6901 > Endocrine > Flashcards

Endocrine Flashcards

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1
Q

3 types of hormones

A
  • peptide/protein: stored in granules then released: insulin, ADH GH
  • amino/amino: catecholamines, thyroxine
  • lipids: derived from cholesterol, not stored, usually bound to plasma proteins: steroid
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2
Q

hormone control mechanisms (3)

A
  • neural
  • biorhythms
  • feedback
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3
Q

endocrine system

A
  • regulation of behavior
  • growth
  • metabolism
  • fluid status
  • development
  • reproduction
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4
Q

pituitary gland

A
  • pea-sized gland in sella turcica (sphenoid bone)

- connected to hypothalamus by hypophyseal stalk

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5
Q

anterior pituitary gland

A
  • 80% of pituitary
  • communicates with hypothalamus via vascular system
  • GH, TSH, ACTH, FSH, LH, prolactin
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6
Q

posterior pituitary gland

A
  • communicates with hypothalamus via neural pathways (hormones already synthesized)
  • ADH, oxytocin
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7
Q

panhypopituitarism

A
  • lack of all pituitary hormones

- more common than a decrease in a single hormone

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8
Q

pituitary gland: hyposecretion - causes

A
  • large nonfunctional pituitary tumors
  • postpartum shock
  • irradiation
  • trauma
  • hypophysectomy
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9
Q

pituitary gland: hyposecretion - treatment

A
  • require thyroid and steroid replacement peri-op
  • diabetes insipidus after removal: have vasopressin
  • surgical approach is transphenoidal
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10
Q

anterior pituitary: hyposecretion - transphenoidal approach considerations

A
  • sitting position
  • precordial doppler and EtCO2 monitoring for air embolism
  • smooth intubation and extubation
  • quick emergence to allow for neuro checks
  • no N2O
  • intraoperative muscle relaxation
  • will have nasal packing
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11
Q

anterior pituitary: hyposecretion - transphenoidal approach complications

A
  • CSF leak
  • meningitis
  • ischemic stroke
  • visual loss
  • diabetes insipidus
  • hyponatremia
  • epistaxis
  • cranial nerve damage
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12
Q

anterior pituitary: hypersecretion of growth hormone - acromegaly

A
  • bones and organs are enlarged
  • lung volumes increase with increased extrathoracic obstruction
  • coarse facial features
  • glucose intolerance and diabetes
  • cardiac problems

**caution with airway: mask fit difficult, smaller ETT due to larger vocal cords, OSA, difficult DL

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13
Q

posterior pituitary: ADH release

A
  • 284 mOsm/L
  • 10-20% decrease in plasma volume or BP: baroreceptors send signal via vagal and glossopharyngeal nerves
  • pain
  • emotional stress
  • nausea

**surgery increases ADH release

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14
Q

posterior pituitary: diabetes insipidus treatment

A
  • neurogenic versus nephrogenic
  • vasopressin (short term), desmopressin (long term)
  • monitor plamsa osm, UOP, Na qh
  • isotonic fluids if serum osm < 290, hypotonic if >290
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15
Q

posterior pituitary: SIADH treatment

A
  • fluid restriction

- hypertonic saline with lasix

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16
Q

what is the rate limiting step in thyroid hormone formation?

A

iodide trapping - which is under the control of TSH

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17
Q

thyroid gland: effects of hormone

A
  • increased metabolic rate and heat production
  • increased O2 consumption
  • increased heart, liver, kidney function
  • role in growth and development
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18
Q

thyroid gland: hormones secreted

A
  • T4: most abundant, less potent, non-active
  • T3: less abundant, more potent, active
  • calcitonin: regulates short term calcium
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19
Q

thyroid gland: nerves nearby

A
  • recurrent laryngeal

- external motor branch of superior laryngeal

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20
Q

thyroid gland: location

A
  • below larynx

- both sides and anterior of trachea

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21
Q

thyroid gland: thyrotoxicosis S/S

A
  • goiter
  • tachycardia
  • heat intolerance
  • weight loss
  • eye signs
  • a-fib
  • skeletal muscle weakness
  • anxiety
  • tremor
  • insomnia
  • fatigue
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22
Q

thyroid gland: thyrotoxicosis diagnosis

A
  • low TSH

- high T4

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23
Q

thyroid gland: thyrotoxicosis treatment

A
  • inhibit hormone synthesis (methimazole, propylthiouracil)
  • prevent hormone release (potassium, sodium iodine)
  • mask adrenergic overactivity
  • radioactive iodine
  • surgical removal
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24
Q

