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Small Animal Medicine > Endocrinology - Cushings 1 > Flashcards

Endocrinology - Cushings 1 Flashcards

1
Q

What is Cushing’s?

A

Hyperadrenocorticism

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2
Q

What does HAC mean?

A

Hyperadrenocorticism

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3
Q

What does PDH mean?

A

pituitary-dependent hyperadrenocorticism

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4
Q

What does ADH mean?

A

adrenal dependent hyperadrenocorticism

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5
Q

What is an FAT?

A

Functional adrenal tumor

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6
Q

What is LDDST?

A

Low dose dexamethasone suppresion test

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7
Q

What is HDDST?

A

high dose dexamethasone suppression test

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8
Q

What is HPA?

A

hypothalamic-pituitary-adrenal axis

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9
Q

What is the catabolic role of glucocorticoids?

A

Accelerate protein break down and inhibit DNA, RNA, and protein synthesis

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10
Q

What roles do glucocorticoids have in metabolism?

A

Increase gluconeogenesis, increase fatty acid metabolism, stimulate muscle catabolism, prevent muscle and fat uptake of glucose, oppose the actions of insulin, and increase glycogen storacge

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11
Q

How do glucocorticoids act on the CNS?

A

Appetite stimulation

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12
Q

How do glucocorticoids act on the vasculature?

A

maintain normal BP and constrict the vasculature

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13
Q

How do glucocorticoids act on the GI tract?

A

They maintain normal perfusion and motility

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14
Q

How do glucocorticoids act on the inflammatory/immune systems?

A

They keep neutrophils in the blood vessels and inhibit their function, inhibit inflammation, and inhibit wound healing

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15
Q

What renal effects do glucocorticoids have?

A

Inhibit ADH action at the kidney (nephrogenic diabetes insipidus) and PU/PD

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16
Q

What is hyperadrenocorticism?

A

chronic excess of circulating glucocorticoids

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17
Q

What are the ‘3 flavors’ of Cushing’s?

A

Pituitary depended hyperadrenocorticism, functional adrenal tumors, and iatrogenic disease

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18
Q

What causes PDH?

A

A pituitary tumor - microadenomas or macroadenomas

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19
Q

What is another term for functional adrenal tumors?

A

adrenal dependent hyperadrenocorticism

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20
Q

What can cause iatrogenic Cushing’s?

A

exogenous glucocorticoid administration

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21
Q

What is the signalment for Cushing’s?

A

Middle to older aged dogs - poodles, boxers, and dachschunds are overrepresented

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22
Q

What size dog typically gets PDH?

A

Small breed dogs

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23
Q

What are the high risk breeds for ADH?

A

GSD, Daschund and Labrador retriever

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24
Q

What are the common signs associated with Cushing’s?

A

THEY ARE SLOW ONSET - Polydipsia, polyuria, polyphagia, pot-bellied, hair loss, skin infections, panting, muscle weakness, and lethargy

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25
Q

What are the not so common but common signs associated with Cushing’s disease?

A

Various cutaneous changes, myotonia, and CNS signs

26
Q

True or False: Dogs with Cushing’s are not generally sick

27
Q

What conformational changes are associated with Cushing’s?

A

hepatomegaly, abdominal muscle weakness, increased intra-abdominal fat, and muscle atrophy which results in pendulous abdomen

28
Q

What cutaneous changes are associated with Cushing’s?

A

Symmetrical alopecia, comedones, hyperpigmentation, and scaling

29
Q

What signs are associated with pituitary macroadenoma syndrome?

A

Lethargy, listlessness/dullness, aimless wandering, head pressing, behavioral alterations, seizures, circling, and ataxia

30
Q

How do you diagnose Cushing’s?

A

History, PE findings, clinical pathology data, and adrenal function tests

31
Q

What will you find on a CBC in a patient with Cushing’s?

