Studing guide Endocrinology includes 9 main pathologies: metabolic syndrome, Addison’s disease, Cushing’s disease, SIADH, diabetes insipidus, pheochromocytoma, Conn’s syndrome, hyperprolactinemia, PCOS; and list of pituitary and adrenal gland hormones.

Partner Brand: PaigeRNFancyNotes THERE ARE 17 CARDS IN THIS DECK (pdf download only) :))Topics included in this deck are diabetes insipidus, SIADH, pituitary adenoma, acromegaly, hypophysectomy, Addisonian crisis, Addison’s disease, Cushing’s disease.Within these flashcards I have included risk factor, signs and symptoms, assessments you need to do, lab values, diagnostic testing, intervention/treatment, pre-op, intra-op, post-op, and complications.I created these flashcards during nursing school. I used them to pass all my exams and classes. They are now revamped and better organized so they are easier to understand and remember. I am a visual learner so these cards have pictures to help you remember information for exam day.These are simplified versions of all my study materials combined so that you do not have to remember extra or unneeded information. Your files will be available to download once payment is confirmed.  Instant download items don’t accept returns, exchanges or cancellations. Please contact the seller about any problems with your order.

Is your dog getting a pot belly and losing his hair as he gets older? It might not mean he has male pattern baldness … or that he’s been getting too many snacks or not enough exercise! A pot-bellied look and hair loss can be some signs of Cushing’s disease. So … here’s some information about this condition. What is Cushing’s DiseaseWhat are the symptomsHow will your vet diagnose itAnd what you can do to help your dog if he gets it What Is Cushing’s Disease? There are three types of Cushing’s. They all mean your dog’s adrenal glands produce too much of the stress hormone, cortisol. That’s called hyperadrenocorticism. The clue’s in the name … “hyper” means too much. Note: Cushing’s is the opposite of Addison’s Disease, which is hypoadrenocorticism. That means the adrenals don’t produce enough (“hypo”) cortisol. You may hear the term Cushing’s syndrome. That’s a broader term than Cushing’s disease. It means hyperadrenocorticism of any kind. Types Of Cushing’s Disease Pituitary-Dependent Hyperadrenocorticism (PDH) As the name suggests, it’s caused by enlargement of the pituitary gland … usually due to a tumor on the gland. The pituitary gland is a tiny gland at the base of the brain. The pituitary gland controls the endocrine system. It makes a hormone called ACTH (adrenocorticotropic hormone). ACTH causes the adrenal glands to make cortisol. Another name for cortisol is glucocorticoids. In Cushing’s disease, the pituitary gland is enlarged due to a tumor … so it produces too much ACTH. And it makes the adrenals produce too much cortisol. It’s the most common form of Cushing’s … involving about 85-90% of cases. The tumors are usually benign. The other, rarer kind is Atypical Cushing’s, or … Adrenal-Dependent Hyperadrenocorticism (ADH) This usually means there’s a tumor on the adrenal gland itself. This also causes the adrenals to produce too much cortisol. There’s about a 50-50 chance these adrenal tumors will be malignant. This adrenal Cushing’s is about 10-15% of cases. And there’s a third kind … Iatrogenic Cushing’s Syndrome It’s caused by overuse of steroid drugs. That can happen even with steroids like eye or ear drops! In fact one study described a dog who got it ... from absorbing the topical steroids his owner used for her psoriasis. The owner said her 2 other dogs had died in the past 4 years. Both dogs were diabetic, and both had clinical signs that also suggest Cushing’s. So be careful even if you use these topical steroids yourself. It’s a Cushing’s lookalike condition but it’s a lot easier to manage. Caution: always ask your vet about stopping any steroid drug. Usually your dog has to be weaned off them very gradually. So let’s focus on the pituitary (PDH) and adrenal (ADH) Cushing’s. Causes Of Cushing’s Disease In Dogs So … why do dogs get Cushing’s? Obviously … we know that a tumor on the pituitary or adrenal glands causes Cushing’s. But none of the experts talk about what’s causing the tumors! So … I asked holistic veterinarian Dr Patricia Jordan about her experience with Cushing’s. Dr Jordan told me … “I