Beruflich Dokumente
Kultur Dokumente
ArRan)
VETERINARY
ENDOCRINOLOGY
Hormones
Produksi dan Regulasi Hormon
• Pada hewan sehat perubahan
konsentrasi hormon ditentukan oleh
perubahan laju produksinya.
• Laju produksi dikontrol oleh sejumlah
“negative feedback loops”
• Respon terhadap feedbak system
akan berlangsung dalam hitungan
menit-jam hingga mencapai
HOMEOSTASIS
• Mekanisme regulasi hormon:
– Konsentrasi fluktuatif insulin
– Konsentrasi konstan thyroxine
Hormone Deficiency
(Hypofunction)
Decrease or
failure
production of
hormone Kegagalan
Acquired
dalam
disorders
beraksi
Congenital
Endocrine
defect of idiopathic
gland function
Hyperfunction
Functional
neoplasia
Endocrine Abnormalities
Hormon-like
of feedback
substance Hyperfunction regulation
Exogenous
hormone
administration
Polyuria and Polydipsia
• ADH Secretion
E. Coli endotoxin
Decrease sensitivity of renal
Hypokalemia
tubules to ADH
hypercalcemia
History
• PU n PD biasanya terjadi bersamaan
• Polyuria vs Pollakiuria
• Estimasi water intake normal
– Anjing: 20-90 ml/kg/day
– Kucing: 0-45 ml/kg/day
• Estimasi produksi normal urine
– Anjing: 20-40 ml/kg/day
– Kucing: 20-45 ml/kg/day
Physical Exam
• Abd. Palpation (bladder, kidneys n Liver)
• Lymphnode palpation
• Rectal exam (urethra n Tumor)
– LUTD -> Tick of urethra
– Anal sack sarcoma -> hypercalcemic, polyuria,
large lymphnode
• Blood pressure (elevated: renal dz,
hyperthyroidism, cushing’s, diabetes in dog,
liver dz, CNS dz, hyperaldosteronism,
idiopathic hypertention)
• Banyak minum??
– >90 ml/kg/day (dog) >60ml/kg/day (cat)
• Water intake variable
• Seberapa banyak owner yg mengukurnya?
• Banyak pipis??
– >50ml/kg/day
• Sulit diukur kalau tidak dilakukan observasi
di klinik
• When a Patient is
presented for PU/PD,
What’s the 1 test you
st
want to do?
URINALISIS
• SG if USG >1.020 in a dog or >
1.030 in a cat not consistent with
polyuria
• Full Urinalysis
– Casts, bacteria, cells, protein can suggest
renal disorder
– Glucose -> DM
– Mild proteinuria consistent with
hyperadrenocorticism
– Protein losing nephropathy
Other test
• Chemistry profile (BUN, Cr, SGPT,
ALP, Elektrolit (Ca, K, P, Na),
Glukosa)
• CBC (anemias, leukon)
• Imaging
– USG renal architecture, bladder, adrenal
gland, liver, Ln
– X-ray abdomen: liver size, masses,
urolith, kidney
– Thorax calcification, neoplasia
(hypercalcemia), effect of
hypertention
Most Common Causes - Dogs
• Renal Disease
• Diabetes Melitus
• Hypercortisolism
• Pyometra
• Subacute leptospirosis
• Hypercalcemia
• Hypoadrenocorticism
• Psychogenic
• Advanced Liver Disease
Most Common Causes - Cats
• Renal Disease
• Diabetes Melitus
• Hyperthyroidism
• Pyometra
• hypokalemia
Canine Hypothyroidism
Drh. M. Ar Raniri Putra
Principal cells (sel folicular): Thyroglobulin
Parafollicular cells : calsitonin
REGULATION
Canine Hypothyroidism
• Common endocrine disorders in dogs ??