thyroid gland: thyrotoxicosis preoperative management

A
  • needs to be euthyroid
  • continue antithyroid and BB
  • assess airway: enlarged thyroid can cause tracheal deviation
  • blood volume increased, PVR decreased, pulse pressure wide
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25
thyroid gland: thyrotoxicosis intraoperative management
- avoid SNS stimulation (no ketamine, pancuronium, atropine) - monitor core temperature - treat hypotension with direct-acting vasopressors - avoid hypercarbia and hypoxia (because they stimulate SNS) - increased incidence of myopathies and myasthenia gravis: no muscle relaxants after induction - ETT with NIM (+ electrodes on vocal cords)
26
thyroid gland: thyroid storm occurrence time
- anytime in peri-op period | - most likely 6-18 hours post-op
27
thyroid gland: thyroid storm versus malignant hyperthermia
-malignant hyperthermia has sudden rise in EtCO2 and trismus
28
thyroid gland: thyroid storm treatment
- iv hydration with glucose-containing fluids - Tylenol (cooling) - BB - potassium iodide - correct electrolyte and acid-vase imbalances - antithyroid drugs
29
thyroid gland: recurrent laryngeal nerve palsy
- unilateral: hoarseness | - bilateral: aphonia and stridor = immediately reintubate
30
thyroid gland: hypothyroidism S/S
- myxedema - lethargy - hypotension - bradycardia - CHF - gastroparesis - hypothermia - hypoventilation - hyponatremia - poor mentation
31
thyroid gland: hypothyroidism diagnosis
- low T4 | - high TSH
32
thyroid gland: hypothyroidism preoperative assessment
- myocardial function and baroreceptors may be depressed | - airway evaluation: large thyroid gland and tongue, myxedematous
33
thyroid gland: hypothyroidism peri-operative
- -hypotension: reduced plasma volume - sensitive to non-depolarizers - less sensitive to inotropic drugs - slower GI emptying - monitor core temperature - risk for hypoxia and hypercarbia
34
thyroid gland: myxedemia
- high risk of anesthetic complications - hypothyroidism, hypothermic, hypoventilation, hyponatremic - only life-saving surgeries
35
90% of the time hyperparathyroidism is due to _____
adenoma
36
parathyroid gland: hyperparathyroidism diagnosis
-high Ca and PTH levels
37
parathyroid gland: hyperparathyroidism S/S
- profound muscle weakness - confusion - N/V - lethargy - calcifications
38
parathyroid gland: hyperparathyroidism treatment
- hypercalcemia if treated with isotonic saline and loop diuretics - surgical removal
39
parathyroid gland: hyperparathyroidism operative considerations
- dehydration - avoid preop sedatives - hyperventilation decreases ionized calcium, more calcium is bound - sensitive to NM blockers (especially sux) - treat arrhythmias and HTN with calcium channel blockers
40
parathyroid gland: hypoparathyroidism operative consideration
- potential for hypocalcemia and laryngospasm | - avoid hyperventilation decreases ionized calcium
41
pancreas - secretory cells
islets of langerhans beta=insulin alpha=glucagon delta=somatostatin F cell=pancreatic polypeptides
42
average patient with diabetes will spend ____ more time in the hospital recovering from surgery
50%
43
diabetes: chronic complications
- HTN - peripheral, retinal, and cerebral vascular disease - increased risk of silent MI - autonomic neuropathy - renal failure
44
diabetes: anesthesia considerations
- evaluate end order damage - evaluate cardiac status - gastroparesis with delayed gastric emptying - impaired respiratory response to hypoxia - limited-mobility joint syndrome - neuropathies - kidney function
45
diabetes: cardiac-diabetic autonomic neuropathy
- HTN - orthostatic hypotension - lack of HR variability - resting tachycardia - lack of sweating - silent MI - asymptomatic hypoglycemia - reduced HR response to atropine or propranolol
46
diabetes: anesthesia care
- first case of day - fluids=normal saline, no lactated ringers - half or hold dose - measure glucose
47
diabetes: metformin
- hypotension - renal impairment - lactic acidosis *hold 48 hours prior to surgery
48
diabetes: avoid ____ when patient takes NPH because it causes _____
protamine -- anaphylaxis
49
diabetes: hypoglycemia S/S
- diaphoresis - tachycardia - nervousness - confusion
50
diabetes: hypoglycemia treatment
