Derm/endocrine: Adrenal

Front 1

Part of the adrenal gland that secretes catecholamines

Back 1

Medulla

Front 2

Zone of the adrenal cortex that excretes mineralocorticoids

Back 2

Zona glomerulosa

Front 3

Zone of the adrenal cortex that excretes glucocorticoids

Back 3

Zona fasiculata

Front 4

Zone of the adrenal cortes that excretes weak sex steroids

Back 4

Zona reticularis

Front 5

SIte of metabolism of corticosteroids

Back 5

Liver

Front 6

Where are metabolized corticosteroids excreted in the dog?

Back 6

Urine

Front 7

Where are metabolized corticosteroids excreted in the cat?

Back 7

Bile

Front 8

This class of substances increases liver gluconeogenesis, decrease peripheral glucose utilization, cause protein catabolism, and increase lipolysis.
Released as response to stress.
Increase renal excretion of water.

Back 8

Glucocorticoids

Front 9

Released from the hypothalamus in response to stress

Back 9

Corticotropic releasing hormone

Front 10

CRH acts on pituitary gland to release...

Back 10

ACTH

Front 11

ACTH stimulates the adrenal cortex to release...

Back 11

Cortisol

Front 12

Cortisol has this effect on hypothalamus and pituitary

Back 12

Negative feedback

Front 13

Major mineralocorticoid

Back 13

Aldosterone

Front 14

True or false: Cortisol has a minor mineralocorticoid activity

Back 14

True

Front 15

This hormone maintains electrolyte balance, maintains extracellular water volume, increases renal sodium retention, increases renal potassium and H secretion, and causes a minor increase in intestinal sodium resorption.

Back 15

Aldosterone

Front 16

Aldosterone increases retention of.... and secretion of .... and ....

Back 16

Retention: Na
Secretion: K and H

Front 17

Aldosterone has a direct effect on plasma concentration of this ion

Back 17

Potassium

Front 18

Hypotension stimulates the excretion of this hormone.

Back 18

Aldosterone

Front 19

Primary catecholamine excreted from adrenal medulla.

Back 19

Epinephrine

Front 20

Two catecholamines excreted from renal medulla.

Back 20

Epinephrine
Norepinephrine

Front 21

This class of bioactive substances causes BV constriction, increased cardiac rate and strength, inhibits GI activity, causes mydriasis, and increases metabolic rate.

Back 21

Catecholamine

Front 22

80-85% of cases of canine hyperadrenocorticism fall under this classification:

Back 22

Pituitary dependent

Front 23

Is PDH or ADH more common?

Back 23

PDH

Front 24

Peak age on onset of hyperadrenocorticism in the dog

Back 24

7-9 years

Front 25

Is hyperadrenocorticism more common in dogs or cats?

Back 25

Dogs, by far

Front 26

Is PDH more common in males or females?

Back 26

Equal

Front 27

Is ADH more common in males or females?

Back 27

Females

Front 28

Breeds most predisposed to PDH

Back 28

Miniature poodles
Dachshunds
Boston terriers
Silky terriers

Front 29

True or false: ADH occurs most frequently in small dogs.

Back 29

False. Large dogs.

Front 30

Type of hyperadrenocorticism caused by overproduction of ACTH

Back 30

Pituitary dependent

Front 31

Type of hyperadrenocorticism caused by a functional adrenal tumor

Back 31

Adrenal dependent

Front 32

Potential causes of PDH

Back 32

Functional pituitary tumor (90%)
Idiopathic excessive hypothalamic stimulation (10%)

Front 33

Bilateral adrenal cortical hyperplasia caused by this form of hyperadrenocorticism

Back 33

PDH

Front 34

Most common type of adrenal tumor

Back 34

Adenocarcinoma

Front 35

A unilateral adrenal mass will most likely cause this form of hyperadrenocorticism

Back 35

Adrenal-dependent

Front 36

Adrenal masses tend to be either...

Back 36

Adenocarcinoma
Adenoma

Front 37

True or false: All cases of ADH are marked by a unilateral adrenal mass.

Back 37

False. Possibly bilateral.

Front 38

If there is a unilateral adrenal mass causing ADH, how will the other adrenal gland appear?

Back 38

Atrophied b/c of negative feedback on hypothalamus and pituitary

Front 39

Type of hyparadrenocorticism that results in low ACTH

Back 39

ADH

Front 40

Type of hyparadrenocorticism that results in elevated ACTH

Back 40

PDH

Front 41

CS of hypercortisolemia

Back 41

PU/PD
Pendulous abdomen
Bilaterally symmetrical alopecia
Hepatomegaly
Lethargy
Polyphagia
Muscle weakness
Comedones
Calcinotis cutis

Front 42

CS of hypercortisolemia

Back 42

PU/PD
Pendulous abdomen
Bilaterally symmetrical alopecia
Hepatomegaly
Lethargy
Polyphagia
Muscle weakness
Comedones
Calcinotis cutis

Front 43

Most common biochemical abnormality seen with hyperadrenocorticism

Back 43

Increased serum AP

Front 44

90% of cats with hyperadrenocorticism also have...

Back 44

Diabetes mellitus

Front 45

Changes frequently seen on urinalysis with hyperadrenocorticism

Back 45

Proteinuria
Bacteriuria

Front 46

This organ frequently becomes enlarged in hyperadrenocorticism

Back 46

Liver

Front 47

How does ultrasonaography help differentiate between ADH and PDH?

