Case 3 Endocrinology Part 2 Answers

1 Test / Procedure: Fecal Protease Activity
Results:

Normal

Review indications & protocol in notes.

What is your assessment?
This test has limited sensitivity and specificity for the diagnosis of EPI in cats. The results suggest that EPI is not present and the stools may be the result of another disease.

2 Test / Procedure: Fecal Flotation
Results:

Negative

Review indications & protocol in notes.

What is your assessment?
Endoparasites are not present and another cause for eosinophilia must be found.

3 Test / Procedure: ECG
Results:

HR: 220; R waves in lead II are greater than 0.9 mv

Review indications & protocol in notes.

What is your assessment?
Sinus tachycardia is present. Left ventricular hypertrophy is present. Both could be present with cardiomyopathy. Would not expect LVH with feline dirofilariasis.

4 Test / Procedure: Thoracic Radiographs
Results:

The left ventricle is mildly enlarged. Lung fields are negative and pulmonary vessels appear normal.

Review indications & protocol in notes.

What is your assessment?
Findings consistent with mild cardiomyopathy as observed in feline hyperthyroidism. Feline dirofilariasis seems unlikely.

5 Test / Procedure: Echocardiogram
Results:

The left ventricular wall is mildly thickened. Fractional shortening time is mildly increased.

Review indications & protocol in notes.

What is your assessment?
Results are consistent with mild thyrotoxic cardiac disease and is often observed in cats with hyperthryoidism.

6 Test / Procedure: Total T4
Results:

50.0 ng/ml (normal 5.0-25 ng/ml)

Review indications & protocol in notes.

What is your assessment?
These results confirm the diagnosis of feline hyperthyroidism; a disease most commonly associated with benign thyroid adenomas.

7 Test / Procedure: Occult Heartworm Test
Results:

Negative

Review indications & protocol in notes.

What is your assessment?
Either cat is really negative or it has a unisex infection (all males). Probably the former and not the latter.

B. Final Diagnosis

Feline hyperthyroidism, mild thyrotoxic cardiac disease, eosinophilia most likely associated with miliary dermatitis, hepatomegally and mammary hyperplasia associated with chronic megesterol acetate therapy.

C. Therapeutic Plan

There are 3 options for treatment: methimazole, radioiodine, and thyroidectomy. Methimazole is the least expensive initial treatment but many side effects occur. Radioiodine is the most effective therapy and has minimal side-effects. A selective beta-blocker (atenolol) should be given to decrease heart rate and decrease blood pressure.

Endocrinology Case 3

Expanded Case Evaluation
Expert's Answers

Endocrinology Case 3

Expanded Case Evaluation Expert's Answers

Expanded Case Evaluation
Expert's Answers