Endocrine Flashcards
(119 cards)
1
Q
What are the 7 hypothalamic hormones?
A
Luteinizing hormone
Corticotropin hormone
Thyrotropin
Prolactin releasing
Prolactin inhibiting
Growth hormone inhibiting
Growth hormone stimulating
2
Q
Where is the pituitary gland located?
A
Sella turcica
Anterior - adenohypophysis
Posterior - neurohypophysis
3
Q
Which hormones are released from the anterior pituitary?
A
FLAT PiG
Follicle
Luteinizing
Adrenocorticotropic
Thyroid stimulating
Prolactin
Growth
4
Q
What does the follicle stimulating hormone do?
A
Germ cell maturation and follicle growth in females
5
Q
What does the luteinizing hormone do?
A
Testosterone production in males and ovulation in females
6
Q
What does the adrenocorticotropic hormone do?
A
Adrenal hormone release
7
Q
What does the thyroid stimulating hormone do?
A
Thyroid hormone release
8
Q
What does prolactin do?
A
Lactation
9
Q
What does growth hormone do?
A
Cell growth
10
Q
What two hormones are from the posterior pituitary ? What are their functions?
A
Antidiuretic - water retention
Oxytocin - uterine contraction and breast feeding
11
Q
Anesthetic complications for acromegaly?
A
Everything is large + glucose intolerance
Large face, teeth, epiglottis, narrowing of cords, turbinate’s
Increased risk of CAD, HTN, rhythm disturbances
Muscle weakness
12
Q
Differentiate T3 to T4, source?
A
T4 - Released from thyroid
T3 - extrathyroid conversion of T4 to T3
13
Q
Differentiate T3 to T4, highest concentrations?
A
T4 - in the blood (T4 delivers T3)
T3 - In the target cell
14
Q
Differentiate T3 to T4, protein binding?
A
T4 - more
T3 - less
15
Q
Differentiate T3 to T4, potency?
A
T4 - Less
T3 - more
16
Q
Differentiate T3 to T4, half life?
A
T4 - 7 days
T3 - 1 day
17
Q
How does iodine deficiency affect T3 and T4?
A
Iodine is a substrate that the thyroid needs to make T3 an T4
without it, NO T3 or T4
18
Q
How does the thyroid affect cardiac function?
A
Increases
Chronotropy
Inotropy
Lusitropy
Number of beta receptors
Decreases
SVR
Number of muscarinic receptors
19
Q
How does the thyroid affect respiratory function?
A
Increases CO2, O2 and Minute ventilation
20
Q
How does the thyroid affect MAC?
A
Has NO effect
BUT
hyperthyroidism can have a slower induction time
hypothyroidism can have a faster induction time
21
Q
Most common cause of hyperthyroidism?
A
Graves
also
MG
Carcinoma
Pregnancy
22
Q
Most common cause of hypothyroidism?
A
Hashimoto’s thyroiditis
Also
iodine deficiency
Neck radiation
Thyroidectomy
Amiodaron can effect both
23
Q
How are T3 and T4 affected by hyper/hypothyroidism?
A
Hyper - Low TSH and High T3+T4
Hypo - High TSH and Low T3+T4
24
Q
Myxedema coma vs cretinism?
A
Myxedema coma - end stage hypothyroidism that leads to coma
Cretinism - neonatal hypothyroidism -
25
What three thioamides can treat hyperthyroidism ?
PTU, Methimazole, Carbimazole
Block iodine
Need 6-7 weeks to work and are only PO
26
Why are beta blockers used in hyperthyroidism?
Reduce SNS stimulation and inhibit peripheral conversion of T4 to T3
27
Contraindications to radioactive iodine?
Pregnancy
Breast feeding
28
When can surgery be done in patients with hyper/hypothyroidism?
Hyper - Do not proceed with elective, for emergency - give beta blockers, potassium iodine, glucocorticoid, PTU
Hypo - okay if mild or moderate disease
29
Best way to secure an airway with a goiter?
Awake intubation
or a technique that maintains spontaneous ventilation
30
Which drugs should be avoided in hyperthyroidism?
