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Equine Med and Surgery II > Lecture 13: Approach to Endocrine Disease > Flashcards

Lecture 13: Approach to Endocrine Disease Flashcards

1
Q

Why can diagnosing endocrine diseases be challenging (especially Cushing)

A

seasonal changes in hormones affect test interpretation

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2
Q

where does PPID affect in body

A

pars intermedia

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3
Q

PPID is the result of loss of __of the pars intermedia a

A

dopaminergic inhibition

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4
Q

how does dopamingeric inhibition work in healthy horse pars intermedia

A

dopaminergic neurons inhibit the pars intermedia and therefore limit release of ACTH and related peptides

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5
Q

Describe what happens when you lose dopaminergic inhibition in PPID and what causes it

A

pars intermedia hyperplasia/adenoma—> loss of dopaminergic inhibition -> increased release of aCTH and related peptides

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6
Q

what products are released from pars intermedia

A

POMC—> ACTH and B-endorphin

ACTH—> a-MSH and CLIP

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7
Q

what cleaves ACTH to a-MSH and CLIP in normal horses

A

prohormone convertase 2 (PC2)

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8
Q

is PPID a condition of older or younger horses

A

older

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9
Q

what are some clinical signs of PPID

A
  1. Hirsutism
  2. Muscle wasting/weight los
  3. PU/PD
  4. Hyperhydrosis
  5. Immunosupression
  6. Behavior changes
  7. Infertility
  8. Blindness
  9. Regional adiposity and insulin resistance
  10. Inappropriate lactation
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10
Q

what early/subtle clinical findings is highly suggestive of PPID

A

regional hypertrichosis/delayed shedding

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11
Q

what is an advanced sign strongly suggestive of PPID

A

generalized hyerptrichosis

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12
Q

what is the protocol for testing for PPID with few, mild or early clinical signs in younger horse

A
  1. TRH stimulation test and assess insulin status
  2. Results in interpretative zone of PPID unlikely zone—> recheck 3-6 months
  3. Results supportive of PPID—> start pergolide
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13
Q

What is protocol for testing for PPID when there are many, severe, more advanced clinical signs, older horse

A
  1. Baseline ACTH test and assess insulin status
  2. Results unlikely zone—> TRH stimulation test—> if supportive of PPID start pergolide or if unlikely zone recheck in 3-6 months
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14
Q

what test is recommended for early PPID

A

TRH stimulation test with ACTH measured

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15
Q

what test is recommended for advanced PPID

A

basal ACTH concentration

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16
Q

a Dexamethasone suppression test can be used to dx PPID, but why is it risky

A

increase risk of laminitis

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17
Q

what tests are not appropriate to dx PPID

A
  1. ACTH stim test
  2. Baseline cortisol
  3. Diurnal cortisol rhythm
  4. TRH stim with cortisol measured
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18
Q

what is procedure for doing baseline ACTH test

A
  1. Collect in EDTA (purple top) tube
  2. Keep on ice
  3. Centrifuge
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19
Q

what is procedure for TRH stimulation test

A
  1. Keep horses off grain
  2. Give TRH IV
  3. Collect in EDTA (purple top) tube at 0 minutes and 1-0 minutes
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20
Q

currently there is no normal TRH stimulation result between what months, but a __ test is likely valid

A

july and December, negative

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21
Q

what is MOA of pergolide/prascend

A

dopamine receptor agonist- restores inhibition of melanocytes

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22
Q

do not exceed what dose of pergolide

A

0.01mg/kg

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23
Q

t or f: pergolide cures PPID

A

false- manages disease

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24
Q

what other drug can be added as adjunct to pergolide to tx PPID and what is MOA

A

cyproheptadine- serotonin antagonist, antihistamine activity, anticholinergic

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25
Q

what comorbidities do you want to test for in PPID patient

A
  1. BCS
  2. FEC
  3. Baseline lateral films- laminitis
  4. Baseline bloodwork
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26
Q

what lab findings besides increase ACTH are often found in PPID patients

A

lymphopenia/neutrophilia, hyperglycemia, hyperinsulinemia, hypertriglyceridemia, hypophosphatemia, high fecal egg count

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27
Q

what are the most characterizing clinical signs of equine metabolic syndrome

A
  1. general or regional adiposity
  2. Insulin resistance- hyperinsulinemia
  3. Predisposed to laminitis
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28
Q

based on the appearance of this horse- what endocrine disease is more likely- PPID or EMS