Back 47

Screens for adrenal mass and ID's gland affected

Front 48

True or false: Systemic hypertension is seen in about 25% of Cushings' patients.

Back 48

False. 60%!

Front 49

How is a definitive diagnosis of hyperadrenocorticism made?

Back 49

Typical CS
Abnormal adrenal function tests
R/O other causes of PU/PD and elevated AP, etc.

Front 50

Is urine cortisol:creatinine ratio more sensitive or specific?

Back 50

High se, low sp

(Other things can raise urine cortisol)

Front 51

List 3 ways to differentiate PDH and ADH

Back 51

HDDS test
Endogenous ACTH
Abdominal US

Front 52

A dog with hyperadrenocorticism undergoes HDDS. What will the results be for PDH vs. ADH?

Back 52

PDH: Suppression <50% of baasal value
ADH: No suppression at 8h

Front 53

Most reliable test for differentiating between PDH and ADH

Back 53

Endogenous ACTH

Front 54

Main treatment for PDH. How does it work?

Back 54

Trilostane, blocks cortisol production

Also mitotane, which selectively destroys adrenal cortex

Front 55

1 year survival for PDH treated with trilostane or mitiotane

Back 55

70%

Front 56

60% of adrenal tumors causing ADH are...

Back 56

Adenocarcinomas
(Half will be inoperable at time of sx)

Front 57

Generally, immediate post-op survival for ADH is...

Back 57

Pretty good, may approach 100%

Front 58

Primary hypoadrenocorticism results when...

Back 58

Adrenal cortices are destroyed

Front 59

Secondary hypoadrenocorticism results when...

Back 59

Lack of ACTH from pituitary gland

Front 60

Are most cases of hypoadrenocorticism primary or secondary?

Back 60

Primary

Front 61

If only glucocorticoids are deficient, is that a sign of primary or secondary hypoadrenocorticism?

Back 61

Secondary

Front 62

If both glucocorticoids and mineralocorticoids are deficient, is that a sign of primary or secondary hypoadrenocorticism?

Back 62

Primary

Front 63

Signalment for typical case of hypoadrenocorticism

Back 63

Young adult dog (4-4.5 y), usually intact female (or less commonly castrated male.)

Front 64

Is hypoadrenocorticism more common in dogs or cats?

Back 64

Dogs

Front 65

List some breeds at highest risk of hypoadrenocorticism

Back 65

Portuguese water dog
Great Dane
West Highland White Terrier
Standard Poodle
Wheaten Terrier
Rottweiler
Springer Spaniel
German Shorthaired Pointer
Bassett Hound

Front 66

Most common cause of primary hypoadrenocorticism

Back 66

Immune-mediated adrenal atrophy/destruction

Front 67

CS of glucocorticoid deficiency

Back 67

Weakness and lethargy
Inability to deal with stress/illness/exercise
Hypoglycemia

Front 68

Pathophysiology of mineralicorticoid deficiency

Back 68

Severe Na loss
Hypovolemia
K retention
Decreased secretion of H, causing acidosis
Excess colonic Na and H2O loss

Front 69

High levels of this ion may cause a negative cardiac ionotropic effect, bradycardia, no P wave, high T wave, and widened QRS.

Back 69

Potassium

Front 70

CS of hypoadrenocorticism

Back 70

Anorexia
Lethargy and depression
Vomiting
Weakness
Wax/wane course
Dehydration
Diarrhea
Hypothermia
Shock

Front 71

Typical biochemical abnormalities seen with hypoadrenocorticism

Back 71

Na:K under 27
High K, BUN, P
Low Na
High creatinine and Ca

Front 72

Isosthenuria is more commonly associated with this adrenal dysfunction

Back 72

Hypoadrenocorticism

Front 73

Radiographic signs associated with hypoadrenocorticism

Back 73

Small heart and great vessels
Rarely transient megaesophagus

Front 74

Small adrenal glands < 3.2 mm are consistent with...

Back 74

Hypoadrenocorticism

Front 75

Very sensitive and specific test for hypoadrenocorticism

Back 75

Basal cortisol level < 1 ug/dL

Front 76

Hypoadrenocorticism is unlikely when basal cortisol is at this level

Back 76

Over 2 ug/dL

Front 77

Definitive diagnosis of hypoadrenocorticism is made based on the results of this test...

Back 77

ACTH stimulation test
Post-stim cortisol below reference range

Front 78

List some hematologic abnormalities seen in patients with hyperadrenocorticism.

Back 78

Eosinopenia
Lymphopenia
Stress leukogram
Occasionally erythrocytosis

Front 79

When diagnosing hyperadrenocorticism, rule-outs include:

Back 79

Uncontrolled diabetes
Liver disease
Renal failure

Front 80

List three diagnositc tests for hyperadrenocorticism

Back 80

ACTH stimulation test
Low dose dexamethosone suppression test
Urinary cortisol:cratinine ratio

Front 81

Most specific test for hyperadrenocorticism (fewest false +)

Back 81

ACTH stimulation test

(High sp, low se)

Front 82

Is LDDS test more sensitive or specific?

Back 82

High se, low sp

Front 83

Positive result on LDDS indicated by...

Back 83

Cortisol over 1 ug/dL at 8h

Front 84

Low-dose dexamethosone suppression test diagnoses this form of hyperadrenocorticism

Back 84

PDH