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Internal Medicine Y5 S1 Grey : disorder Blue : etiology Red :…

- - - - Hypocorticism : D cortisol prod
        
        Acute : immune, infection, shock
        Chronic (Addisson) : prolonged admin in horses, lesions on adrenocortex or pituitary in cats and dogs
        1ary if destruction of glands, 2ary if pituitary failure
        
        Chronic : adrenocortical lesions → tumors, atrophy, hemo or pituitary → insufficient ACTH → bilateral atrophy of adrenal cortex
        
        Acute : depression, GI & CV disorders, sudden death in apoplectic form
        Chronic : same + hypothermia & meladonermia
        
        Acute : blood (D Na, I K, D glu)
        Chronic : blood (same + eosinophilia), ACTH stimulation test
        
        Cortisone (in all forms), vit C, in cats, fluids w electrolytes + CV drugs
      - Hypercorticism
        
        Global hypercorticism syndrome : high production of all adrneocortical hormones
        
        Tumors → I corticosteroid prod, milk fever in cows
        
        In milk fever : D Ca → D blood Pa, V, cardiac contractility, Na+ → activation or RAAS → aldosterone prod → I blood Pa, V, Na abs, K secretion
        
        Edema, metabolic alkalosis
        
        Hormone panel, imagery (tumor), pregnand(r)iol, ACTH stimulation test
        
        Surgery only if not tumoral, glucocorticoids, estrogens, low Na & carb diet
        
        Cushing's syndrome (HAC) : I corticosteroid prod
        
        Pituitary neoplasia, adrenal gland tumor or hyperplasia, iatrogenic cortisol admin
        
        I ACTH prod → I cortisol prod → I glycemia, and insulin resistance, immunosuppresion, I BP, infertility, mineralisation, prod catabolism
        
        PuPd, alopecia, skin enlargment, sexual disorders, weakness, ectopic calcification, hypertension
        
        ACTH stimulation test, dexamethasone suppression test, I ALAT, AST, lipid, glu, D urea, P, proteinuria, imagery (I gland >4cm)
        
        Surgery if adrenal tumor (not pituitary), trilostane, seligiline, mitotane, ketoconazole
        
        Feline hyperadrenocorticism : cat's version of Cushing's
        
        Pituitary disease
        
        Same as dogs but skin fragility and more susceptible to diabetic effect of glucocorticoids
        
        ACTH stimulation test
        
        Conn syndrome : I mineralocorticoid prod
        
        Primary (unilat adrenal adenoma), secondary (liver, hear, kidney disorders)
        
        → ↑ Na⁺ and H₂O retention, ↑ K⁺ and H⁺ loss
        
        Hypertension, D K+, m weakness, arrythmia, PuPD, alkalosi
        
        Adrenogenital syndrome : I prod of androgens
        
        Congenital enzyme deficiency, tumors, neutering
        
        Masculinization (rough, hard, hair, aggression, clitoral hypertrophy, male-like appearance, m hypertrophy), rarely feminization of males
    - - Urine catecholamine dosage, BP and biochem changes, imagery
        
        Hypo : hypertensive drugs, surgery (tumors)
        Hyper : hypotnesive drugs
      - Hyperepinephria : I cathecolamine prod
        
        Hypertensive epinephroma or pheochromocytoma
        
        → hypertensive crisis (excess adre)
        
        Paroxysmal arterial hypertension, I glu, K, glucosuria, albuminuria, uremia
      - Hypoepinephria syndrome : D catecholamine prod
        
        W hypocorticism, primaraly by tumor, phreochromocytoma
        
        Hypotension, hypoglu, weakness, low P, RBC, tachycardia, hypoxia, acites, hindlimb edema
  - - - Primary : tissue destruction
        Secondary : D Mg, chronic I Ca
        
        → Hyperexcitability, I P in blood, D P in urine, D Ca in blood, I Ca in urine (→ lithiasis)
        
        Acute : sudden intense neuromuscu excitability
        Chronic : less intense, genenralized only when stressed
      - PTH admin