Exam 1 - Endocrine Flashcards by AE G

common signs of diabetes mellitus

different signs in dogs vs cats

weight loss
polyphagia
PUPD
cataracts (dogs)
frosty paws/plantigrade stance/neuropathies (cats)
recurrent infections
hepatomegaly

How well did you know this?

Not at all

Perfectly

clinicopathologic findings of diabetes mellitus

hyperglycemia
glucosuria
elevated cholesterol
elevated liver enzymes
min concentrated urine

How well did you know this?

Not at all

Perfectly

dogs get what type of DM?
cats?

dogs type I
cats type II

How well did you know this?

Not at all

Perfectly

can cats get type I DM?

yes - with chronic insulinemia
beta cells produce amylin > amyloid > destroys beta cells = no more production of insulin (NOT immune mediated)

How well did you know this?

Not at all

Perfectly

recommended dietary components for glycemic control in dogs and cats

dogs - complex carbs + exercise
cats - protein, low carbs

How well did you know this?

Not at all

Perfectly

dog insulin recommendation

vetsulin/lente or NPH given SQ twice daily
intermediate-acting

How well did you know this?

Not at all

Perfectly

cat insulin recommendation

PZI or glargine given SQ twice daily
long-acting

How well did you know this?

Not at all

Perfectly

insulin recommendation for DKA patient

regular insulin once a day given IM or CRI
short-acting

How well did you know this?

Not at all

Perfectly

what should be monitored in a diabetic patient

clinical signs - watch for decrease PUPD, decrease appetite, weight loss stabilization, weight gain if thin

How well did you know this?

Not at all

Perfectly

lab results to monitor in diabetic patients

urine dipstick - glucose and ketones
spot glucose reading
+/- fructosamine

How well did you know this?

Not at all

Perfectly

what lab data should you acquire if DM is poorly regulated

minimum database (CBC, biochem, UA)
glucose curve

How well did you know this?

Not at all

Perfectly

insulin dose in dogs & cats
when do you worry about insulin resistance

dogs 0.25-1.25 units/kg/dose
cats 1-5 units/dose

IR in dogs > 1.5 units/kg/dose
IR in cats > 5 units/dose

How well did you know this?

Not at all

Perfectly

DKA clinical signs

lethargy, anorexia, vomiting, dehydration, shock
history of weight loss, polyphagia, PUPD

How well did you know this?

Not at all

Perfectly

DKA clinpath abnormalities

hyperglycemia
azotemic (pre-renal)
acidosis
increased liver enzymes
hypoNa/Cl
hyperkalemia
glucosuria & ketonuria

How well did you know this?

Not at all

Perfectly

initial diagnostics for DKA patient

venous blood gas
urine dipstick

How well did you know this?

Not at all

Perfectly

recommended therapy for DKA patient

1 fluids & electrolytes to correct acidosis

insulin + glucose
identify triggers (counter-reg hormones)

How well did you know this?

Not at all

Perfectly

why monitor P & K in a DKA patient

after treatment - intracellular shift
hypokalemia - muscle weakness (e.g. cervical ventroflexion)
hypophosphatemia - hemolysis/anemia

How well did you know this?

Not at all

Perfectly

precursor for all adrenal product

cholesterol

How well did you know this?

Not at all

Perfectly

what enzyme converts cholesterol/11-deoxycorticosterone → aldosterone

aldosterone synthase

How well did you know this?

Not at all

Perfectly

what enzyme converts cholesterol/11-deoxycorticosterone → cortisol, DHEA, androstenedione

17𝛼-hydroxylase

How well did you know this?

Not at all

Perfectly

clinical signs of Cushing’s disease

(primarily dogs)

PUPD
polyphagia
weight gain
muscle wasting or redistribution to abdomen “pot belly” & nape of neck
hypertension
immunosuppression/infections
alopecia/calcinosis cutis
stress leukogram (increased neut/mono, decrease lymp/eos)
hepatomegaly w/ increased ALP, cholesterol & glucose
low USG
bacteriuria w/o pyuria

How well did you know this?

Not at all

Perfectly

what screening tests can you do for Cushing’s

urine-cortisol:creatinine ratio to rule out
ACTH stim (only test for iatrogenic)
LDDST

How well did you know this?