don’t see dogs with this disease that are not heavily vaccinated … or the offspring of heavily vaccinated parents. “In fact, I have never seen a dog that wasn’t vaccinated and had Cushing’s” Dr Jordan explained that vaccines can cause cancer. They dysregulate the immune system. And they can alter proper hormonal functioning. She says patients develop hormonal diseases like Cushing’s … “after aggressive vaccination administration.” She also commented that over-vaccination can cause blindness from SARDS (Sudden Acquired Retinal Degeneration). “SARDS mimics Cushing’s and I believe there should be research into how these 2 diseases are related.” Man-made radiation could also be a factor. It causes cancer. And it disrupts proper cell signaling ... which can impact proper hormonal signaling. So, aside from these factors … might your dog be susceptible to Cushing’s? Types Of Dogs That Get Cushing’s Dogs with Cushing’s disease are usually middle-aged or older … around 7 to 12 years old. Breeds that get Cushing’s disease (pituitary) more often include … Poodles, especially miniature poodlesDachshundsBoxersBoston terriersYorkshire terriersStaffordshire terriers Adrenal tumors are more common in large breeds … with three times more females than males. Spay/neuter may be a factor, although not a large one, and mostly in females. One 2017 study reported … spayed females had slightly higher odds than intact ones of getting Cushing’s. The odds for neutered males were minimally higher. What if you suspect your dog might have Cushing’s? Symptoms Of Cushing’s Here are some of the more common symptoms of Cushing’s. Very thirsty (polydipsia)Lots of peeing (polyuria), accidents at nightRecurrent urinary tract infectionsIncreased hungerExcessive pantingPot bellyObesity, with fat especially on neck and shouldersHair lossLack of energyMuscle weakness, especially hind legsThin or darkened skinBruisingHard, white scaly patches on the skin, elbows, etc. So … if you notice a few of these symptoms, it’s time for the vet. Now for the hard part – diagnosing Cushing’s. Diagnosis Of Cushing’s Disease In Dogs Cushing’s is quite difficult to diagnose. There may be several stages to the tests your vet does when she suspects Cushing’s. After a physical exam, she’ll do a regular blood chemistry panel and urinalys. These tests may offer additional signs that point to possible Cushing’s … High alkaline phosphatase (ALP, SAP)High alanine aminotransferase (ALT)High cholesterolHigh blood glucoseHigh neutrophils and lower lymphocytesProtein in urineLow specific gravity of urine (diluted because your dog’s drinking too much) If your dog does have some suspicious lab results … as well as some of the symptoms I listed, then your vet may do some more testing. Caution: If your dog has these kind of test results but none of the Cushing’s symptoms I listed … he may not have Cushing’s. If that’s the case, ask your veterinarian to explore other causes for the abnormal lab results. For example, thyroid problems are often mistaken for Cushing’s. This is important. Vets are often on the lookout for Cushing’s … and it gets misdiagnosed. If that happens, your dog could get treatments (including drugs) that he doesn’t actually need. Read Dr Deva Khalsa’s explanation of how a Cushing’s misdiagnosis can happen. If you and your vet agree it’s appropriate to do more testing for Cushing’s ... these are the likely tests she’ll do. Low Dose Dexamethasone Suppression (LDDS) This is considered the most accurate test. False negative rates are only 5-8%. But it means your dog has to spend 8 hours in the clinic. Because of the stress this causes … this sensitive test often shows false positives. Here’s how the test works. First they test the blood cortisol levelThen they give your dog a small injection of dexamethasone (a corticosteroid)They re-test the blood cortisol levels at 4 and 8 hours Here's what test tells your vet ... In healthy dogs, the pituitary gland produces ACTH. That tells the adrenal glands to make cortisol. When cortisol increases, ACTH gets lower. So when they give your dog the dexamethasone, the pituitary will stop producing ACTH. And the adrenals aren’t prompted to produce cortisol. But if your dog has Cushing’s, cortisol is high all the time. In a normal dog, the dexamethasone should suppress cortisol production. So the 4 and 8 hour tests will be lower. If that doesn’t