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81 Cards in this Set
- Front
- Back
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Why give fluids with hypoadrenocorticism?
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Hypovolemic shock can kill (no aldosterone, severe polyuria)
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What should you use to replace glucocorticoids when initially treating addisons?
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Dexamethasone because it doesn't react with cortisol assays
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What should you do to lower potassium in addisons treatment?
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Fluids. Can give insulin to drive K into cell, if so also give dextrose
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What are the mineralocorticoid supplements for addisons?
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DOCP or Florinef
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Where does most T3 come from?
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Peripheral deiodinization of T4
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What makes hypothyroidism such an overdiagnosed disease?
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Many diseases result in decreases in circulating concentrations of Thyroid hormone
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What is the most common cause of hypothyroidism?
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Lymphocytic thyroiditis
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What is secondary hypothyroidism?
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loss of pituitary TSH secretion
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What is another name for congenital hypothyroidism?
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Cretinism
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What are some skin signs of hypothyroidism?
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alopecia, hyperpigmentation, poor wound healing, myxedema (mucopolysaccharides accumulating in skin) causes tragic face, RAT TAIL,
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What happens to the heart with hypothyroidism?
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Bradycardia because thyroid hormone sensitizes heart to catecholemines.
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What are UA results with hypothyroidism?
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Usually normal. Immune mediated disease can cause glomerular nephritis
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What does the CBC show with hypothyroidism?
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Normocytic normochromic nonregenerative anemia (no EPO?)
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What does the chemistry show in hypothyroidism?
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Hypercholesterolemia (metabolism and clearance are inhibited a lot) Hypertriglyceridemia and lipemia
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If you find a normal TT4, can the animal be hypothyroid?
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No
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If you find a low TT4, is the dog hypothyroid?
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Maybe. Lots of diseases cause low thyroid hormone
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What drugs cause low TT4?
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benzodiazepines, phenobarb, glucocorticoids, imidazoles, penicillins, sulfonylureas, salicylates, phenothiazines
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What should serum TSH be in hypothyroid dogs?
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Usually it is high. Some dogs have normal.
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What do you need to diagnose hypothyroidism?
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Clinical signs, low free T4 and 2 of 3 of these: high TSH, anti-thyroglobulin Ab, hypercholesterolemia
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What usually causes feline hyperthyroidism?
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an autonomously hyperfunctioning adenoma of the thyroid.
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What do you find in a hyperthyroid UA?
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Isosthenuria. TH is a diuretic.
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What do you find in a hyperthyroid CBC?
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Erythrocytosis
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What do you find in hyperthyroid chemistry?
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Increased ALT and low alkaline phosphatase
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If an animal is very sick and has a normal T4, what could that mean?
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That the animal is hyperthyroid, because T4 should be low in a sick animal
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What should the result of the T3 suppression test be in a hyperthyroid cat?
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Should have no effect because nodule isn't under the control of TSH.
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Why should you measure T3 before and after the T3 suppression test?
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To make sure the cat got the T3 pill
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What drugs are used to treat feline hyperthyroidism?
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Methimazole and radioiodine
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What often happens after a thyroidectomy?
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Hypocalcemia due to loss of parathyroid gland
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Why treat hyperthyroidism with methimazole first?
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Because it could be masking chronic renal disease and methimazole can be stopped
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How does hypoalbuminemia effect calcium levels?
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It lowers them
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How do you correct for decreased albumin?
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Ca - albumin + 3.5
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Which is the important form of calcium?
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Serum ionized
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What is teh #1 rule out for hypercalcemia?
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lymphoma
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What are the causes of hypercalcemia?
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granulomatous disease, osteolysis, spurious, hyperparathyroidism, Vit D toxicity, addisons, renal disease, neoplasia, idiopathis, temperature (GOSHDARNIT)
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What is made in hypercalcemia of malignancy?
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PTH-related peptide. Acts like PTH on bone, not kidneys
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What do 40% of hypercalcemic dogs with lymphoma have?
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mediastinal masses
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What causes primary hyperparathyroidism?
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autonomously hyperfunctioning adenoma of chief cells of parathyroid gland
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What can be seen in chemistry in hypercalcemic animals?
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Low serum phosphorus
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What can be seen in UA of hypercalcemic animals?
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Calcium-containing crystals, isosthenuria, hematuria
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What medical treatment should be done on hypercalcemic animals?
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fluids, furosemide, glucocorticoids, pamidronate (decreases bone resorption)
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What is the treatment of choice for hypercalcemic animals?
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Surgical parathyroidectomy, then watch for post-op hypocalcemia.
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Why does addisons cause hypercalcemia?
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glucocorticoids promote renal excretion of calcium so the lack of them means increased resorption.
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What causes pseudo- hypocalcemia?
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hypoalbuminemia.
