Exam 4: Endocrine Flashcards Preview

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Flashcards in Exam 4: Endocrine Deck (87):
1

Type of disturbance typically seen with tumors/cancer:

Hyperfunction; sometimes mass effect

2

Types of target cell failure:

↓ in # of receptors
Impaired receptor function
Presence of antibodies against receptors
Antibodies acting as agonists
Unusual expression of receptors

3

Hormones secreted by the hypothalamus:

GnRH (→ FSH/LH)
TRH (→ TSH)
CRH (→ ACTH)
PIF (→ prolactin)
GHRH (→ GH)

4

Hormones secreted by the anterior pituitary:

FLAT PEG

FSH
LH
ACTH
TSH

Prolactin
Growth hormone

5

Posterior pituitary syndromes:

DI
SIADH
Oxytocin deficiency
Hypopituitarism
Null cell adenoma
Ischemic necrosis/Sheehan syndrome
Ablation

6

Pituitary adenomas:

Prolactinomas
GH adenoma
ACTH adenoma
Gonadotroph adenoma
TSH cell adenoma

7

Hypothalamus site of hormone synthesis:

Supraoptic and paraventricular nuclei

8

Requirement for hormones to be transported in blood:

Bound to proteins

9

Clinical manifestations of SIADH:

Water retention
Hyponatremia
Hypoosmolarity

10

Cause of neurogenic vs. nephrogenic DI:

Neurogenic: insufficient ADH produced
Nephrogenic: inadequate response to ADH

11

S/s of DI:

Polyuria
Polydipsia
Unconcentrated urine

12

Sheehan syndrome is:

Ischemic necrosis of pituitary due to heavy blood loss during delivery

13

Panhypopituitarism usually from:

Cell destroying/null cell tumors

14

Non-neoplastic causes of panhypopituitarism:

Head trauma, infection, etc

15

Most common cause of hyperpituitarism:

Slow-growing benign pituitary adenoma

16

S/s of pituitary adenoma:

Headache/fatigue
Visual changes
Hyposecretion of neighboring ant.pit. hormones

17

Cause of acromegaly:

↑ GH during adulthood

18

Cause of gigantism:

↑ GH during childhood/adolescence

19

S/s of acromegaly:

Overgrowth in nose, face, scalp, forehead

20

Anesthesia implications of acromegaly:

Can be difficult to intubate/manage airway

21

S/s of gigantism:

Proportional growth beyond typical sizes

22

Cause of dwarfism:

↓ GH in childhood

23

S/s of dwarfism:

Proportionally stunted growth; 1/3rd are able to go through puberty/reproduce

24

Three major effects of panhypopituitarism:

Hypothyroidism
Depressed cortisol production
Suppressed sex hormone production

25

Three major effects of panhypopituitarism:

Hypothyroidism
Depressed cortisol production
Suppressed sex hormone production

26

Causes of hyperthyroidism:

Graves disease
Hyperfunctioning adenoma
TSH cell adenoma
Iatrogenic

27

Causes of hypothyroidism:

Hashimoto's
Iodine deficiency
Ablation
Idiopathic

28

Carcinomas of the thyroid:

Papillary
Anaplastic
Medullary
Follicular

29

Part of anterior pituitary that secretes TSH:

Pars distalis

30

Short feedback loop goes between thyroid and:

Anterior pituitary gland/pars distalis

31

Long feedback loop goes between thyroid and:

Hypothalamuc

32

Conditions that cause ↑ TSH and ↑ T3/T4:

Pituitary adenoma secreting TSH
Ectopic TSH production (small cell carcinoma in lung)

33

Conditions that cause ↑ TSH, ↓ T3/T4:

Hashimoto's thyroiditis
Iodine deficiency

34

Conditions that cause ↓ TSH, ↑ T3/T4:

Graves' disease
Toxic goiter
Thyroxine-secreting thyroid cancer

35

Conditions that cause ↓ TSH, ↓ T3/T4:

Panhypopituitarism
Null cell adenoma
Sheehan's syndrome

36

Pathogenesis of Grave's disease:

Antibodies called TSIs (thyroid stimulating globulins) act like TSH and cause constant T3/T4 production via ↑ cAMP

37

Half-time of TSH and TSIs:

TSH: 1 hr
TSIs: 12 hrs

38

S/s of hyperthyroidism:

Anxiety
Irritability
Insomnia
Rapid/irregular heartbeat
Tremors
Diaphoresis
Heat-sensitivity
Weight loss
Brittle hair
Goiter
Light menstrual periods
Diarrhea
Exophthalmos

39

Tx for hyperthyroidism:

β blockers
Anti-thyroid meds
Radioactive iodine
Surgery

40

Pathogenesis of Hashimoto's thyroiditis:

Autoimmune destruction of receptors and gland, causing inflammation

41

S/s of hypothyroidism:

Cold sensitivity
Constipation
Pale, dry skin
Puffy face
Goiter/hoarse voice
Elevated cholesterol
Weight gain
Muscle aches/tenderness/stiffness
Heavy menstrual periods
Depression

42

Tx of hypothyroidism:

Levothyroxine
Iodine if deficient

43

Role of immune system in Hashimoto's:

Thyroid-specific helper T cells (CD4) stimulate cytotoxic T cells (CD8) and B cells (humoral)

CD8 cells responsible for parenchymal destruction

B cells secrete antibodies against TSH receptors et al.

