Endocrine Diseases Flashcards
(117 cards)
1
Q
what does the anterior pituitary gland produce? (6)
A
- adrenocorticotrophic hormone (ACTH)
- thyroid stimulating hormone (TSH)
- growth hormone (GH)
- follicle-stimulating hormone (FSH)
- lutenizing hormone (LH)
- prolactin
2
Q
what does the posterior pituitary gland secrete?
A
- anti-diuretic hormone (ADH)
- oxytocin
3
Q
how is secretion from the anterior pituitary regulated?
A
the hypothalamus
*transported via capillary portal system
4
Q
what is the difference in how hormones are produced and secreted by the anterior and posterior pituitary?
A
- anterior PRODUCES hormones and releases them into circulation under hypothalamus control
- posterior SECRETES hormones produced in the hypothalmus after neural stimulation
5
Q
where does prolactin act?
A
prolactin acts on the milk producing cells in the breast, causing lactation
6
Q
where does ACTH act?
A
the adrenal cortex, releasing adrenalin
7
Q
where does GH act?
A
the body’s cells, causing growth
8
Q
what does TSH do?
A
acts on the thyroid, causing thyroxin secretion, stimulating growth and metabolism
9
Q
where does FSH and LH act?
A
the testes and ovaries, causing
- androgen and sperm production
or
- egg production
10
Q
where does oxytocin act?
A
the uterus, causing labour contractions
11
Q
where does ADH act?
A
the kidneys, regulating water levels
12
Q
what is the difference between T4 and T3?
A
T3 is more potent and less protein bound,
but glands release more T4 (10:1)
13
Q
whats T4 called?
A
thyroxine
14
Q
whats T3 called?
A
tri-iodothyronine
15
Q
what is hyperthyroidism?
A
overproduction of T3 and/or T4
16
Q
what can cause hyperthyroidism?
A
- grave’s disease
- TSH-secreting pituitary tumors
- iatrogenic (caused by medicine)
- thyoiditis
17
Q
what are symptoms of hyperthyroidism?
A
- weight loss
- fatigue
- arrhythmias
- anxiety
- exopthalmos (eyeballs popping out)
- widened pulse P
18
Q
what do T3 and T4 act on?
A
adenylate cyclase
- affects speed of rxns, O2 use, and energy output (heat production)
19
Q
whats the most common cause of hyperthyroidism?
A
graves disease
*in women 20-40 yo
20
Q
how do you treat hyperthyroidism?
A
- antithyroids or beta antagonist
- surgical total, subtotal or lobar thyroidectomy
21
Q
what intra-op considerations would you have for a PT with hyperthyroidism?
A
- esmolol
- no SNS stimulants
- PTs usually hypovolemic
- NO change of MAC
- exaggerated hypotensive response upon induction
22
Q
what are some post op concerns for hyperthyroidism?
A
- RLN injury (horseness)
- hematoma/tracheomalacia
- hypocalcemia
23
Q
what does radioiodine do? Specific to the thyroid?
A
destroys thyroid cell function
24
Q
what pre-op info is relevant for elective thyroidectomy?
A
- RHR
25
what is the most serious post-op threat for thyroid PTs?
- thyrotoxic crisis (thyroid storm)
| * usually 6-18hrs post-op
26
what are symptoms of thyrotoxic crisis?
- abrupt axiety
- fever
- tachycardia
- cardiovascular instability
27
treatment of thyrotoxic crisis?
- IV cooled crystalloids
- continuous esmolol infusion
- dexamethasone (2mg q6)
or cortisol (100-200 mg q8)
28
what can inhibit conversion of T4 to T3?
propylthiouracil (250-500 mg q6 PO)
29
what muscle relaxant should we avoid with hyperthyroid PTs?
pancuronium
30
what condition does thyrotoxic crisis mimic?
malignant hyperthermia
31
what is a primary cause for hypothyoidism?
dysfunction/destruction of thyroid tissue
- Hashimoto's Thyroiditis
* high TSH but low T3/T4
32
what is a secondary cause for hypothyroidism?
hypothalmic/pituitary axis disfunction
* normal or low TSH and low T3/T4
- iatrogenic
- myxedema coma
33
what are sympoms of hypothyroidism?
- lethargy
- weight gain
- cold intolerance
- hypoactive reflexes
34
how can you treat hypothyroidism?
PO T4
| *synthroid
35
what is an extreme case of hypothyroidism more common in elderly women with a long history of hypothyroidism?
myxedema coma
36
What should be done with hypothyroid PTs preop?
- minimize premed
- gastric emptying
- TAKE YOUR SYNTHROID
- warm
37
what are some intraop concerns for hypothyroid PTs?
