Exam 3: Endocrinology

which form of DM do mostly all dogs get? what is it characterized by?

• Type 1, destruction of B-cells

which form of DM do mostly all cats get? what i it cahracterized by?

• Type 2, insulin resistnace

Type of DM caused by diestrus, use of glucocorticoids, and pancreatitis, which may be reversible

• Transient diabetes mellitus

What is the primary cause for DM in animals?

• Immune-mediated destruction / resistance

Which dog breeds are predisposed to increased risk for DM?

• Keeshond

• terriers

• schanuzers

• poodles

  • beagles

What is the clinical triad for DM?

• PU/PD

• polyphagia

• weight loss

What secondary findings can be seen with untreated DM in dogs?

• cataracts

• hepatomegaly

• delayed wound healing

What diagnostic results should be seen with an animal with diabetes mellitus?

• fasting hyperglycemia + glucosuria

Which diet is best used for managing a patient with diabetes mellitus

• High fiber, complex carbohydrate, low fat

short acting insulin with a duration of 1-4 hours used in clinic patients can be given IV, IM, or SQ

• Regular insulin (Humulin R)

FDA approved insulin which is a porcine insulin zinc suspension with a duration of 14 hours intermediate insulin

• Vetsulin

Which insulin class is most often used in cats d/t thier inabilty to cope with human intervention

• Long acting insulins

  • Glargine (Lantus)

  • Detemir (Levemir)

  • PZI (ProZinc)

Degludec and Glargine are known as _ and can be dosed once daily in cats

• Basal insulin

veterinary products are _ whle human products are _

• U40 and U100

Which of the following is an “intermediate-acting” insulin commonly used in dog species?

• Vetsulin

Which insulin should be shaken and not rolled?

• Vetsulin

which is more important tests glycemic testing with urine strips and glucosuria or physical clinical signs

• physical clinical signs way more important

What is the term used for the period on a glucose curve which is half-way through the dosing interval?

• Nadir

If nadir is too high on a glucose curve, what does this typically indicate?

• patiet is under dosed

Term used to describe an overdose of insulin which may lead to insulin resistance and hyperglycemia

• Somogyi

Which test should never call for adjustement of insulin dose without a proper glucose curve?

• Spot checks

What flash glucose monitoring system can be used to make managing diabetic animals more straighforward?

• FreStyle Libre

Compound which is a glycated protein that can indicate poor glycemic control with elevated levels

• Fructosamine

What is fructosamine best used for?

• Differentiating stress hyperglycemia and diabetes melliutus

Why is fructosamine often used in clinical settings?

• can indicate longer periods of hyperglycemia up to 2 weeks prior

What is the leading cause for diabetes mellitus in felines?

• Obesity

What secondary clinical sign can indicate DM in a feline patient?

• Plantigrade stance

What diet is most effective when treating feline patients with DM?

• High protein, low carbohydrate

type 2 DM in cats is reversible in some cases if caught early. What management should be provided to increase the likelihood of this?

• treat underlying obesity

Which drug(s) are FDA approved for treating DM feline patients

• Bexacat, Senvelgo (SGLT2 inhibitor)

How do SGLT2 inhibitors function?

• Promote loss of glucose in the urine improving B cell function

In which circumstances are SGLT2is contraindicated?

• Patient is/has receiving insulin or is clinically ill

What is the most severe side effect that can occur with cats on SGLT2is?

• DKA

Insulin which are Q-12 hours in feline patients which are NOT peakless

• Glargine, Detemir

Insulin which is FDA approved for cats which has Q12 hour dosing and has a more variable onset and DOA than glargine or detemir?

• ProZinc

What is the ultimate goal of insulin therapy in cats?

• Diabetic remission

A cat treated with SGLT2is is unknown if remission occurs

• true

What diagnostic signs indicate DM in feline patients?

• Hyperglycemia and glucosuria

Which of the following can cause insulin resistance?

• Inflammatory cytokines in response to secondary diseases

Disease in cats which causes insulin resistance d/t a pituitary adenoma with clinical findings such as weight gain, broad face, widened interdental spaces, and respiratory stridor

• Acromegaly

What is the treatment of choice for a cat surffering from acromegaly?

• External beam radiation therapy

What is the treatment of choice for hyperlipidemia which can cause a secondary insulin resistance?

• Low fat diet, bezafibrate r fenofibrate

Undiagnosed or poorly controlled DM may lead to what severe disease process?

• Diabetic ketoacidosis

What process has to occur in order for ketones to built up in the body with a DKA patient?

• Lipolysis

Ketone buildup can lead to osmotic diuresis and severe dehydration causing a build up of lactic acid. What process can excess lactic acid in the body cause?

• Metabolic acidosis

What are some common clinical signs of a DKA patient?

• GI (vomiting, diarrhea, anorexia), lethargy, wekaness, signs of DM

On physical examination of a patient, what finding often raises a red flag for potential DKA?

• Smell of acetone breath

On urine dipstick analysis of DKA patient what will often come back positive?

• Glucose and ketones

What is the FIRST treatment of choice for a patient with DKA?

• fluid/electrolyte replacement

Which electrolyte must be provided for an animal with DKA? why are we providng it?

• Phosphorus, blood levels will be decreased after IV fluids and insulin management

What are some clinical signs of a DKA patient being treated with fluids that may indicate hypophosphatemia?

