Hyperadrenocorticism Treatment Quiz
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Questions and Answers

What is one of the potential causes of hypoglycemia in dogs?

  • Hyperadrenocorticism
  • Obesity
  • Cushing's disease
  • Congenital enzyme deficiency (correct)

    • Which clinical sign is associated with growth hormone (GH) deficiency in dogs?

  • Retention of primary hairs
  • Coughing with exercise
  • Increased aggressiveness
  • Lack of growth despite normal body proportions (correct)

    • What laboratory finding would indicate hypoglycemia in a dog?

  • Blood glucose above 60 mg/dL
  • Increased liver enzymes
  • Normal insulin level
  • Inappropriately high insulin level with low glucose (correct)

    • Which of the following can be a result of suboptimal cortisol levels in dogs?

    <p>Hyperpigmented skin</p> Signup and view all the answers

    What is a common consequence of insulinoma in dogs?

    <p>Hypoglycemia with an increased insulin level</p> Signup and view all the answers

    Which condition typically does NOT lead to hypoglycemia in dogs?

    <p>Weight loss</p> Signup and view all the answers

    What is an appropriate protocol before testing a dog for insulin levels?

    <p>Fast the dog</p> Signup and view all the answers

    What is one of the treatment protocols for hypoglycemia in dogs?

    <p>Monitoring glucose concentrations</p> Signup and view all the answers

    What serum sodium concentration indicates normal levels in a patient with potential hyperaldosteronism?

    <p>142 mEq/L</p> Signup and view all the answers

    What is typically observed in clinical signs related to primary hyperaldosteronism?

    <p>Ventroflexion of the neck</p> Signup and view all the answers

    Which condition is indicated by a serum potassium level of 5.4 mEq/L in the context discussed?

    <p>Normal potassium</p> Signup and view all the answers

    What role does ionized calcium (iCa) play in the context of calcium metabolism?

    <p>It is the most important biologically active fraction</p> Signup and view all the answers

    What is the primary reason for measuring serum ionized calcium in patients suspected of having calcium metabolic disorders?

    <p>tCa may not accurately predict iCa</p> Signup and view all the answers

    In cases of systemic hypertension related to sodium and fluid retention, which of the following is a possible cause?

    <p>Hypokalemia</p> Signup and view all the answers

    Which of the following diagnoses is least likely to present with normal blood urea nitrogen (BUN) levels?

    <p>Dehydration</p> Signup and view all the answers

    What physiological changes occur in patients with elevated phosphorus levels affecting calcitriol production?

    <p>Decreased parathyroid hormone production</p> Signup and view all the answers

    What is a common post-surgery complication related to pancreatic conditions?

    <p>Pancreatitis</p> Signup and view all the answers

    Which hormone's concentration is typically low in young individuals experiencing deficiencies related to growth?

    <p>Insulin-like growth factor 1 (IGF-1)</p> Signup and view all the answers

    What dietary recommendations should be followed to manage insulin-related conditions?

    <p>High in fat, protein, and complex carbohydrates</p> Signup and view all the answers

    What is a significant characteristic of acromegaly in cats?

    <p>Excess of growth hormone production</p> Signup and view all the answers

    Which treatment option is known for effectively decreasing insulin release from pancreatic beta cells?

    <p>Diazoxide</p> Signup and view all the answers

    What is the prognosis for patients diagnosed with acromegaly?

    <p>Long-term prognosis is guarded to poor</p> Signup and view all the answers

    How soon can skin and hair responses be expected after injections of Growth Hormone (GH)?

    <p>6 to 8 weeks</p> Signup and view all the answers

    What happens to patients regarding insulin synthesis when octreotide is administered?

    <p>It inhibits insulin synthesis</p> Signup and view all the answers

    What is a potential consequence of oversuppression of cortisol production?

    <p>Hypoadrenocorticism</p> Signup and view all the answers

    Which treatment option is the most successful for adrenal tumors?

    <p>Adrenalectomy</p> Signup and view all the answers

    What is the primary method for monitoring the effectiveness of Trilostane treatment?

    <p>ACTH response test</p> Signup and view all the answers

    Which of the following describes a common side effect associated with Ketoconazole?

    <p>Delayed wound healing</p> Signup and view all the answers

    In the context of hypoadrenocorticism, which statement is true regarding its pathogenesis?

    <p>Idiopathic adrenocortical atrophy is a common cause.</p> Signup and view all the answers

    Which of the following treatments has not shown effective long-term results for managing hyperadrenocorticism?

    <p>L-Deprenyl</p> Signup and view all the answers

    What type of hormone production does Trilostane inhibit?

    <p>Glucocorticoid, mineralocorticoid, and adrenal androgen production</p> Signup and view all the answers

    Which type of supplementation may be necessary after a bilateral adrenalectomy for pituitary-dependent hyperadrenocorticism (PDH)?

    <p>Both mineralocorticoids and glucocorticoids</p> Signup and view all the answers

    What is a potential reason that animals with poorly controlled diabetes mellitus (DM) may appear thin?

    <p>Preference for water over food intake.</p> Signup and view all the answers

    How does insulin resistance in acromegaly affect existing diabetes mellitus?

    <p>May result in poorly controlled diabetes.</p> Signup and view all the answers

    Which diagnostic measure is used to assess the concentration of growth hormone in suspected acromegaly cases?

    <p>Elevated concentrations of IGF-1</p> Signup and view all the answers

    What is characteristic of urine when assessing for nephrogenic diabetes insipidus (DI) in affected animals?

    <p>Urine is hyposthenuric or isosthenuric.</p> Signup and view all the answers

    What does hypernatremia with hyposthenuria typically suggest in an animal's diagnosis?

    <p>The animal may have nephrogenic diabetes insipidus.</p> Signup and view all the answers

    What does the modified water deprivation test assess in relation to urine specific gravity (USG)?

    <p>The effects of dehydration on urinary concentration.</p> Signup and view all the answers

    In cases of central diabetes insipidus (CDI), how does absolute vasopressin deficiency manifest?

    <p>Persistent hyposthenuria and severe diuresis.</p> Signup and view all the answers

    What is a consideration when performing a modified water deprivation test?

    <p>It should not be conducted on dehydrated animals.</p> Signup and view all the answers

    What is the preferred insulin type for initial therapy in cats with hyperglycemia?

    <p>Lente or NPH insulin</p> Signup and view all the answers

    In managing hyperglycemia, what is the typical initial insulin dosage recommended?

    <p>0.5 unit/kg twice daily</p> Signup and view all the answers

    Which cause is not typically associated with hyperglycemia in cats?

    <p>Hypoglycemia</p> Signup and view all the answers

    What should be measured to assess the efficacy of the initial insulin therapy after administration?

    <p>Glucose concentration at 4 and 6 to 7 hours</p> Signup and view all the answers

    Why is beef origin insulin generally avoided in therapy?

    <p>It may induce antibody formation</p> Signup and view all the answers

    What characteristic is NOT associated with subclinical thyroiditis?

    <p>High TSH concentration</p> Signup and view all the answers

    Which statement best describes the condition of subclinical hypothyroidism?

    <p>Normal or borderline low thyroid hormone concentrations</p> Signup and view all the answers

    In clinical hypothyroidism, what is a significant laboratory finding?

    <p>Low thyroid hormone concentrations and elevated TSH concentration</p> Signup and view all the answers

    Which statement accurately describes the role of parathyroid hormone (PTH) in calcium metabolism?

    <p>PTH increases renal calcium retention when ionized calcium is low.</p> Signup and view all the answers

    What could indicate an excessive T4 supplement dose in a patient?

    <p>Signs of hyperthyroidism such as anxiousness and panting</p> Signup and view all the answers

    What is the mechanism of action for bisphosphonates in treating hypercalcemia?

    <p>Acts as osteoclast poisons to decrease bone turnover.</p> Signup and view all the answers

    When considering the treatment of primary hyperparathyroidism, what is the underlying cause of elevated ionized calcium?

    <p>Parathyroid tumor secreting excess parathyroid hormone.</p> Signup and view all the answers

    When should thyroid supplements be stopped to accurately test for hypothyroidism?

    <p>4 to 6 weeks before testing</p> Signup and view all the answers

    Which factor does NOT influence the absorption of T4 supplements?

    <p>Body weight of the patient</p> Signup and view all the answers

    What role does synthesized calcitriol play in calcium metabolism?

    <p>It enhances bone resorption and calcium absorption.</p> Signup and view all the answers

    What effect does the retention of calcium by the kidneys have on serum calcium levels?

    <p>Maintains normal serum calcium levels when calcium intake is low.</p> Signup and view all the answers

    Which is a characteristic finding in the diagnosis of subclinical hypothyroidism?

    <p>Low thyroid hormone levels</p> Signup and view all the answers

    Which of these is a common result of decreased bone resorption due to changes in calcium metabolism?

    <p>Increased risk of fractures.</p> Signup and view all the answers

    Which breed is mentioned as having normally lower concentrations of thyroid hormones?

