Case 9 Endocrinology Part 2 Answers

1 Test / Procedure: Occult Heartworm Test
Results:

Negative

Review indications & protocol in notes.

What is your assessment?
Dirofilariasis is very unlikely. Clincial signs caused by another disease.

2 Test / Procedure: Controlled Fast: Blood Glucose Assay
Results:

Blood sugar decreased to 50 mg/dl and fast was stopped. Serum saved for insulin assay.

Review indications & protocol in notes.

What is your assessment?
Hypoglycemia is confirmed. Need to pursue most common causes of hypoglycemia.

3 Test / Procedure: Insulin:Glucose Pairs
Results:

Glucose 50 mg/dl; Insulin 28 microunits/ml (5-20 microunits/ml)

Review indications & protocol in notes.

What is your assessment?
The insulin is inappropriately increased for a blood glucose of 50 mg/dl. Insulinoma should be strongly suspected.

4 Test / Procedure: ACTH Stimualation Test
Results:

Baseline cortisol: 2.7 mcg/ml; Post ACTH cortisol: 15.0 mcg/ml (normal values: baseline: 1-5 mcg/ml and post ACTH: 10-40 mcg/ml)

Review indications & protocol in notes.

What is your assessment?
Hypoadrenocorticism is ruled out in this dog.

5 Test / Procedure: Cystocentesis UA
Results:

Sp. Gr.: 1.025, protein plus 3; WBC's: 0-2; RBC's: 1-2; bacteria: negative.

Review indications & protocol in notes.

What is your assessment?
Previous sample was contaminated. Pyuria and bacteruria not present. BUT, proteinuria is present. Glomerular disease should be suspected.

6 Test / Procedure: Thoracic Radiographs
Results:

Normal

Review indications & protocol in notes.

What is your assessment?
Concurrent heart failure is rule out. Heartworm disease seems unlikely. Heart murmur most likely due to non-symptomatic mitral valve regurgitation.

7 Test / Procedure: Fecal Flotation
Results:

negative

Review indications & protocol in notes.

What is your assessment?
Internal parasites do not seem to be the etiology of the eosinophilia.

B. Final Diagnosis

1. Beta-cell neoplasia; 2. Eosinophilia (cause not determined at this time); 3. Proteinuria (suspect glomerular disease)

C. Therapeutic Plan

Surgical exploration and tumor removal are the best options. Effective chemotherapy is lacking. Pallative medical therapy with prednisone, diazoxide, and frequent feedings can be offered if surgery is not successful.

Endocrinology Case 9

Expanded Case Evaluation
Expert's Answers

Endocrinology Case 9

Expanded Case Evaluation Expert's Answers

Expanded Case Evaluation
Expert's Answers