hypothyroidism sig higher with standard
Subclinical hypothyroidism sig higher with standard
No diff in % azotemia but sig higher serum creatinine and higher % rise in creatinine for standard vs low dose
JVIM 2017
39
What is the appropriate time frame to wait to measure thyroid function tsting after withdrawal of oral thyroxine?
1 week
| JVIM 2017
40
What are thyroid cysts and what is their clinical relevance?
93% were functional
Most are palpable and large >8cm^3
fluid cytology may not reflect true tumor type: of 19 - 12 noninflammatory, 3 neoplstic, 4 inflammatory
8 removed - 4/8 carcinoma, 4/8 cystadenoma
- bilateral disease more likely to have hypocalcemia and higher mortality rate
60% functional: Treated w/ I-131 hyper T resolved in 92%, 50% cysts resolved
JVIM 2017
41
What breeds, coat coloroe and length are associated with hyperT?
Decreased: Tonkinese, Abyssinian, British Shorthair, Persian, Siamese, Burmese
Increaseed risk: Long hair, non-purebread
coat colore/pattern not associated
JVIM 2017
42
What is the relationship between homocysteine, folic acid and thyroid hormone in hypothyroid dogs?
Increased homocysteine
decreased folic acid
jvim 2017
43
What are general causes for central hypothryoidism and is there a link in miniature schnauzers?
TSH deficiency from pituitary tumor, lymphocytic adenohypophysisits, head trauma, nontraumatic intracranial hemorrhage or hypophysectomy
3/7 had dwarfism and were dx at 7 months to 2 years
No disease-cuasing mutation in TSH gene or TSH-releasing hormone gene in miniature schnauzer
JVIM 2016
44
What is the connection between body weight, BCS and muscle condition in cats with hyperthyroidism?
most hyper tw lose weight but maintain ideal or overweight BCS - only 1/3 underweight
weight loss from muscle loss - >75% of cats
weight gain w/ successful treatment - 50% may not regain normal muscle mass
JVIM 2016
45
In what conditions can betahydroxybutryate concentrations rise other than diabetes mellitus?
hepatic lipidosis > CKD > hyper T
| JVIM 2016
46
What is expected to happen with cobalamin and MMA leels in hyperthyroid cats before and after radioiodine treatment?
13% HT have low B12 but normal MMA - indicates adquate cell stores and o need to supplement
Low B12 normalized w/ euthyroid state
JVIM 2016
47
What % of cats referred for I131 have changes on abdominal ultrasound?
up to 36% - 23% CKD, 2.4% neoplasia
only 2.2% had changes that changed decision to treat
JVIM 2015
48
What is the effect of feeding an iodine restricted diet in cats with spontaneous hyperthyroidism?
Clinical signs resolved in all 8 cats
Decreased total and free t4 by 8-16 weeks
- tt4 normalized in 42% by 60 d, 83% by 180 days - take longer w/ higher tT4
BW doesn't increased, HR doesn't decrease, Creatining decreased JVIM 2015
49
Is there a correlation between thyroid voume on thyroid outcome in cats?
Not volume
increased odds if several numbers of foci are noted.
Effect of thyroid volume on radioiodine therapy outcome in hyperthyroid cats
JFMS 2016
50
What is the impact on hyperthyroid cats with increased disease duration prior to I131 therapy?
a. Prevalence of severe hyperthyroidism, large thyroid tumors, multifocal disease, intrathoracic thyroid masses, and suspected malignant disease all increase with disease duration in cats referred for RIT
(JVIM 2016)
51
What effect has food had on occurance of hyper thyroidism in cats?
No effect from canned food
| JVIM 2016
52
What are the noted changes in plasma lipids in dogs with diabetes mellitus?
Median TB, cholesterol, HDL-C, VLDL, C,LDL, Non HDL-C, ApoB sig higher in DM
(JVIM 2016)
53
What is POMC and what is its association with DM in Labrador Retrievers?