    <p>Sighthounds like Greyhounds</p> Signup and view all the answers

    What potential consequences arise from the over-secretion of parathyroid hormone due to a parathyroid tumor?

    <p>Excessive mobilization of calcium from bone storage.</p> Signup and view all the answers

    How does vitamin D influence calcium metabolism similarly to parathyroid hormone?

    <p>It enhances intestinal calcium absorption and promotes bone resorption.</p> Signup and view all the answers

    Which clinical sign is a common indication of deficiencies in calcium, vitamin D, or excessive phosphate intake in young animals?

    <p>Bone pain and limb deformities</p> Signup and view all the answers

    What condition results from a progressive reduction in renal tubule cells affecting calcium retention?

    <p>Renal secondary hyperparathyroidism</p> Signup and view all the answers

    Which of the following biochemical findings is associated with a diagnosis of diabetes mellitus in dogs?

    <p>Hypercholesterolemia</p> Signup and view all the answers

    What is an expected physiological consequence of decreased calcitriol levels in the body?

    <p>Increased resorption of calcium from bone</p> Signup and view all the answers

    In diabetic dogs, which of the following must be observed for a diagnosis of diabetic ketoacidosis (DKA)?

    <p>Ketone bodies in urine</p> Signup and view all the answers

    What clinical sign commonly associated with diabetes mellitus can also lead to dehydration and muscle wasting?

    <p>Polyuria</p> Signup and view all the answers

    Which process is directly implicated in the development of neurologic signs during chronic renal failure (CRF)?

    <p>Excess parathyroid hormone (PTH)</p> Signup and view all the answers

    What is the threshold for blood glucose concentration that usually triggers clinical signs of diabetes mellitus in dogs?

    <p>180-200 mg/dL</p> Signup and view all the answers

    What is the recommended dosage of oral calcium for Siamese cats?

    <p>50 to 100 mg elemental calcium/kg/day</p> Signup and view all the answers

    Which treatment for hypocalcemia has the fastest onset of action?

    <p>Calcitriol</p> Signup and view all the answers

    What potential condition can occur with the treatment of hypocalcemia?

    <p>Hypercalcemia</p> Signup and view all the answers

    What is the least effective form of vitamin D for correcting hypocalcemia?

    <p>Ergocalciferol</p> Signup and view all the answers

    Which of the following is NOT a cause of hypocalcemia?

    <p>Chronic hypercalcemia</p> Signup and view all the answers

    What is the most prevalent clinical condition causing hypoparathyroidism?

    <p>Trauma to the parathyroid gland</p> Signup and view all the answers

    In the context of magnesium depletion, what is a common consequence?

    <p>Decreased parathyroid function</p> Signup and view all the answers

    What clinical condition is prevalent in lactating bitches or queens during the first three weeks postpartum?

    <p>Puerperal tetany (eclampsia)</p> Signup and view all the answers

    Which type of insulin is classified as long-acting?

    <p>Ultralente</p> Signup and view all the answers

    What should be monitored to assess the effectiveness of diabetes mellitus treatment?

    <p>Appetite and water consumption</p> Signup and view all the answers

    Which insulin type is typically used in place of poor absorption in diabetic dogs?

    <p>Protamine zinc insulin (PZI)</p> Signup and view all the answers

    During which situation should glucose curves be performed?

    <p>During initial regulation of treatment</p> Signup and view all the answers

    Which insulin type is classified as intermediate-acting?

    <p>Neutral protamine Hagedorn (NPH)</p> Signup and view all the answers

    What is the typical duration of action for glargine insulin in cats?

    <p>12 to 16 hours</p> Signup and view all the answers

    What is the initial recommended dosage range for insulin therapy in cats?

    <p>1 to 3 units/cat twice daily</p> Signup and view all the answers

    What insulin types are preferred for use in cats?

    <p>Lente and PZI</p> Signup and view all the answers

    After starting insulin therapy, when should glucose concentrations be measured?

    <p>4 and 6-7 hours</p> Signup and view all the answers

    What might be necessary regarding the insulin dose after two weeks in cats using glargine?

    <p>Decrease the dosage if needed</p> Signup and view all the answers

    Which factor is not associated with conditions leading to hyperglycemia in cats?

    <p>Hypoglycemia</p> Signup and view all the answers

    What is a common effect of glucocorticosteroids on diabetic cats?

    <p>Increase in insulin resistance</p> Signup and view all the answers

    Which is a characteristic of insulin therapy in cats with diabetes mellitus?

    <p>Frequent adjustments to dosage may be required</p> Signup and view all the answers

    What is the primary cause of death in severe diabetic ketoacidosis (DKA)?

    <p>Metabolic acidosis</p> Signup and view all the answers

    Which condition is most commonly associated with insulin resistance in cats?

    <p>Hyperadrenocorticism</p> Signup and view all the answers

    In cases of insulinoma, which is a common characteristic regarding the age of affected dogs?

    <p>Typically seen in middle-aged to older dogs</p> Signup and view all the answers

    What does fructosamine reflect in dogs with diabetes mellitus?

    <p>Blood glucose levels over the past week</p> Signup and view all the answers

    Which is an unlikely clinical sign associated with hypoglycemia in dogs?

    <p>Weight gain</p> Signup and view all the answers

    What is a known effect of the Somogyi phenomenon in diabetic patients?

    <p>Incorrect interpretation of blood sugar levels as poor control</p> Signup and view all the answers

    Which of the following statements accurately describes a common predisposition in insulinoma cases?

    <p>Medium to larger breed dogs are predisposed</p> Signup and view all the answers

    What is the expected course of action regarding insulin dose adjustment after recording glucose levels?

    <p>Repeat glucose curve 1 week after altering insulin dose</p> Signup and view all the answers

    Why is the high-dose dexamethasone suppression test not recommended for diagnosing HAC?

    <p>It may reveal normal suppression despite pituitary tumors</p> Signup and view all the answers

    What indicates a low concentration of endogenous ACTH in adrenal tumors?

    <p>Enhanced feedback from excess cortisol to the pituitary</p> Signup and view all the answers

    What clinical sign is typically seen in dogs with PDH?

    <p>Polyuria or polydipsia</p> Signup and view all the answers

    How might abdominal ultrasound findings differ between adrenal tumors and PDH?

    <p>One adrenal gland may appear enlarged with irregular contours in adrenal tumors</p> Signup and view all the answers

    What is a common clinical pathology finding associated with hyperadrenocorticism?

    <p>Hyperglycemia with or without glucosuria</p> Signup and view all the answers

    Which of the following is a major concern when handling samples for endogenous ACTH measurement?

    <p>Sample handling is critical due to the labile nature of ACTH</p> Signup and view all the answers

    Which breed of dog is at increased risk for developing adrenal tumors?

    <p>Large breeds weighing more than 20 kg</p> Signup and view all the answers

    What is a characteristic of clinical signs seen in hyperadrenocorticism?

    <p>Abdominal distension leading to a pot-bellied appearance</p> Signup and view all the answers

    What is a potential reason for insufficient insulin efficacy in a diabetic dog?

    <p>Improper injection technique</p> Signup and view all the answers

    Which condition is likely to cause an increase in blood glucose levels in unregulated diabetic dogs?

    <p>Acromegaly</p> Signup and view all the answers

    What is the recommended frequency of insulin administration for optimal management in diabetic dogs?

    <p>Twice daily</p> Signup and view all the answers

    Which of the following is NOT a common cause of insulin antagonism in dogs?

    <p>Chronic pancreatitis</p> Signup and view all the answers

    What is a consequence of insulin-induced hyperglycemia in diabetic dogs?

    <p>Increased thirst</p> Signup and view all the answers

    During serial blood glucose monitoring, what should be observed to adjust insulin dosing?

    <p>Nadir levels and duration of action</p> Signup and view all the answers

    What is an indication that a diabetic dog may require a dosage change in insulin therapy?

    <p>Nadir levels that are too high</p> Signup and view all the answers

    Which of the following is a distinguishing factor for selecting insulin regimens in unregulated diabetic dogs?

    <p>Underlying hormonal disorders</p> Signup and view all the answers

    What can result from improper insulin storage in diabetic dogs?

    <p>Insulin degradation</p> Signup and view all the answers

    What is commonly monitored to assess the adequacy of insulin therapy in dogs?

    <p>Serial blood glucose levels</p> Signup and view all the answers

    What is the initial insulin dosing protocol recommended for diabetic cats?

    <p>0.5 unit/kg twice daily</p> Signup and view all the answers

    Which insulin type is generally avoided due to its potential to induce antibody formation?

    <p>Beef insulin</p> Signup and view all the answers

    Which condition is specifically associated with renal disease as a cause of hyperglycemia?

    <p>Cushing disease</p> Signup and view all the answers

    What physiological contribution is most significant in cases of stress-induced hyperglycemia in cats?

    <p>Elevated corticosteroid levels</p> Signup and view all the answers

    What glucose measurement protocol is crucial for assessing the effectiveness of initial insulin therapy?

    <p>Measure at 4 and 6 to 7 hours post-injection</p> Signup and view all the answers

    What clinical sign is most commonly associated with decreased potassium in animals?

