Pathophysiology of the Adrenal Glands

Question 1

what are the glucocorticoid actions?

Answer 1

carbohydrate metabolism
protein metabolism
fat metabolism
effects on inflammation
effects on blood
other effects

Question 2

what do glucocorticoids do with carbohydrate metabolism?

Answer 2

stimulate hepatic gluconeogenesis
decrease rate of peripheral cellular glucose utilization

Question 3

what do glucocorticoids do with protein metabolism?

Answer 3

reduce protein stores: decrease synthesis and catabolic effect

Question 4

what are the anti-inflammatory effects of glucocorticoids?

Answer 4

stabilizes lysosomal enzymes
decreases capillary permeability
decreases phagocytosis by white blood cells
suppresses T lymphocytes
anti-pyretic

Question 5

what is the adrenal cortex divided into?

Answer 5

zona glomerulosa
zona fasciculata
zona reticularis

Question 6

what is the etiology of the majority of dogs with Cushing’s disease?

Answer 6

pituitary-dependent
micro or macroadenoma of the anterior pituitary

Question 7

what percentage of dogs with Cushing’s have an adrenal tumor?

Answer 7

15-20%

Question 8

which dogs are more likely to have adrenal tumors?

Answer 8

larger dogs
65% female

Question 9

what breed is predisposed to both pituitary-dependent Cushing’s and adrenal tumor?

Answer 9

poodles

Question 10

what are the clinical signs of Cushing’s disease?

Answer 10

PU/PD
polyphagia
abdominal enlargement
muscle weakness
lethargy
dermatologic signs

Question 11

what is calcinosis cutis?

Answer 11

dermatologic sign with Cushing’s: mineralized

Question 12

what are the respiratory signs associated with Cushing’s disease?

Answer 12

increased panting: obesity, muscle weakness, dyspnea due to pulmonary thromboembolism, pneumonia (predisposed)

Question 13

what is steroid hepatopathy?

Answer 13

deposition of glycogen in hepatocytes
results in hepatomegaly
vacuolar hepatopathy

Question 14

what are the neurologic signs associated with Cushing’s disease?

Answer 14

mental dullness
disorientation
anorexia
restlessness
aimless pacing
ataxia

Question 15

what are the CBC findings with Cushing’s disease?

Answer 15

leukocytosis
mild erythrocytosis
thrombocytosis

Question 16

what is increased in greater than 85% of dogs with Cushing’s on their chemistry profile?

Answer 16

alkaline phosphatase activity

Question 17

what do most cats with Cushing’s disease have?

Answer 17

diabetes mellitus

Question 18

where does POMC and ACTH come from?

Answer 18

pars intermedia

Question 19

what is the epidemiology of equine hyperadrenocorticism?

Answer 19

older horses and ponies
breed predisposition maybe: ponies, morgans

Question 20

what are the main clinical signs of equine hyperadrenocorticism?

Answer 20

hisutism/hypertrichosis
hyperhidrosis
muscle loss
abnormal fat distribution
chronic laminitis

Question 21

how common is hyperadrenocorticism in ferrets?

Answer 21

very common endocrine disorder

Question 22

what do ferrets produce in excess in hyperadrenocorticism?

Answer 22

estradiol-17beta: most common
17-hydroxyprogesterone
androstenedione
dehydroepiandrosterone sulfate

Question 23

what is thought to be the etiology of hyperadrenocorticism in ferrets?

Answer 23

early spaying a neutering
hereditary
unnatural light cycles

Question 24

what species does not get polydipsia/polyuria with hyperadrenocorticism?

Answer 24

ferrets

Question 25

what are the clinical signs of hyperadrenocorticism in ferrets?

Answer 25

progressive alopecia generalized pruritus thin skin spayed females: enlarged vulva neutered males: aggression, prostatic hyperplasia, dysuria anemia, thrombocytopenia

Question 26

who is hyperaldosteronism seen in?

