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APEX: Flashcards > Endocrine > Flashcards

Endocrine Flashcards

1
Q

paracrine function

A

hormone acts adjacent to site of origin

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2
Q

endocrine function

A

hormone enters blood & acts at distant site

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3
Q

autocrine function

A

hormone acts at site of origin

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4
Q

Hormones released by hypothalamus

A
  • luteinizing hormone-releasing hormone
  • corticotropin-releasing hormone
  • thyrotropin-releasing hormone
  • prolactin-releasing factor
  • prolactin-inhibiting factor
  • growth hormone-releasing factor
  • growth hormone-inhibiting factor
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5
Q

Where is the pituitary gland located?

A
  • sella turcica
  • connected to hypothalamus by pituitary stalk
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6
Q

adenohypophysis

A

anterior pituitary gland

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7
Q

posterior pituitary gland

A

neurhypophysis

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8
Q

hormones released by anterior pituitary gland

A

F- Follicle-stimulating hormone
L- Luteinizing-hormone
A- Adrenocorticotropic hormone
T- Thyroid stimulating hormone
P(i)- Prolacting
G- Growth hormone

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9
Q

FSH

A
  • stimulates germ cell maturation & ovarian follicle growth
  • HYPERSECRETION = early puberty
  • HYPOSECRETION = infertility
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10
Q

LH

A
  • stimulates testosterone production, ovulation
  • HYPERSECRETION = early puberty
  • HYPOSECRETION = infertility
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11
Q

ACTH

A
  • stimulates adrenal hormone release
  • HYPERSECRETION = cushing’s disease
  • HYPOSECRETION = secondary adrenal insufficiency
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12
Q

TSH

A
  • stimulates thyroid hormone release
  • HYPERSECRETION = hyperthyroidism
  • HYPOSECRETION = hypothyroidism, cretinism
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13
Q

Prolactin

A
  • stimulates lactation
  • HYPERSECRETION = infertility
  • HYPOSECRETION = menstrual dysfunction
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14
Q

GH

A
  • stimulates cell growth
  • HYPERSECRETION = acromegaly, giantism
  • HYPOSECRETION = dwarfism
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15
Q

Where is ADH synthesized?

A

supraoptic nuclei of the hypothalamus

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16
Q

Where is oxytocin synthesized?

A

paraventricular nuclei of hypothalamus

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17
Q

Posterior pituitary gland releases:

A
  1. ADH
  2. oxytocin
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18
Q

ADH

A
  • stimulates water retention
  • HYPOSECRETION = SIADH
  • HYPERSECRETION = DI
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19
Q

Oxytocin

A
  • stimulates uterine contraction & breast feeding
  • HYPERSECRETION = 0
  • HYPOSECRETION = uterine atony
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20
Q

SIADH

A
  • TOO MUCH ADH
  • Associated w/ *TBI, small cell lung CA, carbamazepine
  • HYPOnatremia (< 135)
  • plasma osmo = hypotonic = < 275
  • low UOP
  • high urine omso & Na+
  • Tx:
    1. fluid restriction
    2. demeclocylcidine
    3. hypertonic NaCl if Na+ < 120
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21
Q

DI

A
  • TOO LITTLE ADH
  • Associated w/ *pituitary surgery, TBI, SAH
  • polyuria
  • plasma omso = hypertonic = > 290
  • hypernatremia ( > 145)
  • high UOP, low urine osmo
  • Tx:
    1. DDAVP/vasopressin
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22
Q

Acromegaly

A
  • secretion of GH after adolescence
  • associated w/ pituitary adenoma
  • difficult mask (distorted facial features)
  • difficult laryngoscopy (large tongue, teeth, epiglottis)
  • difficult ETT placement - use smaller tube (subglottic narrowing
  • epistaxis - avoid nasal intubation (turbinates enlarged)
  • OSA
  • HTN, CAD, rhythm disturbances
  • glucose intolerance
  • skeletal muscle weakness
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23
Q

thyroid anatomy

A
  • left & right lobe joined by thyroid isthmus
  • RLN runs lateral of each lobe
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24
Q

T4

A
  • inactive form
  • released directly from thyroid
  • high concentration in blood
  • highly protein bound
  • low potency
  • 1/2 life = 7 days
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25
Q

T3

A
  • active form
  • high concentration in target cell
  • low protein binding
  • high potency
  • 1/2 life = 1 day
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26
Q

Production & release of TH

A

Anterior pituitary releases TSH
1. stimulates thyroid to produce T3, T4 (+iodine)
2. stimulates follicular tissue to produce thyroglobulin colloid
3. stimulates iodide pump

