Endocrine 4

Question 1

_________ are bone cells that promote bone deposition

Answer 1

Osteoblasts

Question 2

__________ are bone cells that promote bone resorption

Answer 2

Osteoclasts

Question 3

Osteoblasts add Ca2+ to the bone which

Answer 3

reduces the ionized Ca2+ concentration in the blood

Question 4

Describe the process for decreased Ca2+ levels

Answer 4

parathyroid glands release PTH–> osteoclasts release Ca2+ from bone–> Ca2+ is reabsorbed by the kidneys–> Ca2+ absorption in the small intestine increases vitamin D synthesis–> Ca2+ level in blood increases

Question 5

Describe the process for increased Ca2+ levels

Answer 5

thyroid gland releases calcitonin–> osteoclast activity is inhibited–> Ca2+ reabsorption in the kidneys decreases–> ca2+ level in blood decreases

Question 6

After the parathyroid gland is removed, a decline in ________ indicates successful removal

Answer 6

PTH level

Question 7

Signs and symptoms of hypoparathyroidism include

Answer 7

hypotension
myocardial depression
long QT interval
tetany
seizures
paresthesias
muscle spasms
abdominal cramping

Question 8

Signs and symptoms of hyperparathyroidism include

Answer 8

hypertension
short QT interval
confusion
lethargy
psychosis
bone pain
osteopenia
pathologic fractures
muscle weakness
anorexia
N/V
abdominal pain
peptic ulcer disease
pancreatitis
polyuria
polydipsia
kidney stones

Question 9

Match each region of the adrenal gland with the class of hormones it produces:
zona glomerulosa
adrenal medulla
zona reticularis
zona fasciculata
androgens
catecholamines
mineralocorticoids
glucocorticoids

Answer 9

Zona fasciculata- glucocorticoids
zona glomerulosa- mineralocorticoids
zona reticularis- androgens
adrenal medulla- catecholamines

Question 10

The adrenal gland is divided into

Answer 10

the cortex and the medulla

Question 11

The cortex synthesizes and releases 3 classes of steroids:

Answer 11

mineralocorticoids (aldosterone)
glucocorticoids (cortisol)
androgens (sex hormones)

Question 12

The medulla synthesizes and releases 2 cathecolamines:

Answer 12

epinephrine (80%)
norepinephrine (20%)

Question 13

Aldosterone release is caused by

Answer 13

RAAS activation
hyperkalemia
hyponatremia

Question 14

Aldosterone stimulates the kidney to

Answer 14

conserve sodium and water and excrete potassium and hydrogen

Question 15

_________ increases cortisol production

Answer 15

Stress

Question 16

Increased cortisol initiates

Answer 16

gluconeogenesis, protein catabolism, and fatty acid mobilization

Question 17

Cortisol mitigates ____________ by reducing cytokine release

Answer 17

the inflammatory cascade

Question 18

Cortisol imrpoves

Answer 18

myocardial performance

Question 19

The zona glomerulosa secretes

Answer 19

mineralocorticoids

Question 20

The zone fasciculata secretes

Answer 20

glucocorticoids

Question 21

The zona reticularis secretes

Answer 21

androgens

Question 22

The medulla secretes

Answer 22

catecholamines

Question 23

Cortisol production is

Answer 23

15-30 mg/day

Question 24

Normal serum cortisol levels are

Answer 24

12 mcg/dL

Question 25

Cortisol is required for the vasculature to respond to

Answer 25

the vasoconstrictive effects of catecholamines

Question 26

How does cortisol production change in response to perioperative stress?

Answer 26

major perioperative stress can increase cortisol production upwards of 100 mg/day with a serum level up to 30-50 mcg/dL

Question 27

What are the hemodynamic effects of cortisol?

Answer 27

cortisol improves myocardial performance by increasing the number and sensitivity of beta receptors on the myocardium

Question 28

Order each drug in terms of its glucocorticoid potency dexamethasone aldosterone methylprednisolone aldosterone

Answer 28

dexamethasone methylprednisolone cortisol aldosterone

Question 29

_________ has equal glucocorticoid and mineralocorticoid effects

Answer 29

Cortisol

Question 30

______ does NOT have glucocorticoid effects

Answer 30

aldosterone

Question 31

_________ is an analog of cortisol, making it a good choice to treat adrenocortical insufficiency (Addison's disease)

Answer 31

Prednisone

Question 32

The following do NOT have mineralocorticoid effects

Answer 32

dexamethasone betamethasone triamcinolone

Question 33

Triamcinolone is commonly adminsitered

Answer 33

in the epidural space to treat lumbar disc disease

Question 34

Triamcinolone is unique because it is associated with

Answer 34

a higher incidence of skeletal muscle weakness & more likely to cause sedation and anorexia

Question 35

What are the 3 most relevant endogenous steroids?

Answer 35

cortisol aldosterone cortisone

Question 36

Primary hyperaldosteronism is caused by

Answer 36

excessive aldosterone release

Question 37

Primary hyperaldosteronism is known as

Answer 37

Conn's syndrome

Question 38

Etiologies of primary hyperaldosteronism include

Answer 38

aldosteronoma pheochromocytoma primary hyperthyroidism

Question 39

_____________________ causes a syndrome that highly resembles hyperaldosteronism

Answer 39

Long-term licorice ingestion

Question 40

Anesthetic considerations for the patient with Conn's syndrome inclue

Answer 40

hypertension & hypokalemia

Question 41

What's the difference between primary and secondary hyperaldosteronism?

Answer 41

primary: aldosterone release from adrenal gland secondary: stimulus from extra-renal location

Question 42

Clinical features of Conn's syndrome include

Answer 42

hypertension hypokalemia metabolic alkalosis (H+ wasting)

Question 43

Treatment of Conn's syndrome includes

Answer 43

removal of aldosterone secreting tumor aldosterone antagonists (spironolactone or eplerenone) potassium supplementation Na+ restriction

Question 44

S/sx of hypokalemia include

Answer 44

muscle weakness/cramping increased sensitivity to non-depolarizing NMBs U wave on EKG avoid hyperventilation

Question 45

Name a cause of secondary hyperaldosteronism

Answer 45

renovascular hypertension