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What mainly causes hypocalcemia
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primary hypoparathyroidism (parathyroid destroyed by immune-mediated mechanisms) or post-thyroidectomy hypoparathyroidism
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What are some less common causes of hypocalcemia?
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eclampsia, early renal failure, pancreatitis, GI malabsorption, ethylene glycol, hypomagnesemia (needed for PTH), blood transfusions, lab error
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What is type one diabetes?
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Islet destruction (Insulin dependent) dogs mostly
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What is type 2 diabetes?
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resistant to peripheral actions of insulin (non-insulin dependent) cats mostly
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What is the honeymoon period in diabetes?
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High concentrations of blood glucose are toxic to beta cells, and cause secretory failure. So as hyperglycemia is corrected with insulin, beta cells regain some of their function and insulin resistance will dissipate and insulin may no longer be needed. (temporary!)
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What can you use to try to stimulate growth hormone?
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xylazine
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What causes acromegaly?
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A growth hormone-secreting tumor of the pituitary in cats. In dogs, progesterone stimulation of the mammary gland, which produces GH.
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Why are cats with acromegaly insulin resistant diabetics?
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Growth hormone antagonizes insulin
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How do you treat acromegaly in female dogs?
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Ovario hysterectomy
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What is central diabetes insipidus?
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Lack of ADH
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What can cause central Diabetes insipidus?
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trauma, neoplasia, pituitary cysts, inflammation, usually idiopathic
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What do you have to do before doing a water deprivation test?
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Exclude all other causes of PU/PD
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When do you stop a water deprivation test?
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if urine specific gravity rises to 1.030, when 3-5% of body weight is lost, upon clinical dehydration
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If 5% of body weight is lost with no increase of USG, what should you do?
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Give ADH. Dogs with diabetes insipidus will concentrate urine within 2 hours
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What can you do instead of the water deprivation test to diagnose diabetes insipidus?
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Give DDAVP (desmopressin) (also give to treat)
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Why give thiazide diuretics in case of diabetes insipidus?
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If you limit dietary salt, it has a paradoxical effect and decreases urine volume!
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Why is there polyuria in cushings?
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Cortisol interferes with ADH. Also increases threshold for osmo receptors
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What causes hepatomegaly in cushings?
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Steroid hepatopathy due to glycogen storage and hepatocellular vacuolization.
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What are skin signs associated with cushings?
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symmetrical alopecia, thin, wrinkly, hyperpigmentation, calcinosis cutis, comedones, long hair in horses and people
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What shoudl be on the UA of a cushings dog?
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glucosuria, dilute urine, UTI, sometimes proteinuria
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What should be in the CBC of a cushings dog?
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Stress leukogram
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What should be in the chemistry of a cushings dogs?
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High alkaline phosphatase, high ALT, glucose, cholesterol
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Is basal cortisol a useful test for cushings?
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No
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What shoudl happen in cushings dogs with the ACTH stimulation test?
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If pituitary-dependent: exaggerated response and elevated basal cortisol. In adrenal tumors, not consistent
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If the cushings is iatrogenic, what will happen with ACTH stimulation?
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No response because the adrenals will have atrophied
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What will low dose dexamethasone suppression do in cushings dogs?
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It won't suppress very much.
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What kidney function test can be done to diagnose cushings?
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Urine cortisol: creatinine ratio should be very high
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How does the high dose dex test differentiate pituitary cushings from an adrenal tumor?
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If there is still suppression after 8 hours the cause has to be pituitary. If there is no suppression at all there is a 50% chance of an adrenal tumor
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Why measure endogenous ACTH to diagnose cushings?
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If it's pituitary-dependent there will be a lot of ACTH. If it is an adrenal tumor there will be little, due to negative feedback
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What drugs do you use to treat cushings?
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Mitotane (lysodren) to kill fasciculata an dreticularis (use loading dose) Ketoconazole to inhibit steroidogenesis
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What usually causes cushings in cats?
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pituitary adenoma
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How do cat clinical signs of cushings differ from dogs?
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less PU/PD, more insulin-resistant diabetes, more cutaneous abnormalities like skin that falls off
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How do you diagnose cats with cushings?
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Do ACTH stimulation with High dose dex. Will have no suppression and exaggerated response to ACTH
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What is the treatment for hyperadrenocorticism in cats?
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adrenalectomy
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What is primary hypoadrenocorticism?
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immune mediated destruction of the adrenal cortex
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What is secondary hypoadrenocorticism?
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Decreases ACTH from the pituitary. Mineralocorticoids remain intact
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What is atypical hypoadrenocorticism?
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primary, but only glucocorticoid loss (more gradual destruction)
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What are signs of Hypoadrenocorticism?
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lethargy, weakness, excercise intolerance, vomiting, diarrhea, waxing/waning disease
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