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47 Cards in this Set
- Front
- Back
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Hypothyroidism
aka |
-addisons
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Primary addisons disease
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-adrenal insufficiency
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Secondary addisons
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-pituitary insufficency
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Typical addisonian
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-glucocorticoid and mineralocorticoid deficiency
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Atypical addisonian
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-glucocorticoid deficiency
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Addisons disease
-main type |
-primary addisons
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Primary addisons
-causes |
-Atrophy/destruction of adrenal cortex***
-Infiltrative disease -Iatrogenic |
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Atrophy of adrenal cortex
-due to |
-immune mediated
-genetic link |
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Infiltrative disease causing addisons
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-granuloma
-amyloidosis -infarction -hemorrhage -metastatic dz |
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Iatrogenic causes of addisons
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Exogenous Glucocorticoid
-aldosterone deficiency -GC deficiency |
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Cortisol Deficiency
-common signs |
-anorexia/weight loss
-lethargy -hypoglycemia -GI signs |
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Aldosterone deficiency
-common signs |
-Hyponatremia, Hypochloremia, Hyperkalemia
-dec. plasma volume -PU |
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Addisons
-signalment |
-young/middle-aged dog
-female -breed predilections: Great Dane, Westie, Poodle, Basset hound, bearded collie |
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Addisons
-clinical signs |
Early stages--> basal hormone levels usually sufficient unless stressed
-anorexia/hyporexia -lethargy -vomiting/diarrhea -PU -weakness -weight loss -regurgitation/abdominal pain |
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addisons
-amount of adrenal cortex loss for clinical signs to appear |
-85%
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Addisonian crisis
-severe signs |
-bradycardia
-hypovolemia -weak pulse -hypothermia -shock -melena -collapse |
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Addisons
-profound hypovolemia is due to: |
-hypotonic dehydration
*opposite of Diabetes insipidus |
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Addisons
-minimum data base |
CBC
-anemia (steroid effect on bone marrow) -lack of stress leukogram (EO and Lymph elevated) Serum chem -azotemia -hyponatremia, hypochloremia (aldosterone deficiency) -hyperkalemia (aldosterone deficiency and acidosis) -hypoglycemia (mild) -hypercalcemia (mild) -hypoalbuminemia (mild) -acidosis (dec. renal H+ secretion) Urinalysis -infection -dilute USG despite dehydration (aldosterone def.) |
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Addisons
-Na/K ratio |
-27/1 suspicious
-20/1 supportive |
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Addisons
-reason misdiagnosed as renal failure |
-azotemia
-dehydration -dilute urine |
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Addisons
-Imaging |
-radiography and US usually not helpful
-US could show abnormal adrenal glands -thoracic radiographs show hypovolemia, megaesophagus |
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Addisons
-importance of electrocardiogram |
Cardiac arrhythmias from elevations in K+
-bradycardia, spiking T wave -Tall T waves, wide QRS, increased P-R interval, decreased to invisible P wave -S-T segment deviation, V-fibrillation, V-asystole |
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Addisons
-definitive test |
-ACTH stimulation test
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Addisons
-other diagnostic tests |
-Endogenous ACTH (ACTH expected to be high in primary hypoadrenocorticism)
-Basal cortisol level -Aldosterone level (confirm mineralocorticoid deficiency) |
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Adrenal crisis
-treatment goals |
-volume replacement
-hormone replacement (after fluid treatment) -treat hyperkalemia if needed -treat acidosis (not usually needed) |
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Addisonian crisis
-importance of volume replacement |
-death due to collapse and shock
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Addisonian crisis
-volume replacement treatment |
-fluids (NaCl)
-isotonic fluids |
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Addisonian crisis
-reason why acidosis not usually a problem |
-re-established renal flow usually fixes
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Giving an ACTH stim test when there is a high suspicion of addisons
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-test prior to administering GC
-should administer GC before test results known because test takes about an hr |
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Addisons
-glucocorticoid supplementation |
-dexmethasone
-prednisolone sodium succinate ($$$, emergency drug) |
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Addisons
-mineralocorticoid supplementation |
Single dose not harmful to dogs who don't have addisons
-hydrocortisone (ultra short acting, not used) -fludrocortisone (short acting, oral, $$$$) -desoxycorticosterone (long acting, SQ) |
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Addisons
-hyperkalemia treatment |
Usually not needed
If life threatening -10% calcium gluconate (slow IV w/ ECG monitor) cardioprotective -Dextrose + Humulin-R (water moves into cells and brings k+ along) |
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Addisons
-what to monitor with treatment with dextrose + Humulin-R |
-hypovolemia
-hypokalemia |
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Addisonian crisis treatment
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-fluids for 24-48 hrs to replenish electrolytes
nursing care and monitoring -hydration status, electrolytes, urine output -supportive care -No food for 24-48 hrs if vomiting -injectable steroids until oral tolerated |
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Addisons
-maintenance therapy (mineralocorticoids) |
Mineralocorticoid replacement
-DOCP -slow release of mineralocorticoids with no GC activity (need to give prednisolone) -Fludrocortisone -minor GC activity (usually don't need additional GC therapy) $$$$$ |
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Addisons
-maintenance therapy (glucocorticoids) |
Goal is to provide physiologic levels of glucocorticoids
-Prednisone (hormone replacement) |
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Addisons
-glucocorticoid maintenance: when to give extra prednisone |
Anticipated stressful situations
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Only treatment needed for atypical addisons
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-prednisone
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Addisons
-long term monitoring |
Serial evaluation of electrolytes
-every 1-2 wks til stable -every 3-4 months after -adjust mineralocorticoid dose based on results Serial evaluation of clinical signs -owner observations -may have subtle manifestations -inc. GC if not quite right -dec. with signs of GC excess No need for serial ACTH stim -cortex will always be destroyed |
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Addisons
-prognosis |
Excellent if:
-owners are educated about disease -compliance excellent -close follow-up maintained |
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Feline hypoadrenocorticism
-types |
-Primary (very rare)
-Secondary |
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Feline addisons
-primary addisons cause |
-immune mediated
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Feline addisons
-secondary addisons cause |
Iatrogenic
-megestrol acetate -glucocorticoids |
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Feline addisons
-clinical signs |
Similar to dog
-anorexia/hyporexia -lethargy -vomiting/diarrhea -PU -weakness -weight loss -regurgitation/abdominal pain |
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Feline addisons
-lab abnormalities |
-similar to dog
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Feline addisons
-diagnosis |
ACTH stim test
-take sample before, 30 min, 60 min |
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Feline addisons
-treatment |
Similar to dog
-clinical signs might not resolve as quickly |
