Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pathophys II > Anesthesia for patients with adrenal disease > Flashcards

Anesthesia for patients with adrenal disease Flashcards

1
Q

The adrenal cortex releases

A

glucocorticoids–> cortisol
mineralocorticoids–> aldosterone
androgens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the percentage of epinephrine and norepinephrine in the adrenal medulla

A

epinephrine 80%

norepinephrine 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The adrenal glands are

A

multifunctional and secrete a variety of hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The two portions of the adrenal gland are the

A

cortex 80-90% (zona glomerulosa, zona fasciculata, zona reticularis)
medulla 10-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

There is complex regulation in the adrenal glands which is through the

A

hypothalamus–> anterior pituitary–>adrenal cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Physiological functions of the adrenal glands includes

A

blood glucose regulation
protein turnover
fat metabolism
sodium, potassium, and calcium balance
maintenance of cardiovascular tone
modulation of tissue response to injury or infection
survival as a result of stress (most important)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cushings syndrome is the result of

A

excessive cortisol secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Excessive cortisol secretion can be

A

ACTH dependent or

ACTH independent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ACTH dependent excessive cortisol secretion includes

A

Cushings disease pituitary corticotroph tumors (microadenomas)
non endocrine tumors of lung, kidney, or pancreas ectopic corticotropin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ACTH independent excessive cortisol secretion includes

A

benign or malignant adrenocortical tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Signs and symptoms of Cushing’s disease include

A 
sudden weight gain (usually central)
thickening of the facial fat "moon face"
electrolyte abnormalities
systemic hypertension
glucose intolerance
menstrual irregularities
decreased libido
skeletal muscle wasting
depression and insomnia
osteoporosis
hypercoagulable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Diagnosis of Cushing’s syndrome and disease can be performed through

A 
plasma & urine cortisol levels- 24 hour urine collection, plasma cortisol levels; if both elevated it indicates Cushing's syndrome
CRH stimulation test
dexamethasone suppression test
inferior petrosal sinus sampling
CT & MRI once diagnosis is confirmed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment of Cushing’s syndrome is dependent

A

upon the cause
includes:
surgical-transphenoidal microadenectomy & adrenalectomy
irradiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anesthetic management considerations for patients with Cushing’s syndrome includes

A 
preop evaluation
positioning 
skeletal muscle weakness
cortisol
blood loss
choice of agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Preoperative considerations for the patient with Cushing’s syndrome includes

A

HTN, intravascular volume, electrolytes- hypokalemia & hypernatremia; acid-base status- hypokalemic metabolic alkalosis; cardiac compromise- CHF; diabetes- check glucose level- control with small amounts of IV insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Positioning considerations for the patient with Cushing’s syndrome includes

A

osteoporosis & osteomalacia- vertebral compression fractures–> be careful with airway positioning
obesity
use appropriate padding
check position throughout the case
care when moving to stretcher use of roller

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Anesthetic considerations related to muscle weakness for the patient with Cushings syndrome includes

A

hypokalemia-contributing factor
decreased requirements for muscle relaxants
use a peripheral nerve stimulator
maintain 1 twitch if using neostigmine for reversal
w/ LMA may not be able to breath adequately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe the use of cortisol for the patient with Cushing’s syndrome.

A

unilateral or bilateral adrenalectomy–> hydrocortisone usually started intraoperatively, dose reduced over 3-6 days to maintenance dose, mineralocorticoid may also need supplementation, unilateral continue therapy may not be required depending upon remaining gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Blood loss for adrenalectomy for the patient with Cushing’s icnludes.

A 
may be significant
T&S
major surgery- T&C
CVP
A-line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Anesthetic agents for the patient with Cushings disease include

A

drugs or techniques not likely to influence attempts to decrease cortisol levels–> some inhalation agents depress adrenal response to stress & ACTh
etomidate inhibits enzymes involved in cortisol & aldosterone synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

The changes in ACTH caused by anesthetic agent or type are

A

insignificant when compared to increase in cortisol secretion with surgical stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Complications of transphenoidal microadenomectomy include

A

VAE, transient diabetes insipidus, & meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Complications with adrenalectomy are related to

A

laparoscopic–> position, insufflation

open–> pulmonary complications d/t retractors leading to atelectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Conn’s syndrome is