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27
Q

Hyperthyroidism

A
  • increased TH + BMR + O2 consumption + CO2 production
  • Etiologies: **Grave’s, MG, goiter, carcinoma, pregnancy, pituitary adenoma
  • Dx: ** Low TSH, High T3, T4
  • HTN, tachyarrhythmias, afib, increased Ve, goiter, weight loss, muscle weakness, warm, fine hair, heat intolerance, diarrhea, tremor, exophthalmos, hypercalcemia
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28
Q

Hyperthyroidism anesthesia considerations

A
  • Do NOT proceed to elective surgery until pt
    euthyroid
  • Goiter = awake intubation
  • Avoid sympathomimetic, anticholinergics,
  • ketamine, pancuronium
  • risk of corneal abrasion
  • increased incidence of MG - careful w/ NMBs
  • careful positioning
  • MAC unchanged
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29
Q

Medical MGMT hyperthyroidism

A
  1. Block synthesis
    - PTU, carbimazole, methimazole K+ iodide
  2. Block release
    - radioactive iodine, K+ iodide
  3. Block T4-T3 coversion
    - PTU, propanolol
  4. Block beta receptors (SNS)
    - propanolol, esmolol
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30
Q

Hypothyroism

A
  • Etiology: **Hashimoto, iodine deficiency, HPA dysfx, neck radiation, thyroidectomy, amiodarone
  • Dx: **High TSH, Low T3,T4
  • decreased HR, decreased contracility, HF, pericardial effusion, decreased Ve, pleural effusion, goiter, weight gain, fatigue, dry thick skin, brittle hair, cold intolerance, constipation, delayed gastric emptying
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31
Q

Hypothyroidism anesthesia considerations

A
  • levothyroxine
  • cancel surgery for severe hypothyroidism
  • airway obstruction (tongue, swollen VC, goiter)
  • increased risk aspiration (delayed emptying)
  • increased risk hypotension (hypodynamic circ)
  • inhalation induction faster
  • corticosteroids
  • increased sensitivity to NDNMBs
  • MAC unchanged
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32
Q

thyroid storm

A
  • increased TH in r/t stressful events
  • can occur w/ hyper/euthyroid pt
  • 6-18 hours postop
  • S/S
    1. fever, tachycardia, HTN, CHF, shock, AMS, n/v
  • Tx: 4 B’s
    1. Block synthesis (methimazole, carbimazole, PTU,
    K+ iodide)
    2. Block release (radioactive iodine, K+ iodide)
    3. Block T4 to T3 conversion (PTU, propanolol,
    glucocorticoids)
    4. Block beta receptors (propanolol, esmolol)
    Cooling
    glucocorticoids
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33
Q

myxedema coma

A

complication of severe hypothyroidism

34
Q

cretinism

A

Complication of neonatal hypothyroidism

35
Q

subtotal/total thyroidectomy

A
  • treatment for hyperthyroidism
  • complications
    1. hypothyroidism
    2. hemorrhage
    3. RLN injury (NIM tube)
    4. hypocalcemia (PTH removal)
  • tetany, laryngospasm, AMS, hypotension, prolonged QTi, paresthesia, chvostek, trousseau
36
Q

osteoblasts

A
  • promote bone deposition
  • add Ca+ to bone
37
Q

osteoclast

A
  • promote bone resorption
  • remove Ca+ from bone
38
Q

PTH site of production

A

parathyroid gland

39
Q

PTH site of release

A

parathyroid gland

40
Q

What stimulates release of PTH?

A
  • decreased ionized Ca+
  • increases phosphate
41
Q

PTH release effects

A
  1. increases ionized ca+
    • increases bone resorption
    • increase ca+ absorption in intestine & kidney
  2. decreases phosphate
    • decreased phosphate reabsorption in kidney
42
Q

Calcitonin site of production

A

C cells (parafollicular cells) in thyroid gland

43
Q

Calcitonin site of release

A

thyroid

44
Q

What stimulates release of calcitonin?

