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50 Cards in this Set

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