• Hemolysis, neuromuscular signs

When treating a DKA patient in clinica, what type of insulin should be provided and via what route of administration?

• Regular insulin IM or CRI IV

Which species is most likely to have hypothyroidism?

• canine -

what are some clinical signs of hypothyroidism

• Lethargy, unwilling to exercise, mental dullness, weight gain, cold intolerant, repro issues

Bilateral truncal alopecia is most associated with which endocrine disorder?

• Hypothyroidism

On physical exam, which clinical signs will you see that may indicate hypothyroidism

• Hypothermia, bradycardia, myxedema

On blood work what CBC finding can be concurrent with hypothyroid animals

• Decreased erythropoiesis (non-regenerative anemia)

Diagnosis of hypothyroidism must be based on _ as a low TT4 can be caused by any disease process.

• clinical suspicion

A_____ TT4 rules out HypoT, but a _____ TT4 is not diagnostic alone for HypoT

• Normal, low

Why may free T4 be better suited for helping diangose an animal with hypothyroidism?

• less affected by sick euthyroid syndrome

This test can be used in conjunction with a TT4 to accurately diagnose hypothyroidism

• TSH -

Which dog breed class normally has a lower FT4 and T4 which could be an inconsequential finding?

• Sighthounds

What is the treatment of choice for hypothyroidism?

• Levothyroxine

What is the earliest clinical sign that indicates a postive response to hypothyroid treatment

• increased activity, 1-2 weeks

If treatment failure occurs for hypothyroidism, what other treatment option may need to be given?

• T3 supplementation

Hyperthyroidism is mostly a primary disease caused by a ____ tuor

• Benign

Most cats that present with hyperthyroidism are often ___ years of age

• 12-13 older cats

Which of the following clinical signs are mostly seen in cats with potential hyperthyroidism

• Weight loss, polyphagia, hyperactivity, PU/PD

Term for animals with hyperthyroidism but present with anorexia and weight loss

• Apathetic hyperthyroidism

A cat present with a poor BCS, unkempt hair coat, agitated, tachypneic, and a thyroid slip. what is tyour top differential?

• Hyperthyroidism

What is the primary diagnosis which helps confirm hyperthyroidism in cats?

• presenting clinical signs

A cat with a higher but still within RI thyroid level, is there need for futher evaluation?

• yes further evaluation is needed

Which of the following substances is trapped and concentrated by the thyroid and can be used to diangose hyperthyroidism?

• T3dhn35ium-99m

During a T3 suppression test the animal fails to suppress, is this a normal animal or not

• Not a normal healhty animal

What drug is used to treat HyperT cats by inhibiting iodide incorporation?

• Methimazole

How often should T4 levels in a HyperT cat be checked when recieving methimazole for signs of euthyroid?

• 2-3 weeks

HyperT treatent method which is trapped by the thyroid and destroys tissues within a certain distance. One time cure treatment, but expensive

• Radioactive Iodine

Which type of diet can be used in cats that may help to some extent treat HyperT?

• Iodine restricted diet

Majority of Cushings cases are ___ dependent

• pituitary

Type of Cushings which is autonomous (non-responsive to ACTH), unilateral and episodic in nature

• adrenal dependent

Overuse of glucocorticoids can cause ___ HyperA

• Iatrogenic

What are some of the most common clinical signs seen with cushings patients?

• Polyhagia, PU/PD, “Pot belly” appearane, symmetrical alopecia

Which of the following tests is NOT a confirmatory test for diagnosing Cushings?

• Urine cortisol: creatinine

Due dogs with cushings tend to feel generally well or bad

• they feel well

This rule out test is used in animals with suspected Cushings and uses a urine sample usually first of the morning

• Urine cortisol: creatinine

Test which uses Cortrosyn after an initial baseline cortisol and rechecks in one hour for results

• ACTH stimulation test

which of the following ACTH stimulation results indicates a response that is consistent with Cushings?

• increases significantly

Which of the following ACTH stimulation results indicates a response that is consistent with Iatrogenic Cushings?

• no change at all

Which of the following ACTH stimulaiton results indicates a response that is consistent with a normal healhty animal?

• increases a little

60% of PDH patients will ____ a LDDST

• suppress

When should cortisol levels be taken after administrating dexamethasone for a LDDST?

• 4 and 8 hours

Which of the following is consistent with a normal healthy response to LDDST?

• light blue

• starts high slowly decreases

Which of the following is consistent with a PDH repsonse to LDDST?

• Dark blue / red

• starts high decreases fast and goes back up again fast

• or atypical red

Which of the following is consistent with a AT or PDH response to LDDST?

• red

On a LDDST, an animal which suppresses, then escapes is ALWAYS ____

• PDH

When ultrasounding an adrenal gland, which of the following is most associated with a functional adrenal tumor (FAT)?

• one large and irregular adrenal gland, contralateral gland atrophy

When ultrasounding an adrenal gland, which of the following is most associated with PDH?

• Bilaterally symmetric normal or enlarged glands

When ultrasounding an adrneal gland, which of the following is most associated with Iatrogenic hyperadrenocorticism? (IH)

• Bilaterally small adrenal glands

Which of the following treatments can be used for PDH patients which can inhibit the synthesis of cortisol?

• Trilostane, Ketoconazole

FDA approved PDH/FAT medication for dogs suffering from Cushings which comeptitively inhibits 3-b-hydroxysteroid dehydroganse

• Trilostane