Feline Endocrinology

Developed by the most renowned experts in this field, this unique and practical handbook of feline endocrinology will be the most valuable tool for small animal veterinarians who want to deepen their understanding on the pathophysiology, clinical signs, diagnosis, treatment, and prognosis of every endocrine condition recognized in cats. Rather than have the authors treating cats as small dogs, a cat-only text will allow fully focused description of conditions in this one species. Allowing these experts in feline endocrinology space to fully teach us what they have learned about cats will result in a superior resource composed of text, figures, boxes, tables, algorithms, and videos (presented on an electronic version of the text).

SECTION 1 - HYPOTHALAMUS AND PITUITARY Chapter 1 Pituitary anatomy and physiology Pituitary anatomy Pituitary physiology Hormones of the adenohypophysis (AL) Hormones of the neurohypophysis Chapter 2 GH excess: acromegaly (hypersomatotropism) Background and history Incidence and pathogenesis Pituitary pathology Consequences of pituitary pathology Clinical features and diagnosis Treatment Prognosis Chapter 3 Other pituitary tumors Pituitary masses: hyperplasia, adenoma or carcinoma? Incidence and cell origins of pituitary tumors Effect of pituitary tumors on target organs and the direct effects of large tumors Functional consequences of autonomous hormone production Chapter 4 Pituitary surgery Introduction and general observations Surgical anatomy Imaging of the feline pituitary gland Pituitary adenomas Transsphenoidal hypophysectomy Postoperative care Complications after pituitary surgery Prognosis Chapter 5 Pituitary irradiation Introduction Clinical presentation Advanced imaging Role of radiation therapy Modalities of radiation therapy Nonfunctioning tumors Growth hormone-secreting pituitary tumors and acromegaly Adrenocorticotropic hormone-secreting pituitary tumors and feline Cushing’s disease Radiation-related adverse effects Chapter 6 Pituitary GH deficiency and pituitary dwarfism Introduction Etiopathogenesis Clinical features Differential diagnosis for failure to grow Diagnosis Treatment Chapter 7 Polyuria, polydipsia and diabetes insipidus Introduction Water requirements in healthy cats Urine concentrating ability in healthy cats Mechanisms of water retention Causes of polyuria and polydipsia in cats The diagnostic approach to polyuria and polydipsia Treatment of central diabetes insipidus Prognosis