- hypotension and increased sensitivity to agents
- blunted baroreceptors
- maybe avoid GA if possible
- use KETAMINE if you must do GA
38
why might hypothyroid PTs have impaired pulmonary function?
TH aids in surfactant production
39
how does PTH affect serum calcium and phosphate?
- increases calcium (bone resorption, dec. excretion)
| - decreases phosphate (renal excretion)
40
what can cause primary hyperparathyroidism?
- adenoma
- carcinoma
- hyperplasia of PTH glands
41
what can cause secondary hyperparathyroidism?
PTH increase due to hypocalcemia
42
what are symptoms of hyperparathyroidism?
- hypercalcemia
| * renal stones, HTN, constipation, fatigue
43
what medical treatment can be done for hyperparathyroidism?
- saline
| - loop diuretics
44
what causes hypoparathyroidism?
decreased PTH by iatrogenic causes
45
what symptoms result from hypoparathyroidism?
result from hypocalcemia
- acute paresthesia, NM irritability
- chronic EKG changes, lethargy, cataracts
46
what should we avoid in hypoparathyroid PTs?
don't hyperventilate
47
what is a positive chvostek's sign?
facial muscle twitching with tapping the mandible
| *for nerve hypersensibility
48
what is a positive trousseau's sign?
occluding brachial artery for 3 minutes, causes spasm of forearm due to hypocalcemia
* for nerve hypersensibility
* more sensitive than chvosteks sign
49
what is DiGeorge syndrome?
congenital hypoplasia of the thymus and parathyroid
50
what does the thymus do?
immune organ that develops lymphocytes into T-cells for adaptive immune function
51
what may you see in your airway exam for PTs with DiGeorge syndrome?
micrognathia
52
what concerns do you have for Digeorge syndrome peri-op?
- NMB unpredictable
- hypervent could exacerbate hypocalcemia
- micrognathia
53
What does the adrena medulla secrete?
catecholamines (epi, norepi, dopamine)
54
what does the adrenal cortex secrete?
- glucocorticoids (cortisol)
| - minerocorticoids (aldosterone, Na, K)
55
what stimulates the adrenal cortex to release cortisol?
corticotropin
56
glucocorticoids have a role in what metabolic pathway?
gluconeogenesis (inhibiting peripheral glucose use, causing hyperglycemia)
57
what is the net effect of aldosterone? (3)
- increased extracellular fluid volume
- decreased plasma K+
- metabolic alkalosis
58
how are androgens significant for anesthetic management?
THEYRE NOT
59
what important disease process is associated with the adrenal medulla?
PheoChromoCytoma (PCC)
60
what causes cushing's syndrome?
excess cortisol by ACTH -secreting adenoma
61
what are symptoms of cushing's?
- obesity
- HTN
- muscle wasting
- glucose intolerance
- osteoporosis
62
what are some preop considerations for cushing's syndrome PTs?
- BP, electrolytes, hypervolemic and hypokalemic
| - blood sugar
63
intraop considerations for cushings
osteoperosis and obesity
64
post op considerations for cushings
- poor would healing
| - infection
65
what is conn syndrome?
hyperaldosteronism, usually caused by a tumor
66
what are symptoms of conn syndrome?
- metab. alkalosis
- hypokalemia
- headache, cramps
67
what can be done to treat conn syndrome?
- spironolactone
| - surgery
68
what can be done perioperatively for PTs with Conn syndrome?
- treat hypokalemia
| - treat any HTN
69
what is spironolactone?
an aldosterone antagonists
| - a K+ sparing diuretic
70
what is a primary adrenocorticoid deficiency?
addison's disease (autoimmune)
71
what is a secondary adrenocorticoid deficiency?
cortisol deficiency with normal aldosterone, caused by chronic steroid use
72
what are some symptoms of adrenocorticoid deficiency?
- hypotension
- hyponatremia
- hypovolemia
- hyperkalemia
- fatigue
- hyperpigmentation
73
how do you treat adrenocorticoid deficiency?
replace minero/glucocorticoids
| *hydrocortisone 100 mg q6 hrs
74
what should you be aware of peri-op for PTs with adrenocorticoid deficiency?
addisonian crisis
- keep stress free
* avoid etomodate
75
what causes hypoaldosteronism?
- congenital deficiency of aldosterone synthase
- hyporeninemia
- adrenalectomy procedure
76
how do you treat hypoaldosteronism?
fludrocortisone (a minerocorticoid)
77
what is pheochromocytoma?
PCC is a catecholamine secreting tumor of the medulla, secreting NE and Epi 85:15
78
what are some signs of PCC?