Sympathomimetics
Anticholinergics
Ketamine
Pancuronium
31
What is a thyroid storm?
Stressful in hyperthyroid and euthyroid and occurs 6-18 hours after surgery
S/sx
Fever > 38.5
Tachycardia
HTN
CHF
Shock
Agitation
Can mimic MH
32
How manage a thyroid storm?
Block synthesis (methimazole, carbimazole, PTU, potassium iodide)
Block release ( radioactive iodine, potassium iodide)
Block T4 to T3 (PTU, propranolol, glucocorticoids)
Block beta receptors (Propranolol, esmolol)
Support
33
How can you assess the RLN?
Have the patient say E or Moon
Can also look under DL, and use a NIM tube
34
What happens if the parathyroid is resected?
Hypocalcemia at least 6-12 hours after surgery
S/sx of hypocalcemia
Muscle Spasm
DELAYED GASTRIC EMPYTING (increased risk for aspiration)
Laryngospasm
Hypotension
Prolonged QT
Paresthesia
Chvostek's sign
Trousseau's sign
35
3 layers of the adrenal cortex?
GFR
G- Mineralocorticoids (aldosterone) salt
F- Glucocorticoids (cortisol) sweet
R- Androgens (dehydroepiandrosterone) sex
36
What is released from the adrenal medulla?
Catecholamines
Epi - 80%
Norepi - 20%
37
Where is angiotensinogen made?
liver
38
Where is ang 1 made?
systemic
39
Where is ang 2 made?
lung
40
How much cortisol is produced in a day?
15-30mg/day with a normal level of 12 mcg
Stress can create 100mg/day
41
How does cortisol affect cardiovascular function?
Improves it by increasing the number of beta receptors
Also helps vasculature respond to vasoconstriction
42
Which steroids have no glucocorticoid effects?
Aldosterone
43
Which steroids have no mineralocorticoid effects?
Dexamethasone
Betamethasone
Triamcinolone
44
Unique side effects of epidural triamcinolone?
Used to treat lumbar disc disease
Muscle weakness
Sedation
Anorexia
45
What is Conn's syndrome?
Too much aldosterone
Primary - from adrenal gland
Secondary - from renin secreting tumor
s/sx of increased mineralocorticoids
-HTN from Na and water
-Hypokalemia from wasting
- Metabolic alkalosis from H wasting
46
High intake of what food resembles hyperaldosteronism?
Long term licorice ingestion (glycyrrhizic acid)
47
Treatment for Conn's?
Aldosterone antagonists (spironolactone or eplerenone)
Potassium supplementation
Na restriction
Removal of aldosterone secreting tumor
48
Cushing's syndrome vs Cushing's disease?
Syndrome - too much cortisol
Disease - too much ACTH
49
** What are glucocorticoid effects?
Hyperglycemia
Weight Gain
Infection
Osteoporosis
Mood disorder
Muscle weakness
50
** What are mineralocorticoid effects?
-HTN from Na and water
-Hypokalemia from wasting
-Metabolic alkalosis from H wasting
51
** What are androgenic effects?
Women become masculinized (hirsutism, thin hair, acne, amenorrhea)
Men become feminized (gynecomastia, impotence)
52
How does Cushing's present?
Will present with excess of all three groups
Mineral
Gluco
Androgenic
53
Which endocrine disorder can occur after resection of pituitary gland?
DI ( too little ADH )
54
Presentation of adrenal insufficiency?
Addisons
Low electrolytes except for Hyperkalemia
Muscle weakness
Anorexia
Acidosis
N/V
Hyperpigmentation
55
Treatment for addisons?
Steroids
56
What is acute adrenal crisis? Treatment?
From stress - medical emergency
Fever
Hemodynamic instability
Hypoglycemia
Impaired mental state
Steroids (hydrocortisone)
Fluids (D5NS)
Supportive
57
What is the stress response in patients with chronic steroid therapy?
Suppresses the ACTH so the patient will not be able to increase their cortisol
58
Graph for who needs steroids?
59
What are the 4 hormones produced by the pancreas which cells produce them?
