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!Small Animal Medicine > Pituitary and Parathyroid Disorders > Flashcards

Pituitary and Parathyroid Disorders Flashcards

1
Q

Adenohypophysis pituitary

A

ACTH, TSH, GH, FSH and prolactin

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2
Q

Neurohypophysis

A

Vasopression (anti-diuretic hormone)
Oxytocin

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3
Q

Hypersomatotropism (acromegaly) in dogs

A

Mid-age to older females
↑ progestins with Gh secretion from mammary tissue (endogenous)
Megesterol acetate (exogenous)

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4
Q

Hypersomatotropism (acromegaly) in cats

A

Older males (more in cats than dogs)
Pituitary macroadenoma (excess GH and insulin-like growth factor)

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5
Q

CS associated with Hypersomatotropism (acromegaly)

A

PU/PD, prognathism
Widened interdental spaces, face and foreheadand neck (stridor)
Dyspnea, abdominal swelling and weight gain

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6
Q

CS of Hypersomatotropism (acromegaly) in cats only

A

Clubbed paws and CNS signs
with other signs

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7
Q

How to dx Hypersomatotropism (acromegaly)

A

Hyperglycemia
Insulin- like growth factor 1 measurement
Thoracic rads (cardiomegaly)
CT/ MRI (pituitary mass)

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8
Q

How to tx Hypersomatotropism (acromegaly) in dogs

A

OHE and D/C progestins

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9
Q

How to tx Hypersomatotropism (acromegaly) in cats

A

Pituitary radiation (stereotactic/ gamma knife)
Hypophysectomy (supplement thyroid and glucos)
Pasireotide (somatostatin analog)

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10
Q

Pituitary dwarfism

A

Congenital growth hormone deficiency
Failure of complete pituitary genesis
Dx @ 2-5m of age

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11
Q

CS of pituitary dwarfism

A

Growth retardation
Fluffy haircoat, alopecia, hyperpigmentation, bilateral cryptorchidism (males), persistent anestrus (females)

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12
Q

Dx pituitary dwarfism

A

Clonidine Stimulation Test- GNRH stimulation test that measures GH (gold standard)
IGF-1 levels low

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13
Q

How to tx pituitary dwarfism

A

Porcine growth hormone
Progesterone
Thyroid supplementation
+/- glucos supplementation

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14
Q

Porcine growth hormone

A

Identical to K9 GH, expensive
Helps with long bone growth
Delay onset of renal dysfunction

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15
Q

Progesterone

A

↑ GH levels (OHE prior to prevent pyometra)
Helps with long bone growth
Delay onset of renal dysfunction

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16
Q

Central Diabetes Insipidis

A

Vasopressin deficiency
Complete or partial

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17
Q

Congenital nephrogenic DI

A

ADH receptor deficiency
Partial or complete

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18
Q

Acquired nephrogenic DI

A

ADH receptor blockage
Most common!

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19
Q

Primary polydipsia (psychogenic) DI

A

Non-vasopressin associated polydipsia
Behavioral or 2 degree central lesion/ head trauma

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20
Q

Dx of DI

A

Confirm patient really has PU/PD (measure water intake- 40-60 ml/kg/dy)
Rule out causes of nephrogenic DI prior to pursuing CDI v. 1 degree PD
Modified water deprivation test
Desmopressin trial

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21
Q

How do tx central DI

A

DDAVP (desmopressin)

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22
Q

How to tx first degree polydipsia

A

Behavior modification, limit water access
If 1st degree brain tumor is cause → radiation therapy

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23
Q

How to tx congenital nephrogenic DI

A

Low sodium diet
Thiazide diuretics (rarely used)

24
Q

Parathyroid hormone (PTH)

A

Synthesized, stored and secreted by chief cells
Binds to type1 receptors in target tissues regulating Ca fluxes across bone, kidney and intestines

25
Q

Regulation of PTH

A

Secretion regulated by Ca concentrations (high= inhibits, low=stimulates)
Hypophosphatemia: inhibit PTH secretion
Vit D and ↑ plasma: inhibits PTH

26
Q

Net affect of ↑ PTH

A

↑ Ca and ↓ P
Mobilizes Ca from bone and kidney, delayed effect on mobilizing Ca from GI tract

27
Q

Primary hyperparathyroidism

A

Hyperplasia (adenoma, adenomatous hyperplasia)
Carcinoma

28
Q

Hypercalcemia

A

↑ PTH → ↑ vit. D →↑ Ca++ from GI
↑ Osteoclastic activity
↑ resorption of Ca++ from DRT

29
Q

Signalment for hyperparathyroidism

A

Old dogs (large breeds)
Keeshond (autosomal dominant gene)

