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72 Cards in this Set

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What is the distribution between pituitary-dependent and adrenal-dependent hyperadrenocorticism in dogs?
85% pituitary
15% adrenal
Predict the following in pituitary-dependent hyperadrenocorticism:
Adrenal size
Circulating ACTH
Circulating cortisol
Adrenal size (normal to bilaterally enlarged)
Circulating ACTH (HIGH)
Circulating cortisol (HIGH)
Predict the following in adrenal-dependent hyperadrenocorticism:
Adrenal size
Circulating ACTH
Circulating cortisol
ADH
Adrenal size (unilaterally enlarged w/contralateral hypoplasia)
Circulating ACTH (LOW)
Circulating cortisol (HIGH)
ADH (LOW)
What are the most common clinical signs associated with hyperadrenocorticism in dogs?
PU/PD/PP
Pendulous abdomen
Alopecia (& other cutaneous signs)
(also lameness, weakness, panting, UTI signs)
What are some common clinpath signs associated with hyperadrenocorticism in dogs?
Hypercholesteremia
Diabetes mellitus
Increased ALP (sALP)
Hypertension
Which of the following is NOT associated with hyperadrenocorticism in dogs?
a) Pyoderma
b) Hypotension
c) Congestive heart failure
d) SARDS
e) Diabetes insipidus
b) Hypotension
c) Congestive heart failure (usuallya CONCURRENT disease)
e) Diabetes insipidus
Which of the following ARE associated with hyperadrenocorticism in dogs?
a) hypothyroidism
b) proteinuria
c) hypovolemia
d) anterior uveitis
e) thrombocytosis
a) hypothyroidism
b) proteinuria
e) thrombocytosis

(note - should be HYPERvolemia and Sudden Acute Retinal Degeneration)
Cushing's disease is a ____________ disease.
clinical
T or F:
An ACTH stim test with a low post stimulation result is highly indicative of adrenal disease absence.
False!
Due to its low sensitivity, ACTH stim test is really a screening test only (miss 40% of positives).
T or F:
A LDDS test that successfully suppresses is highly indicative of adrenal disease absence.
True!
LDDS has good sensitivity!
Which of the following is the most likely result of a LDDS test in a patient with pituitary dependent HAC?
a) no suppression whatsoever
b) does not suppress under 50% of initial cortisol value
c) drops under 50% at 4h but increases afterwards
d) drops under 50% at 4 and 8 h.
c) drops under 50% at 4h but increases afterwards
Which of the following is the most likely result of a LDDS test in a normal patient?
a) no suppression whatsoever
b) does not suppress under 50% of initial cortisol value
c) drops under 50% at 4h but increases afterwards
d) drops under 50% at 4 and 8 h.
d) drops under 50% at 4 and 8 h.
Which of the following is/are the most likely results of a LDDS test in adrenal dependent HAC?
a) no suppression whatsoever
b) does not suppress under 50% of initial cortisol value
c) drops under 50% at 4h but increases afterwards
d) drops under 50% at 4 and 8 h.
a) no suppression whatsoever
b) does not suppress under 50% of initial cortisol value
T or F:
An animal testing negative on the urine cortisol:creatinine test has a high chance of NOT having adrenal disease.
True!
Urine cortisol:creatinine has a great negative predictive value
Which of the following is/are the most likely results of a HDDS test in adrenal dependent HAC?
a) no suppression whatsoever
b) does not suppress under 50% of initial cortisol value
c) drops under 50% at 4h but increases afterwards
d) drops under 50% at 4 and 8 h.
a) no suppression whatsoever
Which of the following is/are the most likely results of a HDDS test in pituitary-dependent HAC?
a) no suppression whatsoever
b) does not suppress under 50% of initial cortisol value
c) drops under 50% at 4h but increases afterwards
d) drops under 50% at 4 and 8 h.
d) drops under 50% at 4 and 8 h (in 75%; 25% will still not suppress)
T or F:
If a dog has signs of Cushing's but ACTH stim, LDDS, and HDDS are all negative, the dog likely does not have Cushing's.
False!
Gotta rule-out Atypical HAC - do ACTH stim and measure OTHER steroid hormones!
Which of the following are NOT common treatments for a dog with Cushing's?
a) Transphenoidal hypophysectomy
b) Bilateral adrenalectomy
c) Adrenolytic mitotane protocol
d) Melatonin protocol
e) Ketoconazole protocol
a) Transphenoidal hypophysectomy (unless you're Dutch...)
b) Bilateral adrenalectomy
c) Adrenolytic mitotane protocol
e) Ketoconazole protocol
As measured by serum cortisol, what is the goal of mitotane therapy?