Alpha - Glucagon
Beta - Insulin
Delta - Somatostatin
PP - Pancreatic polypeptide
60
Which conditions increase insulin release?
Anything that increases glucose
SNS
PNS
Glucagon
Catecholamines
Cortisol
Growth Hormone
Beta agonists
61
Which conditions decrease insulin release?
Anything that decreases glucose
Insulin
Volatile anesthetics
Beta antagonists
62
What factors stimulate glucagon release?
Anything that uses glucose will stimulate glucagon
Hypoglycemia
Stress
Trauma
Sepsis
Beta agonists
63
What factors inhibit glucagon release?
Insulin
Somatostatin
64
Other uses for glucagon?
Increases contractility, HR, AV conduction by increasing intracellular cAMP.
Beta-blocker overdose
CHF
Low CO after MI or CPB
Improving MAP after anaphylaxis
Relaxes biliary sphincter
65
What is somatostatin?
Regulates endocrine hormone output from islet cells and released by delta cells
Growth inhibiting hormone
Inhibits glucagon and insulin
Inhibits splanchnic blood flow, gastric motility, and gall bladder contraction
66
What is the pancreatic polypeptide?
Inhibits exocrine hormone secretion, gallbladder contraction, gastric acid secretion, and gastric motility
67
What is the classic triad of diabetes?
Polyuria
Dehydration
Polydipsia
68
Type 1 vs 2 diabetes? Causes?
1 - no insulin production (autoimmune)
2 - lack of insulin plus resistance (obesity)
69
What is DKA? More common?
Usually caused by an infection in type 1
Not enough insulin puts the body into ketosis
Patient is hyperglycemia but cells are staved
Metabolic acidosis causes Kussmaul respirations
Acetone causes fruity breath
70
Treatment for DKA?
Volume
Insulin + potassium
71
What is HHS? More common?
Type 2 with hyperglycemia > 600
Metabolic acidosis, dehydration, hypovolemia
NO ANION GAP
72
Long term side effects of DM?
Neuropathy
Retinopathy
Nephropathy
CAD
PAD
Cerebrovascular disease
Stiff joints
Poor wound healing
Cataracts
Glaucoma
73
How does DM affect the ANS?
Painless MI
Reduced vagal tone
Dysrhythmias
Orthostatic hypotension
Delayed emptying
Impaired thermoregulation
Diarrhea
74
What is the prayer sign?
DM cause glycosylation of joints which causes stiff joints
Increased difficult intubation
75
MOA of biguanides? Example? Key facts?
Metformin - Inhibits gluconeogenesis
Does not cause hypoglycemia
Risk of metabolic acidosis
Used in polycystic ovarian disease
76
MOA of sulfonylureas? Example? Key facts?
Stimulate secretion of insulin from beta cells
Glipizide, glimepiride, glyburide
Risk of hypoglycemia, avoid in sulfa allergies
77
MOA of meglitinides? Example? Key facts?
Stimulate secretion of insulin from beta cells
Repaglinide, Nateglinide
Risk of hypoglycemia
78
MOA of thiazolidinediones? Example? Key facts?
Decrease insulin resistance
Rosiglitazone, Pioglitazone
Does not cause hypoglycemia
BLACK BOX WARNING FOR CHF
79
MOA of glucagon like peptide 1 receptor agonists? Example? Key facts?
Increases insulin from beta cells, decreases gastric emptying, decreases glucagon from alpha cells
Liraglutide, exenatide
Risk for hypoglycemia
80
MOA of dipeptidyl-peptidase-4 inhibitors? Example? Key facts?
Increases insulin from beta cells, decreases glucagon from alpha cells
Suffic - liptin
Risk for hypoglycemia
81
MOA of amylin agonists? Example? Key facts?
decreases gastric emptying, decreases glucagon from alpha cells
Pramlintide
N/V
Hypoglycemia
Does not alter insulin levels
82
Insulin Table
83
Risks, presentations, and treatment of hypoglycemia
highest risk if insulin given during fasting
S/sx : SNS stimulation
Hard to diagnose
Possible delayed emergence
Rebound hyperglycemia
D50 or glucagon
84
Association between insulin and allergic reactions?