PMC (pro-opiomelanocortin) gene deletion - assocatied w/ food motivation and obesity
No association w/ this and DM in labrador retrievers
(JVIM 2016)
54
What is the epidemilogy of DM in primary care veterinarians in England?
Tonkinese, Norweigian Forest, Burmese - increased
>4 kg, >6 yr old increased odds
not sex
(jvim 2016)
55
What was the signalment of 3 cat sw/ hypersomatotropism w/o DM
o. 16 yo DSH with neurologic signs: pituitary mass, IGF-1 > 700
p. 9 yo DSH with weight gain: IGF-1 >700, pituitary enlargement, histopath of pituitary consistent with plurihormonal adenoma
q. 16 yo DSH with seizures: IGF-1 >700, pituitary enlargement (JVIM 2016)
56
What is the expected pancreatic lipase activity in serum of dogs w/ DKA
73% of dogs w/ DKA had concurrent inflammation - no affect on prognosis
Fair agreemnt bt PLI and abdominal ultrasound
No affect on duration of hospitalization and short-term outcome (JVIM 2016)
57
What are glycemic predictors of diabetic relapse in cats?
Impaired glucose tolerance (most) impaired fasting glucose conentration (minority) (jvim 2015)
58
What is the incidence of DM in insured Swedish cats?
Male cats 2X higher
Burmese, Russian Blue, Norwegian forest cat, Abyssinian
no sex w/ Burmese
JVIM 2015
59
What is the rate and clinical significance of subclinical pancreatitis in cats with DM?
60% when ultrasound, spec cPL and DGGR lipase utilized together
DGGR correalte best with subclinical pancreatitis
Subclinical pancreatitis may develop over time
57% achieved remission of diabetes
Only correlation was w/ cpL
JVIM 2015
60
Is rebound hyperglycemia an point of concern in cats with DM?
No - only 1.5%
| FMS 2016
61
What is the affect of administration fo acarbose on post prandial BG concentrationsin healthy cats fed high carbohidate vs low carbohydrate diet?
Reduces post prandial BG when fed with a high carb diet but no affect with low carb and acarbose.
High carb + acarbose is still higher than low carb
FMS 2016
62
What is the efficacy of PZI administration for mangement of DM in dogs?
Effective
| FJMS 2016
63
Is insulin determir a safe a effective treatment option for cats?
Yes
13/14 achieved diabet control - 4 remission w/in 14 months
FJMS 2016
64
What is the accuract of serum, plasma, and whole blood when measured by POC when compared to an automated biochemical analyzer?
serum or plasma glucose concentrations more strongly correlated w/ serum glucose concentrationcompared to automated
Whole blood less accurate compared to automated
Use plasma or serum when possible
JAVMA 2015
65
Is insulin detemir a viable treatment option fo insulin in dogs?
Significant decrease in BG
Hypoglycmiea in 22% - clinical in 4/10 dogs
nadi at either 4,6, or 8 hr
JAVMA 2015
66
What is the median dosing interval for DOCP?
58 days
duration of action 62 days - not sig different in new vs previous diagnosis
JVIM 2017
67
Do TSH levels differ significantly in Addisonian dogs before and after treatment?
TSH increased in female dogs
No difference in T4 between dogs with Addison's and those w/o
TSH normalized in 2-4 weeks in 9 dogs, 3-4 months in remaining dogs
JVIM 2016
68
How do cortisol-to-ACTH ratio, ACTH levels and baseline cortisol compare in the diagnosis of Addiosn's in dogs?
Low cortisol-to-ACTH ratio > ACTH > basal cortisol
CARR >0.01 sens 100% and spec 99%
JVIM 2015
69
Is hydrcortisone a viable treatment option in patients with acute Addison's disease?