happen, then your dog may be producing too much cortisol on his own … meaning he has Cushing’s. High Dose Dexamethasone Suppression (HDDS) This test can differentiate between pituitary or adrenal disease in a dog who has Cushing’s. It uses a higher dosage of dexamethasone. If cortisol levels are lower at the 4 and/or 8 hour samples … that confirms pituitary origin Cushing's disease. If the levels are the same as the (higher) pre-injection sample, this confirms adrenal origin Cushing's. ACTH Stimulation Test This is a popular test but it’s not very accurate for Cushing’s diagnosis. Some vets don’t recommend it. Dr Khalsa says the test misses about 20-30% of dogs with a pituitary condition and 50% with an adrenal tumor. They’ll compare baseline cortisol levels vs 1-2 hours after an ACTH hormone injection. The injection should trigger the adrenals to release cortisol. So if the test shows very high levels of cortisol, they may diagnose your dog with Cushing’s. But again, false negatives are common. And it doesn’t differentiate between the two types of Cushing’s. Earlier I mentioned iatrogenic hyperadrenocorticism, caused by prolonged use of steroid drugs. The ACTH Stimulation Test is the preferred test to confirm this diagnosis. Urine Cortisol:Creatinine Ratio (UCCR) This test can also be inconclusive. If it’s negative, it does at least rule out Cushing’s. But stress can cause a false positive result. So it's a good idea to get the urine sample at home. Imaging Other tests may include abdominal ultrasound, CT, or MRI. Ultrasound may help identify adrenal tumors.Pituitary tumors can be seen with MRI or CT scan. Treating Your Dog's Cushing's Disease If your dog’s Cushing’s diagnosis is confirmed, conventional treatment may involve … DrugsSurgeryRadiation I’ll explain some the typical options. But then I’ll tell you about some natural alternatives to help you avoid these treatments. Will Conventional Treatment Help? First of all, will conventional treatment help your dog live longer? Not necessarily. According to the Merck Veterinary Manual these are the prognoses: For dogs with pituitary Cushing’s, prognosis is about 2 years, with or without medical therapy.Radiation treatment of pituitary tumors … or removal of the pituitary gland (hypophysectomy) has a better prognosis of 2-5 years.Adrenal tumors can sometimes be removed with surgery, giving prognosis of 18 months. Options For Conventional Cushing's Treatment The goal of conventional drugs for Cushing’s is two-fold: To reduce the level of cortisolTo reduce pituitary or adrenal tumors They all have their adverse reactions. Some are anti-cancer drugs with severe side effects. Anti-fungals like ketoconazole damage the liver and are no longer recommended. Here are the main conventional drugs vets prescribe. Mitotane (Lysodren®) This is a chemotherapy drug with some harsh side effects. It’s used for pituitary and adrenal Cushing’s. But adrenal tumors are often resistant to mitotane. Dogs may need 4 times the dose of mitotane to respond; and the results are less favorable. If your dog takes this drug, he has to be monitored very carefully. You’ll have to watch for signs of hypoadrenocorticism: anorexia, vomiting, and diarrhea.You’ll monitor your dog’s eating and drinking.Your vet will re-test cortisol levels after 7-10 days.Your dog should see the vet every 3-4 months.The dose may need to be gradually increased to maintain clinical remission. Side effects include: VomitingAnorexiaNeurological symptoms – ataxia, weakness, seizuresLow blood sugarDepression Trilostane (Vetoryl®) This drug for PDH has fewer side effects than Mitotane. But one severe one is that in some cases the drug has caused adrenal necrosis. This permanently destroys adrenal function …. so it’s a serious, irreversible side effect! Other milder side effects can include … DehydrationWeaknessLow sodiumHigh potassium Your dog may need to stop taking the drug and get fluids to recover from these problems. Monitoring of trilostane treatment can also be tricky. Your vet may use the ACTH stimulation test to track your dog’s cortisol levels. Other Treatments Surgery and radiation are also often used in Cushing’s cases. Surgery The type of surgery depends on where the tumor is. Pituitary If your dog has PDH, removal of the pituitary gland (hypophysectomy) may be possible. If successful, symptoms improve quickly and