Exam 4: Endocrine Flashcards
(87 cards)
1
Q
Type of disturbance typically seen with tumors/cancer:
A
Hyperfunction; sometimes mass effect
2
Q
Types of target cell failure:
A
↓ in # of receptors Impaired receptor function Presence of antibodies against receptors Antibodies acting as agonists Unusual expression of receptors
3
Q
Hormones secreted by the hypothalamus:
A
GnRH (→ FSH/LH) TRH (→ TSH) CRH (→ ACTH) PIF (→ prolactin) GHRH (→ GH)
4
Q
Hormones secreted by the anterior pituitary:
A
FLAT PEG
FSH
LH
ACTH
TSH
Prolactin
Growth hormone
5
Q
Posterior pituitary syndromes:
A
DI SIADH Oxytocin deficiency Hypopituitarism Null cell adenoma Ischemic necrosis/Sheehan syndrome Ablation
6
Q
Pituitary adenomas:
A
Prolactinomas GH adenoma ACTH adenoma Gonadotroph adenoma TSH cell adenoma
7
Q
Hypothalamus site of hormone synthesis:
A
Supraoptic and paraventricular nuclei
8
Q
Requirement for hormones to be transported in blood:
A
Bound to proteins
9
Q
Clinical manifestations of SIADH:
A
Water retention
Hyponatremia
Hypoosmolarity
10
Q
Cause of neurogenic vs. nephrogenic DI:
A
Neurogenic: insufficient ADH produced
Nephrogenic: inadequate response to ADH
11
Q
S/s of DI:
A
Polyuria
Polydipsia
Unconcentrated urine
12
Q
Sheehan syndrome is:
A
Ischemic necrosis of pituitary due to heavy blood loss during delivery
13
Q
Panhypopituitarism usually from:
A
Cell destroying/null cell tumors
14
Q
Non-neoplastic causes of panhypopituitarism:
A
Head trauma, infection, etc
15
Q
Most common cause of hyperpituitarism:
A
Slow-growing benign pituitary adenoma
16
Q
S/s of pituitary adenoma:
A
Headache/fatigue
Visual changes
Hyposecretion of neighboring ant.pit. hormones
17
Q
Cause of acromegaly:
A
↑ GH during adulthood
18
Q
Cause of gigantism:
A
↑ GH during childhood/adolescence
19
Q
S/s of acromegaly:
A
Overgrowth in nose, face, scalp, forehead
20
Q
Anesthesia implications of acromegaly:
A
Can be difficult to intubate/manage airway
21
Q
S/s of gigantism:
A
Proportional growth beyond typical sizes
22
Q
Cause of dwarfism:
A
↓ GH in childhood
23
Q
S/s of dwarfism:
A
Proportionally stunted growth; 1/3rd are able to go through puberty/reproduce
24
Q
Three major effects of panhypopituitarism:
A
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