- sudden malignant HTN
- cardiac dysrhthmias
- headache
- perspiration
79
how much NE does the average PCC tumor contain?
100-800 mg NE
80
how do you treat PCC?
cut out the tumor, manage BP with alpha-antagonists and B blockers
81
what can result peri-op with PCC PTs?
- HTN before removal
- Hypotension after
- HTN crisis can cause blindness
- CVA
* have an A-line
82
what causes acromegaly?
excess GH, usually from a tumor on pituitary gland
83
what will a PTs airway with acromegaly look like?
excess soft tissue & catilage, making DL difficult
| *increased subglottic stenosis incidence
84
what is diabetes insipidus?
deficiency or resistance to vasopressin
85
what are symptoms of diabetes insipidus?
extreme thirst, excess urination
86
how do you treat neurogenic diabetes insipidus?
- synthetic vasopressin (desmopressin)
| * due to lack of vasopressin secretion
87
how do you treat nephrogenic diabetes insipidus?
- keep Na+ levels low w/ diuretics
| * vasopressin levels should be normal, just decreased response
88
what should we monitor peri-op with diabetes insipidus?
electrolyte imbalances
- high Na+
- low K+
- low Mg2+
89
___ % of glucose production comes from hepatic glycogenolysis and ___ % comes from hepatic gluconeogensis during the postabsorption phase of digestion.
75%, 25%
90
what is a normal hemoglobin A1C?
91
what do the Islets of Langerhans do?
75% B cells - secrete insulin
| 20% a-cells - secrete glucagon
92
what does glucagon do?
increases glycogen breakdown in the liver (gluconeogensis)
93
what does insulin do?
lowers blood glucose by transporting glucose into the cell
94
what does somatostatin do (from Delta cells)?
decreases motility of stomach, duadenom, gall bladder to increase absorption time
*inhibits insulin, glucagon, growth hormon, gastrin, motilin
95
how is glucagon and insulin affected by parasympathetic and sympathetic innervation? (T5-T10)
- sympathetic stimulates glucagon release
| - parasympathetic stimulates insulin release
96
what hormones can stimulate insulin release?
GH and cortisol
97
what effect can lack of insulin have on glucose, fat and protein?
- cells cant use glucose
- increase fat as energy source, increase lipase and LDL
- increase muscle wasting
98
what are the type of DM?
type I - 5-10% of cases, autoimmune destruction of B cells
type 2 - 90%, insulin resistance
gestational - 2-3% of pregnancies, resolves post partum, dangerous for baby
99
what are symptoms of DM?
- polyurea, polydypsia, polyphagia
- weight loss from muscle/fat used as energy
- asthenia (no strength)
- sweet breath from acetone
- vision problems until blood sugar controlled
100
long term complications of DM
- HTN
- vascular disease
- neuropathy
- renal failure
101
what is the most common cause of death in older diabetics?
- MI
| * 20x greater risk periop
102
what is diabetic ketoacidosis? (DKA)
decreased insulin activity leading to more metabolism of fatty acids and an accumlation of organic acids by-products
*occurs when exogenous insulin isn't given
103
how do you treat DKA?
crystalloid and insulin
104
what are clinical signs of DKA?
```
blood sugar 320+
fatigue
polyuria
mental stupor
ketones in urine
```
105
what is a hyperosmolar non-ketotic coma?
hyperglycemic (600+ BS) diuresis that results in dehydration and hyperosmolality
106
what do you do to treat hyperosmolar non-ketotic coma?
hypotonic solution and insulin
107
what causes hypoglycemia?
insulin > carb intake
* BS ~50mg/dL
* mostly Type I DM
108
how do you treat hypoglycemia?
IV administration of 50% glucose (each mL will raise BS about ~2mg/dL
109
regular insulin can be given IV. All other insulin products must be given how?
subcutaneously
110
what is metformin for?
1st line for obese type II DM PTs. decreases insulin requirements
111
what are the four major classes of oral hypoglycemics?
- secretagogues (sulfonylureas)
- biguanides (metformin)
- glitazones
- a-glucosidase inhibitors (acarbose)
112
when do you treat high glucose intra-op?
when BS is >150 mg/dL
| *check every hr
113
how do you treat high blood sugar intra-op?
give insulin
| *(bs-100)/40 = units of insulin to give
114
how much will 1 unit of insulin lower blood sugar?
25-30 mg/dL
115
what is carcinoid syndrome
tumors of the GI tract causing massive serotonin and histamine release
116
what will you see with carcinoid syndrome?
flushing and diarrhea, maybe massive hypotension
117
what can you do to treat carcinoid syndrome?
- a line
- zofran
- octreotide, somatostatin