A

excess secretion of aldosterone from a functional tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Conn's syndrome occurs more in
women than men; rarely in children
26
Conn's syndrome results in
secondary hyperaldosteronism as a result of increased circulating serum renin stimulating the release of aldosterone
27
Signs & symptoms of Conn's disease are
non-specific & some are asymptomatic | may also include systemic hypertension & hypokalemia
28
Systemic hypertension in Conn's disease reflects
aldosterone induced sodium retention and resulting increased fluid retention. MAY BE RESISTANT TO TREATMENT may see headache, diastolic BP 100-125 mmHg
29
Anesthesia management for the patient with hyperaldosteronism as a result of Conn's disease includes
correct decreased K+ & HTN- spironolactone assess cardiac/renal status avoid hyperventilation--> further decreases K+ monitors: a-line adequate fluids w/ vasodilators/diuresis check acid-base, electrolytes frequently exogenous cortisol 100 mg/q 24 hours
30
Addison's disease is a result of
primary adrenal insufficiency due to | idiopathic/autoimmune most common primary cause
31
There are no symptoms of Addison's disease until
90% of adrenal cortex has been destroyed
32
Addison's disease results in deficiency of
all adrenal cortex secretions including mineralocorticoids, glucocorticoids, and androgens
33
Signs & symptoms of Addison's disease include
chronic fatigue, muscle weakness, hypotension, weight loss, anorexia, N/V, diarrhea, increased BUN & hemoconcentration due to hypovolemia; hyponatremia, hyperkalemia, hypoglycemia, abdominal or back pain, hyperpigmentation in sun-exposed areas and the distal extremities
34
Diagnosis of Addison's disease is from
baseline plasma cortisol level <20 ug/dL Cortisol level <20 ug/dL after ACTH stimulation test - cortisol levels are measured 30 & 60 minutes following administration of ACTH -positive test yields a poor response to ACTH & is indicative of adrenal cortex impairment
35
Addisonian crisis is triggered in
steroid-dependent individuals who do not receive increased dose during stress
36
Stress for the patient with Addisonian crisis can result in
circulatory collapse including hypoglycemia, electrolyte imbalance, and depressed mentation
37
Treatment of Addisonian crisis includes
IV cortisol for 24 hours D5 0.9% NS volume- colloid, whole blood inotropic support
38
Anesthetic management considerations for the patient with Addison's disease include
administer exogenous corticosteroids if on a daily dose- patient should take day of surgery recommended dose for surgery is 25 mg for minor 100 mg bolus or 100 mg q6 for major
39
For the patient with Addison's disease who develops intraoperative hypotension,
rule out usual causes of shock | measure CVP- fluids
40
Treating intraoperative hypotension for the patient with Addison's disease includes
vasopressor- even if it did not have effect before cortisol administer cortisol 100 mg IV fluids invasive monitoring
41
Anesthetic management considerations for the Addison's disease patient regarding electrolytes includes
measure glucose levels preop & every hour hypoglycemia- replace with dextrose solutions check electrolytes frequently- potassium levels a concerns (consider avoiding LR)
42
Anesthetic management considerations for the Addison's disease patient in regards to anesthetic medications include:
avoid etomidate inhalation agents- sensitive to drug induced myocardial depression PNS- titrate muscle relaxants due to skeletal muscle weakness
43
Hypoaldosteronism is a result of
congenital deficiency hyporeninemia nonsteroidal inhibitors of prostaglandin synthesis
44
Describe how hyporeninemia results in hypoaldosteronism.
due to long standing diabetes & renal failure and/or treatment with ace inhibitors--> loss of angiotensin stimulation
45
Describe how nonsteroidal inhibitors of prostaglandin synthesis result in hypoaldosteronism.
May inhibit renin release and exacerbate condition in presence of renal insufficiency
46
Signs and symptoms of hypoaldosteronism includes
hyperkalemic acidosis severe hyperkalemia hyponatremia myocardial conduction defects
47
Hypoaldosteronism treatment includes
mineralocorticoids- fludrocortisone | liberal sodium intake
48
A pheochromocytoma is a
******* catecholamine-secreting tumor
49
A pheochromocytoma originates in the
adrenal medulla and related tissues elsewhere in the body - about 90% originate in adrenal medulla with 10% involving both adrenal glands - most common in young to mid adult life
50
Predominant symptoms of pheochromocytoma include
continuous or paroxysmal HTN headache diaphoresis/pallor palpitations/tachycardia
51
Associated symptoms of pheochromocytoma
orthostatic hypotension, anxiety, tremor, chest pain, epigastric pain, flushing (rare), painless hematuria (rare)
52
The timing of episodes for pheochromocytoma include
duration: one hour or less frequency: daily to once every few months
