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Internal Medicine Y5 S1 - Endocrine sst Grey : disorder Blue :…

- - - - 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
    - - 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
  - - - Hypo : hypertensive drugs, surgery (tumors)
        Hyper : hypotnesive drugs
    - - Hypertensive epinephroma or pheochromocytoma
        
        → hypertensive crisis (excess adre)
        
        Paroxysmal arterial hypertension, I glu, K, glucosuria, albuminuria, uremia
    - - W hypocorticism, primaraly by tumor, phreochromocytoma
        
        Hypotension, hypoglu, weakness, low P, RBC, tachycardia, hypoxia, acites, hindlimb edema
- - - - Sweating, tremors, seizures, confusion, hunger, coma, seizures, obesity, high BP, dislipidemia, fatigue
    - - Insulin R : weight loss, low-gly diet, GLP1 agonists
        Tumor : surgery, radio, corticoids, glu, ACTH
  - - - Obesity. Cats
        
        Viceral fat I → prod substances that D insulin sensitivity → β c compensate then wearout → dysfunction → D insulin secretion → persisten hypergly
        
        Same as type 1 excess after +
      - Same as type 1
        
        Diet (I fibers+pro, D fat+glu, I frequency) → manage weight, oral hypoglycemient, insulin SC
    - - Autoimmune, idiopathic. Dogs
        
        Genes misID β c + infection or other trigger → creation of ab destroying β c → no insulin at all → hyperglycemia + no more energy in c ⇒ use fat → ketone bodies → DKA
        
        PuPd, polyphagia, fatigue, cataract, infections + DKA, weight loss
      - [glu] in blood, I cholesterol, I N, glucosuria
        
        Diet (I fibers+pro, D fat+glu, I frequency) → stabilize [glu], oral hypoglycemient, insulin SC
  - - - → uncontrolled insulin secretion → I glu uptake in c and D gly → hypoglycemia and neuroglycopenia
        
        Neuro signs + adrenergic signs (in crisis)
    - - Glu IV, prot and complex carbs rich diet, surgery, prednisolone
- - - - → 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
  - - - Secondary : → I P and/or D Ca in blood → triggers I PTH secretions
        
        Acute : neuromoscu D excitability, fatigue, emesis, apathy, I P in blood and urine, Ca changes
        Chronic; same but D P in blood, urinary calculus, P-Ca precipitates int issues
    - - Primary : surgery, crugs to control Ca
        Secondary ; correct diet, sup Ca, vit D3, UVB light, treat kidney, monitor blood levels, rest in bone fragility
- - - - X-ray, dosage of STH, in cat : ACTH test, I somatomedin C, tomography of gland, ineffective manegement of diabetes
      - 4-7 yo female dogs w hyperprogesteronemia (in luteal phase or iatrogenic), tumors 8-14 yo male cats
        
        Incremental aberant growth of bones and viscera, obesity, diabetes, gonadal and sexual inefficiency, I glu
        Dogs : inspiratory stridor, fatigue, abdo enlargement, breast tumors, vaginal leakage, I interdental spaces
        Cats : insulin-R diabetes, kidney failure, pleural effusion, I size heart, kidneys, liver, I prot, cholesterol, N, RBC in blood
    - - Tumors, infections disrupting somatotrophs
        
        Tumors → hyperplasia of eosinophilic c → I STH prod
        
        I limb length, V and wieght of viscera, hypogonadism, CV sst dvlped in size but not capacity
      - Signs and lab tests
        
        Specific diet, somatostatin, radiotherapy, surgery, diuretics, insulin
    - - Congenital or acquired (tumor, infection, trauma, intoxicatino)
        
        Lesions on adenohypophysis → bad GH prod regulation → D or stops secretion → plurihormonal insufficiency
        
        Small limbs, micrpcephaly, genital infantilism, PuPf, articular laxity, swelling of face and abdo, abnormal fat distrib→ snoring and inspiratory dyspnea
        
        Small limbs dimensions, microcephaly, genital infantilism
        
        Swelling of face and abdomen, prognathism with thin teeth, hypertrophy of buccal soft
        
        tissues → Snoring + Inspiratory dyspnea
        
        Polyuria + Polyphagia
        
        Articular laxity, walk on anterior face of phalanges
        
        Cats: insulin-susceptible diabetes, visceromegaly, thick folded neck skin, bone changes
      - DD w rickets (no bone deformation), thyroid dwarfism (not primary), acondroplastic swarfism (no disproportion) and renal dwarfism (no renal signs)
        
        Etiological, hormones admin, pituitary extracts
    - - Hyperfunctional, non-functional, panhypopituitarism
        
        I prod or destroy tissues (compression, etc) → D prod
        
        behavior changes, paresis, nystagmus, seizures, blindness, hormonal changes
      - Radiotherapy, surgery, hormone replacement, symptomatic
  - - - Diencephalon-hypophyseal, plasma tranport or hepatic sst disorders
        
        → D water retention → hyperconcentrated blood and hyperdiluted urine
        
        PuPd, dehydration → seizures, coma, death, hyposthenuria, I hematocrit, I[Na+], I [Cl-], normal uremia
      - Central : therapeutic
        Nephrogenic : confirm true polyuria → DD diabetes mellitus → WDT → DD central
        
        Desmopressin, hydrochlorothiazide, diet, etiology
    - - Tumor >> lesions, trauma, infection, etc
        
        Hypogonadism, I appetite, dwarfism
      - MRI, vision testing, hormone dosage
        
        Surgery, diet, hormone replacement
  - - - Tumor, infection, trauma, autoimmune, dystocia, vascular, toxic
        
        Destruction of pituitary cells → D prod → 2ary atrophy → pluriglandular insufficiency → disorders in systems
        
        Genital atrophy, weakness, cold intolerance, D glu, HR, milk prod
      - Neg response to ACTH and insulin, effectiveness of hormone therapy, imaging, D elimination of some steroids and FSH
        
        Hormone replacement, surgery
- - - - I thyroid hormones → I [X] in blood → thyrotoxicosis → effects on metabolism (+ neg feedback D TSH)
        
        Metabolic, I CV parameters, CNS excitement, I thyroid size → breathing pb, GI disorders
    - - Antithyroid drugs, radiation, surgery
  - - - → sst1 metabolic slowdown
        
        Weakness, D m mass, myxedema, alopecia, variation thyroid size, death, genital disorders (infertility, D prod, dystocia).
        Pigs : anemia, I cholesterol, body uneven.
        Dogs : anemia (non-regen), I cholesteral, obesity, seborrhea, bilateral assymetry, cold skin, pyoderma
    - - Prevention in prod animals (iodine salt + potassium iodine supplementation), synthetic levothyroxine + iodine supplements in pets
  - - - Sof painless enlargement, asphyxia, laryngeal noise, stasis edema
    - - Iodine (water or SC) + prophylactic in gestation
  - - - Strepto or staphylo infection, M. tuberculosis cold abcess
        
        Pyogenic bacterias → acute infla wneutrofilic infiltration + abcess → neutrophils dies, releasing their enzymes and DNA → pus + necrosis of thyroid w hormone leakage (→ thryoitoxicosis)
        
        Same as non-supp but more intense and quick + fistulation possible, but better prognosis
      - I neutrophils, I CBC, I→D thyroid hormones, D→I TSH, imaging (hyperechoic fluid, abcess and assymetry), FNA
        
        Same as non-sup + thyroidectomy (open + drain pus)
    - - Pneumococcus infection, rheumatism, thyroid fever, septicemia, epithelial glomerulonephritis
        
        Trigger → antithyroid immune response → lymphoplasmocytic infiltration → progressive destruction of thyroid follicles → hypothyroidism, atrophy & fibrosis
        
        Local hot and painful thyroid enlargment, discomfort w head mvM, compression, subfebrile state, I HR, exophtalmia
      - I lymphocytes or normal WBC, CBC, I→D thyroid hormones, D→I TSH, imaging (diffuse hyperechoic), FNA
        
        Antibiotic + ACTH + Cortisone + Antithyroid substance
  - - - Asymptomatic, lung metastasis, local invasion of ventral cervical area (swelling, dispnea, cough, dysphagia), hyperthryoidism (and consequences)
    - - Surgery or chemo, doxorubicin for carcinoma regression