A

EMS- crust neck, fat pads
Normal hair coat so unlikely PPID

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29
Q

what horses have genetic predisposition to EMS

A

Pony breeds, andalusians, Morgans, minis, warm bloods

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30
Q

what is the algorithm to diagnose EMS

A
  1. Test for insulin dysregulation and PPID
  2. Negative- manage obesity or PPID
  3. Positive and obese ID—> limit calories, low carb diet—> normalize insulin recheck 6 months, but if remains ID—> pharmacological intervention
  4. Positive and non-obese ID—> maintain body condition- lower carb, high fat diet—> normalize ID check q6 months or remains ID—> pharmacological intervention
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31
Q

what tests can be done to dx EMS

A
  1. Resting insulin concentrations
  2. Dynamic insulin testing
  3. Leptin
  4. Triglycerides
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32
Q

when doing resting insulin concentrations for EMS horses can’t have grain within __hrs

A

4hrs

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33
Q

what resting insulin concentration is diagnostic

A

> 50uU/L

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34
Q

how do you do dynamic insulin testing for EMS

A

oral sugar test with corn syrup, measure insulin and glucose, >45uU/L diagnostic

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35
Q

leptin is produced by __ cells

A

adipose cells

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36
Q

T or f: high leptin alone can indicate insulin resistance

A

false

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37
Q

PPID or EMS: normal leptin and insulin resistance

A

PPID

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38
Q

PPID or EMS: high leptin and insulin resistance

A

EMS

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39
Q

t or f: thyro-L is an appropriate tx for EMS

A

false- can be appropriate if unable to exercise b/c of laminitis

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40
Q

what is first line treatment for EMS

A

dietary modification and exercise

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41
Q

Case ex: 19yr Tennessee Walking Horse, mare. Walking on eggshells T=100.9, P=48, R-16, BCS: 4/9. What is gait indicative of

A

laminitis

42
Q

what dietary modifications should be made in EMS or PPID to address insulin resistance

A

reduce starch, grass hay

43
Q

what is anhydrosis

A

lose ability to sweat

44
Q

what are some possible causes of anhidrosis

A
  1. Down regulation of B2 adrenergic receptors
  2. Decreased stimulation of receptors
  3. Aquaporin-5 water channel dysregulation
45
Q

what are the equine sweat glands and what are each important for

A
  1. Humoral- B2 adrenergic secreted from adrenal medulla, more important in exercise
  2. Nervous- autonomic adrenergic nerves, most consistently important
46
Q

how can you test anhidrosis

A

terbutaline test

47
Q

did a terbutaline test on 3 horses for anhidrosis- what horse is normal, partial sweater and and anhidrotic horse

A
  1. Normal
  2. Partial sweater
  3. Anhidrotic horse
48
Q

how do you manage anhidrosis

A
  1. Move horse to drier climate
  2. Diet/electrolytes (potassium)
  3. A/C supplement (L-tyrosine, ascorbic acid, niacin, cobalt)
49
Q

how does L-tyrosine work to manage anhidrosis

A

precursor of dopamine/catecholamines may help desensitize B-2 receptors

50
Q

what triggers hyperlipidemia/hyperlipemia

A

negative energy balance—>fat stores mobilized

51
Q

what is triglyceride range for hyperlipidemia

A

54-500mg/dl

52
Q

what is triglyceride range for hyperlipemia

A

triglycerides >500mg/dl

53
Q

what breeds are predisposed to hyperlipidemia/hyperlipemia

A

minis, pony breeds, donkeys

54
Q

hyperlipidemia/hyperlipemia is a condition characterized by atypical __

A

VLDLs

55
Q

horses with hyperlipidemia/ hyperlipemia have a apolipoprotein __ instead of __

A

apoB-48, apoB-100

56
Q

what is a major consequence of hyperlipidemia/ hyperlipemia

A

hepatic lipidosis

57
Q

how can you prevent hyperlipidemia/ hyperlipemia

A

monitor triglycerides in high risk patients, appropriate nutrition

58
Q

what is tx for hyperlipidemia/ hyperlipemia

A
  1. Enteral feeding with NG tube, small frequent feedings, IV dextrose
  2. Parenteral nutrition- dextrose and amino acids
  3. Monitor glucose frequently
59
Q