53
Diagnosis of pheochromocytoma is through
urine tests- useful for screening but unreliable for definitive plasma levels- reliability reflects the presence of pheo (more neo than epi!) radiographic tests to locate tumor-CT/MRI
54
Treatment of pheochromocytoma includes
surgical excision restore intravascular volume--> decreased Hct evident restore release of insulin with alpha block persistant tachy-beta block (esmolol) test: phenoxybenzamine (alpha 1 & 2) or prazosin (selective alpha 1)
55
With pheochromocytoma, it is important to NOT administer
non selective beta block in the absence of alpha-block-heart depressed by beta block b/c unable to maintain CO w/ unopposed alpha mediated vasoconstriction
56
Pertinent preop history & labs for the pheochromocytoma patient includes
increased PVR--> myocardial ischemia, ventricular hypertrophy, CHF, cardiomyopathy history of cerebral hemorrhage hyperglycemia- decreased circulating insulin with increased glycogenolysis
57
Preop criteria for the patient undergoing pheochromocytoma includes
no BP reading >165/90 for 48 hours prior to surgery BP on standing should not be <80/45 ECG without ET-T wave changes that are not permanent No more than 1 PVC q 5 min.
58
Fluid management for the patient with pheochromocytoma includes:
hypovolemic- pre-hydrate falsely elevated HCT--> T & C renal function fluid replacement plan (4/2/1)
59
Additional anesthetic considerations for the pheochromocytoma patient include
good communication with the surgeon b/c need to know when to expect hypotension continue adrenergic blockade- depends on surgeon as may be d/c'ed prior to surgery
60
Anesthetic techniques for the patient with a pheochromocytoma includes
heavy premedication with benzos & opioids gentle positioning anesthetic technique- combined GA/ continuous lumbar epidural, epidural prior to induction, invasive monitoring
61
Monitors utilized for pheochromocytomas include:
EKG A-line- BP control, ABGs, electrolytes, glucose levels Swan ganz/ TEE- depends on cardiac status CVP U/O temperature peripheral nerve stimulator
62
When preparing for hyperdynamic blood pressure with pheochromocytoma, consider the following medications:
lidocaine 1 to 2 mg/kg propofol 3 mg/kg opioids- do not administer morphine due to histamine release (stimulates catecholamine release)- sufentanil 0.5 to 1 mcg/kg or fentanyl 3 to 5 mcg/kg
63
Laryngoscopy considerations for the patient with pheochromocytoma include
``` must have adequate depth- inhalation agent to deepen lidocaine IV 1-2 mg/kg 1 min. before opioid fentanyl 100-200 mcg nitroprusside 1-2 mcg/kg phentolamine-alpha blockers beta blocker- esmolol no drugs that release histamine ```
64
Intraoperative blood pressure control for the pheochromocytoma patient includes
nitroprusside--> preferred phentolamine- tachyphylaxis, tachycardia, & longer duration magnesium sulfate calcium channel blockers
65
Heart rate control for the patient with pheochromocytoma includes
esmolol-preferred labetalol metoprolol
66
Intraoperative management of the patient with pheochromocytoma includes:
inhalation agent for maintenance- O2/air (desflurane- avoid d/t tachycardia, sevoflurane) 1.5-2 MAC more control than opioid technique combined technique with epidural opioid muscle relaxant- vecuronium/rocuronium
67
Drugs to avoid with pheochromocytoma include
histamine releasers- morphine, atracurium halothane- sensitizes myocardium to epinephrine succinylcholine- fasciculations of abdominal muscles may cause release of catechols from tumor pancuronium & atropine metoclopramide
68
With surgical ligation of pheochromocytoma tumor's venous drainage it results in
decreased catechols so prepare for hypotension by: stopping antihypertensives decrease concentration inhalation agent volume first- crystal/colloids administer pressors- phenylephrine, norepinephrine combine RA/GA decreases hypotension- adequate volume replacement preoperatively
69
Persistent hypotension with pheochromocytoma may require an
infusion of norepinephrine until the vasculature can adapt to decreased levels alpha stimulation
70
Postoperative considerations for the patient with pheochromocytoma include
analgesia- CLE, PCA, opioids 50% of patients will remain hypertensive- continue antihypertensive therapy, elevated catecholamine levels for 10 days postop early extubation- young, no lung involvement
71
Describe postoperative considerations for pheochromocytoma regarding glucose control
hypoglycemia- excess insulin release and ineffective lipolysis and glycogenolysis
72
Describe postoperative considerations for pheochromocytoma regarding steroid supplementation.
bilateral adrenalectomies or hypoadrenalism requires steroid supplementation
73
Describe postoperative considerations for pheochromocytoma regarding postoperative HTN.
presence of occult tumors volume overload continue monitoring

Pathophys II (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions