Diseases of the Endocrine SystemDiseases of the Endocrine System

DeeDee Schumacher CVT, VTS (ECC) Jeannie Stall , R.V.T.

Credits: ClipArt/ Google Images

Alleice Summers

DeeDee Schumacher CVT, VTS (ECC) Jeannie Stall , R.V.T.

Credits: ClipArt/ Google Images

Alleice Summers

DiabetesDiabetes

Diabetes Mellitus: Beta cells in pancreas quit adequate production of the hormone “insulin” or when tissues in the body become resistant to insulin

Insufficient insulin to switch off glucose prod. by the liver or efficiently store excess glucose from energy foods. Blood concentration of glucose rises & exceeds level @ which the kidneys let glucose leak into the urine.

Diabetes Mellitus: Beta cells in pancreas quit adequate production of the hormone “insulin” or when tissues in the body become resistant to insulin

Insufficient insulin to switch off glucose prod. by the liver or efficiently store excess glucose from energy foods. Blood concentration of glucose rises & exceeds level @ which the kidneys let glucose leak into the urine.

Type I vs Type IIType I vs Type II

Type I = Insulin-dependent diabetes

100 % of K9’s & 50% of cats

Tx.: High fiber diet/daily insulin replacement Type II = Non-insulin-dependent diabetes

50 % of cats

Tx.: Drug therapy/ diet restriction

Type I = Insulin-dependent diabetes

100 % of K9’s & 50% of cats

Tx.: High fiber diet/daily insulin replacement Type II = Non-insulin-dependent diabetes

50 % of cats

Tx.: Drug therapy/ diet restriction

Diabetes cont’d ….Diabetes cont’d ….

Symptoms: Non-ketotic diabetes

Polyuria / polydipsia / wt. loss / muscle loss / sudden

cataracts / polyphagia / recurrent infections/

dehydration/ plantigrade posture in cats (“hock walking”)

Ketotic diabetesAll of the above + : Depression/ weakness/ tachypnea/

vomiting & “acetone” breath odor

Symptoms: Non-ketotic diabetes

Polyuria / polydipsia / wt. loss / muscle loss / sudden

cataracts / polyphagia / recurrent infections/

dehydration/ plantigrade posture in cats (“hock walking”)

Ketotic diabetesAll of the above + : Depression/ weakness/ tachypnea/

vomiting & “acetone” breath odor

Most likely victims…..Most likely victims…..

4 – 14 yrs old dogs / Female dogs higher % All ages of cats/ NM’s higher % Poodles/schnauzers/keeshonds/beagles/

Cairn terriers/ dachshunds & cockers

4 – 14 yrs old dogs / Female dogs higher % All ages of cats/ NM’s higher % Poodles/schnauzers/keeshonds/beagles/

Cairn terriers/ dachshunds & cockers

DiabetesDiabetes

Dx: Clin. signs / glycosuria /

Fasted, bl. glucose test >200 mg/dl Tx: High fiber-complex carb. diet

ie: Hill’s R/D or W/D

Regularly scheduled meals & exercise

Insulin: Cats-Prozinc K9’s-Human insulinTypes of insulin ie: Ultralente (long-acting)

NPH (intermediate-acting)

Dx: Clin. signs / glycosuria /

Fasted, bl. glucose test >200 mg/dl Tx: High fiber-complex carb. diet

ie: Hill’s R/D or W/D

Regularly scheduled meals & exercise

Insulin: Cats-Prozinc K9’s-Human insulinTypes of insulin ie: Ultralente (long-acting)

NPH (intermediate-acting)

Insulin Insulin

Care & Handling:

Can be damaged by heat, rough handling

or chemicals

DON’T SHAKE VIAL! Gently roll/invert

Refrigerate insulin

Use syringes free of chemicals/soaps

Care & Handling:

Can be damaged by heat, rough handling

or chemicals

DON’T SHAKE VIAL! Gently roll/invert

Refrigerate insulin

Use syringes free of chemicals/soaps

Blood Glucose levels…Blood Glucose levels…

Blood glucose curve: Series of glucose tests to evaluate insulin dose/glucose levels

NOTE: Stress can elevate glucose levels

W/ fractious cat, possibly place IV cath.

for multiple blood draw ease during day.

High levels not good but LOW glucose

can be FATAL !

Blood glucose curve: Series of glucose tests to evaluate insulin dose/glucose levels

NOTE: Stress can elevate glucose levels

W/ fractious cat, possibly place IV cath.

for multiple blood draw ease during day.

High levels not good but LOW glucose

can be FATAL !

DiabetesDiabetes

Insulin ShockInsulin Shock

Dangerously low glucose levels d/t: Inconsistent feeding schedule (type & amt.)

-anorexia, vomited meal but rec’d insulin… Unregulated exercise ( excessive activity ) Failure to monitor bl. glu. levels Inconsistent insulin doses / insulin care

Emergency-Seizure/coma RxKaro syrup/treats

Dangerously low glucose levels d/t: Inconsistent feeding schedule (type & amt.)

-anorexia, vomited meal but rec’d insulin… Unregulated exercise ( excessive activity ) Failure to monitor bl. glu. levels Inconsistent insulin doses / insulin care

Emergency-Seizure/coma RxKaro syrup/treats

InsulinomaInsulinoma

Insulin-secreting tumor (Beta cells in pancreas) Symptoms d/t hypoglycemia (15-78 mg/dl):

Seizures / weakness/ collapse / ataxia / brain damage /

lethargy

Victims: St. poodle / Irish setter / boxer / fox terrier/

Germ. Shep./ Cats: Rarely (1 Siamese) Ferrets!!

Dx: Ultrasound, bl. glu. level Tx- Surgically remove tumor

Medical mgmt. via Rx Pred /Diazoxide

Insulin-secreting tumor (Beta cells in pancreas) Symptoms d/t hypoglycemia (15-78 mg/dl):

Seizures / weakness/ collapse / ataxia / brain damage /

lethargy

Victims: St. poodle / Irish setter / boxer / fox terrier/

Germ. Shep./ Cats: Rarely (1 Siamese) Ferrets!!

Dx: Ultrasound, bl. glu. level Tx- Surgically remove tumor

Medical mgmt. via Rx Pred /Diazoxide

HypocalcemiaHypocalcemia

Causes: Parathyroidism

Chronic/acute renal failure

Acute pancreatitis

Ecalmpsia (puerperal tetany)

Tx: Correct underlying cause

Supplement Vit. D & calcium

Causes: Parathyroidism

Chronic/acute renal failure

Acute pancreatitis

Ecalmpsia (puerperal tetany)

Tx: Correct underlying cause

Supplement Vit. D & calcium

Normal function…..Normal function…..

Hypothalamus directs Pituitary glandPituitary gland produces ACTH (adrenocorticotrophic hormone)This hormone is released into the bloodstream & stimulates the

body's two adrenal glands, located near the kidneys, to secrete glucocorticoid (cortisone-like or cortisol) hormones into the bloodstream. (Cortisol helps the body respond to stress)

When bl. cortisol levels are high enough--- pituitary stops secreting ACTH

When bl. cortisol levels dip low , the pituitary secretes more ACTH.

Adrenals respond by secreting glucocorticoid hormones in response to the pituitary, just as the pituitary responds by secreting ACTH in response to the adrenals.

Net effect : A mildly fluctuating balance is achieved

Hypothalamus directs Pituitary glandPituitary gland produces ACTH (adrenocorticotrophic hormone)This hormone is released into the bloodstream & stimulates the

body's two adrenal glands, located near the kidneys, to secrete glucocorticoid (cortisone-like or cortisol) hormones into the bloodstream. (Cortisol helps the body respond to stress)

When bl. cortisol levels are high enough--- pituitary stops secreting ACTH

When bl. cortisol levels dip low , the pituitary secretes more ACTH.

Adrenals respond by secreting glucocorticoid hormones in response to the pituitary, just as the pituitary responds by secreting ACTH in response to the adrenals.

Net effect : A mildly fluctuating balance is achieved

Cushing’s diseaseCushing’s disease

This balanced process has gone

away d/t hypersecretion of cortisol Pituitary tumor = excess ACTH Adrenal tumor = excess cortisol Veterinary interference= Rx Corticosteroids

Result : Chronic excess of blood

cortisol levels in the body

AKA: Hyperadrenocorticism

This balanced process has gone

away d/t hypersecretion of cortisol Pituitary tumor = excess ACTH Adrenal tumor = excess cortisol Veterinary interference= Rx Corticosteroids

Result : Chronic excess of blood

cortisol levels in the body

AKA: Hyperadrenocorticism

Cushing’sCushing’s

Symptoms :Polyuria / polydipsia / polyphagia/

sagging, pot-bellied appearance/

excessive panting / obesity

muscle weakness/ lethargy/ lameness/ pruritis/

pyoderma/ bilateral, symmetrical alopecia/

abnormal gonad function / slow hair regrowth/

dark skin

Symptoms :Polyuria / polydipsia / polyphagia/

sagging, pot-bellied appearance/

excessive panting / obesity

muscle weakness/ lethargy/ lameness/ pruritis/

pyoderma/ bilateral, symmetrical alopecia/

abnormal gonad function / slow hair regrowth/

dark skin

Cushing’sCushing’s

Hyperadrenocorticism Hyperadrenocorticism

Cushing’sCushing’s

Dx: Increased Alk. Phos/ALT/cholesterol/ bl. glu Decreased BUN / lipemia present

Urine protein/creatinine ratio : Rule out only Higher ratio indicates more cortisol in urine = more in blood

ACTH stimulation test: Fasted , baseline blood sample taken ACTH injection (Cortrosyn @ 0.25 mg/IM -K9 / 0.15 mg/IM cats) Bl. samples @ 0 & 60 min K-9/ 0,30 & 60 min. cats Cortisol levels measured

Dx: Increased Alk. Phos/ALT/cholesterol/ bl. glu Decreased BUN / lipemia present

Urine protein/creatinine ratio : Rule out only Higher ratio indicates more cortisol in urine = more in blood

ACTH stimulation test: Fasted , baseline blood sample taken ACTH injection (Cortrosyn @ 0.25 mg/IM -K9 / 0.15 mg/IM cats) Bl. samples @ 0 & 60 min K-9/ 0,30 & 60 min. cats Cortisol levels measured

Cushing’sCushing’s

Dx: Low dose dex supression test

Fasted , baseline blood sample Dex injection (synthetic glucocorticoid) Blood samples 4 & 8 hours later Can’t definitively differentiate between adrenal &

pituitary dogs (suggestive)

Dx: Low dose dex supression test

Fasted , baseline blood sample Dex injection (synthetic glucocorticoid) Blood samples 4 & 8 hours later Can’t definitively differentiate between adrenal &

pituitary dogs (suggestive)

Cushing’sCushing’s

Dx: High dose dex supression test

After dx cushings Differentiates between adrenal & pituitary

Similar to low dose but high dose given A dog w/ adrenal tumor won’t suppress at all. Adrenal

tumor simply doesn't "care" about the level of blood cortisol so it keeps pumping out cortisol.

A dog w/ a pituitary tumor still has some limited ability to respond to feedback & should respond to a high dose of dexamethasone by showing a suppressed cortisol level.

Dx: High dose dex supression test

After dx cushings Differentiates between adrenal & pituitary

Similar to low dose but high dose given A dog w/ adrenal tumor won’t suppress at all. Adrenal

tumor simply doesn't "care" about the level of blood cortisol so it keeps pumping out cortisol.

A dog w/ a pituitary tumor still has some limited ability to respond to feedback & should respond to a high dose of dexamethasone by showing a suppressed cortisol level.

