Clin Chem > Endocrine 2 > Flashcards

Endocrine 2 Flashcards

(40 cards)

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1
Q

Why are e-lytes affected w/ Addison’s, not Cushings?

A

Addisons =GC + MC’s

Cushings =GC only

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2
Q

3 forms of Cushings

A 
1 - Pituitary dependent
       • ↑ ACTH production (dog)
2- Adrenal dependent
       •adrenocortical adenoma
3 - Iatrogenic
       • Adrenal atrophy
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3
Q

Signalment of Cushing’s dog

A
  • Middle aged / older dog
  • PU / PD / PP
  • bilateral alopecia
  • pot-belly
  • thin-skinned
  • Calcinosis cutis
  • Weak/lethargic
  • “old dog”
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4
Q

Signalment of Cushing’s cat

A
  • Extra thin Skin –> tearing
  • STRONG assoc w/ DM (75% of cushiness = DM)

• Mostly Pituitary origin

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5
Q

Signalment of Cushing’s horse

A

not the same pathogenesis (Adenoma of Pituitary Pars intermedia)
• Hirsutism

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6
Q

Erythron of Cushing’s patient

A

↑ androgens –> Stimulate polycythemia
• high Hct (may seem like dehydration, w/o other evidence)
• inappropriate polychromasia w/ nRBCs

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7
Q

Clin Chem changes assoc’d w/ Cushings

A 
• ↑ ALP (cALP)
       - mild ↑ ALT/GGT
• ↑ glucose (no glucouria)
• ↑ cholesterol / lipemia
• USG -- GC block ADH at kidney/central
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8
Q

What are atypical changes in liver enzymes for Cushings

A

Lg’er elevations in ALT / GGT / Bc
• more than drug induction
• indicate hepatopathy
- hydropic change (glycogen) –> swelling –> block canuliculi

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9
Q

What might you see in a Equine cushing’s patient that is diff than other species

A

Glucosuria

- due to higher levels of circulating glucose

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10
Q

Pathogenesis of Cushings to DM

A

GC anatagonist to insulin –> burn out –> DM

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11
Q

Why do you see ↑ cholesterol/ lipemia?

A

Antagonize insulin –> ↑ lipoprotein lipase activity –> ↓ lipoprotein breakdown –> prolong cholesterol +/- TG 1/2 life

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12
Q

Signalment & presenting signs of Addison’s

A
  • Young / middle aged dog (cat = rare)
  • Female
  • GI signs (vomiting)
  • Bradycardia (from ↑ K)
  • Addisonian crisis - cardiovascular collapse & shock
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13
Q

CBC/chem of Addison’s

A
  • Lack of stress response (w/ ill dog)
  • lymphs / eosins (maybe elevated)

• ↓ glucose (37%) - lack of basal GC
• ↑ K
• ↓ Na
• < 23:1 Na:K ratio (strongly suggestive)
• ↑ Ca possible
• Pre-renal azotemia (vomiting)
- ↓ Na –> 2° renal azotemia (medullary washout)

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14
Q

If you see ↑ K/ ↓ Na (ratio < 23:1) what are the possible ddx?

A

• Addisons!!
• Consider parameters individually
- GI sequestration + acidosis – could cause this too

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15
Q

Describe Thyroid hormone

A

• 80-90% secreted as T4
• 99% is protein bound
- free T3 = 3-5x’s»_space; free T4 activity

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16
Q

What is ↓ protein’s affect on thyroid?

A

↓ total thyroid measure – in euthyroid animal

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17
Q

Signalment of hyperthyroid

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A
  • older cat
  • hyperactive
  • thin
  • PP

( hyperplasia / adenoma )

18
Q

CBC/chem assoc’d w/ hyperthyroid

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A
  • polycythemia (50%)
  • ↑ Heinz bodies

• ↑ ALT, ALP

  - 2/3 cases show enzyme ↑ -- reasons unclear
  - DON'T think these ONLY mean liver!
19
Q

Dz assoc’d w/ heinz bodies in cats

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A

1 - Hyperthyroid
2- DM
3- Lymphosarcoma
4- Exogenous oxidants - acetaminophen, onion tox

• New methylene blue stain

20
Q

Signalment for Hypothyroid

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A
  • Doberman / Dachshund / cocker
  • middle aged
  • Mid-sized
  • Heat-seeker & hypothermic W/O shivering
  • Obesity
  • Bilateral alopecia w/ dry skin

Glandular atrophy / lymphocytic thyroiditis

21
Q

What are clinical signs that are assoc’d w/ Critical condition hypothyroid?

