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Week 2 Lesson 15 Lab Endocrine Cases

Endocrine Lab (Lesson#15)Step 1: Case Introduction and Initial Impressions ActivityStep 2: Data AnalysisStep 3: Generate and Prioritize Differential Diagnoses ActivityExpectations for Group PresentationCase 1: Signalment and HistoryPhysical ExaminationHematology Results (Potato)Biochemical Profile Results (Potato)Case 2: Signalment and HistoryHematology Results (Buster)Biochemical Profile Results (Buster)Endocrine Data (Buster)Additional Results (Buster)Endocrine Data Analysis for BusterCase 3: Signalment and HistoryPhysical ExaminationHematology Results (George)Biochemical Profile Results (George)Endocrine Data Analysis for GeorgeCase 4: Signalment and HistoryPhysical Examination for QueenBiochemical Profile Results (Queen)
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Week 2 Lesson 15 Lab Endocrine Cases

Endocrine Lab (Lesson#15)

  • Instructors: Dr. Dawn Seddon, Dr. Steve Stockham.

  • Overview of the Lab:

    • Analyze four cases in groups, with 10 minutes allocated per case for discussion.

    • Class discussions will occur after cases 1-2 and cases 3-4.

Step 1: Case Introduction and Initial Impressions Activity

  • Reviewing Case Details:

    • Signalment: Include species, breed, age, sex, and reproductive status.

    • History: Summarize presenting complaints and relevant historical details (chronic issues, recent events, behavioral changes).

  • Group Discussion Points:

    • Identify key clinical problems (e.g., weight loss, polydipsia, alopecia).

    • Discuss affected organ systems.

    • Compile at least three differential diagnoses.

Step 2: Data Analysis

  • Review Laboratory Results:

    • Examine hematology, biochemistry, and endocrine data by comparing values to provided reference intervals.

  • Guided Analysis Activity:

    • Identify Abnormal Values: Determine what these abnormalities suggest (e.g., hyperglycemia indicates an endocrine disorder).

    • Look for Patterns: Indicate specific organ involvement or systemic issues.

Step 3: Generate and Prioritize Differential Diagnoses Activity

  • Developing a Differential List:

    • Utilize findings from signalment, history, and lab results to propose potential diagnoses including:

      • Hyperadrenocorticism (Cushing’s disease)

      • Hypothyroidism

      • Milk Fever (hypocalcemia)

      • Diabetes Mellitus

  • Prioritizing by Likelihood:

    • Rank the differential diagnoses based on likelihood and severity.

  • Justification for Top Choice:

    • Identify the top differential diagnosis and explain reasoning:

      • How clinical signs and lab results support the diagnosis

      • Discussion of pathogenesis

Expectations for Group Presentation

  • Present the following:

    • Key clinical problems

    • Prioritized differential diagnosis list

    • Justification of the top diagnosis with emphasis on clinical and lab data interpretation

  • Be prepared for class discussions explaining your reasoning.

Case 1: Signalment and History

  • Signalment: Potato, an 8-year-old male neutered mixed breed.

  • History: Exhibits polydipsia, polyuria, weight loss, abdominal cramping for one month.

Physical Examination

  • Findings: Tense abdomen, thin, mild truncal alopecia, and comedones on dorsal midline.

Hematology Results (Potato)

Parameter

Result

Reference Interval

Notes

Packed Cell Volume (%)

48

37-55

Total Nucleated Cell Count (x10³/µL)

34.4

6-17

Segmented Neutrophils (x10³/µL)

29.0

3-11.5

Band Neutrophils (x10³/µL)

2.0

0-0.3

Monocytes (x10³/µL)

3.4

0.1-1.3

Lymphocytes (x10³/µL)

0

1-4.8

Platelets (x10³/µL)

Adequate

150-900

Plasma Protein (g/dL)

9.0*

6-8

*Elevated

Biochemical Profile Results (Potato)

Parameter

Result

Reference Interval

Notes

Glucose (mg/dL)

353

65-122

Calcium (mg/dL)

11.5

9.0-11.2

Phosphorus (mg/dL)

6.0

2.8-6.1

Total Protein (g/dL)

6.0

5.4-7.4

Albumin (g/dL)

2.7

2.7-4.5

Globulin (g/dL)

3.3

1.9-3.4

Cholesterol (mg/dL)

900

130-370

Alanine Aminotransferase (IU/L)

987

10-120

Alkaline Phosphatase (IU/L)

1200

35-280

Sodium (mEq/L)

139

145-158

Potassium (mEq/L)

3.1

4.1-5.5

Chloride (mEq/L)

100

106-127

Case 2: Signalment and History

  • Signalment: Buster, a 10-year-old MN Staffordshire Bull Terrier.