Cushing’sCushing’s

Tx Depends on type of cushings & health of animal

Concurrent problems-complicated tx Comfort of patient goal not to increase life span

Surgery may be indicated for adrenal tumors. Chemotherapy : Lysodren or Ketaconazole Anipryl w/ pituitary-dependent Cushing's. NOTE: Life-long treatment ~ 20-30 month life expectancy

Tx Depends on type of cushings & health of animal

Concurrent problems-complicated tx Comfort of patient goal not to increase life span

Surgery may be indicated for adrenal tumors. Chemotherapy : Lysodren or Ketaconazole Anipryl w/ pituitary-dependent Cushing's. NOTE: Life-long treatment ~ 20-30 month life expectancy

Equine Cushing’sEquine Cushing’s

Very common / Late teens to early twenties

Symptoms:Weight loss / long, poorly-shed hair/ Muscle wasting/ Lethargy/ SweatingPU / PD / Recurrent laminitis

Dx: dex suppresion test

Very common / Late teens to early twenties

Symptoms:Weight loss / long, poorly-shed hair/ Muscle wasting/ Lethargy/ SweatingPU / PD / Recurrent laminitis

Dx: dex suppresion test

Equine Cushing’sEquine Cushing’s

Tx : Good mgmt via : Food Hoof care Body clipping

Dopamine receptor agonists

ie: Pergolide or Bromocriptine

Cyproheptadine: < $ but < effective

Tx : Good mgmt via : Food Hoof care Body clipping

Dopamine receptor agonists

ie: Pergolide or Bromocriptine

Cyproheptadine: < $ but < effective

Addison’sAddison’s

Hypoadrenocorticism :

Uncommon

Insufficient production of mineralocorticoids (primarily aldosterone) by adrenal cortex

Idiopathic / Immune mediated? / trauma/

fungal infection/ neoplasia / hereditary/

excessive Lysodren therapy

Hypoadrenocorticism :

Uncommon

Insufficient production of mineralocorticoids (primarily aldosterone) by adrenal cortex

Idiopathic / Immune mediated? / trauma/

fungal infection/ neoplasia / hereditary/

excessive Lysodren therapy

Addison’s Addison’s

Symptoms :

Middle-aged (< 7 yrs old), female dogs

Intermittent , subtle signs / lethargy / weakness / anorexia / vomiting / diarrhea / wt. loss / P/U / P/D / bradycardia / dehydration

NOTE: Consider Addison’s w/ vomiting K-9

having a > elevated BUN but not a renal case

Symptoms :

Middle-aged (< 7 yrs old), female dogs

Intermittent , subtle signs / lethargy / weakness / anorexia / vomiting / diarrhea / wt. loss / P/U / P/D / bradycardia / dehydration

NOTE: Consider Addison’s w/ vomiting K-9

having a > elevated BUN but not a renal case

Addison’sAddison’s

DxHyperkalemia (elev. K ) Hyponatremia (low Na) Na:K ratio < 27:1 ( normal range b/t 27:2 & 40:1 ) > BUN , Creatinine & Calcium / < bl. glu & albumin ECG - Associated with hyperkalemia

ACTH stimulation test: ACTH inj. incites subnormal or negative response in

dogs w/ hypoadrenocorticism. Baseline & post-ACTH samples w/ cortisol level of < 2 micrograms

per dl are diagnostic for hypoadrenocorticism

DxHyperkalemia (elev. K ) Hyponatremia (low Na) Na:K ratio < 27:1 ( normal range b/t 27:2 & 40:1 ) > BUN , Creatinine & Calcium / < bl. glu & albumin ECG - Associated with hyperkalemia

ACTH stimulation test: ACTH inj. incites subnormal or negative response in

dogs w/ hypoadrenocorticism. Baseline & post-ACTH samples w/ cortisol level of < 2 micrograms

per dl are diagnostic for hypoadrenocorticism

Addison’sAddison’s

Tx: Acute Addisonian crisis

Collect samples & initiate treatment immediately Restore blood volume-IV 0.9% saline @ 44-88 ml/kg IV glucocorticoids ie: Solu-Delta-Cortef or IM or SQ- Percorten-V or PO- Florinef Primary Addison’s requires lifetime corticosteriod

therapy/monitoring / Flare-ups d/t stress, trauma ,sx Prognosis: Excellent when dz. Dx’d early & appropriate therapy is begun

Tx: Acute Addisonian crisis

Collect samples & initiate treatment immediately Restore blood volume-IV 0.9% saline @ 44-88 ml/kg IV glucocorticoids ie: Solu-Delta-Cortef or IM or SQ- Percorten-V or PO- Florinef Primary Addison’s requires lifetime corticosteriod

therapy/monitoring / Flare-ups d/t stress, trauma ,sx Prognosis: Excellent when dz. Dx’d early & appropriate therapy is begun

HyperthyroidismHyperthyroidism

Most common endocrine issue in cats -- Rarely seen in dogs unless neoplasia Excessive prod. & secretion of triiodothyronine

(T3) & thyroxine (T4) by the thyroid gland Increased metabolic rate / middle-aged to older cats Risk factors: Canned food / Cat litter / Genetics?