A

increased ionized ca+

45
Q

Calcitonin release effects

A
  1. decreased ionized ca+
    • increased ca+ bone deposiiton
  2. increased phosphate
46
Q

Primary hyperPTH

A
  • most common cause of hyperca+
  • cause = PTH adenoma
  • high PTH level, hyperca+, hypophos
  • Tx: parathyroidectomy
  • S/S:
    1. HTN, short QTi, confusion/lethargy/psychosis, bone pain, osteopenia, pathologic fx, anorexia, n/v, PUD, abd pain, pancreatitis, polyuria, polydipsia, kidney stones
47
Q

Secondary hyperPTH

A
  • most common cause = CKD
  • renal osteodystrophy = bone disease caused by increased PTH 2nd to CKD
48
Q

HypoPTH

A
  • cause = iatrogenic removal during thyroidectomy
  • S/S
    1. hypotension, myocardial depression, long QTi, tentany, paresthesias, SZ, muscle spasms, abd cramping
49
Q

Adrenal cortex synthesizes/releases

A

G - Salt
F - Sugar
R - Sex

  • zona Glomerulosa = (Salt) mineralcorticoids (aldosterone)
  • zona Fasciculata = (Sugar) glucocorticoids (cortisol)
  • zona Reticularis = (Sex) androgens
50
Q

Adrenal medulla synthesizes/releases

A
  1. Epi (80%)
  2. NE (20%)
51
Q

Aldosterone release is increased by

A
  1. RAAS
  2. Hyperkalemia
  3. Hyponatremia
52
Q

Aldosterone

A
  • Fx: resorption of Na+/H2O, excretion of K+ & H+
  • regulates IV volume
53
Q

Cortisol

A
  • glucocorticoid
  • production = 15-30 mg/day, 12 mcg/dL
  • Fx:
    1. gluconeogenesis
    2. protein catabolism
    3. fatty acid mobilization
    4. anti-inflammatory effects
    5. improves myocardial fx by increasing # & sensitivity of beta receptors in myocardium
54
Q

Most to least glucocorticoid effect potency

A
  1. dexamethasone, betamethasone (25)
  2. fludrocortisone (10)
  3. methylprednisolone, triamcinolone (5)
  4. prednisone, prednidisolone (4)
  5. cortisol (1)
  6. cortisone (0.8)
  7. aldosterone (0)
55
Q

Conn’s syndrome

A
  • too much mineralocorticoid (aldosterone)
  • Causes:
    1. too much aldosterone release (pheo, hyperthyroid)
    2. renovascular HTN
  • licorice ingestion (glycyrrhizic acid) resembles conn’s
  • S/S
    1. HTN (Na+/H2O retention)
    2. Hypokalemia (K+ excretion)
    3. Metabolic alkalosis (H+ excretion)
      -Tx: remove tumor, spironolactone (aldosterone antagonist), K+, Na+ restriction
  • Anesthesia
    1. low K+ = sensitive to NMBs, U wave on EKG, avoid hyperventilation
    2. HTN
56
Q

Cushing’s syndrome

A
  • too much cortisol
  • Causes: pituitary tumor (Cushing’s Dz) too much ACTH, adrenal tumor releases cortisol
  • Glucocorticoid effects
    1. hyperglycemia
    2. weight gain (central obesity, buffalo hump, moon
      face)
    3. increased infection risk
    4. osteoporosis
    5. muscle weakness
  • Mineralocorticoid effects
    1. HTN
    2. hypokalemia
    3. metabolic alkalosis
  • Androgenic effects
    1. women become masculinized
    2. men become feminized
  • Tx
    1. transsphenoidal resection pituitary gland
    2. adrenalectomy
    3. pituitary radiation
  • MGMT
    1. aseptic technique
    2. careful positioning
    3. steroids
    4. DI following pituitary resection
57
Q

A patient w/ adrenal insufficiency & sepsis requires an emergency intubation in ICU. Which drug should be avoided?
Etomidate
Propofol
Ketamine
Thiopental

A

Etomidate. Inhibits 11-beta-hydroxylase & causes adrenocortical suppression for > 8 hours.

58
Q

Adrenal Insufficiency (Addison’s Disease)

A
  • destruction of all cortical zones
  • decreased production of mineralocorticoids, glucocorticoids, & androgens
  • muscle weakness, fatigue, hypotension, hypoglycemia, hyponatremia, hyperkalemia, metabolic acidosis, n/v, hyperpigmentation
  • Tx: steroids (15-30 mg cortisol/day)
59
Q

Acute adrenal crisis

A
  • medical emergency
  • caused by chronic AI faced w/ stress
  • HD instability/collapse, fever, hypoglycemia, AMS
  • Tx: steroids, D5NS, HD support
60
Q

alpha cells

A

glucagon

61
Q

beta cells

A

insulin

62
Q

delta cells

A

somatostatin

63
Q

PP cells

A

pancreatic polypeptide

64
Q

Things that stimulate insulin release

A
  • PNS & SNS stimulation
  • glucagon
  • catecholamines
  • cortisol
  • GH
  • beta agonists
65
Q

Things that reduce insulin release

A
  • insulin
  • VA
  • beta antagonists
66
Q

insulin receptor

A
  • 2 alpha & 2 beta subunits joined together by disulfide bonds
  • insulin binds to receptor & activates tyrosine kinase which activates insulin receptor substrates
67
Q

Things that stimulate glucagon release

A
  • hypoglycemia
  • stress
  • trauma
  • sepsis
  • beta agonists
68
Q

Things that reduce glucagon release

A
  • somatostatin
  • insulin
69
Q

What are uses for glucagon other than increasing blood sugar?