Want cortisol BELOW REFERENCE RANGE after ACTH stimulation
Which cells does mitotaine effect?
a) zona glomerulosa
b) zona fasiculata
c) zona reticularis
d) medullary parenchyma
b) zona fasiculata
c) zona reticularis
Central Diabetes Insipidus, Keratoconjunctivitis Sicca, and Hypothyroid are side-effects to which Cushing's treatment? Which of the conditions is irreversible?
Transphenoidal hypophysectomy (hypothyroid is irreversible)
Your dog is on mitotaine therapy and stops eating and begins vomiting. What is your next step?
a) continue therapy
b) increase dose 25%
c) discontinue mitotaine
d) reduce dose 25%
c) discontinue mitotaine (YOU'RE GIVING THE DOG ADDISON'S; administer glucocorticoids)
What is the mechanism of action for trilostane? How is its efficacy monitored?
Trilostane inhibits steroid production (monitor via ACTH stim 2-6 hrs post pill)
T or F:
Radiotherapeutic ablation of microadenomas greatly lessens the clinical signs of pituitary-dependent Cushing's.
False!
May improve neuro signs but doesn't help the Cushing's.
T or F:
Mitotane and trilostane are of little use to adrenal-dependent Cushing's.
True! They usually don't work well and are $$$$$$$$$$$$$$$$$.
Removal of which adrenal is the most difficult?
Right side!
T or F:
During a unilateral adrenalectomy, pre, peri, and post-op glucocorticoids should be administered.
True!
Give dex or hydrocortisone to not interfere with ACTH stim tests!
What are options for inoperable adrenal tumors? What is the mechanism of action for each?
Melatonin
Lignins
(both are steroid enzyme inhibitors)
If a cat has Cushing's, which form is the most likely?
Pituitary
T or F:
In terms of signalment in dogs, small breeds get pituitary-dependent HAC while large breed get adrenal.
True (kinda)
Boxers get pituitary dependent
Which of the following tests work with feline Cushing's?
a) ACTH stim
b) LDDS test
c) HDDS test
d) endogenous ACTH
c) LDDS test (at levels like a HDDS in dogs)
c) HDDS test (higher dex levels than in dogs)
d) endogenous ACTH
Which forms of treatments have success in treating feline Cushing's?
a) Mitotane
b) Ketoconazole
c) Trilostane
d) bilateral adrenalectomy
e) unilateral adrenalectomy
f) Hypophysectomy
c) Trilostane
d) bilateral adrenalectomy
f) Hypophysectomy
What are the mineralocorticoids? Which is the most potent?
Cortisol
11-deoxycorticosterone
Aldosterone (most potent)
Which of the following can lead to increased aldosterone secretion?
a) high renal blood pressure
b) low renal blood pressure
c) increased NaCl
d) decreased NaCl
e) high plasma K
b) low renal blood pressure
d) decreased NaCl
e) high plasma K
What effect does aldosterone have on the kidney?
Causes Na retention as well as release of K and H+.
T or F:
Hyperaldosteronism typically affects both dogs and cats.
False! pretty rare disease but affects cats more than dogs
Choose primary or secondary hyperaldosteronism...
...renin-dependent.
Secondary
Choose primary or secondary hyperaldosteronism...
...associated with heart failure.
secondary
Choose primary or secondary hyperaldosteronism...
...associated with neoplasia.
primary
What is the common signalment for hyperaldosteronism?
older female cat with low K and high BP
What are major clinical signs of hyperaldosteronism?
Weakness
PU/PD
Cardiac arrthymias
Hypertension
Retinopathy
Which are common tests for hyperaldosteronism?
a) serum K
b) Serum aldosterone
c) aldosterone:renin ratios
d) serum renin
b) Serum aldosterone
What are acceptable treatments for hyperaldosteronism?
Adrenalectomy
Medical management (ACE inhibitors, spironolactone, Ca channel blockers)
Which drug is an aldosterone antagonist?
Spirinolactone
What is the prognosis for hyperaldosteronism treatment?
If kidneys are OK, GOOD PROGNOSIS!
What is the precursor to all catecholamines? How is catecholamine production regulated?