Most common endocrine issue in cats -- Rarely seen in dogs unless neoplasia Excessive prod. & secretion of triiodothyronine

(T3) & thyroxine (T4) by the thyroid gland Increased metabolic rate / middle-aged to older cats Risk factors: Canned food / Cat litter / Genetics?

HyperthyroidismHyperthyroidism

Symptoms:Wt. loss / polyphagia / vomiting/ polyphagia/

tachycardia (+/- murmurs) / aggressive behavior/ enlarged thyroid gland / > systolic bl. pressure/

retinal detachment blindness

Dx: Enlarged thyroid gland / > T4 /

> Alk Phos, > ALT , BUN & Creatinine

Symptoms:Wt. loss / polyphagia / vomiting/ polyphagia/

tachycardia (+/- murmurs) / aggressive behavior/ enlarged thyroid gland / > systolic bl. pressure/

retinal detachment blindness

Dx: Enlarged thyroid gland / > T4 /

> Alk Phos, > ALT , BUN & Creatinine

HyperthyroidismHyperthyroidism

Tx: Surgical removal of thyroid- NOT parathyroids Medications- Methimizole ( Tapezole ) Radioactive iodine

Tx: Surgical removal of thyroid- NOT parathyroids Medications- Methimizole ( Tapezole ) Radioactive iodine

HypothyroidismHypothyroidism

Seen in dogs : Goldens/Cockers/Dobes/Schnauzers Irish setters/ Dachshunds are predisposed Decreased metabolic rate Thyroid gland atrophy Symptoms: Lethargy / wt. gain/ “rat tail”/ hyperpigmentation/ dry coat/ alopecia/ hypercholesterolemia/ cold intolerance/ > shedding/ anemia

Seen in dogs : Goldens/Cockers/Dobes/Schnauzers Irish setters/ Dachshunds are predisposed Decreased metabolic rate Thyroid gland atrophy Symptoms: Lethargy / wt. gain/ “rat tail”/ hyperpigmentation/ dry coat/ alopecia/ hypercholesterolemia/ cold intolerance/ > shedding/ anemia

HypothyroidismHypothyroidism

Dx:Total thyroxine (TT4) test / Total T 3 (TT3) / Free T4 (FT4)

Tx: Life-long trt……. Synthetic Levothyroxine sodium (Soloxine) Rx : 0.1 / .0.2 / 0.3 / 0.4 / 0.5 / 0.6 / 0.7 & 0.8 mg. tablets

Results in normalization of both T4 and T3 concentrations

Dx:Total thyroxine (TT4) test / Total T 3 (TT3) / Free T4 (FT4)

Tx: Life-long trt……. Synthetic Levothyroxine sodium (Soloxine) Rx : 0.1 / .0.2 / 0.3 / 0.4 / 0.5 / 0.6 / 0.7 & 0.8 mg. tablets

Results in normalization of both T4 and T3 concentrations

Parathyroid Dz.Parathyroid Dz.

Hypercalcemia from excessive PT hormone Older dogs (7-11 yrs), Primarily Keeshonds, also

Germ. Shep., poodles, retrievers, dobes Clin. signs: Anorexia/ V / constipation/ P/U

P/D / listless /weakness/ incontinence/

exercise intolerance

Tx: Sx. removal of parathyroid glands/

Heat or chemical ablation of glands

Hypercalcemia from excessive PT hormone Older dogs (7-11 yrs), Primarily Keeshonds, also

Germ. Shep., poodles, retrievers, dobes Clin. signs: Anorexia/ V / constipation/ P/U

P/D / listless /weakness/ incontinence/

exercise intolerance

Tx: Sx. removal of parathyroid glands/

Heat or chemical ablation of glands

The EndThe End