do not use __ in parenteral nutrition formula

A

lipid fraction

60
Q

pheochromocytoma is neoplasia of __

A

adrenal gland

61
Q

how do horses with pheochromocytoma typically present

A

hemoabdomen

62
Q

what are some signs of pheochromocytoma

A
  1. Increased catecholamines
  2. Tachycardia
  3. Weight loss
63
Q

how do you dx pheochromocytoma

A

Urinary catecholamines

64
Q

Inappropriate lactation is most often secondary to __

A

PPID

65
Q

__ in forage can cause inappropriate lactation

A

phytoestrogens

66
Q

how do you tx inappropriate lactation

A
  1. Pergolide
  2. Dietary modification- grass hay, no grain
67
Q

what are some differentials for increase Ca2+ in horses

A
  1. Chronic renal failure
  2. Neoplasia- lymphoma—> increase PTHrP
  3. Vitamin D toxicity
  4. Primary hyperparathyroidism
68
Q

how do you know if increase ca2+ is related to chronic renal failure

A

Issues with creatinine

69
Q

if you have increase Ca2+ in horse and thickened colon wall on ultrasound what is presumptive dx

A

lymphoma

70
Q

what are some differentials for decreased Ca2+

A
  1. Blister beetle toxicosis
  2. Exercise induced exhaustion
  3. Sepsis
  4. Lactation
  5. Acute renal failure
  6. Primary hypoparathyroidism
71
Q

what other sign besides decreased Ca2+ in blister beetle toxicosis is supportive

A

urine positive for cantharidin

72
Q

what other bloodwork sign besides decreased Ca2+ supports acute renal failure

A

Mg2+ low

73
Q

if you have a horses with recent history of weight loss. What questions do you need to ask

A
  1. Is horse eating and losing weight vs loss of appetite
  2. Determine muscle wasting vs weight loss vs both
74
Q

Case: 18yr old horse presents with recent hx of weight loss, bloodwork shows hypercalcemia- what is likely dx

A

neoplasia- increase PTHrp

75
Q

case ex: 6yr Arabian competed in 50 mile endurance race in Oklahoma yesterday. Colicky signs early this morning. Bloodwork shows hypocalcemia- what is likely dx

A

canthardin- blister beetle toxicosis

76
Q

if you have a male jack donkey breed with female mare what offspring do you get

A

mule

77
Q

if you bred a stallion horse with Jenny donkey what do you get

A

hinny

78
Q

what is normal TPR for donkeys

A

T= 98.8 (97.2-100.0)
P= 44 (36-68)
R 12-20; 13-31

79
Q

t or f: donkeys are more prone to obesity than horses

A

true

80
Q

t or f: crest fat may be insignificant

A

true

81
Q

In Obese donkeys what do you need to be cautious about with IM vaccines/drugs

A

avoid IF injections

82
Q

describe the hoof anatomy of donkeys/mules

A

“U” shaped foot, more upright wall, thicker sole and walls, P3 not aligned with dorsal wall

83
Q

t or f: elevate heel in laminitis donkeys

A

false

84
Q

what is a significant hematology finding in donkeys/mules vs horses

A

signifiant dehydration (12-15%) may occur before PCV increases

85
Q

what is the serum color in donkeys/mules compared to horses

A

lighter than horses (horses more icteric)

86
Q

t or f: creatinine, total bilirubin higher in donkeys/mules

A

false- lower

87
Q

t or f: creatinine kinase, GGT, and alkaline phosphate higher in donkeys

A

true

88
Q

T or f: insulin is lower in donkeys/mules and ACTH is higher

A

true

89
Q

what dx should be on your differential list with any sick donkey

A

hyperlipemia

90
Q

what can cause hyperlipemia

A

decrease feed intake for any reason, increase feed requirement

91
Q

sick donkey presents- pull blood and this is what serum looks like- what is wrong

A

Hyperlipemia

92
Q

what is triglyceride value for hyperlipemia in donkeys. What normal

A

> 500mg/dl (normal <200mg/dl)

93
Q

what is prognosis for hypothermia in donkeys

A

poor prognosis, 80% mortality

94
Q

what Is potentially involved in hypothermia in donkeys

A

thyroid

95
Q

what are common locations for colic in donkeys

A

pelvic flexure, cecum

96
Q

parasitism in donkeys can result in ___

A

rectal prolapse

97
Q

how does excretion of flunixin meglumine, phenylbutazone, and trimethoprim sulfamethoxazole differ in donkeys vs horses/mules

A

cleared much faster

98
Q

donkeys and mules require __dose of alpha 2 agonists

A

higher

99
Q

t or f: donkeys are more sensitive to guiafenesin

A

true

100
Q

t or f: ketamine is cleared more slowly in donkeys

A

false

101
Q

what is answer and what is likely cause of 2/6 heart murmur in this horse

A

C. Endogenous ACTH and FEC
2/6 HM- aortic regurgitation

102
Q

what answer

A

C. Serum triglycerides

Equine Med and Surgery II (15 decks)

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