Endocrinopathies Adrenal gland

Question 1

Hypoadrenocorticism

- different types (pathogenesis)

Answer 1

Def: Addisons disease, AC hormones are decreased

Primary (if 90% of AC tissue is lost):

• decreased cortisol and aldestorone, increased ACTH
• Autoimmune destruction of AC (–> atrophy)
• (bilateral adrenal tumor, amyloidosis, infection)
• “atypical”: only decreased cortisol (yet), no problem with aldosterone production

Secondary

• decreased ACTH and cortisol (secondary down regulation), Aldosterone
• unprofessional glucocorticoid therpy
• (hypophysis tumor, trauma, inflammation)

Question 2

Hypoadrenocorticism

- signalment

Answer 2

• rare, but life threatening disease of dogs
• young and middle-aged animals
• more frequent in bitches
• Great dane, rottweiler, poodle, schnauzer, westie, bearded collie, English cocker spaniel (in hungary most common)
• very rare in cats

Question 3

Hypoadrenocorticism

- clinical manifestations

Answer 3

• Decreased aldosterone (most severe form) leads to: dehydration, increased K+, Addisonian-crisis
• Decreased cortisol (milder form) leads to: lethargy and decreased stress response
• periodic improvement and relapse
• stress might cause a crisis (animals are able to deal with stress by increasing cortisol secretion, but patients with adrenal cortes disease are not)
• depression, weakness, tremor, weight loss, hypothermia, anorexia
• vomiting/diarrhea (+/- bloody), abdominal pain, PU/PD
• shock, increased CRT, bradycardia, weak pulse (= Addisonial crisis! normally hypovolemic shock is compensated with tachycardia, so in case of shock + bradycardia always thing of addisonial crisis!)

Question 4

Hypoadrenocorticism

- laboratory and instrumental findings

Answer 4

• normocytic normochronic anemia(dehydration can mask the anemia)
• lack of “stress leukogram”: Neu/Ly <2,3, eosinophilia, lymphocytosis
• hyponatremia, hyperkalemia, hypochloremia (all present simultaneously), Na/K <27 (<22)
• (hypoglycemia), decreased albumin, prerenal azotemia
• ECG: spiked T wave, Q-T distance increased, QRS complex wide, P wave low, P-R distance increased, bradycardia
• X-ray: microcardia, V.cava caudalis decreased
• Abdominal US: “thinner” adrenals

Question 5

Hypoadrenocorticism

- differential diagnosis

Answer 5

• renal failure, gastroenteritis, acute pancreatitis (ileus)

Question 6

Hypercortisolism of Dogs

- def

Answer 6

• cushings syndrome
• increased cortisol
• (hyperaldosteronism is rare)

Question 7

Hypercortisolism of Dogs

- pathogenesis

Answer 7

Pituitary dependent (PDH: 85%)

• spontaneous form, usually due to benign tumor
• Increased ACTH and cortisol
• Hypophysis (A.L) hyperplasia, adenoma

Adrenocortical tumors (ADH: 15%)

• increased Cortison and Decreased ACTH
• peripheral disease
• AC adenoma or carcinoma (usually unilateral)

Iatrogenic form: long-lasting glucocorticoid therapy

• dogs are very sensitive
• Decreased ACTH and cortisol (AC atrophy)
• will happen after 2-3 weeks

Question 8

Hypercortisolism of Dogs

- signalment

Answer 8

• common endocrinopathy
• middle-aged and old dogs
• poodle, dachshund, yorkshire terrier, hungarian vixsla, boxer
• PDH: small dogs
• AC tumors: large dogs

Question 9

Hypercortisolism of Dogs

- clinical manifestations

Answer 9

• Increased Glucocorticoids leads to: increased proteolysis (catabolic consequences, increased GNG and increased lipogenesis
• PU/PD (severe in the first weeks)
• PP, centripetal obesity, abdominal enlargement (pot-belly), muscle wasting
• thin atrophic skin, keratin plugs, alopecia (develops after a while), hyperpigmentation, calcinosis cutis (most severe symptom)
• hepatomegaly (glucocorticoid hepatopathy –> high amount of glycogen storage)
• testicular atrophy, anestrus
• secondary infections (skin, urinary tract, demodex in old dogs)
• (cerebral signs)

Question 10

Hypercortisolism of Dogs

- laboratory and instrumental findings

Answer 10

• leucocytosis, neutrophilia
• increased AP (and SIAP)
• increased cholesterol and blood glucose
• lipemia
• low specific gravity of urine (sometimes also UTI)
• US: enlargement of adrenal glands, metastases (liver, vessels)
• X-ray: hepatomegaly, osteoporosis, calcinosis cuis, lung metastasis
• CT: primary tumor
• Hypertension +/-

Question 11

Hypercortisolism of Cats

- signalment

Answer 11

• rare disease

- middle-aged to old animals

Question 12

Hypercortisolism of Cats

- clinical manifestations

Answer 12

(like the dog, but)

• alopecia, hyperpigmentation, keratin plugs are less pronounced
• the skin is very fragile (full thickness skin defect), unkempt hair coat
• (insulin resistant) diabetes mellitus is common