• Over diagnosed
– Gejala klinis non spesifik
– Diganostic test yg tidak tepat
Thyroid Hormone Metabolism
• >99% dari T3 dan T4 protein bound
• Free hormones (Free T4)
– Enter cells
– Have metabolic effect
– Regulate pituitary feedback
• Total T4 = Free T4 + Bound T4
Canine Hypothyroidism
• Primary Hypothyroidism
– Destruksi thyroid gland
• Lymphocytic thyroiditis
• Idiopathic thyroid atrophy
• Central hypothyroidism
– Kegagalan sekresi TSH oleh pituitary
• Malformasi dari pituitary
• Supresi sekresi TSH dari pituitary temporary dan
reversible
– Exogenous administration of glucocorticoid
– Spontaneous hyperadrenocorticism
• Congenital hypothyroidism
– Uncommon
– Thyroid hypoplasia, aplasia, dysgenesis atau
dyshormonogenesis
– “fading puppy” syndrome atau disproportionate
dwarfism
Clinical Features
• Metabolic features
– Lethargy
– Exercise intolerance
– Weight gain and obesity
Dermatological features
• Present in over 85% cases
• Alopecia
• Dryness
• Abnormal keratinitation (Scaling) seborrhoea
• Hyperpigmentation
• Poor wound healing
• In extreme cases, mucopolysaccharides accumulate in
the skin causing it to thicken, especially in the face
myxoedema
• Neuromuscular
– Myopathy
– LMN dz
– Laryngeal paralysis and megaoesophagus
– Mixoedema coma
• Cardiovascular
– DCM
• Reproductive
– Anestrus
– Infertilitas
– Penurunan libido jantan
Diagnosis
• Clinical pathology
– QBC: non regenerative anemia often presen
– Biochemistry
• Hypercholesterolaemia (>75% cases)
• Hyperlipidemia
• ↑ALP, ALT
• ↑ fructosamine (up to 80%)
Total T4
• Useful screening test
• Most of dogs with hypothyroidism have low value
• Many dogs with other diseases (ESS) have low value
too
• Further test should be performed if low, low normal
or unexpectedly high
The following may falsely decrease t4
• Glucocorticoid
• Sulphonamides
• Anticonvulsan
• Furosemide
• Euthyroid sick syndrome (ESS)
• Thyroid hormone autoantibodies
• Breed (sight hounds have lower T4 values)
Free T4
• Two assay methods
– Analogue techniques
• Confer no advantages over assay of total T4
– Equilibrium dialysis
• Increased sensitivity an spesificity over total T4
• Validated canine assay available
Advantages – free T4
• Free T4 is biologically active portion
– Diffuse into cells
– Exerts negative feedback on pituitary
• Changes in total T4 with illness and drugs may not
affect fT4
• Equilibrium dialysis assay is less affected by thyroid
hormone autoantibodies
Disadvantages-fT4
• Must be run with Equilibrium dialysis (human lab
used Analogue techniques)
• Expensive (ED)
T3 & rT3
• Poor indicator of thyroid function
– 80% is produced in extra-thyroidal tissues
• No difference in T3 in normal dogs, hypothyroid dogs
and ESS dogs.
• Anti-T3 autoantibodies are more common than anti-
T4
• rT3 partly increased in ESS dogs and after drug
application
TSH
• Lack of negative feedback on pituitary should lead to
elevation of TSH
• Combination with fT4 or T4 (High TSH & Low fT4 or
T4)
– Sensitivity 87%
– Specificity almost 100%
Feline Hyperthyroidism
Drh. M. Ar Raniri Putra
Etiology
• Adenomatous hyperplasia
• Histopatological similar to toxic nodular goiter
• Cause unknown
• No evidence of immunopathy
• Thyroid carcinoma in 1-2% of cats
Canned food and Hyperthyroidism
• Risk factors: Flea sprays, indoors, herbicides, canned food (scarlett et al,
1988)
• Increased risk in cats thet prefer fish or liver or giblets flavored canned
food (Martin et al, 2000)
