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Endocrine Pathophysiology > Pathophysiology of the Adrenal Glands > Flashcards

Pathophysiology of the Adrenal Glands Flashcards

1
Q

what are the glucocorticoid actions?

A

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

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2
Q

what do glucocorticoids do with carbohydrate metabolism?

A

stimulate hepatic gluconeogenesis
decrease rate of peripheral cellular glucose utilization

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3
Q

what do glucocorticoids do with protein metabolism?

A

reduce protein stores: decrease synthesis and catabolic effect

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4
Q

what are the anti-inflammatory effects of glucocorticoids?

A

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

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5
Q

what is the adrenal cortex divided into?

A

zona glomerulosa
zona fasciculata
zona reticularis

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6
Q

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

A

pituitary-dependent
micro or macroadenoma of the anterior pituitary

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7
Q

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

A

15-20%

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8
Q

which dogs are more likely to have adrenal tumors?

A

larger dogs
65% female

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9
Q

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

A

poodles

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10
Q

what are the clinical signs of Cushing’s disease?

A

PU/PD
polyphagia
abdominal enlargement
muscle weakness
lethargy
dermatologic signs

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11
Q

what is calcinosis cutis?

A

dermatologic sign with Cushing’s: mineralized

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12
Q

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

A

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

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13
Q

what is steroid hepatopathy?

A

deposition of glycogen in hepatocytes
results in hepatomegaly
vacuolar hepatopathy

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14
Q

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

A

mental dullness
disorientation
anorexia
restlessness
aimless pacing
ataxia

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15
Q

what are the CBC findings with Cushing’s disease?

A

leukocytosis
mild erythrocytosis
thrombocytosis

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16
Q

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

A

alkaline phosphatase activity

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17
Q

what do most cats with Cushing’s disease have?

A

diabetes mellitus

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18
Q

where does POMC and ACTH come from?

A

pars intermedia

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19
Q

what is the epidemiology of equine hyperadrenocorticism?

A

older horses and ponies
breed predisposition maybe: ponies, morgans

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20
Q

what are the main clinical signs of equine hyperadrenocorticism?

A

hisutism/hypertrichosis
hyperhidrosis
muscle loss
abnormal fat distribution
chronic laminitis

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21
Q

how common is hyperadrenocorticism in ferrets?

A

very common endocrine disorder

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22
Q

what do ferrets produce in excess in hyperadrenocorticism?

A

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

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23
Q

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

A

early spaying a neutering
hereditary
unnatural light cycles

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24
Q

what species does not get polydipsia/polyuria with hyperadrenocorticism?

A

ferrets

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25
Q

what are the clinical signs of hyperadrenocorticism in ferrets?

A

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

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26
Q

who is hyperaldosteronism seen in?

A

occasionally in cats
rarely in dogs

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27
Q

what is hyperaldosteronism due to?

A

aldosterone-secreting adrenal tumor

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28
Q

what are the clinical consequences of hyperaldosteronism?

A

serum chemistry abnormalities
hypokalemic polymyopathy
hypertension

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29
Q

what are the clinical signs of hyperaldosteronism?

A

weakness
cervical ventrofelxion
blindness/retinal detachment

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30
Q

what does hypoadrenocorticism typically result from?

A

destruction of all three layers of the adrenal cortex

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31
Q

what is the etiology of hypoadrenocorticism?

A

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

32
Q

which breeds have familial hypoadrenocorticism?

A

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

33
Q

how common is hypoadrenocorticism in cats?

A

uncommon

34
Q

what are the clinical signs of hypoadrenocorticism?

A

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

35
Q

what are the cbc findings with hypoadrenocorticism?

A

mild anemia
leukogram
lack of stress leukogram on a sick patient

36
Q

what are the chemistry findings with hypoadrenocorticism?

A

hyponatremia and hyperkalemia
azotemia
hypoglycemia
hypercalcemia
hypoalbuminemia

37
Q

what are the effects of norepinephrine?