44

Role of antithyroglobulin and antithyroid peroxidase antibodies in Hashimoto's:

Not pathogenic, but useful serologic markers of disease

45

Pathogenesis of myxedema:

↑ chondroitin and hyaluronic acid cause interstitial fluid ↑ and edema

46

Pathogenesis of cretinism:

Hypothyroidism (extreme) in fetal life, infancy, or childhood

47

S/s of cretinism:

Skeletal growth stunted more than soft tissue; obesity, large tongue, etc

Dwarfism
Unique facial features
Absent/scant secondary hair
Poorly developed breasts
Potbelly
Umbilical hernia

48

Role of PTH glands:

Regulator of serum Ca++
Antagonizes calcitonin
Excretes PO4-

49

Role of PTH glands:

Regulator of serum Ca++
Antagonizes calcitonin
Excretes PO4-

50

S/s of hyperparathyroidism:

Hypercalcemia
Hypercalcuria
Kidney stones
PUD
Pancreatitis
N/V/anorexia
Osteoporosis
Confusion/poor memory
Muscle weakness/fatigue

51

Tx of hyperparathyroidism:

Surgery

52

Anesthetic considerations for hyperparathyroidism surgery:

Positioning - weak bones, muscles
Avoid benzos and muscle relaxants

53

S/s of hypoparathyroidism:

Hypocalcemia
Tetany, esp. in smaller muscles

54

Hypocalcemic tetany in the hand is called:

Carpopedal spasm

55

Tx for hypoparathyroidism:

PTH
Vitamin D

56

Mineralocorticoid hormones produced in:

Zona glomerulosa of adrenal cortex

57

Activity of mineralocorticoid hormones:

↑ activity of epithelial Na+ pump
Na+ retention, K+/H+ loss

58

Most potent naturally occuring mineralocorticoid hormone:

Aldosterone

59

Glucocorticoid hormones produced in:

Zona fasciculata of adrenal cortex

60

Glucocorticoid hormone release stimulated by:

ACTH

61

Activity of glucocorticoid hormones:

Hyperglycemia
Anti-inflammatory
Growth suppression
Sleep/awareness

62

Most potent naturally occuring glucocorticoid hormone:

Cortisol

63

Adrenal estrogens and androgens produced in:

Zona reticularis of adrenal cortex

64

Adrenal estrogens and androgens produced in:

Zona reticularis of adrenal cortex

65

Production of strong androgens like testosterone:

Weak androgens (DHEA, androstenedione) produced in adrenal cortex and converted to stronger androgens in periphery

66

Catecholamines produced in:

Chromaffin cells/pheochromocytes in adrenal medulla

67

Endogenous causes of hypercortisolism/Cushing's:

Pituitary tumor
Adrenal tumor
Ectopic secreting tumor
Iatrogenic

68

Causes of hyperaldosteronism/Conn's:

Overrelease of aldosterone
Overrelease of renin

69

Most common cause of Cushing's:

Excess ACTH

70

S/s of Cushing's:

Hyperglycemia
Hypertension
Fat redistribution to trunk/face
Fatigue
Muscle weakness
Moon face
Stretch marks
Thin skin, easy bruising
Slow healing
Depression, anxiety, anger
Acne
Thicker hair
Absent menstrual periods
ED

71

Tx for Cushing's:

↓ steroid use if iatrogenic
Surgery
Radiation
Medical/drugs

72

Cause of Conn's disease:

Tumors in zona glomerulosa

73

S/s of Conn's:

Hypokalemia
Metabolic alkalosis
↑ ECF/blood volume
↑ Na+/H2O retention
HTN

74

S/s of adrenogenital syndrome:

Virilization

75

Tx of adrenogenital syndrome:

Cortisol

76

S/s of Addison's:

Muscle weakness/fatigue
Weight loss
Anorexia
Hyperpigmentation
Hypotension/syncope
Hypoglycemia
Hyponatremia/salt craving
N/V/D
Irritability
Depression

77

Tx of Addison's:

HRT
Salt tabs

78

S/s of pheochromocytoma:

Tachycardia
Arrhythmias
Sweating
Chest pain
Upper abdominal pain
Headaches
Tremors
Anxiety/fright
Pale skin
Hypertension

79

Tx of pheochromocytoma:

α blockers
β blockers

80

Tx of pheochromocytoma:

α blockers
β blockers

81

Reticular activating system response to acute stress:

Activates so we won't sleep

82

Amygdala response to acute stress:

Behavioral changes

83

Arcuate nucleus response to acute stress:

Release of NE from the locus coeruleus
Release of neuropeptide Y (NPY)
Drives BP/HR up

84

Hypothalamus response to acute stress:

Secretes CRH to stimulate ACTH release from ant pit

85

Cortisol role in acute stress:

Negative feedback to pituitary and hypothalamus to bring levels back down to normal when appropriate

86

Effect of chronic stress on stress pathway:

Dampens the negative feedback of cortisol so that you have perpetually ↑ levels of CRH, ACTH, cortisol

87

Effect of chronic stress on anesthesia:

Labile BPs d/t catecholamine depletion
Hyperglycemia