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A
  • Weakness
  • NON-pitting edema
  • Serous cavity effusion

• Myxedema w/ stupor = rare life-threatening

22
Q

CBC assoc’d w/ Hypothyroid

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A

• Mild non-regenerative anemia
- ↓ oxidative metabolism – body is good at ↓ Hct
• usually no stress leukogram

– differentiated it from cushings!

23
Q

Chemistry assoc’d w/ hypothyroidism

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A

• ↑ cholesterol

- > 500 = strongly suggests hypothyroid

24
Q

Ddx for ↑ cholesterol

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A 
1 - Hypothyroid ( >500)
2- Pancreatitis
3- Cholestasis
4- DM
5- Renal failure (nephrotic syndrome)
25
What is "Sick Euthyroid Syndrome"? | Should you supplement T4?
Degree of ↓ correlated w/ degree of sickness (ICU patients) - protective mechanism to ↓ metabolism during Negative nitrogen balance - Do not give T4 -- will correct itself
26
Dz / Drugs assoc'd w/ Sick Euthyroid Syndrome
``` Dz • Cushings / Addisons • DM • Chronic renal failure • Liver dz • Pyoderma ``` ``` Drug • Anesthetics • Glucocorticoids • NSAIDs • Furosemide • Anti-convulsants ``` - resolve 1° condition
27
Hormones that regulate Ca++
PTH - ↑ Ca ↓ P Calcitonin - ↓ Ca ↓ P Vitamin D - ↑ Ca ↑ P
28
Ddx of hypercalcemia
* 1° hyperparathyroidism * Humoral hypercalciemia of malignancy * Hypervitaminosis D * addisons * granulomatous dz involving bone Horse • Renal dz
29
Classic pattern of 1° hyperparathyroidism
↑ Ca / ↓ P ↑ Ca --> deposits in tubules --> renal failure • Phos may be normal if renal failure (due to ↑ retention)
30
Most common cause of significant hypercalcemia
Humoral hypercalcemia of Malignancy • Lymphosarcoma • Anal sac adenoma
31
Classic pattern hypervitaminosis D
↑ Ca / normal to ↑ Phos (even w/o azotemia) • if there is azotemia --> you may want to interpret it as ↑ Phos due to azotemia, but should be thinking about ↑ Vit D too!
32
Differentiate btwn 1° renal failure & hypercalcemia-induced renal failure, using ↑ Ca
1° renal failure --> mild ↑ in Ca Hypercalcemia induced renal failure • ↑ ↑ ↑ Ca --> renal failure
33
#1 cause for Hypocalcemia
Hypoalbuminemia | - mild change
34
Causes for hypocalcemia
``` 1 - hypoalbuminemia 2- Renal failure (non-equine) - esp. Ethylene glycol tox 3- Hypoparathyroidism 4- Pancreatitis 5- Parturient paresis 6- Hypomagnesemia 7- Blister beetles 8- Mercurial skin compound (horse) ```
35
Hypoparathyroid
↓ Ca ↑ Phos • measure PTH during hypocalcemia - if low during this time = hypocalcemia
36
Parturient paresis
Milk fever = cow ↓ Ca --> ↓ Ach release --> flaccid paralysis Eclampsia = Bitch & mare ↓ Ca --> ↓ membrane stability --> ↑ firing --> Puerperal tetany
37
Hypomagnesemia
* Grass tetany * Seasonal/winter tetany * calves on whole milk for extended time
38
Clinical signs of hypomagnesemia
- hyper-excitability - Twitching - staggering - paresis - tetany - convulsion
39
what ion is assoc'd with Mg? What does it do with hypomagnesemia?
Ca • Mg required for PTH release • may contribute to clinical signs Phos • mild ↓
40
What is the toxin assoc'd w/ blister beetles? | What are the assoc'd lesions?
Cantharidin • often find them in alfalfa ** Combined GI symptoms, Renal dysfunction, ↓ Ca
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