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50 Cards in this Set
- Front
- Back
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Hemogram of a Cushing's dog?
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Lymphopenia, eosnophilia
mature neurophlia mild erythrocytosis lipemia |
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ALP and cushings
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Increased in 85% of HAC dogs but in alot of other diseases too so can;t be diagnostic
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Hypercholesterolemia
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IN 90% of dogs with HAC
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T4 and cushings
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both may be reduced but free is affected more than total
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Urinlalysis
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1.low specific gravity
2.Bacteriuria 3.Pyuria absent even though a urinary infection is present 4.Proteinuria is common and may be caused by glomerular disease |
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Radiology and cushings
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1. Hepatomegaly, good AB detail, and distension of bladder
2. Adrenomegaly and adrenal calcfication in 50% 3. Dystrophic calcification and oteopenia less common |
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Screening test and sensitivity/specificity
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Most have good sensitivity but poor selectivity
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ACTH stim theory
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Indirectly measures the thickness of the adrenal cortex by assessing cortisol production after max ACTH stimulation
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ACTH uses...
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1. Only one that can dz iatrogenicas well as spontaneous HAC
2. Monitors therapy with DDD or ketaconazole |
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ASTH sen/spec
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1.Sensitivity for HAC is 85%
2. Specificity is slighlty better than LDDS UCCR, but still can be abnormal with nonadrenal illness |
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Hemogram of a Cushing's dog?
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Lymphopenia, eosnophilia
mature neurophlia mild erythrocytosis lipemia |
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|
ALP and cushings
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Increased in 85% of HAC dogs but in alot of other diseases too so can;t be diagnostic
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Hypercholesterolemia
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IN 90% of dogs with HAC
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T4 and cushings
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both may be reduced but free is affected more than total
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Urinlalysis
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1.low specific gravity
2.Bacteriuria 3.Pyuria absent even though a urinary infection is present 4.Proteinuria is common and may be caused by glomerular disease |
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Radiology and cushings
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1. Hepatomegaly, good AB detail, and distension of bladder
2. Adrenomegaly and adrenal calcfication in 50% 3. Dystrophic calcification and oteopenia less common |
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Screening test and sensitivity/specificity
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Most have good sensitivity but poor selectivity
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ACTH stim theory
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Indirectly measures the thickness of the adrenal cortex by assessing cortisol production after max ACTH stimulation
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ACTH uses...
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1. Only one that can dz iatrogenicas well as spontaneous HAC
2. Monitors therapy with DDD or ketaconazole |
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ASTH sen/spec
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1.Sensitivity for HAC is 85%
2. Specificity is slighlty better than LDDS UCCR, but still can be abnormal with nonadrenal illness |
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When is the second blood draw for ACTH?
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1 hour or 2 hour if use gel
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Normal dog resting levels and stimulatory levels...
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1.1-4ug/dl
2. 6-20ug/dl |
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Post -ACTH cortisol levels > 20ug/dl
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Suggestive of spontaneous HAC
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Iatrogenic response to ACTH stim...
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Subnormal response, <6ug/dl
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Excessive stimulation...
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1. 85%-90% of dogs with PDH
2. 60% of dogs with adrenal neoplasia |
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LDDS normal dog...
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Normal dogs, a steroid injection will cause supression of the pituitary ACTH thus decrease cortisol production
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Why do dogs with PDH not respond correctly to steroid injections?
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Pituitary tumors are resistent to negative feedback, and they clear Sex faster than normal dogs
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Why do dogs with AT not respond to LDDS?
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ACTH levels are already suppressed buy autonomous production of cortisol
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LDDS advantages
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high sensitivity but poor specificity
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LDDS disadvantages
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1. Cannot be used to DX iatrogenic HAC
2. takes 8 hours perform |
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Normal levels with LDDS
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supress to <1 by 4 hrs and remains supressed for 8 hrs
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PDH or AT levels with LDDS
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>1.4 at 8 hrs are consistent with PDH or AT
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PDH levels of LDDS
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Suppression to <1 at 4 hrs followed by an "escape" to pre-suppression values at 8 hrs is highly suggestive of PDH
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UCCR
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a negative test rules out HAC, but a postitive test must be followed by another screening test
2. >35 is suggestive of HAC or nonadrenal illness |
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HDDS with PDH
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High dose overcomes resistance of pituitary tumor to negative feedback, resulting in suppression of both ACTH and cortisol
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HDDS with AT
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No change
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HDDS interpretations...
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1. <1.5 at 8 hrs occurs in 75% of dogs with PDH
2. Failure to suppress occurs in 100% of dogs with AT and 25% of dogs with PDH 3. Suppression is indicative of PDH, but lack of suppression is non-conlusive |
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Endogenous plasma ACTH theory
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Endogenous levels are high in PDH and low in AT due to negative feedback
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Advantages of endogenous testing
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DIfferentiate between PDH and AT in over 90% of cases
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Adisadvantages of endogenous testing
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Only useful once the diagnosis of HAC has been made
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Adrenal Ultrasound theory
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allows differentiation between bilateral adrenocortical hyperplasia associated with PDH and adrenocortial neoplasia
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Bilateral Adenomegaly with maintanace of normal shape...
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Suggests PDH
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Unilateral adrenomegaly with distortion of shape...
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Suggestive of AT
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Causes of bilateral adrenal nodules...
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1. Nodular hyperplasia secondary to PDH
2. Bilateral adrenocortical adenomas |
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Mitotane(DDD,lysodren)
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1. Most common treatment foe PDH
2. Selectively kills cells in the zona fasciculata and reticularis thus decreasing cortisol secretion |
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Disadvantages of Mitotane
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1. Hypercortisolemia
2. Lossof aldosterone causing hyperkalemia and low blood pressure 3. Mineralocorticoid deficiency |
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Potential reasons for prolonged mitotane induction
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1. Poor GI absorption so give lots of fat
2. misdiagnosed and its actually an adrenal neoplasia |
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Ketoconazole's mechanism of action
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antifungal that blocks an enzyme in the cholesterol to steroid production
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Alternative medical therapies for HAC
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Trilostane
1-deprenyl |
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Choice of treatment for adrenal neoplasia
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Adernalectomy
Mitotane and ketoconazole can be used too |