A

more restricted
generalized vasoconstriction
pupil dilation
decreased gastrointestinal function

38
Q

what is the hallmark physiologic abnormality of pheochromocytoma?

A

hypertension

39
Q

what are the clinical signs of pheochromocytoma?

A

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

40
Q

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

A

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

41
Q

what is pheochromocytoma?

A

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

42
Q

how are glucocorticoids metabolized?

A

unbound: renal
primarily hepatic

43
Q

what proteins bind glucocorticoids in the blood?

A

cortisol-binding globulin
albumin

44
Q

how do glucocorticoids effect fat metabolism?

A

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

45
Q

how do glucocorticoids cause hypertension?

A

increased levels of renin substrate

46
Q

what are the mechanisms of cortisol excess in the dog?

A

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

47
Q

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

A

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

48
Q

how common are adrenal tumors that cause canine hyperadrenocorticism?

A

15-20%
50% benign or malignant

49
Q

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

A

adrenal tumor
iatrogenic
sex hormone related

50
Q

who commonly gets canine hyperadrenocorticism due to an adrenal tumor?

A

median 11.3 years
65% female
more common in larger dogs

51
Q

what dog breeds are predisposed to pituitary dependent hyperadrenocorticism?

A

poodle
dachshund
terriers
beagle
german shepherd
boxer

52
Q

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

A

poodle
german shepherd
dachshund
labrador retriever
terriers

53
Q

what does steroid hepatopathy result in?

A

hepatomegaly

54
Q

what does SMILED stand for?

A

for hyperadrenocorticism
Segs and Monos Increase
Lymphs and Eos Decrease

55
Q

what contributes to the hypercoagulable state in canine hyperadrenocorticism?

A

thrombocytosis
decreased antithrombin
increased fibrinogen
hypertension

56
Q

how many cats with feline hyperadrenocorticism have concurrent diabetes mellitus?

A

80%

57
Q

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

A

pituitary dependent 80%

58
Q

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

A

POMC and ACTH come from pars intermedia

59
Q

what are the clinical signs of pituitary pars intermedia dysfunction?

A

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

60
Q

what is the pathophysiology of hyperadrenocorticism in ferrets?

A

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

61
Q

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

A

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

62
Q

do ferrets get polydipsia and polyuria with hyperadrenocorticism?

A

no

63
Q

what are the causes of hyperaldosteronism in cats?

A

adrenal adenoma
carcinoma: unilateral

64
Q

what are the serum chemistry abnormalities associated with hyperaldosteronism?

A

hypernatremia
hypokalemia

65
Q

what is hypoadrenocorticism from loss of?

A

mineralocorticoids and glucocorticoids

66
Q

what does hyponatremia in hypoadrenocorticism result in?

A

volume depletion
hypotension

67
Q

what does hyperkalemia in hypoadrenocorticism result in?

A

decreased muscle cell excitability
increased refractory period
slowed conduction

68
Q

how common is hypoadrenocorticism in cats?

A

rare

69
Q

what are the gastrointestinal signs associated with hypoadrenocorticism?

A

vomiting
diarrhea
anorexia
weight loss

70
Q

what is found of physical examination with hypoadrenocorticism?

A

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

71
Q

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

A

eosinophilia
lymphocytosis

72
Q

what is the mild anemia like with hypoadrenocorticism?

A

normocytic, normochromic
nonregenerative

73
Q

what ratio of Na:K is consistent with hypoadrenocorticism?

A

<22:1

74
Q

what is an atypical presentation of hypoadrenocorticism?

A

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

75
Q

what are the effects of epinephrine?

A

diverse activity
selective vasoconstriction
cardiac effects
metabolic effects
bronchodilation

76
Q

who is pheochromocytoma reported in?

A

cattle and dogs
less frequent in cats and horses

Endocrine Pathophysiology (6 decks)

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