Not at all

Perfectly

what discriminatory tests can you do for Cushing’s

LDDST
HDDST
endogenous ACTH
imaging - US, CT, MRI

treatment for PDH Cushing’s

trilostane
stereotactic radiosurgery (SRS)

treatment for ADH Cushing's

trilostane adrenalectomy

clinical signs of Addison's disease

usually young-middle aged female w immune-mediated disease waxing/waning illness lethargy & anorexia/weight loss vomiting bloody diarrhea regurgitation w/ megaesophagus hypotension lack of stress leukogram anemia due to chronic disease PUPD shock increased ALT decreased cholesterol, glucosem albumin increased K, Ca, P, BUN, Cr & decreased NaCl and bicarbonate if aldosterone affected low USG

typical vs atypical Addison's disease

typical - cortisol & aldosterone low (thus will have kidney signs - PUPD, azotemia, hyperkalemia, acidosis, low USG) atypical - cortisol low only (vomit, diarrhea, painful abd)

Ddx for typical addison's

acute kidney injury

Ddx for atypical Addison's

GI foreign body pancreatitis acute hemorrhagic diarrhea syndrome (AHDS)

what Na:K ratio rules in Addison's disease

< 21:1

what test can rule out Addison's disease

baseline cortisol > 2 = no addison's

how can you recognize an Addisonian EKG

no P wave wide QRS complex spiked T wave

how to treat Addison's disease esp the hyperkalemia

#1 fluids replace glucocorticoids w/ Dexamethasone correct hyperkalemia with fluids, insulin + glucose, calcium gluconate, or bicarb (allows for K+ intracellular shift)

therapy treatment for Addison's disease, what glucocorticoid? what mineralocorticoids?

glucocorticoid: prednisone mineralocorticoids: DOCP + prednisone Florinef +/- prednisone

clinical signs of hyperthyroidism (cats)

PUPD, weight loss + polyphagia tachycardia +/- murmurs or arrhymias hypertension nervousness, hyperactivity, aggression unkempt haircoat muscle wasting, fat loss tachypnea increased ALT, ALP, glucose, BUN decreased USG

Name the other common diseases that cause PU/PD, polyphagia and weight loss in cats.

diabetes mellitus

Name the common disease that causes PU/PD and weight loss with decreased appetite in cats.

CKD

best test to screen a cat for hyperthyroidism? why? what other tests can you do?

total t4 very specific fT4 or nuclear scintigraphy - technetium [99m-Tc]

treatment for cats with hyperthyroidism

iodine deficient diet methimazole thyroidectomy I-131

mechanism of radioactive I-131 treatment

healthy atrophied thyroid cells do not take up I-131 active cells are destroyed healthy cells remain and will eventually start to produce T4 again in 1-6 months

what do you use to treat hyperthyroidism sequelae such as hypertension/hypertensive retinopathies (hemorrhage or detachment)

Ca2+ channel blocks - amlodipine

clinical signs of hypothyroidism (dogs)

mental dullness decreased reflexes, paresis, cranial n deficits "tragic face" alopecia weight gain w/ normal/decreased appetite non-regenerative anemia hypercholesterolemia NO PUPD or polyphagia

how would you test a dog for hypothyroidism

tT4 (+/- fT4) & eTSH

treatment for hypothyroidism

L-thyroxine twice daily monitor tT4 6-8 weeks post therapy and 4-6 hours post-pill

causes of hypercalcemia

"gosh darn it" granulomatous (fungal) osteolytic (tumor) spurious (lipemia, hemolysis, hemoconcentration, hyperalbuminemia, acidosis, young animal) hyperparathyroidism vitamin D toxicosis addison's disease renal secondary hyperparathyroidism neoplasia idiopathic in cats toxins

clinical signs of hypercalcemia

PUPD weakness listlessness inappetence cardiac arrhythmias calcium oxalate stones +/- UTI

clinical signs of hypocalcemia

muscle fasciculations/tetany pruritus/facial rubbing panting nervousness seizures cardiac arrhythmias

most common differential diagnoses for PUPD

primary polydipsia secondary nephrogenic DI osmotic diuresis

osmotic diuresis ddx for PUPD

diabetes mellitus post-obstructive diuresis CKD fanconi's syndrome

secondary nephrogenic DI ddx for PUPD

hyperadrenocorticism hypoadrenocorticism hyperthyroidism pyometra hypercalcemia

primary polydipsia ddx for PUPD

hyperthyroidism hyperadrenocorticism hepatic disease

what is the cutoff for polydipsia

> 60-80 ml/kg/day

polyphagia with weight loss ddx

food quality, exercise, growing, pregnant hypermetabolism or nutrient loss

weight gain with increased appetite ddx

treats, exercise, new stressor, client communication hyperadrenocorticism insulinoma growth hormone pregnancy drug

weight gain with decreased appetite ddx

hypothyroidism in dogs hypothalamic dz age Female > male castrating breeds treats edema, ascites, intra-abdominal mass, organomegaly

causes of anorexia

brain mouth primary GI secondary GI

counter-regulatory hormones of insulin

epinephrine cortisol progesterone growth hormone glucagon thyroid hormone