prognosis is good. But it’s a difficult surgery. While 80% of these surgeries achieve remission, there’s about an 11% recurrence rate. And there can be many other side effects after surgery. InfectionComplications from rapid reversal of hyperadrenocorticismYour dog will need thyroid drugsHe may need glucocorticoid drugsHe may develop diabetes, requiring insulin or other diabetes drugs And of course, all of these drugs can create their own side effects! Adrenal Adrenal glands with tumors can sometimes be surgically removed as well. This applies to benign or malignant tumors. But this isn’t a straightforward surgery either. Anesthesia in these surgeries can be hard to manage. It’s complicated because … as soon as the tumor/gland is removed, your dog will develop hypoadrenocorticism (Addison’s). That’s a problem in itself … and may cause secondary problems like … Hyper- or hypotensionArrhythmiasVomitingEsophagitisSeizuresPancreatitisAcute renal failureCardiopulmonary arrest As you can see, there are many very serious risks. Median survival for dogs with malignant tumors after this surgery is 778 days. So it may buy some time with your dog. But the death rate within 1 month after removing one adrenal gland is 14%–60%. The overall rate for cure for adrenal tumors is about 50%. Radiation If your dog has a large pituitary tumor plus neurological signs like seizures, stupor or anorexia … your vet may recommend radiation therapy of the pituitary gland. Radiation therapy of pituitary tumors can be quite successful. But most dogs will also need one of the above drugs as well. This is to manage residual ACTH secretion. Side effects of radiation treatment can include FatigueNausea and diarrheaSkin problemsHair lossBlood cell changes. And remember, radiation treatments use radioactive material that itself is carcinogenic. There are newer types of radiation therapy such as cyberknife or gamma knife. These aren’t proven yet … but may be better than prior techniques. They can treat pituitary tumors in less than 3 days. The side effects are minimal and death rates are low. But it can take several months for the signs of PDH to subside. Long term outcomes are good though … because the pituitary tumor is controlled. Iatrogenic Hyperadrenocorticism This is a bit simpler. Usually, it’s cured once when the steroids are stopped (which must happen gradually). Your vet will first change your dog’s drug to an oral, short acting steroid like prednisone. Then she’ll gradually taper the dose over several weeks. She’ll do regular ACTH stimulation tests. This helps find out when you can discontinue steroid treatment. Another problem with this is that the condition the steroids were treating may come back. So it’s a good idea to work with a holistic vet to find natural alternatives. And speaking of natural alternatives, what are some that can help with your dog’s Cushing’s? It’s best to avoid the conventional treatments and their side effects. Holistic Management Of Cushing’s Always consider food as medicine, first and foremost! Feed a fresh, whole food diet, preferably raw and organic, with pasture-raised meats. These guidelines may improve Cushing’s symptoms. Diet For Dogs With Cushing’s High, digestible protein to prevent muscle wastingLow fat to avoid high cholesterol and pancreatitisKeep calcium lower to avoid bladder stonesFeed veggies and fruits Ask your holistic vet for specific advice on foods too. Traditional Chinese Veterinary Medicine (TCVM) practitioners are good experts to consult with. 4 Natural Therapies For Cushing’s Which natural alternatives you choose will depend on your choice of holistic veterinarian or other practitioner. Herbs – Western or Chinese/TCVMSupplementsHomeopathyAcupuncture For all of these therapies … you’ll need to work with your holistic veterinarian, herbalist or homeopath. Cushing’s is a serious condition needing careful management by an expert practitioner. Don’t try to do it on your own. Here are some remedies you might expect your holistic professional to prescribe. Every veterinarian or herbalist will have their favorite herbs and supplements for Cushing’s. Herbs Chinese/TCVM Herbs Drs Steve Marsden and Susan Wynn recommend Gingko biloba to reduce cortisol levels. They also recommend Chinese formulas such as … Long Dan Xie GanMai Men Dong Tang (Ophiopogon Root) Dr Deva Khalsa also uses these Chinese herbs: Rehmannia 