-25-50 mL of D50, followed by D5 drip
51
in a 70kg pt, ___ mL of ____ can be expected to raise the blood glucose concentration by _____ mg/dL
15 mL d50 30 mg/dL
52
diabetes: diabetic ketoacidosis
- type 1 - volume depletion and hyperglycemia - fruity odor to breath - Kussmaul respirations - metabolic acidosis - coma
53
diabetes: diabetic ketoacidosis triad
- hyperglycemia - acidemia - ketonemia
54
diabetes: diabetic ketoacidosis and hyperglycemia hyperosmolar state treatment
- IV insulin - fluids - correct electrolyte and acid/base imbalances
55
diabetes: hyperglycemia hyperosmolar state
- type II - glucose > 600 - hypovolemia and hypotension - seizures, coma - tachycardia
56
adrenal glands: hormones
adrenal cortex: mineralcorticoids (aldosterone), glucocorticoids (cortisol), androgens adrenal medulla: catecholamines (norepinephrine, epinephrine)
57
adrenal glands: cortisol function (4)
- gluconeogenesis - protein mobilization - fat mobilization - stabilizes lysosomes
58
adrenal glands: hyperaldosteronism types
- primary (Conn syndrome): from adrenal adenoma | - secondary: increased renin production
59
adrenal glands: hyperaldosteronism anesthetic plan
- correct fluid/electrolyte balance - HTN: spironolactone is aldosterone antagonist - avoid hyperventilation because it drives K into cells - monitor EKG and muscle relaxants due to low K
60
adrenal glands: Cushing syndrome anesthetic plan
- correct fluid/electrolyte balance - care with skin and positioning - increased infection risk - supplement steroids
61
adrenal glands: Addison's disease anesthetic plan
- correct fluid/electrolyte balance | - steroid replacement
62
adrenal glands: Addison's disease S/S
- all 3 hormones deficient - hyperpigmentation - weight loss, fatigue, weakness - hypotension, hyponatremia, hyperkalemia, hypoglycemia
63
what induction medication should be avoided in Addison's disease and why
-etomidate: interferes with steroids
64
adrenal glands: pheochromocytoma definition
- catecholamine-secreting tumor | - can be malignant, bilateral, and extra-adrenal
65
adrenal glands: pheochromocytoma S/S (4)
- paroxysmal headache - hypertension - sweating - palpitations
66
adrenal glands: pheochromocytoma diagnosis
- urine metanephrine level: false positive due to coffee, tricycles, phenoxybenzamines - suppression test: clonidine decreases catecholamines that are neurogenically controlled
67
adrenal glands: pheochromocytoma pre-operative
1. alpha blocker (phenoxybenzamine titrate to 1 mg/kg by 10-20 mg every 2-3 days) 2. beta blocker
68
adrenal glands: pheochromocytoma pre-operative treatment endpoints
- BP <160/90 - <1 PVC q5min - presence of orthostatic hypotension - absence of EKG changes for 1 week - HCT <5% for adequate intravascular volume expansion
69
adrenal glands: pheochromocytoma anesthetic considerations
- A-line - 2 large bore IV - CVP - deep intubation - Foley - anticipate labile BP, avoid SNS stimulation (ketamine, ephedrine) and histamine release (morphine, atracurium)
70
multiple endocrine neoplasia: MEN 1
* parathyroid - pancreatic - pituitary
71
multiple endocrine neoplasia: MEN 2
* medullary thyroid - pheochromocytoma - parathyroid
72
multiple endocrine neoplasia: MEN 3
* mucosal neuromas - pheochromocytoma - medullary thyroid
73
carcinoid syndrome: definition
- complex of S/S caused by the secretion of vasoactive substances from enterochromaffin cells - serotonin (constrict), histamine (dilate), kallikrein (dilate) - mainly in GI tract
74
carcinoid syndrome: S/S (5)
- R sided heart failure - dramatic BP swings - cutaneous flushing - bronchospasm - diarrhea and abdominal pain
75
carcinoid syndrome: pre-operative
- histamine blocker - octreotide (2 weeks) - evaluate extra-intestinal manifestations
76
carcinoid syndrome: anesthetic considerations
- A-line - 2 large bore IV - CVP - deep intubation - steroids, histamine blockers - avoid histamine releasing substances - vasopressin for refractory hypotension - have octreotide available
77
liver's role in carbohydrate metabolism (3)
- glycogenesis - glycogenolysis - gluconeogenesis
78
glucose transporters (4)
GLUT 1: all cells, RBCs, BBB GLUT 2: renal, GI GLUT 3: neurons GLUT 4: adipose, muscle
6901
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