SECTION 2 - THYROID GLAND Chapter 8 Thyroid anatomy and physiology Anatomy of the feline thyroid gland General thyroid physiology Serum protein binding of thyroid hormones Hypothalamic-pituitary-thyroid axis Extrathyroidal metabolism of thyroid hormone Thyroid hormone kinetics in the cat Action of thyroid hormone Chapter 9 Hyperthyroidism: background, etiopathogenesis and changing prevalence of feline thyroid disease History of thyroid disease in cats Studies into the etiopathology of feline hyperthyroidism Epidemiology of hyperthyroidism: a common worldwide disorder of senior to geriatric cats Why has feline nodular goiter reached such epidemic proportions? Conclusions Chapter 10 Hyperthyroidism: clinical signs and physical examination findings Signalment Clinical signs Physical examination Chapter 11 Hyperthyroidism: laboratory diagnosis Clinicopathologic abnormalities associated with hyperthyroidism Thyroid hormone abnormalities associated with hyperthyroidism Other diagnostic tests Conclusion Chapter 12 Thyroid and kidney disease in cats Hyperthyroidism and chronic kidney disease (CKD) Effect of hyperthyroidism on serum test results of renal function Effect of hyperthyroidism on urinary markers of renal function Effect of hyperthyroidism on systolic blood pressure Effect of treatment of hyperthyroidism on renal function Effect of azotemia on how hyperthyroid cats are managed Suggested management strategies for hyperthyroid cats with CKD Chapter 13 Thyroid imaging Introduction Thyroid embryology, radiographic anatomy, and ectopic thyroid tissue Normal thyroid Hyperthyroidism Ectopic thyroid Thyroid carcinoma Thyroid cysts Hypothyroidism Chapter 14 Treatment of hyperthyroidism: antithyroid drugs Considerations prior to initiating therapy with antithyroid drugs Mechanism of action of antithyroid drugs Formulations of antithyroid drugs Dosages of antithyroid drugs Adverse reactions with antithyroid drugs Monitoring cats treated with antithyroid drugs Other drugs of interest in managing hyperthyroid cats Success rate and survival in hyperthyroid cats managed with an antithyroid drug Renal function and hyperthyroidism Conclusion Chapter 15 Treatment of hyperthyroidism: surgical thyroidectomy Introduction and overview Anatomy of the thyroid gland and surrounding structures Preoperative evaluation General anesthesia Feline thyroidectomy techniques Perioperative complications Postoperative recurrence of hyperthyroidism Surgical excision of thyroid adenocarcinoma Summary and conclusions Chapter 16 Treatment of hyperthyroidism: radioiodine Introduction Advantages and disadvantages of radioiodine treatment of hyperthyroidism Principles of radioiodine treatment Specific indications for radioiodine treatment Patient selection and preparation before radioiodine treatment Thyroid scintigraphy for evaluation of hyperthyroid cats before 131I treatment Estimation of the radioiodine dose to administer to cats with hyperthyroidism Adverse effects or complications associated with radioiodine treatment Follow-up thyroid function testing after radioiodine treatment Prognosis after radioiodine treatment Chapter 17 Treatment of hyperthyroidism: diet General nutritional assessment for the hyperthyroid cat Weight loss and muscle wasting Nutrients needed for the hyperthyroid cat Nutritional management of feline hyperthyroidism: feeding alow-iodine diet Chapter 18 Treatment of hyperthyroidism: severe, unresponsive, or recurrent hyperthyroidism Introduction Etiology and pathogenesis of severe, unresponsive or recurrent hyperthyroidism Correlation between the severity and duration of hyperthyroidism and the severity of clinical signs Causes for treatment failure Therapy for severe, unresponsive hyperthyroidism Summary Chapter 19 Hypothyroidism Introduction Causes of hypothyroidism Clinical subtypes of hypothyroidism Naturally occurring, congenital hypothyroidism in kittens and junior cats Naturally occurring hypothyroidism in adult cats Iatrogenic hypothyroidism in adult cats Refractory hypothyroidism

SECTION 3 - CALCIUM AND PARATHYROID GLANDS Chapter 20 Hypercalcemia Overview Calcium physiology Laboratory testing Initial investigation in hypercalcemic cats Differential diagnosis of hypercalcemia Chapter 21 Feline primary hypoparathyroidism and hypocalcemia Introduction Distribution of calcium in the body Control of calcium (Ca) homeostasis Hypocalcemia in people and dogs Hypoparathyroidism in cats Differential diagnosis of hypocalcemia Diagnostic testing Treatment

SECTION 4 - ADRENAL GLANDS Chapter 22 Adrenal anatomy and physiology Adrenal anatomy Adrenal physiology Chapter 23 Cushing’s syndrome (hypercortisolism) Introduction Etiology Clinical features Clinicopathological findings Endocrine testing Diagnostic imaging Treatment Prognosis Chapter 24 Primary hyperaldosteronism (Conn’s syndrome) Introduction Primary hyperaldosteronism Chapter 25 Other adrenal cortical tumors and pheochromocytoma Introduction and differential diagnosis Working up a feline adrenal mass Excessive progesterone production Combined excesses in progesterone and aldosterone Excessive androgen or estradiol production Pheochromocytoma Non-functional adrenal tumors Chapter 26 Adrenal surgery via open and laparoscopic approaches Introduction Diagnostic evaluation Case selection Patient preparation Surgical techniques Post-operative care Complications Chapter 27 Feline hypoadrenocorticism Introduction Prevalence Causes Age, breed and gender Clinical signs Clinical pathology Diagnostic imaging Electrocardiography and echocardiography Endocrine tests Differential diagnoses Treatment Prognosis Chapter 28 Glucocorticoid therapy Physiology Pharmacology Therapeutic applications Adverse effects Glucocorticoid reduction protocol