30
Q

CS of hyperparathyroidism

A

Leth, PU/PD, urinary continence, muscle weakness/ wasting, anorexia, depression, UB stones
Shivering, UT signs, C, constipation, mental dullness, coma/ CNS signs

31
Q

Lab findings of hyperparathyroidism

A

Hypercalcemia, fasting, persistent
Low to normal P
Poorly concentrated urine
Ca oxalate or Ca phophate urolithiasis
Genetic testing

32
Q

Humoral hypercalcemia of malignancy

A

Production of PTH realted protein (PTH-rP):mimics PTH and binds PTH receptors

33
Q

What causes hypercalcemia of malignancy

A

Lymphosarcoma
Multiple myeloma
Apocrine gland adenocarcinoma of the anal sac
Thymoma

34
Q

Diagnostic imaging of hyperparathyroidism

A

Rads: mineralization of vessels and other ST urinary calculi
U/S: parathyroid nodules

35
Q

Acute (emergency) therapy for hyperparathyroidism

A

Diuresis (0.9% NaCl, 0.45% NaCl + 5% dextrose or loos diuretics- furosemide)
Glucos
Salmon calcitonin
Parathyroidectomy
Parathyroid ablation

36
Q

Glucocorticoid therapy for hyperparathyroidism

A

↓ osteoclastic formation and activity
PU/ ↑ Ca excretion in urine
Lympholytic

37
Q

Salmon calcitonin

A

Inhibits bone resorption
↑ Ca++ excretion in urine

38
Q

Hypoparathyroidism

A

Immune-mediated and iatrogenic
Causes hypocalcemia
Middle aged female dogs (mini poodles, schaunzer and dachshunds)

39
Q

CS for hypoglycemia

A

Twitching of facial muscles
Pawing @ face
Muscle fasciculations
Stiff/Stiled gait *

40
Q

Lab findings of hypoparathyroidism

A

Total and ionized hypocalcemia
Mild hyperphosphatemia
Low PTH levels
Definitive: atrophied parathyroids on histopath

41
Q

Emergency therapy for hypoparathyroidism

A

Calcium gluconate 10% IV slowly
Monitor ECG for bradycardia, short QT interval, sudden elevation of ST segment, VPCs

42
Q

Therapy for hypoparathyroidism is stailized

A

Ionized Ca
Elemental Ca (gluconate or chloride)
Ca++ gluconate

43
Q

Maintenance therapy for hypoparathyroidism

A

Calcitriol (dihydroxycholecalciferol)- not in hyperphosphatemic patients (t first with oral Ca carbonate)
Feed reg diet with oral Ca++ carbonate

44
Q

Hyperaldosteronism

A

Conn’s dz or primary aldosteronism
From ↑ secretion of aldosterone from adrenal gland

45
Q

Primary hyperaldosteronism

A

Independent of RAAS
Most commonly caused by unilateral adrenal neoplasia or bilat adrenal neoplasia
Cause of hypokalemia or hypertension

46
Q

Secondary Hyperaldosteronism

A

Occurs in response to RAAS
Dehydration, hypertension, ↓ renal perfusion or Na deficiency

47
Q

Signalment for Hyperaldosteronism

A

Middle age to older

48
Q

Hyperaldosteronism hallmarks

A

Primary: hypokalemia, hypertension, ↑ serum aldosterone
Secondary: ↑ aldosterone due to ↑ renin

49
Q

Hypokalemic myopathy (hyperaldosteronism)

A

Most common for adrenal hyperplasia
Muscle dysfunction, dysphagia, collapse, ataxia, etc
Weakness most common then central ventroflexion

50
Q

Other CS of hyperaldosteronism

A

Acute onset blindness due to retinal detachment or intraocular hemorrhage from hypertension

51
Q

Lab findings of hyperaldosteronism

A

Hypokalemia, low phosphorus, met. alk
Azotemia and proteinuria

52
Q

Dx for hyperaldosteronism

A

Plasma aldosterone (plasma renin activity) *: aldosterone ↑ with low renin
Plasma aldosterone concentration (PAC): ↑ aldosterone with low K

53
Q

Medical tx for hyperaldosteronism

A

Goal: control hypokalemia and hypertension- K gluconate
Amlodipine for hypertension
Spironolactone for hypokalemia and hypertension

54
Q

Sx tx for hyperaldosteronism

A

Adrenalectomy (unilateral tumors)
Post-op fludrocortisone for hyperkalemia

55
Q

Most common cause of death with hyperaldosteronism

A

CKD or thromboembolism if medically managed

!Small Animal Medicine (37 decks)

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