Not as common now
*NPH AND FISH ALLERGY MAY SENSITIZE PATIENT TO PROTAMINE
85
Which drugs counter hypoglycemia effect of insulin?
Epi
Glucagon
Cortisol
86
Which drugs extend or enhance hypoglycemia of insulin?
MAOI
Salicylates
Tetracyclines
87
What is carcinoid syndrome?
Secretion of vasoactive substances from enterochromaffin cells
GI tract or lungs
Release - histamine, serotonin, kinins, kallikrein
88
Carcinoid tumor
89
Most common s/sx of carcinoid tumor?
Flushing and diarrhea
90
Most common s/sx of carcinoid crisis?
tachycardia
Hyper.hypotension
Flushing
Abd pain
Diarrhea
91
How is carcinoid crisis treated?
Somatostatin
Antihistamines
5-HT3 antagonists
Steroids
Phenyl or vaso
92
Which should be avoided in carcinoid crisis?
Histamine releasing drugs
Succ
Exogenous catecholamines
Sympathomimetic agents (ketamine, ephedrine)
93
Pituitary Hormones Photo
94
Hyperthyroidism vs hypo systemic effects?
Hyper - Everything is revved up
95
Hyperthyroidism vs hypo, goiter?
Both
96
Hyperthyroidism vs hypo, fine hair, diarrhea, tremor, moist skin, heat intolerance ?
Hyperthyroidism
97
Hyperthyroidism vs hypo, weight gain, fatigue, dry and thick skin, cold intolerance, dry brittle hair, large tongue, constipation?
Hypothyroidism
98
Low TSH, and high T3+T4?
Hyperthyroidism
99
High TSH, and low T3+T4?
Hypothyroidism
100
A patient has emergency surgery, Which medication should be given for hyperthyroidism first?
Esmolol because it will have a fast effect
PTU should be given but it takes days to take affect
101
What drugs should be used for hyperthyroidism?
4 B's
Block- synthesis
Block- release
Block - conversion
Block - beta
PTU, propranolol, and potassium iodide are all great choices
102
What does potassium iodine do?
Reduces thyroid hormone synthesis and release
Takes 10 days to work
103
What does radioactive iodine do?
Destroys thyroid tissue
Don't give to pregnant or breastfeeding moms
104
How do beta blockers help in hyperthyroidism? Which ones?
Reduces SNS stimulation
Propranolol + esmolol
105
How does propranolol help in hyperthyroidism ?
Reduces SNS
and
Inhibits conversion of T4 to T3
106
Examples of thioamides and their function? Side effects?
-PTU, methimazole, carbimazole
-inhibits synthesis which takes 6 to 7 weeks
- PTU also inhibits conversion
-Bad for liver
-Only PO
107
What drugs should be avoided with hyperthyroidism?
Sympathomimetics
Anticholinergic
Ketamine
Panc
108
Complications of thyroidectomy?
RLN injury
Hypocalcemia
109
Is there an increased sensitivity to NMB in hypothyroidism ?
Yes
110
Inhalation induction times with hypo/hyperthyroidism?
Inhalation induction is faster in hypo
and
slower in hyper
111
How does the parathyroid gland move calcium?
When calcium is low in the blood, the parathyroid secretes its hormone and pulls calcium from the bone into the blood
112
What is the most common cause of hypercalcemia?
Hyperparathyroidism
113
How is hypoparathyroidism treated?
Calcium
Vit D
Magnesium
114
Does cortisol have anti-inflammatory effects?
Yes through lysosomal membrane stabilization and reducing cytokine release
115
Order glucocorticoid potency from most to least
1. Dexamethasone
2. Methylprednisolone
3. Cortisol
4. Aldosterone
116
Which steroid is an analog of cortisol?
Prednisone
117
Which steroids are just glucocorticoids?
Dexamethasone, betamethasone, and triamcinolone
TBD
118
Which steroid has zero glucocorticoid coverage?
Aldosterone
119
Best steroid to treat Addison's?
Prednisone because it resembles cortisol