11Rehmannia 14Ophiopogon Powder Liver Happy Dr Casey Damron, a herbalist veterinarian, also recommends these Chinese herbs. Ophiopogon formulaRehmannia 14 Dr Lena McCullough uses these Chinese formulas: Si Miao SanEight TreasuresLiu Wei Di Huang WanGingko biloba Western Herbs There’s a long list of Western herbs that can help with Cushing’s. Consult a herbalist for the best ones for your dog, as well as dosing. Herbalists Mary L Wulff and Gregory L Tilford recommend herbs to support stressed organs and systems in the body. These include: Dandelion rootBurdock rootGarlicNettleSiberian ginsengKelp Dr Patricia Jordan formulated a product for Pet Wellbeing. It’s to support adrenal gland function. It includes these herbs: Ashwaganda rootHoly Basil leafTurmericBacopaAstragalusMilk thistleBlessed thistleChaste tree berryPrickly ash bark Herbs To Avoid Tilford and Wulff recommend avoiding these herbs because they stimulate adrenal activity: LicoriceBorage leaf Supplements For Cushing's Disease There are a number of supplements that can help with Cushing’s symptoms. Glandulars Feeding glandular meats or supplements may help manage your dog’s adrenal function. Feeding a specific organ or gland can often help support the functioning of the matching organ in the body. It may not be easy to get adrenal glands for your dog, but you can give a glandular supplement! Melatonin and Lignans Other holistic veterinarians, including Dr Marc Smith and Dr Casey Damron, find supplementing with melatonin and lignans helps manage Cushing’s. Melatonin: regulates hormones, maintains circadian rhythms and provides antioxidants. Can help maintain coat.Lignans: HMR lignans extracted from the Norwegian spruce tree convert to enterolactone. This acts as a phytoestrogen in the body. It causes downregulation of estrogen production from the adrenal gland … helping to manage Cushing’s. Here’s how to dose this combination. Melatonin Dogs under 25 lbs – 1.5 mg once or twice dailyMedium to large dogs – 3 mg once or twice dailyDogs over 100 lbs – 6 mg once or twice daily Lignans (dosing recommended by University of Tennessee) Dogs under 25 lbs – 10 mg dailyMedium to large dogs – 20 to 30 mg dailyDogs over 100 lbs – 40 mg daily. Studies show that another supplement, Phosphatidylserine, derived from lecithin, may support hypothalamo‐pituitary‐adrenal function and help reduce cortisol levels naturally. Ask your holistic vet about giving this to your dog. Homeopathy There are many remedies that may help, depending on your dog’s specific symptoms. Your homeopath will analyze your dog’s case and prescribe the appropriate remedy. Here are some remedies your homeopath may use. Quercus Robur: Derived from acorns. Helps with abdominal swelling, breathlessness and varicose veins.Adrenalinum: Good for adrenal balance.Arsenicum Album: helps with excessive thirst (often due to diabetic complications), digestive upset skin problems .Pituitarum Posterium: helps with problems in the pituitary glands.Sulphur: helps with pain, frequent urination (especially with diabetic complications of Cushing’s), skin and liver problems.Chelidonium Majus: for liver, bile, and digestive issues.Hepar Sulfuris Calcareum: for skin problems, abdominal distention or bloating, and liver problems.Mercurius Solubilis: for digestive issues, jaundice, enlarged liver, vertigo, intense thirst, memory and thinking issues, and belching. Homeopath Cheyanne West CHom, often uses these remedies. Homeopathic Pituitary – This remedy is made from the posterior lobe of the pituitary gland and helps balance the actions of the gland. Dosing calls for low potencies (30c) over a long period of time and should be monitored closely.Homeopathic Formic Acid has been very effective in early stages and has a history of restoring the health of the animal as well as restoring the coat. A potency of 6x has been most effective, given over a period of 1-2 months. Acupuncture Acupuncture can help as an adjunct therapy. It helps regulate the endocrine system. It can also reduce inflammation. Dr Lena McCulloch says once a dog is stable, many Cushing’s dogs will only need acupuncture about every two months. So … I hope now you can see that there's hope for your dog with Cushing's. Conventional treatments are by no means the only option. Natural alternatives can help your dog’s Cushing’s symptoms … and preserve his quality of life!