    <p>Systemic hypertension</p> Signup and view all the answers

    Which metabolic condition is indicated by a serum potassium level at or above 5.4 mEq/L?

    <p>Hyperkalemia</p> Signup and view all the answers

    What is the primary function of thyroid-releasing hormone (TRH)?

    <p>To initiate the production of thyroid-stimulating hormone (TSH)</p> Signup and view all the answers

    Which thyroid hormone is considered the active form?

    <p>Free T3</p> Signup and view all the answers

    Which condition is least likely to cause fluid retention related to primary hyperaldosteronism?

    <p>Hypernatremia</p> Signup and view all the answers

    In the context of calcium metabolism, what is the physiological role of ionized calcium (iCa)?

    <p>It is the most biologically active form of calcium.</p> Signup and view all the answers

    What do thyroglobulin autoantibodies (TgAA) indicate in dogs?

    <p>Lymphocytic thyroiditis presence</p> Signup and view all the answers

    What is the effect of T3 autoantibodies (T3AA) on thyroid measurements?

    <p>They may interfere with T3 and FT3 measurement</p> Signup and view all the answers

    Which statement best describes the relationship between elevated phosphorus levels and calcitriol production?

    <p>Elevated phosphorus levels inhibit calcitriol production.</p> Signup and view all the answers

    What is the significance of measuring serum total calcium (tCa) in diagnosing calcium metabolic disorders?

    <p>tCa does not effectively predict ionized calcium status.</p> Signup and view all the answers

    Why is the T3 suppression test utilized?

    <p>To diagnose hyperthyroid conditions in cats</p> Signup and view all the answers

    What is measured in the 'pre' sample of the T3 suppression test?

    <p>T3, T4, FT3, and FT4</p> Signup and view all the answers

    Which of the following best describes one of the common clinical signs in older animals diagnosed with primary hyperaldosteronism?

    <p>Ventrosternal flexion of the neck</p> Signup and view all the answers

    Which hormone's elevated levels promote negative feedback on TSH production?

    <p>Triiodothyronine (T3)</p> Signup and view all the answers

    What is the typical cause of elevated creatine kinase levels in cases related to decreased potassium?

    <p>Muscle injury or damage</p> Signup and view all the answers

    What does the presence of T4 autoantibodies (T4AA) suggest in dogs?

    <p>Interference with certain T4 measurements</p> Signup and view all the answers

    What is the primary effect of elevated PTHrP in the plasma?

    <p>Bone resorption and renal calcium conservation</p> Signup and view all the answers

    Which statement best describes parathyroid-independent hypocalcemia?

    <p>Results from the demand for ionized calcium exceeding the supply</p> Signup and view all the answers

    What is a significant diagnostic challenge when evaluating for malignancy related to PTHrP?

    <p>Presence of PTHrP may occur in non-malignant conditions as well</p> Signup and view all the answers

    What is the recommended initial treatment approach for cases of hypercalcemia where other treatments have not worked?

    <p>Switch to a high fiber diet</p> Signup and view all the answers

    What underlying condition is primarily associated with the clinical signs of hypocalcemia?

    <p>Destruction of parathyroid glands</p> Signup and view all the answers

    Which of the following is a common feature of parathyroid-independent hypercalcemia?

    <p>Elevated iCa concentration with suppressed PTH</p> Signup and view all the answers

    In the context of hypoadrenocorticism, what effect does treating underlying conditions like hypovolemia have on hypercalcemia?

    <p>It resolves hypercalcemia</p> Signup and view all the answers

    What is an important consideration when diagnosing causes of calcium imbalance, particularly in cases of malignancy-related hypercalcemia?

    <p>Diagnosis should exclude evidence of parathyroid tumors first</p> Signup and view all the answers

    Which disorder is most commonly associated with renal secondary hyperparathyroidism?

    <p>Chronic renal failure</p> Signup and view all the answers

    What is a common biochemical finding in humoral hypercalcemia of malignancy?

    <p>Increased serum ionized calcium</p> Signup and view all the answers

    Which parathyroid hormone level would you expect in a case of primary hyperparathyroidism?

    <p>Increased</p> Signup and view all the answers

    In nutritional secondary hyperparathyroidism, what happens to the serum phosphorus level?

    <p>Increased</p> Signup and view all the answers

    What is the typical response of serum calcium levels in a case of idiopathic hypercalcemia in cats?

    <p>Increased total calcium</p> Signup and view all the answers

    What laboratory finding would indicate hypervitaminosis D?

    <p>Increased serum phosphorus</p> Signup and view all the answers

    What is a distinctive feature of cholecalciferol toxicity in terms of biochemical markers?

    <p>Increased ionized calcium and phosphorus</p> Signup and view all the answers

    In dehydration, which serum parameter is likely to be altered?

    <p>Increased serum total calcium</p> Signup and view all the answers

    What is the expected laboratory finding in a case of hyperthyroidism in cats?

    <p>Increased ionized calcium</p> Signup and view all the answers

    What physiological condition is associated with aluminum exposure and renal failure?

    <p>Increased serum phosphorus and decreased PTH</p> Signup and view all the answers

    What type of insulin is categorized as short-acting?

    <p>Regular</p> Signup and view all the answers

    Which monitoring procedure is recommended when hypoglycemia is suspected during initial treatment regulation?

    <p>Perform glucose curves</p> Signup and view all the answers

    What is a type of long-acting insulin listed in the provided content?

    <p>Protamine zinc insulin (PZI)</p> Signup and view all the answers

    Which type of insulin treatment is known for its poor absorption?

    <p>Long-acting insulin</p> Signup and view all the answers

    What clinical signs should be monitored to assess the effectiveness of insulin treatment?

    <p>Water consumption and general well-being</p> Signup and view all the answers

    Which hormone is primarily responsible for increasing calcium levels in the blood?

    <p>Parathyroid hormone (PTH)</p> Signup and view all the answers

    What is the primary effect of synthesized calcitriol on calcium metabolism?

    <p>Enhances bone resorption and intestinal calcium absorption</p> Signup and view all the answers

    Which treatment option acts specifically as an inhibitor of bone resorption in hypercalcemia management?

    <p>Bisphosphonates</p> Signup and view all the answers

    In primary hyperparathyroidism, what process causes elevated ionized calcium levels?

    <p>Parathyroid tumor secreting excess PTH</p> Signup and view all the answers

    Which mechanism is NOT a direct action of parathyroid hormone (PTH)?

    <p>Inhibiting the conversion of 25-hydroxyvitamin D to calcitriol</p> Signup and view all the answers

    What is a common characteristic of disorders associated with excessive bone resorption?

    <p>Hypercalcemia</p> Signup and view all the answers

    What role does vitamin D play in calcium metabolism?

    <p>Facilitates absorption of calcium from the intestine</p> Signup and view all the answers

    Which drug is known to facilitate the correction of dehydration in hypercalcemic patients?

    <p>Furosemide</p> Signup and view all the answers

    What is the recommended glucose concentration maintenance range for diabetic dogs?

    <p>100 to 200 mg/dL</p> Signup and view all the answers

    What does the glucose nadir indicate in the context of insulin therapy?

    <p>The peak insulin action timing</p> Signup and view all the answers

    What clinical sign is typically observed in dogs and cats with diabetic ketoacidosis (DKA)?

    <p>Dehydration and lethargy</p> Signup and view all the answers

    How long can it take for clinical signs of diabetic ketoacidosis to develop after initial onset?

    <p>A few days to over 6 months</p> Signup and view all the answers

    What is the definition of glucose differential in diabetic monitoring?

    <p>The difference between glucose nadir and pre-insulin dose glucose</p> Signup and view all the answers

    What condition may lead to diabetic ketoacidosis in pets receiving inadequate insulin?

    <p>Infection or inflammation</p> Signup and view all the answers

    When should blood glucose concentration be measured in relation to insulin administration?

    <p>Every 2 hours until 8 to 12 hours after insulin</p> Signup and view all the answers

    What is the target range for glucose nadir in diabetic dogs?

    <p>80 to 120 mg/dL</p> Signup and view all the answers

    What is the preferred type of insulin for initial therapy in cats with diabetes mellitus?

    <p>Lente</p> Signup and view all the answers

    What dosage range is typically recommended to start insulin therapy in cats?

    <p>1 to 3 units/cat twice daily</p> Signup and view all the answers

    How long does glargine insulin typically last in cats?

    <p>12 to 16 hours</p> Signup and view all the answers

    What is important to monitor after the initial administration of insulin therapy in cats?

    <p>Glucose concentration 4 and 6-7 hours later</p> Signup and view all the answers

    What is a potential adjustment that may be needed after 2 weeks of insulin therapy in cats?

    <p>Decrease the dosage if using glargine</p> Signup and view all the answers

    Which of the following is NOT a common drug that may influence insulin therapy in cats?

    <p>Amiodarone</p> Signup and view all the answers

    What is a notable characteristic of the effects of using glargine in insulin therapy for cats?

    <p>Takes several days for maximum effect</p> Signup and view all the answers

    In the context of insulin therapy for cats, what is the significance of measuring glucose concentration at certain intervals?