• Cats fed pop-top canned food at any time had 2.5x to 5x risk of
hyperthyroidism VS cats fed dry food (Edinboro et al. 2004)
Breed
• Siamese
• Himalayan Decreased risk
• Purebred
Sex
• Male increased risk
Age
• Middle-aged Older cat (>4yo) increased risk
Historical Findings
• Weight loss 88%
• Hyperactivity 61%
• Polyphagia 49%
• PU/PD 36%
• Vomiting 44%
• Diarrhea 15%
• Decreased Appetite 16%
• Large fecal volume 8%
• Anorexia 7%
Physical Findings
• Goiter (enlargement of Thyroid Glnd) 83%
• Thin 65%
• Heart murmur 54%
• Tachycardia 42%
• Gallop 15%
• Aggression 15%
• Unkempt 9%
• Thick claws 6%
Diagnosis
• Urinalysis
• CBC
– Leukositosis, eosinopenia, increased PCV
• Chemistry profile
– Increased ALT (90%)
– Azotemia (25%)
• Blood pressure
• Serum total T4
Diagnostic test
Therapy Drug Dose Route Sampling Assay euthyroi HyperT
times dism
T3 Liothyron 20 mg Oral 0 and 2-4 Total T4 <20 >20nmol/
Suppressi ine q8h for 7 hours after nmol/l l ± <35%
on doses last dose with suppressi
>50% on
suppressi
on
TSH Bovine 0.5 IU/kg IV 0 and 6 Total T4 >100% Minimal
Stimulati TSH hours increase to no
on increase
rhTSH 25ug/cat IV 1 and 6-8 Total T4 >100% Minimal
hours increase to no
increase
CRF (+)
Pituitary pars
cortisol (-) distalis
Adrenal cortex
CAUSES OF HYPERCORTISOLISM
Pituitary-dependent hypercortisolism (PDH)
Most common
Persisten sekresi ACTH
Micro or macroadenoma of pars distalis
Bilateral adrenal hyperplasia
ACTH merangsang sekresi cortisol tapi negative feed
back cortisol thd ACTH tidak terjadi [cortisol] dan
[ACTH] ↑ ↑
Adrenal Tumor
Cortex secara autonom mensekresikan cortisol
Negative feed back cortisol terhadap ACTH tetap
terjadi [cortisol] ↑ sementara [ACTH]↓
Iatrogenic = corticosteroid in long term
PREDISPOSITIONS
Age Pred
2-16 yo, adrenal tumor rata2 11 tahun
Breed Pred
Dog : Poodle, boston terrier, boxer, dachshund
PDH;
german shepherd and toy poodle adrenal tumor
Cat : none
Sex pred
Dog: none, but female make up 70% of adrenal tumor
Cat: female
CLINICAL SIGN
Pu.PD (90%)
Due to ADH antagonism
Decreased renal tubular water permeability
Decreased vasopressin secretion
Polyphagia
Direct effect of glucocorticoid, or can be due to an anti
insulin effects (77-87% dogs)
CLINICAL SIGNS: SKIN
Bilaterally symmetrical alopecia (55-90%)
Thin skin
Skin tears easily in cats
Decubital ulcers in severe cases
Pembuluh darah subcutis terlihat jelas
Hyperpigmentation
Comedones
CLINICAL SIGNS : MUSCLE
Muscle atrophy and lethargy
Direct effect of glucocortioids
Abdominal enlargement (93-95%)
Wasting Abd. Muscle
Redistribution of fat to ventral abdomen
Hepatomegaly induksi vakuolisasi sel hati dan
akumulasi glikogen
Muscle
Atrophi
Pot belly
CLINICAL SIGNS
Respiratory system
Panting is common abd. Fat n disposisi lemak yg
berlebih pada thorax, kelemahan otot respirasi
Dyspnea due to pulmonary embolism
Obesity
Endocrine system
Insulin resistance
Diabetes is common in dogs and cats with hypercortisolism
Infertility
Malebilateral testis atrophy, penurunan libido
Female (bitches) prolonged unestrus
Nervous system
Seizures, blindness, circling due to macroadenoma
DIAGNOSIS
14
12
?PDH/ADH
10
PDH
8
Normal
6
HypoAd or Iatrogenic
4 hyperAd
0
0 4 8
RATIO OF URINE CORTISOL AND
CREATININE
Vomiting
Owner harus
Collapse mempersiapkan
Diare prednisone kalau side
Ataxia
effect muncul
STEROIDOGENESIS INHIBITORS
Ketoconazole
Metyrapone
Trilostane
Cholesterol
Aldosterone
Inhibited by ketoconazole
Inhibited by Trilostane
Inhibited by metyrapone
STEROIDOGENESIS INHIBITORS