SECTION 5 - ENDOCRINE PANCREAS Chapter 29 Anatomy, histology and physiology of the feline endocrine pancreas Anatomy of the feline pancreas Cell types Cross-differentiation General function of islet hormones Secretory control Relative importance of pancreatic hormones and their contribution to the pathophysiology of diabetes mellitus Pancreatic amyloid as the most typical histological finding in diabetes mellitus Chapter 30 Pathogenesis and clinical observations of uncomplicated diabetes mellitus Introduction Prevalence and epidemiology Risk factors Pathophysiologic mechanisms DM and pancreatitis Clinical and laboratory findings Survival and prognostic factors Chapter 31 Diabetic ketosis, ketoacidosis, and the hyperosmolar syndrome Introduction Glucose homeostasis Clinical presentation of DKA and HHS Principles of management of DKA and HHS Fluid and electrolyte therapy Insulin therapy Additional supportive therapy in DKA and HHS Prognosis of DKA and HHS in cats Chapter 32 Insulin treatment of diabetes mellitus Aims of the treatment and management plan Insulin therapy Choosing an insulin Frequency of insulin administration, initial insulin dose and change in the type of insulin Storage, mixing and dilution of insulin Owner education Insulin dosing pens Chapter 33 Gastrointestinal hormones and the use of non-insulin therapies for diabetes mellitus Introduction Incretin hormones physiology and pharmacology Metformin Glipizide Acarbose SGLT-2 antagonists Challenges in managing feline DM and potential uses of non-insulin therapies Chapter 34 Dietary management for diabetes mellitus Overview Learning outcomes Case 1: feeding cats that refuse or dislike their “diabetes diet” Case 2: an insulin overdosed diabetic cat that has just recovered from a severe “hypo” (neuroglycopenia) Case 3: non-prescription diet alternatives Case 4: achieving weight loss in a diabetic cat Case 5: managing diabetes in a cat with concurrent disease Case 6: the client has looked up a lot of information about diabetes in cats on the internet Chapter 35 Monitoring diabetes in cats Clinical signs Blood glucose monitoring Continuous glucose monitoring systems (CGMS) and flash glucose monitoring systems Urine glucose measurement Fructosamine concentration Glycated hemoglobin Chapter 36 Diabetic remission Definition of diabetic remission Physiology of diabetic remission Incidence of diabetic remission Predictors of diabetic remission Maximizing the likelihood of diabetic remission Identification and management of the diabetic cat in remission Prognosis and diabetic relapse Conclusions Chapter 37 The unstable diabetic Overview Initial goals of therapy and factors that influence remission Classification of diabetes mellitus and relevance to unstable diabetic cats Inappropriate choice of insulin Inappropriate dosing Choice of intensive versus conservative insulin management of newly-diagnosed diabetics Client factors Underlying diseases Rebound hypoglycemia (Somogyi) The brittle diabetic Monitoring Other management strategies Conclusion Chapter 38 Hypoglycemia Introduction Pathophysiology of hypoglycemia Blood glucose measurement Differential diagnoses Specific diseases or syndromes associated with hypoglycemia in cats Diagnostic approach Treatment of hypoglycemia

SECTION 6 - BLOOD PRESSURE, BODY CONDITION AND NUTRITION Chapter 39 Feline obesity Epidemiology Pathophysiology of obesity Obesity-related diseases Treatment Chapter 40 Disorders of lipid metabolism Introduction The basics of lipoprotein metabolism Definitions and measurement of feline serum lipid concentrations Effect of lipemia on the measurement of other analytes Causes of feline hyperlipidemia Clinical consequences of hyperlpidemia in cats Diagnostic approach to cats with hyperlipidemia Treatment of feline hyperlipidemia Chapter 41 Cachexia and sarcopenia Cachexia Sarcopenia Diagnosis of cachexia and sarcopenia Potential interventions for cachexia and sarcopenia Practical approach to treatment of cachexia and sarcopenia in cats Conclusion Chapter 42 Hypertension Introduction Measurement of blood pressure incats Defining hypertension and deciding when to treat Consequences of hypertension Endocrine causes of hypertension Management of hypertension Annex Conversion tables Conversion to Systeme International (SI) Units

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