Holistic veterinarian, Dr. Cook, discusses symptoms and treatment and supplement options for dogs with Cushing's Disease.

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Cushing’s disease is caused by a tumor of the pituitary gland and often goes undiagnosed. If untreated, it can lead to severe problems.

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Definition and clinical picture We propose the minimal definition of Dercum’s disease to be generalised overweight or obesity in combination with painful adipose tissue. The associated symptoms in Dercum’s disease include fatty deposits, easy bruisability, sleep disturbances, impaired memory, depression, difficulty concentrating, anxiety, rapid heartbeat, shortness of breath, diabetes, bloating, constipation, fatigue, weakness and joint aches. Classification We suggest that Dercum’s disease is classified into: I. Generalised diffuse form A form with diffusely widespread painful adipose tissue without clear lipomas, II. Generalised nodular form - a form with general pain in adipose tissue and intense pain in and around multiple lipomas, and III. Localised nodular form - a form with pain in and around multiple lipomas IV. Juxtaarticular form - a form with solitary deposits of excess fat for example at the medial aspect of the knee. Epidemiology Dercum’s disease most commonly appears between the ages of 35 and 50 years and is five to thirty times more common in women than in men. The prevalence of Dercum’s disease has not yet been exactly established. Aetiology Proposed, but unconfirmed aetiologies include: nervous system dysfunction, mechanical pressure on nerves, adipose tissue dysfunction and trauma. Diagnosis and diagnostic methods Diagnosis is based on clinical criteria and should be made by systematic physical examination and thorough exclusion of differential diagnoses. Advisably, the diagnosis should be made by a physician with a broad experience of patients with painful conditions and knowledge of family medicine, internal medicine or pain management. The diagnosis should only be made when the differential diagnoses have been excluded. Differential diagnosis Differential diagnoses include: fibromyalgia, lipoedema, panniculitis, endocrine disorders, primary psychiatric disorders, multiple symmetric lipomatosis, familial multiple lipomatosis, and adipose tissue tumours. Genetic counselling The majority of the cases of Dercum’s disease occur sporadically. A to G mutation at position A8344 of mitochondrial DNA cannot be detected in patients with Dercum’s disease. HLA (human leukocyte antigen) typing has not revealed any correlation between typical antigens and the presence of the condition. Management and treatment The following treatments have lead to some pain reduction in patients with Dercum’s disease: Liposuction, analgesics, lidocaine, methotrexate and infliximab, interferon α-2b, corticosteroids, calcium-channel modulators and rapid cycling hypobaric pressure. As none of the treatments have led to long lasting complete pain reduction and revolutionary results, we propose that Dercum’s disease should be treated in multidisciplinary teams specialised in chronic pain. Prognosis The pain in Dercum’s disease seems to be relatively constant over time.

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Equine Cushing’s Disease, more correctly called Pars Pituitary Intermedia Dysfunction (PPID), is a non-cancerous but progressive enlargement of the pituitary gland in the horse. It is estimated that 20 percent of horses over the age of 15 will develop PPID. Note that Cushing’s Syndrome in humans and dogs (when not due to giving too much steroidal medication) involves an actual tumour of either the pituitary or the adrenal glands, (either benign or malignant), whereas Cushing’s Disease in horses has a different cause.

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When To Put A Dog Down With Cushing’s Disease? Look for signs of lethargy, increased urination + thirst or loss of appetite.