A
  • increases myocardial contractility, HR, AV node conduction by increasing intracellular cAMP
  • Useful in: BB OD, CHF, low CO after CPB, improving MAP after anaphylaxis, relaxing sphincter of Oddi (ERCP)
  • SE: N/V
70
Q

Diagnostic criteria for diabetes

A
  • fasting glucose > 126
  • random glucose > 200 + classic symptoms
  • 2 hour glucose > 200 during oral glucose tolerance test
  • Hgb A1C > 6.5%
71
Q

Type 1 DM

A
  • lack of insulin production from beta cell destruction
  • causes = **autoimmune, genetic, viral
  • presents in childhood
  • thin
  • low insulin levels, high glucagon but can be suppressed
  • Tx: insulin
  • Associated w/ DKA
72
Q

Type 2 DM

A
  • lack of insulin + insulin resistance
  • cause = obesity
  • presents in adulthood
  • android obesity
  • insulin level normal to high, glucagon high & resistant to suppression
  • Tx: weight loss, diet, oral hypoglycemic, insulin
  • Associated w/ hyperglycemia hyperosmolar syndrome
73
Q

Metabolic syndrome

A

At least 3 of the following:
- fasting glucose > 100-110
- abdominal obesity (waist > 40 in M, > 35 in F)
- triglyceride > 150
- HDL < 40 M, < 50 F
- BP > 130/85

74
Q

DKA

A
  • *More common in DM Type 1
  • Not enough insulin –> ketoacidosis,
  • hyperosmolarity, dehydration
    S/S:
    Labs:
    1. *CBG > 250 mg/dL
    2. pH < 7.3
    3. bicarb < 18
    4. anion gap > 10
    5. hyperosmolarity > 300
    6. ketones > 5
  • Metabolic acidosis
  • Kussmaul’s respirations
  • Fruity-smelling breath
  • Tx:
    1. fluids
    2. insulin
    3. K+
75
Q

Hyperglycemic Hyperosmolar State

A
  • More common w/ DM Type 2
  • Caused by insulin resistance or inadequate
    production
  • Labs:
    1. CBG > 600 mg/dL
    2. osmolarity > 330 mOsm/L
    3. mild metabolic acidosis
    4. pH > 7.3 , no anion gap
  • Tx:
    1. fluids
    2. insulin
    3. correct electrolytes
76
Q

DM Anesthetic MGMT

A
  • painless MI
  • tachycardia (reduced vagal tone)
  • dysrhythmias
  • ortho hypotension
  • aspiration risk
  • hypothermia
  • difficult intubation (stiff joint syndrome-Prayer’s sign)
  • neuropathy
  • LR may contribute to hyperglycemia
  • GA , BB, & DM autonomic neuropathy may mask hypoglycemia
77
Q

Carcinoid syndrome

A
  • GI tumor
  • secretion of vasoactive substances from enterochromaffin cells
  • Most common s/s = flushing, diarrhea
  • Histamine release
    1. bronchoconstriction
    2. vasodilation
    3. hypotension
    4. flushing
  • kinins & kallikrein
    1. bronchoconstriction
    2. vasodilation
    3. hypotension
    4. flushing
  • serotonin
    1. bronchoconstriction
    2. vasoconstriction
    3. HTN
    4. SVT
    5. diarrrhea
78
Q

Carcinoid crisis

A
  • tachycardia
  • hypo/hypertension
  • flushing
  • abd pain
  • diarrhea
79
Q

Drugs to give carcinoid syndrome

A
  • somatostatin (octreotide)
  • antihistamines
  • 5HT3 antagonists
  • steroids
  • phenylephrine, vasopressin
80
Q

Drugs to avoid carcinoid syndrome

A
  • histamine-releasing drugs = morphine, meperidine, atracurium, thiopental, sux
  • catecholamines
  • ephedrine, ketamine (stimulate SNS)

APEX: Flashcards (13 decks)

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