A

Stress leukogram, thrombocytosis, and hemoconcentration

32
Q

There is an acronym to remember what a stress leukogram looks like. It is SMILED. What does it stand for?

A

Segs and Monocytes Increase, Lymphs and Eosinophils Decrease

33
Q

What will you find on a chemistry panel in a patient with Cushing’s?

A

elevated ALP, mild ALT elevation, increases in plasma glucose, hypercholesterolemia, and hypertriglyceridemia

34
Q

What will you find on a UA in patients with Cushing’s?

A

Dilute urine, proteinuria, and potentially a UTI

35
Q

Is thyroid testing a Cushingoid dog reliable?

A

no - hyperadrenocorticism causes euthyroid sick syndrome

36
Q

What will you find on radiographs in Cushing’s patients?

A

Hepatomegaly, good abdominal detail due to fat, pot-bellied appearance, and urinary bladder distension

37
Q

What are some common complications associated with Cushing’s?

A

Hypertension, hypercoagulability (thromboembolism), calcium oxalate urinary stones, and infections

38
Q

What infections can be complications of Cushing’s?

A

UTI, pyoderma, Malassezia, and dermatophytosis

39
Q

How do you test for hyperadrenocorticism?

A

Screening tests to confirm, or localizing tests to determine origin

40
Q

What screening tests can be done to confirm Cushing’s?

A

Urine cortisol-creatine ration, low-dose dexamethasone suppresion test, and ACTH stimulation test

41
Q

True or False: You should test a dog for HAC that is concurrently ill with an acute illness

A

False - you should not because you will get a false positive result

42
Q

Urine cortisol:creatinine test is a reasonable ____ ____ test.

43
Q

If a urine cortisol:creatinine test is normal, how likely is HAC?

44
Q

When is it best to collect a sample for a urine cortisol:creatinine test?

A

collect it at home

45
Q

What is the ACTH stimulation test?

A

Administration of a supraphysiologic dose of ACTH which causes the adrenals to maximally secrete cortisol

46
Q

What does the ACTH stimulation test gauge?

A

The adrenal reserve of corticoids

47
Q

If a dog has PDH, what will the result of the ACTH stimulation test be?

A

an excessive response post administration

48
Q

Dogs with FAT will show _____ responses to ACTH.

49
Q

What are the pros to the ACTH stimulation test?

A

Safe, simple, quick, and specific

50
Q

What are the cons to the ACTH stimulation test?

A

Less sensitive than the LDDST, cannot tell PDH vs. FAT apart, and cost of cosyntropin

51
Q

When is the ACTH stimulation test recommended?

A

In dogs with concurrent non-adrenal illness

52
Q

What is the ACTH stimulation test the preferred diagnostic for?

A

Iatrogenic HAC

53
Q

What does the LDDST test for?

A

decreased HPA axis sensitivity to negative feedback from glucocorticoids

54
Q

True or False: LDDST is the single best test to screen for HAC

55
Q

How is a LDDST done?

A

Measure baseline cortisol, give 0.01 mg/kg dex IV, and then measure cortisol at 4-8 hours post administration

56
Q

How do you interpret the LDDST results?

A

First look at the 8 hour result, then look at the four hour result

57
Q

If your result is greater than 1.4 micrograms/dl at 8 hours, what does that indicate?

A

You have HAC

58
Q

If your result is less than 1.4 micrograms/dl at 8 hours, what does that indicate?

A

You do not have HAC - you are done

59
Q

If there is suppresion of LDDST at 4 hours, what does that indicate?

A

There is PDH

60
Q

If there is no suppression of LDDST at 4 hours, what does that mean?

A

You cannot differentiate between PDH from FAT

61
Q

What are the pros to LDDST?

A

High sensitivity, differentiates PDH from AT in 40% of dogs with HAC, safe, and inexpensive

62
Q

What are the cons to LDDST?

A

Less specific than ACTH stimulation and takes 8 hours

Small Animal Medicine (100 decks)

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