Tyrosine (converted into L-dopa by tyrosine kinase); norepinephrine inhibits this by negative feedback
Which of the following are NOT effects of catecholamines?
a) increased gluconeogenesis
b) vasodilation
c) bronchodilation
d) increase heart rate
e) increased renin release
a) increased gluconeogenesis (should be glycogenolysis)
b) vasodilation (should be vasoconstriction)
Pheochromocytomas are tumors of ____________ cells.
CHROMAFFIN
Why is catecholamine release from pheochromocytomas variable?
no innervation to the tumor
T or F:
Pheochromocytomas cause clinical signs mostly due to their mass effects and not catecholamine release.
False!
Mass effects, hemorrhage, and catecholamine release all cause clinical signs.
What proportion of pheochromocytomas are malignant? What proportion are incidental findings?
50% malignancy; up to 60% incidental findings though!
What are common signs associated with pheochromocytoma?
a) palpable abdominal mass
b) tachycardia
c) pain
d) abdominal distention
e) hypertension
b) tachycardia
e) hypertension
T or F:
Stress or fear can exacerbate signs of pheochromocytoma.
False!
How is pheochromocytoma diagnosed?
Clinical signs then essentially ruling-out Cushing's once an adrenal mass is found.
What pre-op stabilization should be considered before excision of a pheochromocytoma?
Phenoxybenzamine (anti-hypertensive)
Beta blockers (if tachyarrthymias)
T or F:
Hypoadrenocorticism usually manifests as a deficiency in mineralocorticoids and glucocorticoids.
True! (although one part in the notes says that it is primarily glucocorticoids)
T or F:
Primary hypoadrenocorticism is the most common form in small animals and involves atrophy of certain zones of the pituitary gland.
False!
It is the most common form but it involves ADRENAL ATROPHY
What is the most common cause of hypoadrenocorticism in small animals?
a) iatrogenic
b) idiopathic
c) immune-mediated
d) infarct to adrenals
e) idiocracy
b) idiopathic (but immune-mediated is the leading theory right now; also iatrogenic is a main issue with SECONDARY hypo-AC)
What is the common signalment for a small animal with hypoadrenocorticism?
YOUNG ADULT BITCHES
What are common presenting or clinical signs for a dog with hypoadrenocorticism?
Lethargy
GI signs (anorexia, vomiting, diarrhea, melena, wt loss)
Weakness/trembling
PU/PD
muscle wasting
bradycardia
hypothermia
What are some significant laboratory findings for a dog with hypoadrenocorticism?
Absence of stress leukogram
Increased K, decreased NaCl
Mild non-regenerative anemia
Which lab abnormalities in hypoadrenocorticism are due to decreased corrtisol?
a) hyperkalemia
b) hypoglycemia
c) anemia
d) hypocholesteremia
e) metabolic acidosis
b) hypoglycemia
c) anemia
d) hypocholesteremia
Which lab abnormalities in hypoadrenocorticism are due to decreased mineralocorticoids?
a) hyperkalemia
b) hypoglycemia
c) anemia
d) hypocholesteremia
e) metabolic acidosis
a) hyperkalemia
e) metabolic acidosis
What radiographic finding should likely be noted on a dog with hypoadrenocorticism?
Microcardia (due to hypovolemia)
Predict the ACTH stim test results of a dog with primary hypoadrenocorticism and of a dog with secondary hypoadrenocortism.
Both should have baseline cortisol VERY low and NO STIMULATION WHATSOEVER
How can primary hypoadrenocorticism be differentiated from secondary?
Use endogenous ACTH test; primary should have high ACTH, secondary should have low ACTH
What medical response should be given in a patient in an Addisonian crisis?
Shock dose of crystalloid (maybe w/Ca);
IV dexmeth or hydrocortisone;
Insulin + glucose (if hyper K);
Address any acidosis
Give gastric protectants
T or F:
Mineralocorticoids should always be included when treating acute hypoadrenocorticism.
False! Only give them if there are electrolyte abnormalities, once the patient is stabilized.
What drug can be given to address electrolyte abnormalities when managing chronic hypoadrenocorticism?
DOCP (desoxycorticosterone pivalate)
A patient with well-managed Addison's suddenly has a crisis around July 4th. What gives?
Inability of body to respond to stress - need to up the pred dose in times of stress!
How does hypoadrenocorticism present differently in cats than in dogs?
No vomiting or PU/PD in cats!
How is testing for hypoadrenocorticism different between dogs and cats?
Cats - lower dose given and test at 0, 30, 60 min.
Dogs - higher dose given and test at 0, 2, and 3 hrs.