IV hydrocortisone resulted in rapid rseolution of K+ w/in 68% and 100% at 12 and 24 hours
JSAP 2016
70
Does calcitriol impact iCa concentrations when given before or after parathyroidectomy?
a. Prophylactic calcitriol administration was not fond to be significantly associated with postoperative iCa concentrations or its rate of decrease after parathyroidectomy
JVIM 2018
71
Does hypercalcemia before treatment of primary hyperparathyroidism impact hypocalcemia after?
Yes - severity of pre may impact severity of post and warrants post treatment administration of calcitriol +/- calcium supplementaton
JVIM 2017
72
What are the expected results of a caninie patient with hypelipidemia treated with bezafibrate?
91% had resolution of
46 hyperlipidemic - 16 primary, 30 secondary
hyepertriglyceridemia - median 84% decrease in 30 days
Primary had greater decrease
67% had resolution of hypercholesterolemia
ALT sig decreae
Therapy of canine hyperlipidemia with bezafibrate JVIM 2017
73
What are the predicted metabolic and hormonal response to a feed-challenge test in lean and overweight dogs?
Serum leptin concentrations were significantly higher in overweight vs lean dogs
Normal fasting but higher post prandial triglyceride in overweight
Higher fasting cortisol/creatinine ratio was noted in overweight dogs
No sig diff in fasting insulin or glucagon concentration
JVIM 2016
74
What is serum N-terminal type III procollagen propeptide and what is its role in animals with feline hypersomatroptism?
PIIINP is a biomarker of soft tissue proliferation
Higher in hypersomatotropism and secondary DM cats compared to DM cats
Decreased in most cats w/ IGF-1 follow hypophysectomy
Measurement of serum PIIINP concentration may help identify cats with false‐positive or false‐negative IGF‐1 concentrations. Future studies of these clinically challenging groups are warranted
Serum N-terminal type III procollagen propeptide: an indicator of growth hormone excess and response to treatment in feline hypersomatotropismJVIM 2016
75
Are there any noted effects of breed on plasma endothelin-1 concentration, plasma renin activity, or serum cortisol in healthy dogs?
Significant in breed variationsET-1 (67%), coritsol (22%) and renin (19%)
Newfies - highest ET-1
Dachshunds highst renin
Finnish Lapphunds highest cortisol
3) Effect of breed on plasma endothelin-1 concentration, plasma renin activity, and serum cortisol concentration in healthy dogs (JVIM 2016)
76
What is the effective of pasireotide in pats with hypersomatotropism?
Short-acting pasireotide rapidly decreased IGF-1 and increased insulin sensitivity
5 day course of treatment
(2) Pasireotide for the medical management of feline hypersomatotropism JVIM 2015)
77
What is the role of ghrelin in cats with DM and hypersomatotropism?
Ghrelin is suppresed in catss with DM and HSDM
Increased after treament with radiation therapy
May be a marker of treatment effect
3) Evaluation and diagnostic potential of serum ghrelin in feline hypersomatotropism and diabetes mellitus JVIM 2015
78
Is alendronate a viable treatment option in cats with idiopathic hypercalcemia?
Alendronate appears to be a viable treatment option for at least 6 months
JVIM 2015
79
What are some of the expected abdominal ultrasound findings in cats with acromegaly?
Increased kidney length, adrenal gland thickness and pancreatic thickness
Hepatomegaly in up to 63%, bilateral adrenomegaly in up to 50%
80
What are the expected outcomes for dogs treated with percutaneous ultrasound-guided ethanol ablation for presumed functional parathyroid nodules?