  • History: Depression, anorexia, excessive thirst, periodic vomiting, increased respiratory sounds.

    • Abnormal lung pattern seen in radiographs.

Hematology Results (Buster)

Parameter

Result

Reference Interval

Notes

Hemoglobin (g/dL)

16.9

12-18

PCV (%)

49

37-55

Total WBCs (x10³/µL)

11.3

6-15

Neutrophils (seg) (x10³/µL)

9.94

3.6-11.5

Lymphocytes (x10³/µL)

0.22

1-4.8

Monocytes (x10³/µL)

1.13

0.18-1.5

Biochemical Profile Results (Buster)

Parameter

Result

Reference Interval

Notes

Glucose (mg/dL)

123

68-104

ALT (IU/L)

96

<58

ALP (IU/L)

2273

>185

Endocrine Data (Buster)

Parameter

Value

Reference Interval

Notes

Serum Cortisol (Pre) (µg/dL)

4.5

1-4

Serum Cortisol (Post) (µg/dL)

14.6

<1.5

Serum Cortisol (8-hour post) (µg/dL)

1.1

<1.5

Additional Results (Buster)

Parameter

Result

Reference Interval

Calcium (mg/dL)

7.96

8.2-10.6

Sodium (mEq/L)

145

144-162

Potassium (mEq/L)

5.3

3.6-5.8

Chloride (mEq/L)

95

96-108

Endocrine Data Analysis for Buster

Parameter

Result

Reference Interval

ACTH stim: Cortisol (Pre, µg/dL)

3.8

1-4

ACTH stim: Cortisol (Post, µg/dL)

25

10.5-20

LDDST: Cortisol (4 hr, µg/dL)

1.1

<1.45

LDDST: Cortisol (8 hr, µg/dL)

3.2

<1.45

Case 3: Signalment and History

  • Signalment: George, a 3-year-old castrated male Golden retriever.

  • History: Lethargic, seeks heat.

Physical Examination

  • Findings: Obese, poor hair coat, tail head alopecia.

Hematology Results (George)

Parameter

Result

Reference Interval

Notes

Packed Cell Volume (PCV) (%)

34

37-55

MCV (fL)

65

60-72

MCHC (g/dL)

35

34-38

Reticulocytes (x10³/µL)

2

<60

Total WBCs (x10³/µL)

12.5

6-17

Biochemical Profile Results (George)

Parameter

Result

Reference Interval

Notes

ALT (IU/L)

110

10-120

ALP (IU/L)

220

35-280

Calcium (mg/dL)

10.5

9.0-11.2

Phosphorus (mg/dL)

4.0

2.8-6.1

Cholesterol (mg/dL)

720

130-370

Sodium (mEq/L)

143

145-158

Potassium (mEq/L)

4.5

4.1-5.5

Endocrine Data Analysis for George

Parameter

Result

Reference Interval

Notes

TT4 (µg/dL)

1.6

1.4-4.0

Free T4 (ng/dL)

0.24

1.2-3.4

Endogenous TSH (ng/mL)

0.5

0.1-0.45

Case 4: Signalment and History

  • Signalment: Queen, Jersey, 6-year-old female.

  • History: Found in sternal recumbency, unable to get up after calving 36 hours ago.

    • Considered a valuable cow based on milk production.

Physical Examination for Queen

  • Findings: Non-febrile, weak, depressed, head turned into flank.

Biochemical Profile Results (Queen)

Parameter

Result

Reference Interval

Notes

Glucose

65

55-95

Calcium

5.5

8.2-9.9

Phosphorus

3.0

4.3-7.0

Total Protein

7.0

6.3-7.6

Albumin

3.4

2.5-4.3

Globulin

3.6

2.6-5.0

Sodium

142

136-147

Potassium

4.6

3.6-5.2

Chloride

108

95-117