    <p>To adjust the insulin dosage and avoid complications</p> Signup and view all the answers

    What indicates a potential case of hyperadrenocorticism (HAC) in post-dexamethasone cortisol measurements?

    <p>Post-dexamethasone cortisol concentration greater than 30 to 40 nmol/L</p> Signup and view all the answers

    Which of the following best describes occult hyperthyroidism?

    <p>Thyroid hormone concentrations may vary based on concurrent illness</p> Signup and view all the answers

    What consequence can arise from surgical treatment of hyperthyroidism?

    <p>Transient or permanent hypoparathyroidism</p> Signup and view all the answers

    Which laboratory finding may indicate pituitary-dependent hyperadrenocorticism (PDH) after dexamethasone suppression testing?

    <p>Cortisol suppression less than 50% of baseline but above 30 nmol/L</p> Signup and view all the answers

    What is a key factor in the testing for occult hyperthyroidism?

    <p>Using day-to-day variation in thyroid hormone measurements</p> Signup and view all the answers

    Which treatment is not utilized for managing hyperthyroidism?

    <p>Dexamethasone therapy</p> Signup and view all the answers

    Which of the following conditions may result in normal thyroid hormone concentrations despite underlying hyperthyroidism?

    <p>Concurrent nonthyroidal illness</p> Signup and view all the answers

    What indicates a false-positive result in cortisol concentration testing?

    <p>Presence of acute stress or illness</p> Signup and view all the answers

    What is the preferred insulin type commonly recommended for cats with diabetes mellitus?

    <p>Glargine</p> Signup and view all the answers

    Which insulin dosing protocol is typically initiated in cats undergoing treatment?

    <p>1 to 3 units/cat twice daily</p> Signup and view all the answers

    How long does Glargine insulin typically last in cats?

    <p>12 to 16 hours</p> Signup and view all the answers

    What is a critical consideration regarding her insulin dose after two weeks of therapy?

    <p>The dose may need to decrease</p> Signup and view all the answers

    What is the preferred method for monitoring glucose levels post-insulin administration?

    <p>Measure glucose concentration 4 and 6-7 hours post-injection</p> Signup and view all the answers

    Why might cats require high doses of insulin initially?

    <p>They may be resistant to insulin</p> Signup and view all the answers

    Which type of insulin is preferred for initial treatment in cats due to its action?

    <p>Lente insulin</p> Signup and view all the answers

    What insulin concentration should be aimed for when measuring glucose levels after treatment?

    <p>Between 80 to 120 mg/dL</p> Signup and view all the answers

    What is a potential affected factor that could lead to a high nadir in unregulated diabetic dogs?

    <p>Insulin-induced hyperglycemia</p> Signup and view all the answers

    Which condition is least likely to affect insulin metabolism in an unregulated diabetic dog?

    <p>Bacterial infection</p> Signup and view all the answers

    What is the recommended adjustment to insulin therapy if blood glucose levels are consistently too high?

    <p>Increase the dosage</p> Signup and view all the answers

    What is the typical insulin dosage recommended for managing unregulated diabetic patients?

    <p>2.2 U/kg</p> Signup and view all the answers

    Which of the following is NOT considered an error in diabetes management for dogs?

    <p>Proper injection technique</p> Signup and view all the answers

    What is a potential consequence of exogenous steroids in diabetic dogs?

    <p>Insulin resistance</p> Signup and view all the answers

    What is the method of monitoring that aids in adjusting insulin therapy for diabetic dogs?

    <p>Serial blood glucose monitoring</p> Signup and view all the answers

    Which factor can complicate the insulin therapy for an unregulated diabetic dog?

    <p>Hyperandrogenemia</p> Signup and view all the answers

    Which type of insulin administration schedule is recommended for diabetic dogs?

    <p>Twice daily</p> Signup and view all the answers

    What is one of the signs indicating an unregulated diabetic state in dogs?

    <p>Persistent polyuria/polydipsia</p> Signup and view all the answers

    What indicates primary hyperaldosteronism in a patient?

    <p>Elevated aldosterone with low renin levels</p> Signup and view all the answers

    What effect does hypercalcemia have on the kidneys?

    <p>Decreases antidiuretic hormone (ADH) effectiveness</p> Signup and view all the answers

    Which condition is commonly associated with nephrotoxicity caused by hypercalcemia?

    <p>Nephrocalcinosis</p> Signup and view all the answers

    What clinical sign is most commonly observed in cats with hypercalcemia?

    <p>Anorexia</p> Signup and view all the answers

    What laboratory finding would indicate a parathyroid tumor?

    <p>Increased ionized calcium with elevated PTH</p> Signup and view all the answers

    Which statement is true regarding the effects of hypokalemia on aldosterone concentrations?

    <p>Usually causes marked elevation of aldosterone</p> Signup and view all the answers

    Which treatment is appropriate for correcting hypokalemia in a patient with hyperaldosteronism?

    <p>Potassium-sparing diuretic</p> Signup and view all the answers

    What mechanism explains why parathyroid hormone (PTH) production is not suppressed by high levels of ionized calcium in the context of a parathyroid tumor?

    <p>Negative feedback disruption</p> Signup and view all the answers

    What is the primary role of thyroid-releasing hormone (TRH) in the endocrine system?

    <p>To promote the release of thyroid-stimulating hormone (TSH) from the pituitary gland</p> Signup and view all the answers

    Which of the following statements regarding thyroglobulin autoantibodies (TgAA) is incorrect?

    <p>They indicate normal thyroid function.</p> Signup and view all the answers

    What is the potential impact of T3 autoantibodies (T3AA) on laboratory tests?

    <p>They interfere with the measurement of T3 and FT3.</p> Signup and view all the answers

    In the context of the T3 suppression test, what is the purpose of administering T3 supplements?

    <p>To assess the thyroid's functional response.</p> Signup and view all the answers

    Which hormone is primarily measured in diagnosing hyperthyroidism in cats using the T3 suppression test?

    <p>T4</p> Signup and view all the answers

    What is the typical form of thyroid hormones measured in most laboratory tests?

    <p>Total T4, incorporating free and bound forms</p> Signup and view all the answers

    What does an increase in released thyroid hormones imply in terms of feedback control?

    <p>Decreased production of thyroid-releasing hormone (TRH)</p> Signup and view all the answers

    What does the presence of T4 autoantibodies (T4AA) indicate in affected dogs?

    <p>They can interfere with measurements of T4 but not with FT4d.</p> Signup and view all the answers

    In the management of diabetes insipidus, what is the expected effect of administering desmopressin (dDAVP) in animals with central DI?

    <p>A marked increase in urine specific gravity (USG)</p> Signup and view all the answers

    What is the main reason why animals with nephrogenic diabetes insipidus (NDI) fail to concentrate urine effectively when dehydrated?

    <p>Renal tubules' inability to respond to vasopressin</p> Signup and view all the answers

    Which treatment option is considered unnecessary for animals with secondary diabetes insipidus as long as there is a constant water supply?

    <p>No treatment necessary</p> Signup and view all the answers

    How does the pathogenesis of primary diabetes insipidus differ from secondary diabetes insipidus?

    <p>Primary DI involves lack of renal responsiveness, while secondary DI is due to vasopressin deficiency</p> Signup and view all the answers

    What is the typical long-term prognosis for animals diagnosed with conditions related to pituitary tumors, such as insulin resistance and chronic renal failure?

    <p>Very poor, with survival rates typically under 4 months</p> Signup and view all the answers

    What is a significant consequence of chronic renal failure in cats that may arise from underlying endocrine disorders?

    <p>Reduced insulin sensitivity</p> Signup and view all the answers

    Which of the following statements regarding the administration of dDAVP is true in the context of veterinary medicine?

    <p>It improves urine concentration primarily in central diabetes insipidus</p> Signup and view all the answers

    What is the primary mechanism through which gastrinomas cause endocrine-related issues in animals?

    <p>Overproduction of gastrin leading to acid secretion</p> Signup and view all the answers

    Which of the following may contribute to hypoglycemia in dogs?

    <p>Chronic liver shunting</p> Signup and view all the answers

    What is a clinical sign that could indicate growth hormone (GH) deficiency in dogs?

    <p>Bone deformities</p> Signup and view all the answers

    Which physiological condition should be evaluated for its possibility of causing hypoglycemia?

    <p>Insulin overdose</p> Signup and view all the answers

    Which statement best describes the procedure needed before assessing insulin levels in dogs?

    <p>Fast the animal to ensure accurate results</p> Signup and view all the answers

    In the context of insulinoma diagnosis, which laboratory finding would be consistent?

    <p>High insulin levels with low glucose</p> Signup and view all the answers

    What is a potential outcome of a nonpancreatic tumor related to hypoglycemia?

    <p>Disruption of hepatic glucose production</p> Signup and view all the answers

    In cases of severe hypoglycemia, which clinical pathology finding may be observed?

    <p>Low blood glucose with elevated insulin</p> Signup and view all the answers

    Which factor can lead to the inhibition of insulin release when blood glucose is below the normal threshold?