```
85% success rate - usually w/in 72 hours
12% required 2nd procedure
25% became hypocalcemic
11% complication rate
89% long term were normocalcemic
```
Outcomes for dogs with primary hyperparathyroidism following treatment with percutaneous ultrasound-guided ethanol ablation of presumed functional parathyroid nodules: 27 cases (2008-2011) JVIM 2015
81
What is the currently known epidemiology of EPI in cats?
a. Median age 7.7 years
b. Median BCS 3/9
c. 77% had hypocobalaminemia, 47% had increased and 5% had decreased serum folate
d. 91% had weight loss, 62% unformed feces, 50% poor hair coat, 45% anorexia, 42% increased appetite, 40% lethargy, 28% water diarrhea, 19% vomiting
e. 58% had concurrent disease (20% GI, 11% pancreatitis)
f. Treatment response: good in 60%, partial in 27%, poor in 13%
g. TLi < 4 ug/L associated w/ a positive response to TX
h. Cobalamin supplementation improved response to TX
JVIM 2016
82
In one study of 60 cats, what was the sens and spec off spec fpL and DGGR for diagnosis of pancreatitis when compared to panceatic histopathology?
Spec FPL (>/= to 5.4 ug/dL) 42 sens 100 spec
DGGR (>26 U/L) 37% sens and 100% spec
neither had good agreement with histopathology
JVIM 2016
83
What is the role of CT in the diagnosis of pancreatisi in dogs?
Id'd as an enlarged homo to heterogenous attenuating and contrast-enhancing pancreas w/ ill-defined borders was I'd
JVIM 2015
84
What is the connection between pancreatitis and platynosumum in cats?
Mild inflammation that is not suspected to be correlated with parasitic infection
Hypocobalaminemia was noted - unclear the connection
JFMS 2017
85
What are the known complications and clinical relavence of pancreatic histopathology?
Post op complications in 25% - probably pancreatitis
4.5% euthanized within 10 days - did not have post op complications
Pancreatic pathology was found in only 44% of pancreatic biopsies with 37% showing benign pancreatic nodular hyperplasia
Pancreatic surgical biopsy in 24 dogs and 19 cats: postoperative complications and clinical relevance of histological findings
JSAP 2015
86
What is the general rate of postoperative complications of pancreatic biopsies?
23%
| Pancreatic abnormalities in 44%
87
What is the the overall safety of ultrasound-guide FNA in the felie pancreas?
No sig difference compared to other organs
Cytologic recovery rate - 67%
Correlation bt FNA and histopathology - 86%
88
Can iCa be used as a prognostic risk factor in the clinical course of pancreatitis in cats?
Hypo noted in 58% at the time of presentation
Mean iCa was higher in cats who died than in survived
iCa < 1 mmol/l = poor prognosis
Serum ionized calcium as a prognostic risk factor in the clinical course of pancreatitis in cats JFMS 2015
89
How does the use of antimullerian hormone and progesteron concentration factor into the diagnosis of ovairan remnant syndrome in dogs?
Most likely to least likely AMH + P4 (88%) > PR alone > AMH alone
No dogs at histo were neg for both prgoesterone and AMH
JAVMA 2019
90
What formula can be used to accurately determine blood glucose levels in either hemoconcentrated or hemodiluted blood samples in cats?
Corrected POCgluc = POCgluc + ([1.17 × PCV] – 50.2) improved glucose readings
JAVMA 2019
JAVMA 2015 POCgluc + ([1.6XPCV]-81.3])
91
What are the noted affects of pasareotide administration on dogs with pituitary depedent hyperadrenocorticism? secondary to macroadenoma?
No change in cloinopathologic, no changes in ACTH stimualation test results
Decreased macroadenoma size in 6 patients and increased in 6
Javma 2018
92
What is the overall correlation of a snap ELISA vs standard for cortisol ?
25% discordance
Analytic performance evaluation of a veterinary-specific ELISA for measurement of serum cortisol concentrations of dogs Javma 2018
93
What neurohomrone has been shown to help differentiate PDH from SARDS dogs?
Urine MT6:creatinine ratio
plasma melatonin and dopamine, serum serotonin were not sig different
Circulating neurohormone imbalances in canine sudden acquired retinal degeneration syndrome and canine pituitary‐dependent hypercortisolism JVIM 2019