Answer 26

occasionally in cats rarely in dogs

Question 27

what is hyperaldosteronism due to?

Answer 27

aldosterone-secreting adrenal tumor

Question 28

what are the clinical consequences of hyperaldosteronism?

Answer 28

serum chemistry abnormalities hypokalemic polymyopathy hypertension

Question 29

what are the clinical signs of hyperaldosteronism?

Answer 29

weakness cervical ventrofelxion blindness/retinal detachment

Question 30

what does hypoadrenocorticism typically result from?

Answer 30

destruction of all three layers of the adrenal cortex

Question 31

what is the etiology of hypoadrenocorticism?

Answer 31

idiopathic atrophy immune-mediated destruction iatrogenic generalized infections metastatic neoplasia trauma infarction

Question 32

which breeds have familial hypoadrenocorticism?

Answer 32

standard poodles leonbergers bearded collies nova scotia duck tolling retrievers portuguese water dogs

Question 33

how common is hypoadrenocorticism in cats?

Answer 33

uncommon

Question 34

what are the clinical signs of hypoadrenocorticism?

Answer 34

can be episodic illness glucocorticoid vs mineralocorticoid deficiency gastrointestinal signs acute collapse and shock

Question 35

what are the cbc findings with hypoadrenocorticism?

Answer 35

mild anemia leukogram lack of stress leukogram on a sick patient

Question 36

what are the chemistry findings with hypoadrenocorticism?

Answer 36

hyponatremia and hyperkalemia azotemia hypoglycemia hypercalcemia hypoalbuminemia

Question 37

what are the effects of norepinephrine?

Answer 37

more restricted generalized vasoconstriction pupil dilation decreased gastrointestinal function

Question 38

what is the hallmark physiologic abnormality of pheochromocytoma?

Answer 38

hypertension

Question 39

what are the clinical signs of pheochromocytoma?

Answer 39

generalized weakness, collapse panting, tachypnea lethargy, anorexia tachycardia polyuria/polydipsia profuse sweating/panting anxiety flushing horses: muscle fasciculations, abdominal pain

Question 40

what do clinical signs and physical examination findings come from with pheochromocytoma?

Answer 40

space-occupying nature of tumor metastatic lesions secretion of catecholamines spontaneous hemorrhage

Question 41

what is pheochromocytoma?

Answer 41

tumorof adrenal medulla resulting in excess and episodic production of epinephrine and norepinephrine

Question 42

how are glucocorticoids metabolized?

Answer 42

unbound: renal primarily hepatic

Question 43

what proteins bind glucocorticoids in the blood?

Answer 43

cortisol-binding globulin albumin

Question 44

how do glucocorticoids effect fat metabolism?

Answer 44

promote mobilization of fatty acids enhance fatty acid oxidation decrease glucose transport into cells increase insulin secretion

Question 45

how do glucocorticoids cause hypertension?

Answer 45

increased levels of renin substrate

Question 46

what are the mechanisms of cortisol excess in the dog?

Answer 46

corticotroph adenoma, adenohypophysis adrenal cortical adenoma or carcinoma iatrogenic ectopic ACTH secretion

Question 47

what is the etiology of canine hyperadrenocorticism that is pituitary-dependent (PDH)?

Answer 47

micro or macroadenoma of the anterior pituitary 85-90% of cases

Question 48

how common are adrenal tumors that cause canine hyperadrenocorticism?

Answer 48

15-20% 50% benign or malignant

Question 49

what are the etiologies of dogs with hyperadrenocorticism that are not pituitary dependent?

Answer 49

adrenal tumor iatrogenic sex hormone related

Question 50

who commonly gets canine hyperadrenocorticism due to an adrenal tumor?

Answer 50

median 11.3 years 65% female more common in larger dogs

Question 51

what dog breeds are predisposed to pituitary dependent hyperadrenocorticism?

Answer 51

poodle dachshund terriers beagle german shepherd boxer

Question 52

what dog breeds are predisposed to an adrenal tumor causing hyperadrenocorticism?

Answer 52

poodle german shepherd dachshund labrador retriever terriers

Question 53

what does steroid hepatopathy result in?

Answer 53

hepatomegaly

Question 54

what does SMILED stand for?

Answer 54

for hyperadrenocorticism Segs and Monos Increase Lymphs and Eos Decrease

Question 55

what contributes to the hypercoagulable state in canine hyperadrenocorticism?

Answer 55

thrombocytosis decreased antithrombin increased fibrinogen hypertension

Question 56

how many cats with feline hyperadrenocorticism have concurrent diabetes mellitus?

Answer 56

80%

Question 57

is it more common for cats to have hyperadrenocorticism due to pituitary dependent hyperadrenocorticism or an adrenal tumor?

Answer 57

pituitary dependent 80%

Question 58

what is the pathophysiology of pituitary pars intermedia dysfunction in terms of hormones?

Answer 58

POMC and ACTH come from pars intermedia

Question 59

what are the clinical signs of pituitary pars intermedia dysfunction?

Answer 59

hirsutism/hypertrichosis hyperhidrosis weight and muscle loss normal to increased appetite abnormal fat distribution docile behavior chronic laminitis polydipsia/polyuria chronic infections delayed wound healing

Question 60

what is the pathophysiology of hyperadrenocorticism in ferrets?

Answer 60

excess production of sex steroids by the adrenal half adrenocortical hyperplasia 26% adrenocortical carcinoma 16% adrenocortical adenoma

Question 61

why is early spaying and neutering thought to contribute to hyperadrenocorticism in ferrets?

Answer 61

remove negative feedback of estrogen and testosterone on production of gonadotropin-releasing hormone stimulates follicle stimulating hormone and luteinizing hormone receptors on adrenal gland

Question 62

do ferrets get polydipsia and polyuria with hyperadrenocorticism?

Answer 62

no

Question 63

what are the causes of hyperaldosteronism in cats?

Answer 63

adrenal adenoma carcinoma: unilateral

Question 64

what are the serum chemistry abnormalities associated with hyperaldosteronism?

Answer 64

hypernatremia hypokalemia

Question 65

what is hypoadrenocorticism from loss of?

Answer 65

mineralocorticoids and glucocorticoids

Question 66

what does hyponatremia in hypoadrenocorticism result in?

Answer 66

volume depletion hypotension

Question 67

what does hyperkalemia in hypoadrenocorticism result in?

Answer 67

decreased muscle cell excitability increased refractory period slowed conduction

Question 68

how common is hypoadrenocorticism in cats?

Answer 68

rare

Question 69

what are the gastrointestinal signs associated with hypoadrenocorticism?

Answer 69

vomiting diarrhea anorexia weight loss

Question 70

what is found of physical examination with hypoadrenocorticism?

Answer 70

depression, lethargy generalized muscle weakness bradycardia, weak pulse dehydration hypothermia hyperpigmentation peripheral lymphadenopathy

Question 71

what is on the leukogram with a CBC of a hypoadrenocorticism patient?

Answer 71

eosinophilia lymphocytosis

Question 72

what is the mild anemia like with hypoadrenocorticism?

Answer 72

normocytic, normochromic nonregenerative

Question 73

what ratio of Na:K is consistent with hypoadrenocorticism?

Answer 73

<22:1

Question 74

what is an atypical presentation of hypoadrenocorticism?

Answer 74

clinical signs of glucocorticoid deficiency, but normal serum electrolytes impaired secretion of ACTH adrenocortical deficiency: zona fasciculata more far gone than zona glomerulosa

Question 75

what are the effects of epinephrine?

Answer 75

diverse activity selective vasoconstriction cardiac effects metabolic effects bronchodilation

Question 76

who is pheochromocytoma reported in?

Answer 76

cattle and dogs less frequent in cats and horses