    <p>Elevated fatty acid levels</p> Signup and view all the answers

    What percentage of thyroid carcinomas in dogs are likely to be associated with hyperthyroidism?

    <p>10% to 20%</p> Signup and view all the answers

    Which statement regarding the ACTH response test is accurate?

    <p>It helps measure the adrenal cortex's functional capacity.</p> Signup and view all the answers

    Which treatment is recommended post-surgery for dogs diagnosed with thyroid carcinoma?

    <p>Oral thyroxine to suppress TSH</p> Signup and view all the answers

    What disadvantage is associated with the ACTH response test for diagnosing HAC?

    <p>False-positive and false-negative results can occur.</p> Signup and view all the answers

    Which of the following is NOT a clinical sign associated with hyperthyroidism in dogs?

    <p>Excessive weight gain</p> Signup and view all the answers

    When assessing the urinary cortisol-to-creatinine ratio (UCCR), which statement is correct?

    <p>The first urine sample should be collected after an ACTH stimulation test.</p> Signup and view all the answers

    Which zone of the adrenal cortex primarily secretes mineralocorticoids?

    <p>Zona glomerulosa</p> Signup and view all the answers

    In the context of iatrogenic hyperadrenocorticism (HAC), which of the following tests is preferred?

    <p>ACTH response test</p> Signup and view all the answers

    What is the typical clinical feature associated with decreased potassium levels?

    <p>Weakness and lethargy</p> Signup and view all the answers

    Which hormone's production decreases with increased ionized calcium levels?

    <p>Parathyroid hormone (PTH)</p> Signup and view all the answers

    What is the most reliable method to assess calcium metabolic disorders?

    <p>Serum ionized calcium measurement</p> Signup and view all the answers

    What is a common clinical sign observed in patients with primary hyperaldosteronism?

    <p>Polyuria or polydipsia</p> Signup and view all the answers

    What is the recommended duration of action for Glargine insulin in cats?

    <p>12 to 16 hours</p> Signup and view all the answers

    Which insulin type is preferred for managing feline diabetes?

    <p>Lente</p> Signup and view all the answers

    Which laboratory finding is least likely associated with hypokalemia?

    <p>Increased white blood cell count</p> Signup and view all the answers

    Which electrolyte abnormality can lead to systemic hypertension due to sodium and fluid retention?

    <p>Hypernatremia</p> Signup and view all the answers

    What initial insulin dosage is commonly recommended for cats diagnosed with hyperglycemia?

    <p>1 to 3 units/cat</p> Signup and view all the answers

    What laboratory result would most likely indicate a calcium metabolic disorder?

    <p>Serum total calcium greater than 10.2 mg/dL</p> Signup and view all the answers

    What is one potential adjustment required after two weeks of insulin therapy in cats?

    <p>Decrease the insulin dose if high doses were initially required</p> Signup and view all the answers

    What adjustment should NOT be made when interpreting serum calcium and albumin levels?

    <p>Use formulas to correct calcium results</p> Signup and view all the answers

    When monitoring the initial insulin therapy's efficacy in cats, when should glucose concentration be measured?

    <p>4 hours and 6-7 hours post-injection</p> Signup and view all the answers

    Which hormone is NOT mentioned as a factor influencing feline hyperglycemia?

    <p>Thyroid hormone</p> Signup and view all the answers

    What is the primary concern with administering beef origin insulin to cats?

    <p>Higher incidence of allergic reactions</p> Signup and view all the answers

    Which condition is linked to the use of dextrose-containing fluids in cats?

    <p>Diabetes mellitus</p> Signup and view all the answers

    What is the expected urine specific gravity (USG) in animals with nephrogenic diabetes insipidus (DI)?

    <p>Hyposthenuric, typically below 1.008</p> Signup and view all the answers

    Which finding would raise suspicion for diabetes insipidus (DI) in an animal presenting with hypernatremia?

    <p>Hyposthenuria with hypernatremia</p> Signup and view all the answers

    What is a characteristic of absolute vasopressin deficiency in central diabetes insipidus (CDI)?

    <p>Persistent hyposthenuria and severe diuresis</p> Signup and view all the answers

    Which diagnostic measure is essential to differentiate between absolute and partial CDI?

    <p>Water deprivation test responses</p> Signup and view all the answers

    In diagnosing acromegaly in a diabetic cat, what is a potential complication to be cautious about?

    <p>High concentrations of IGF-1 affecting diabetes management</p> Signup and view all the answers

    What is a significant indicator of insulin-resistant diabetes mellitus in the presence of acromegaly?

    <p>Poor control of existing diabetes</p> Signup and view all the answers

    What is the expected duration of recurrence following radiation therapy for pituitary mass in acromegaly treatment?

    <p>12 to 24 months</p> Signup and view all the answers

    Which condition could complicate the diagnosis of diabetes insipidus?

    <p>Hypercalcemia</p> Signup and view all the answers

    What is a less common cause of acromegaly in dogs compared to other species?

    <p>Pituitary neoplasia</p> Signup and view all the answers

    Which breed is primarily associated with congenital growth hormone deficiency?

    <p>German shepherd</p> Signup and view all the answers

    Which clinical signs are indicative of acromegaly in dogs?

    <p>Polyuria and weight gain</p> Signup and view all the answers

    What is the significance of insulin ineffectiveness in diagnosing acromegaly?

    <p>It suggests the presence of a growth hormone-secreting tumor.</p> Signup and view all the answers

    Which of the following clinical signs is considered late in the progression of acromegaly?

    <p>Neurologic signs due to tumor expansion</p> Signup and view all the answers

    What is a common characteristic of acromegaly that might be observed during a physical examination?

    <p>Enlargement of the heart and viscera</p> Signup and view all the answers

    Which clinical abnormalities might be associated with a deficiency of pituitary hormones in affected dogs?

    <p>Cystic distention and metabolic imbalance</p> Signup and view all the answers

    In which age group is acromegaly most frequently observed in cats?

    <p>Older cats aged 8-14 years</p> Signup and view all the answers

    What is a function of thyroid-releasing hormone (TRH) in normal thyroid function?

    <p>Stimulates the release of thyroid-stimulating hormone (TSH)</p> Signup and view all the answers

    What is the role of thyroglobulin autoantibodies (TgAA) in dogs?

    <p>Marker for lymphocytic thyroiditis</p> Signup and view all the answers

    What is the primary objective of calcitriol therapy in the context of glucose metabolism disorders?

    <p>Decrease production of parathyroid hormone (PTH)</p> Signup and view all the answers

    How do T3 and T4 autoantibodies (T3AA and T4AA) affect thyroid testing in dogs?

    <p>They interfere with the measurement of thyroid hormones in some testing methods</p> Signup and view all the answers

    Which statement accurately describes the characteristics of insulin-dependent diabetes mellitus (IDDM) in dogs?

    <p>Most dogs with IDDM exhibit a decrease in serum insulin concentration.</p> Signup and view all the answers

    What does a T3 suppression test primarily diagnose?

    <p>Hyperthyroidism in cats</p> Signup and view all the answers

    What type of information does free T4 (FT4) provide concerning thyroid function?

    <p>It indicates active thyroid hormone levels</p> Signup and view all the answers

    In cats diagnosed with non-insulin-dependent diabetes mellitus (NIDDM), which of the following is true regarding insulin concentration?

    <p>Insulin concentration can be low, normal, or increased.</p> Signup and view all the answers

    What is a key consideration when managing the dietary therapy for dogs with diabetes mellitus?

    <p>Correct obesity if present and maintain consistent meal times.</p> Signup and view all the answers

    What might a high level of thyroglobulin autoantibodies indicate in a canine patient?

    <p>Potential presence of hypothyroid conditions</p> Signup and view all the answers

    Which thyroid hormone includes both free and protein-bound forms?

    <p>Total T4</p> Signup and view all the answers

    What is the recommended use of oral hypoglycemic drugs in cats?

    <p>Only non-insulin-dependent diabetes mellitus in cats can be treated with them.</p> Signup and view all the answers

    In the context of thyroid function tests, which statement about T4AA is accurate?

    <p>They interfere with T4 measurement in some testing methods</p> Signup and view all the answers

    Which effect does severe hyperglycemia have on stressed cats?

    <p>It can occur independently of diabetes status.</p> Signup and view all the answers

    What is the goal of therapy in managing diabetes mellitus?

    <p>To eliminate clinical signs and prevent complications.</p> Signup and view all the answers

    When using glipizide for managing non-insulin-dependent diabetes in cats, what should be monitored?

    <p>Hyperglycemia that persists or recurs.</p> Signup and view all the answers

    Which of the following describes a potential clinical sign associated with excessive vitamin D intake?

    <p>Stiff gait and muscle tremors</p> Signup and view all the answers

    What biochemical change is typically observed in primary hypoparathyroidism?

    <p>Decreased parathyroid hormone (PTH) levels</p> Signup and view all the answers

    Which condition is associated with lymphoplasmacytic destruction of the parathyroid glands?

    <p>Primary hypoparathyroidism</p> Signup and view all the answers

    Which of the following is a typical finding in serum biochemistry for patients experiencing pseudohypoparathyroidism?

    <p>Increased serum phosphate concentration</p> Signup and view all the answers

    What is a likely description of the parathyroid hormone (PTH) level in cases of acute sepsis related to hypocalcemia?

    <p>Increased parathyroid hormone levels</p> Signup and view all the answers

    Which of the following describes the effect of ingested plants containing vitamin D metabolites?

    <p>Severe muscle spasms and tremors</p> Signup and view all the answers

    Which consequence is associated with the ingestion of anti-psoriasis creams that contain vitamin D metabolites?

    <p>Intense pruritus and self-mutilation</p> Signup and view all the answers

    How can the presence of acromegaly complicate the management of diabetes mellitus (DM) in animals?

    <p>It promotes insulin resistance, making existing DM harder to control.</p> Signup and view all the answers

    What laboratory finding may indicate diabetic insipidus (DI) in an animal with hypernatremia?

    <p>Hyposthenuria of urine</p> Signup and view all the answers

    What clinical sign is likely observed in animals with poorly controlled diabetes mellitus?

    <p>Weight loss as a result of prioritizing hydration over food intake.</p> Signup and view all the answers

    Which statement accurately describes one of the challenges in diagnosing acromegaly in diabetic cats?

    <p>Elevated IGF-1 concentrations can also occur with diabetes mellitus.</p> Signup and view all the answers

    What is the significance of documenting a pituitary mass in cats suspected of having acromegaly?

    <p>It helps determine the potential cause of growth hormone excess.</p> Signup and view all the answers

    What is a crucial factor to consider before performing the modified water deprivation test?

    <p>The animal's hydration status to prevent dehydration.</p> Signup and view all the answers

    Which of the following best describes the outcome of absolute vasopressin deficiency in central diabetes insipidus?

    <p>Persistent hyposthenuria despite the animal being dehydrated.</p> Signup and view all the answers

    Why should caution be applied when interpreting elevated IGF-1 levels in diabetic cats?

    <p>Elevated concentrations can also indicate a response to various metabolic disorders.</p> Signup and view all the answers

    Study Notes

    Hyperadrenocorticism (HAC)

    • HAC is a condition characterized by excessive cortisol production by the adrenal glands.
    • HAC can occur in dogs and cats.
    • Signs of HAC include increased thirst and urination, increased appetite, weight gain, muscle wasting, and thinning of the skin.
    • HAC can be diagnosed with blood tests and imaging.
    • Treatment for HAC includes medications and surgery.

    Treatment of HAC

    • Mitotane is a drug that inhibits the production of cortisol.
    • Mitotane is typically given in three phases: induction, maintenance, and monitoring.
    • It can be used to treat HAC, including the pituitary dependent form (PDH).
    • It is commonly used in dogs with HAC.
    • Trilostane is another drug that inhibits the production of cortisol.
    • Trilostane is typically given daily.
    • Ketoconazole is a drug that can be used to treat HAC.
    • Ketoconazole is typically used in cases where other treatments have failed.
    • Surgery is also an option for treating HAC.
    • Adrenalectomy is the most successful treatment method for HAC.
    • Unilateral adrenalectomy is performed if there is an adrenal tumor.
    • Bilateral adrenalectomy is performed if the HAC is caused by PDH.
    • Hypophysectomy is an option for treating PDH.
    • Medical therapy is less successful than surgery or other treatments.

    Hypoadrenocorticism

    • This condition is also known as Addison's disease.
    • Primary hypoadrenocorticism is characterized by a deficiency of both glucocorticoid and mineralocorticoid.
    • Idiopathic adrenocortical atrophy is the most common cause of primary hypoadrenocorticism.

    Hypercalcemia

    • Hypercalcemia is characterized by high levels of calcium in the blood.
    • It can be caused by several factors including:
      • Parathyroid gland disease
      • Certain tumors
      • Dietary deficiencies
      • Kidney disease
      • Increased bone breakdown
    • Hypercalcemia can lead to several health problems, including:
      • Kidney stones
      • Bone loss
      • Weakness
      • Confusion
      • Loss of appetite
      • Increased thirst
      • Increased urination

    Pituitary Dwarfism

    • This condition is characterized by a deficiency of growth hormone.
    • Pituitary dwarfism is usually autosomal recessive.
    • It is most common in German shepherd dogs and Carnelian bear dogs.
    • Signs of pituitary dwarfism include:
      • Short stature
      • Delayed bone growth
      • Delayed tooth eruption
      • Delayed sexual development
      • Thin skin with hair loss
      • Mental dullness.

    Diabetes Insipidus (DI)

    • DI is a condition that causes the body to produce too much urine.
    • This is caused by a deficiency of antidiuretic hormone (ADH) which helps the kidneys to reabsorb water.
    • Signs of DI include:
      • Increased thirst
      • Increased urination
      • Dehydration
    • The urine will be dilute, with a specific gravity less than 1.008.

    Acromegaly

    • Acromegaly is characterized by an excess of growth hormone.
    • It is usually caused by a pituitary tumor.
    • Signs of acromegaly include:
      • Enlarged extremities
      • Thickened skin
      • Muscle weakness
      • Enlarged organs
    • It can lead to:
      • Diabetes mellitus
      • High blood pressure
      • Heart disease
      • Sleep apnea
      • Joint pain
      • Vision problems

    Lymphocytic Thyroiditis

    • Subclinical thyroiditis has normal thyroid hormone and TSH concentrations, focal inflammatory infiltrates of lymphocytes and no clinical signs.
    • Subclinical hypothyroidism has elevated TSH, normal or borderline low thyroid hormone concentrations, extensive lymphocytic inflammatory infiltrates with follicular cell hypertrophy.
    • Clinical Hypothyroidism has low thyroid hormone concentrations, elevated TSH, extensive diffuse lymphocytic inflammatory infiltrates.

    Hypothyroidism

    • Hypothyroidism can be caused by medications, breed predispositions and inherited diseases.

    Hypercalcemia

    • Primary hyperparathyroidism is most common in dogs and is treated with calcium and vitamin D supplementation.
    • Puerperal tetany (eclampsia) occurs in the first 3 weeks postpartum in lactating bitches.

    Diabetic Ketoacidosis

    • Hypoglycemia can be caused by diets deficient in calcium and vitamin D.
    • Clinical signs include bone pain, lameness, limb deformities, fractures.
    • More common in young, growing animals.
    • Diabetic ketoacidosis (DKA) is a common complication of diabetes mellitus.
    • Clinical signs include polyuria, polydipsia, polyphagia, weight loss, blindness.
    • Treatment includes insulin therapy, volume expansion and correction of dehydration.

    Hypocalcemia

    • Hypocalcemia - can be caused by Magnesium depletion, albumin ↓, atrophy of parathyroid gland, trauma, hypoparathyroidism, hypoproteinemia, hypomagnesmia, infarction of the parathyroid gland, nutritional deficiencies, gastrointestinal disease and drugs.
    • Symptoms include tetany, muscle tremors, seizures.
    • Treatment includes calcium supplementation and correction of the underlying cause.

    Canine Hypoadrenocorticism (HAC)

    • HAC is also known as Addison's disease.
    • It is caused by the inadequate production of glucocorticoids and mineralocorticoids by the adrenal cortex.
    • This results in deficiencies in cortisol and aldosterone.

    Diagnosis

    • Diagnosis relies on clinical presentation and laboratory tests.
    • A combination of clinical signs, bloodwork, and urine analysis is used to confirm the diagnosis.
    • High-dose dexamethasone suppression test shouldn't be used for diagnosis.
    • Endogenous ACTH measurement is used, with very low concentrations indicating adrenal tumors.
    • Abdominal ultrasound can reveal an enlarged and irregular adrenal gland with an adrenal tumor.

    Clinical Signs of HAC

    • Polyuria and polydipsia (increased urination and thirst)
    • Polyphagia (increased hunger)
    • Abdominal distension (pot-bellied appearance)
    • Muscle wasting and weakness
    • Lethargy and poor exercise tolerance
    • Skin thinning, decreased elasticity, calcinosis cutis, and hyperpigmentation.
    • Symmetrical alopecia (hair loss)
    • Persistent anestrus or testicular atrophy

    Clinical Pathology Findings

    • Nonspecific findings include:
      • Stress leukogram (neutrophilia, lymphopenia, eosinopenia, monocytosis)
      • Hyperglycemia with or without glucosuria
      • Hypercholesterolemia and hypertriglyceridemia
      • Increased corticosteroid-induced ALP (ciALP), ALT, and bile acids

    HAC: Canine Predisposition

    • HAC is more common in certain breeds, including:
      • Poodles (miniature and standard)
      • Portuguese water dogs
      • Bearded collies
      • Rottweilers
      • Irish setters
      • Labrador retrievers
      • American cocker spaniels
      • Terriers (Yorkshire terrier, Parson Russell terrier, Staffordshire bull terrier)
      • Large breeds weighing more than 20 kg.

    Canine Diabetes Mellitus (DM)

    • DM occurs when the pancreas doesn't produce enough insulin (Type 1) or when the body doesn't respond properly to insulin (Type 2).
    • This leads to a lack of glucose uptake by cells, resulting in hyperglycemia.

    Treatment of DM

    • Insulin therapy is essential in managing DM.
    • Short-acting, intermediate-acting, and long-acting insulins are available.
    • Insulin should be administered twice daily with Lente or PZI preferred.
    • Glargine insulin lasts 12 to 16 hours and takes several days for maximum effect.
    • Initial insulin doses are typically 1 to 3 units per cat twice daily.

    Canine Insulinoma

    • Insulinoma is a rare tumor of the pancreatic beta cells, resulting in excessive insulin production and hypoglycemia.
    • The incidence is higher in middle-aged to older dogs, with a higher predisposition in medium to large breeds.
    • Clinical signs may be episodic and worsen after eating, excitement, or exercise.
    • Symptoms include lethargy, weakness, ataxia, dementia, seizures, coma, death, and weight gain.

    Thyroid Function

    • The hypothalamus secretes thyroid-releasing hormone (TRH) which stimulates the pituitary gland to release thyroid-stimulating hormone (TSH).
    • TSH stimulates the thyroid gland to release thyroid hormones, which include total T4 (thyroxine), total T3 (tri-iodothyronine), free T4 (FT4), and free T3 (FT3) which is the active thyroid hormone.
    • Thyroid hormone production is regulated by negative feedback, where the thyroid hormones inhibit the production of TRH and TSH.

    Thyroid Function Tests

    • Total T4 is a test that measures the total amount of thyroxine in the blood.
    • Total T3 is a test that measures the total amount of tri-iodothyronine in the blood.
    • Free T4 is a test that measures the amount of thyroxine that is not bound to protein.
    • Free T3 is a test that measures the amount of tri-iodothyronine that is not bound to protein.
    • Thyroglobulin autoantibodies (TgAA) are present in dogs with lymphocytic thyroiditis.
    • TgAA can be detected before the development of hypothyroidism.
    • TgAA indicate active inflammation but do not provide information about thyroid function.
    • T3AA and T4AA are present in some dogs with lymphocytic thyroiditis.
    • T3AA interfere with the measurement of T3 and FT3.
    • T4AA interfere with the measurement of T4 and FT4, but not FT4d.

    T3 Suppression Test

    • The T3 suppression test is used to diagnose hyperthyroidism in cats.
    • A "pre" sample is taken for measuring T4, T3, FT4, and FT3.
    • A T3 supplement is given every 8 hours for 6 to 7 treatments.
    • A "post" sample is collected 2 to 4 hours after the last T3 supplement.

    Calcium Metabolism

    • Serum total calcium (tCa) is the sum of serum ionized calcium (iCa), complexed calcium (cCa), and protein-bound calcium (pCa).
    • Ionized calcium is the most important biologically active calcium fraction.
    • tCa does not accurately predict iCa.
    • iCa concentration should be measured when a calcium metabolic disorder is suspected.
    • Formulas that adjust tCa to protein or albumin do not improve the prediction of iCa status.

    Hypercalcemia

    • Hypercalcemia can be caused by parathyroid-dependent (primary hyperparathyroidism) or parathyroid-independent mechanisms.
    • Parathyroid-dependent hypercalcemia is caused by excessive secretion of parathyroid hormone (PTH) which causes an increase in calcium reabsorption from the bones and decrease in calcium excretion by the kidneys.
    • Parathyroid-independent hypercalcemia can be caused by humoral hypercalcemia of malignancy, local osteolytic lesions, hypervitaminosis D, hypoadrenocorticism, hypercitaminosis A, idiopathic hypercalcemia, dehydration, aluminum exposure, hyperthyroidism or raisin/grape toxicity.
    • PTHrP is similar in structure to PTH.
    • PTHrP causes bone resorption and renal calcium conservation.
    • Hypercalcemia caused by PTHrP is associated with malignancy.

    Hypocalcemia

    • Hypocalcemia can be caused by parathyroid-dependent (primary hypoparathyroidism) or parathyroid-independent mechanisms.
    • Parathyroid-dependent hypocalcemia is caused by destruction of the parathyroid glands.
    • Parathyroid-independent hypocalcemia occurs when the demand for iCa exceeds the supply or mobilization.

    Diabetes Mellitus

    • Diabetes mellitus is caused by a deficiency of insulin or a lack of responsiveness to insulin.
    • Insulin deficiency leads to hyperglycemia.
    • Glucocorticoids are a common cause of hyperglycemia.
    • Insulin therapy is the treatment for diabetes mellitus.
    • Insulin for veterinary use should be of human or porcine origin since bovine insulin may induce antibody formation.
    • The initial insulin dose is 0.5 unit/kg twice daily.
    • Glucose concentrations should be measured 4 to 7 hours after the initial insulin dose.

    Hyperthyroidism

    • Significantly elevated thyroid hormones can be seen in fasting hyperlipidemia, hypercholesterolemia, and many cases of hyperthyroidism.
    • Occult hyperthyroidism may present with normal or slightly increased thyroid hormone levels.
    • It may be necessary to perform a T3 suppression test to demonstrate a loss of negative feedback in occult hyperthyroidism.
    • Treatment for hyperthyroidism includes surgical thyroidectomy, radioactive iodine therapy, and chronic methimazole therapy.
    • Complications of treatment include transient or permanent hypoparathyroidism post-surgery, recurrence of hyperthyroidism, reduced glomerular filtration rate (GFR), renal failure, and cardiac arrhythmias.

    Hyperadrenocorticism

    • Causes: pituitary-dependent hyperadrenocorticism (PDH) or an adrenal tumor.
    • Diagnosis: Low-dose dexamethasone suppression test (LDDST) is performed by measuring cortisol levels.
    • Interpreting Results:
      • Cortisol concentration greater than 30 to 40 nmol/L suggests HAC.
      • Suppression of cortisol concentration greater than 50% of baseline (but still greater than 30 to 40 nmol/L) at 3 to 6 hours post or 8 hours post dexamethasone suggests PDH.
      • Suppression of cortisol concentration less than 50% of baseline (but still greater than 30-40 nmol/L) could indicate either PDH or an adrenal tumor.
      • A normal LDDST makes HAC unlikely.
      • False-positive results are seen especially in patients with other illnesses, such as diabetes mellitus.

    Hypercalcemia

    • Causes:
      • Primary hyperparathyroidism
      • Postprandial (dogs), pancreatitis, pheochromocytoma (dogs), progesterone, parenteral nutrition
      • Exocrine pancreatic insufficiency, eating
      • Diabetes mellitus, diestrus (dog), drugs (glucocorticosteroids, progesterone, megestrol acetate, thiazide diuretics), dextrose-containing fluids
    • Treatment:
      • Remove the underlying cause
      • Volume expansion (correct dehydration)
      • Furosemide
      • Glucocorticoids
      • Bisphosphonates
      • Calcitonin

    Primary Hyperparathyroidism

    • Parathyroid tumor secretes PTH, which causes ionized calcium to elevate.
    • More common in dogs than cats.
    • In cats: can be caused by insulin, Lente, or PZI (human or beef origin), glargine.

    Diabetes Mellitus

    • Types of insulin:
      • Short-acting: regular, semi-lente
      • Intermediate-acting: NPH or isophane, Lente
      • Long-acting: Ultralente, PZI, glargine
    • Insulin therapy:
      • In cats, 1 to 3 units/cat twice daily initially.
      • Dose may need to be decreased after 2 weeks, especially if using glargine.
      • Measure glucose concentration 4 and 6-7 hours after initial insulin.
    • Monitoring treatment:
      • Monitor clinical signs such as appetite, water consumption, urination, activity, and general well-being.
      • Perform glucose curves during initial regulation, when hypoglycemia is suspected, and in poorly controlled DM.
    • Hypoglycemia:
      • Signs include ataxia, weakness, lethargy, seizures.
      • Treat with glucose administration (food, sugar water, or IV dextrose).

    Diabetic Ketoacidosis (DKA)

    • Occurs most commonly in dogs and cats with previously undiagnosed DM.
    • May occur in patients receiving inadequate insulin and a concurrent infection, inflammation, or insulin-resistant disorder.
    • Clinical signs may develop over time.
    • Once ketoacidosis develops, severe illness occurs within 7 days.
    • Clinical signs include dehydration, decreased appetite, lethargy, and vomiting.

    Thyroid Disorders

    • Normal thyroid function is regulated by a feedback loop between the hypothalamus, pituitary, and thyroid glands.
    • Hypothalamus secretes thyroid-releasing hormone (TRH), which stimulates the release of thyroid-stimulating hormone (TSH) from the pituitary gland.
    • TSH stimulates the release of thyroid hormones from the thyroid glands.
    • Thyroid hormones exert negative feedback on the hypothalamus and pituitary glands to decrease TSH production.
    • Thyroid hormones include:
      • Total T4 (thyroxine, tetra-iodothyronine): includes free and protein-bound T4
      • Total T3 (tri-iodothyronine): includes free and protein-bound T3
      • Free T4 (FT4)
      • Free T3 (FT3): the active thyroid hormone
    • Tests used in diagnosis of thyroid disease include:
      • Total T4 measurement: This is a common test for thyroid disorders.
      • T3 Suppression Test: Used in the diagnosis of hyperthyroidism in cats. A pre-sample is taken for T4, T3, FT4, and FT3 measurement. T3 supplement (25 ug) is given every 8 hours for six or seven treatments. A post-sample is collected 2 to 4 hours after the last dose.
      • Thyroglobulin autoantibodies (TgAA): Used in dogs only as a marker for lymphocytic thyroiditis. TgAA can be detected before the development of hypothyroidism and indicate active inflammation. However, it does not provide information on thyroid function.
      • T3AA and T4AA: Present in some dogs with lymphocytic thyroiditis. T3AA interferes with the measurement of T3 and FT3, while T4AA interferes with T4 and FT4 measurement (some methods) but does not interfere with FT4d.

    Other Endocrine Disorders

    • Diabetes Insipidus (DI): A disorder characterized by excessive thirst and urination due to a deficiency in vasopressin or an inability of the kidneys to respond to vasopressin.

      • Primary DI (Central DI [CDI]):
        • Defective synthesis or secretion of vasopressin by the hypothalamus
        • May be idiopathic or due to head trauma, neoplasia, or hypothalamic or pituitary malformations
      • Secondary DI (Nephrogenic DI [NDI]):
        • Renal tubules are unable to respond to vasopressin

    • Treatment for DI:

      • CDI: dDAVP (synthetic vasopressin) is administered in the conjunctival sac once or twice daily or parenterally
      • NDI: No treatment is really necessary as long as there is a constant water supply

    • Hypercalcemia: A condition of elevated calcium levels in the blood.

      • Causes:
        • Parathyroid tumor: Excess PTH secretion causes hypercalcemia. The increase in ionized calcium does not suppress PTH production by the tumor.
        • Parathyroid-independent: Ionized calcium concentration increases in serum. Negative feedback causes suppression of PTH production.
      • Clinical signs:
        • Dogs: Polyuria and polydipsia are most common.
        • Cats: Anorexia is the most common sign.
        • Other clinical signs include: depression, weakness, vomiting, and diarrhea

    • Gastrinoma: A tumor that secretes gastrin, leading to increased gastric acid production and potential complications.

      • Etiology:
        • Pancreatic tumor secreting primarily gastrin.

    Adrenal Function

    • Adrenal cortex has three zones: Zona glomerulosa, Zona fasciculata, Zona reticularis
    • Zona glomerulosa secretes primarily mineralocorticoids
    • Zona fasciculata secretes primarily glucocorticosteroids
    • Rare case: Primary hyperaldosteronism in cats
    • Primary hyperaldosteronism is more common in older animals

    Clinical Signs of Adrenal Function

    • Decreased potassium levels
    • Weakness, lethargy, depression, polyuria, polydipsia
    • Reluctance to move, poor muscle tone, apparent muscle pain
    • Systemic hypertension as a result of sodium and fluid retention

    Diagnosis of Adrenal Function

    • Hypokalemia: Potassium often below 3.0 mmol/L
    • Elevated creatine kinase
    • Blood urea nitrogen (BUN) typically normal

    Hypercalcemia

    • Mechanisms of hypercalcemia
    • Parathyroid-dependent (primary hyperparathyroidism)
    • Congenital enzyme deficiency (glycogen storage disease)
    • Hunting dog hypoglycemia
    • Hepatic disease (liver failure, vascular shunts)
    • Sepsis
    • Polycythemia
    • Nonpancreatic tumors (hepatic carcinoma, leiomyosarcoma)
    • Growth hormone (GH) deficiency
    • Hypoadrenocorticism
    • Insulinoma
    • Administration of insulin or drugs
    • Toxins

    Diagnosis of Hypoglycemia

    • Hypoglycemia with an inappropriately high insulin level
    • Fast the animal before testing
    • Blood glucose below 60 mg/dL (3.3 mmol/L) should inhibit insulin release
    • Insulin therapy:
      • Artifact (serum left on clot)
      • Strenuous exercise
      • Prolonged inappetence

    Acromegaly

    • Elevated concentration of IGF-1 accompanied by appropriate clinical signs
    • IGF-1 production parallels GH production
    • Elevated concentrations of IGF-1 also occur in association with diabetes mellitus
    • Presence of acromegaly may result in insulin-resistant diabetes mellitus
    • Documentation of pituitary mass in cats by computed tomography or magnetic resonance imaging
    • Radiation therapy of the pituitary mass has limited availability, and acromegaly often recurs 6 to 18 months later

    Diabetes Insipidus (DI)

    • Polyuria and polydipsia are the most common clinical signs
    • Acquired NDI:
      • Hypoadrenocorticism
      • Hypercalcemia
      • Hyperthyroidism
      • Diabetes mellitus
      • Acromegaly
    • Urine is usually hyposthenuric
    • Hypernatremia with hyposthenuria raises suspicion for DI
    • Differentiating absolute and partial CDI:
      • Absolute vasopressin deficiency causes persistent hyposthenuria and severe diuresis even if dehydrated
      • In partial CDI, animals can increase USG into isosthenuric range but typically not above 1.015
    • Modified water deprivation test:
      • Assesses the effects of water deprivation and dehydration on USG
      • Do not perform if the animal is dehydrated

    Thyroid Function Tests

    • Total T4 is a measurement that includes both free T4 and protein-bound T4.
    • Total T3 is a measurement that includes both free T3 and protein-bound T3.
    • Free T4 is a measurement of the active form of T4.
    • Free T3 is a measurement of the active form of T3.
    • Thyroglobulin autoantibodies (TgAA) can be detected in dogs before the development of hypothyroidism, indicating active inflammation.
    • T3AA and T4AA are present in some dogs with lymphocytic thyroiditis.
    • T3AA interferes with the measurement of T3 and FT3
    • T4AA can interfere with the measurement of T4 and FT4.

    Disorders of Calcium Metabolism

    • Hypocalcemia can occur due to various disorders including primary hypoparathyroidism, pseudohypoparathyroidism, sepsis/critical care, ethylene glycol toxicity, paraneoplastic syndrome, phosphate enema, eclampsia, and hypoalbuminemia.
    • Primary hypoparathyroidism occurs when the parathyroid glands are unable to secrete adequate amounts of parathyroid hormone due to lympho-plasmacytic destruction of the glands.
    • Calcitriol therapy can be used to treat hypoparathyroidism by decreasing the production of PTH and bone resorption, but serum phosphorus must be controlled for maximum effectiveness.

    Diabetes Mellitus (DM)

    • Most dogs with DM have insulin-dependent DM (IDDM) with decreased serum insulin concentration and no increase in insulin after glucose administration.
    • Non-insulin-dependent DM (NIDDM) is very uncommon in dogs.
    • Many cats have NIDDM which may become permanently insulin-dependent.
    • The goal of DM therapy is to eliminate clinical signs, prevent complications, and prevent hypoglycemia.
    • Treatment includes dietary therapy, exercise, and oral hypoglycemic drugs.
    • Oral hypoglycemic drugs are only indicated for NIDDM in cats.
    • Glipizide is a commonly used oral hypoglycemic drug for cats at a dose of 2.5 mg twice daily with food.
    • If hyperglycemia persists or recurs, switching to insulin therapy may be necessary.

    Disorders of Growth Hormone

    • Growth hormone (GH) deficiency can occur due to congenital deficiency of GH or a congenital cystic distention or persistence of the craniopharyngeal duct (Rathke’s pouch).
    • GH deficiencies are more commonly seen in German Shepherds, Weimaraners, Spitz, and Carnelian Bear Dogs.
    • Acromegaly is usually considered only when insulin is ineffective at controlling hyperglycemia.
    • The presence of acromegaly may result in insulin-resistant DM or poor control of existing diabetes.
    • Acromegaly is more common in male cats and usually older cats.
    • Clinical signs of acromegaly include polyuria, polydipsia, weight gain, increased size, enlargement of head, extremities, feet, abdomen, heart, and viscera.

    Central Diabetes Insipidus (CDI)

    • Central Diabetes Insipidus (CDI) occurs when the pituitary gland does not secrete adequate amounts of antidiuretic hormone (ADH).
    • CDI is a rare condition.
    • Clinical Signs of CDI include polyuria, polydipsia, neurologic signs, and weight loss.
    • Diagnosis of CDI requires ruling out other causes of polyuria and polydipsia.
    • The urine of animals with CDI is typically hyposthenuric.
    • A modified water deprivation test can be used to assess the effect of water deprivation on USG and differentiate between absolute and partial CDI.

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    Test your knowledge about Hyperadrenocorticism (HAC) and its treatment options for pets. This quiz covers symptoms, diagnostic methods, and the various medications used to manage HAC, including Mitotane and Trilostane. Dive in to see how well you understand this important veterinary topic!

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