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Critical Care I > Bolick ch 24 Endocrine > Flashcards

Bolick ch 24 Endocrine Flashcards

1
Q

where is the hypothalamus located

A

base of the brain stem

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2
Q

how is the hypothalamus linked to the pituitary gland

A

via the pituitary gland

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3
Q

what two systems are involved in the hypothalamus

A

neuroendocrine organ

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4
Q

what does the hypothalamus regulate

A

hormone secretion from the pituitary gland by secretion of specific stimulating and inhibiting hormones

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5
Q

hypothalamic hormones are also referred to as

A

factors

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6
Q

what are the hypothalamic hormones that are also referred to as factors

A

GHRH (GH releasing hormone)

SRIF (GH inhibiting hormone or somatostatin)

PIH (prolactin inhibiting hormone or dopamine)

TRF (thyrotropin releasing hormone)

CRF (corticotropin releasing hormone)

GnRH (gonadotropin releasing hormone)

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7
Q

How does the pituitary gland respond to the hypothalamic hormones

A

by releasing trophic hormones that effect target glands - these glands produce hormones that feed back to the hypothalamus and pituitary gland to regulate the trophic hormone production

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8
Q

what does the anterior pituitary gland regulate

A

physiological processes including

stress
reproduction
lactation
growth

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9
Q

adenohypophysis

A

anterior pituitary gland

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10
Q

what does Anterior pituitary gland secrete

A

Adrenocorticotropic hormone (ACTH)

Luteinizing hormone (LH)

follicle stimulating hormone (FSH)

GH
PRL

thyroid stimulating hormone (TSH)

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11
Q

what secretes aldosterone

A

adrenal gland - glomerulosa

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12
Q

what does aldosterone do

A

it is a mineralocorticoid

regulates sodium and water balance

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13
Q

what secretes cortisol

A

adrenal gland - fasciculata

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14
Q

what does cortisol do

A

regulates the level of carbohydrate

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15
Q

what secretes progesterone, estrogen, and androgens?

A

adrenal gland - reticularis

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16
Q

glucocorticoids are responsible for regulating what?

How does it do this?

A

the body’s response to stress primarily by increasing gluconeogenesis, increasing cardiac output and suppressing immune function

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17
Q

Mineralocorticoids control what and how?

A

intravascular volume and maintain hemodynamic stability by regulating sodium and water balance

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18
Q

what catecholamines are accountable for the “flight or fight” response when the body receives a threat

A

epinephrine and norepinephrine

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19
Q

when the body senses that the level of cortisol is low what is that tied to?

A

Stress - means the body is stressed

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20
Q

what happens when the level of cortisol is low?

A

activation of the hypothalamic-pituitary-adrenal axis (HPA axis)

a message is sent to the hypothalamus -> release corticotrophin releasing hormone (CRH) ->Anterior pituitary gland -> release adrenocorticotrophic hormone (ACTH) -> adrenal cortex releases cortisol

21
Q

Okay so your cortisol is low, your body activated the HPA axis…..now, cortisol is no longer needed. what happens next

A

cortisol travels to the hypothalamus and anterior pituitary -> inhibits further release

22
Q

the secretion of aldosterone is controlled primarily by

A

renin-angiotensin system and circulating potassium levels

23
Q

In response to low circulating volume, what happens in the kidney

A

Kidney releases renin-> converted to angiotensinogen in the liver forming angiotensin I -> Angiotensin converting enzyme (ACE) in the lungs converts angiotensin I to angiotensin II ->goes to adrenal cortex -> releases aldosterone ->kidney reabsorbs sodium and water -> blood volume increases

24
Q

adrenal dysfunction can be categorized into what 4 groups

A

Primary AI (adrenal insufficiency)

Secondary AI

Tertiary AI

relative AI

25
Q

Primary AI is the result of

can be from what

A

from a destroyed or inactive adrenal gland or a hormone production failure

Addison disease
Adrenal hemorrhage (seen in water-house-Friderichsen syndrome
Severe sepsis
metastatic infiltration
surgical removal
granulomatous lesions (TB)
26
Q

non-traumatic causes of adrenal hemorrhage

A

ACTH
adrenal vein spasm
thrombosis
normally limited venous drainage of the adrenal in the pathogenesis of this condition

the adrenal gland has a rich arterial supply and a limited venous drainage that is critically dependent on a single vein.

during stress, ACTH secretion increases ->stimulates adrenal arterial blood flow that may exceed the venous drainage capacity and could lead to hemorrhage

27
Q

adrenal vein thrombosis can occur in adrenal hemorrhage and in association with

A

sepsis
heparin-induced thrombocytopenia
primary antiphospholipid antibody syndrome
disseminated intravascular coagulation (DIC)

28
Q

bilat adrenal hemorrhage commonly leads to

A

acute AI and adrenal crisis

29
Q

what is the most common infection associated with AI

A

meningococcemia

30
Q

Primary AI that is a result of hormone production failure is associated with

A

CAH (congenital adrenal hyperplasia)

failure to produce corticosteroids

31
Q

in infancy what is the most common cause of AI

A

CAH (congenital adrenal hyperplasia)

32
Q

Secondary AI is associated with the deficiency of

A

ACTH (adrenocorticotrophic hormone)

remember ACTH travels to the adrenal cortex telling it to release cortisol. (when the body is stressed)

33
Q

what are most common causes of ACTH (adrenocorticotrophic hormone) deficiency

A

hypopituitarism secondary to primary pituitary disease

congenital pituitary lesions

developmental anomalies such as anencephaly, holoprosencephaly and craniopharyngiomas

34
Q

what is the most common reason for ACTH (adrenocorticotrophic hormone) deficiency in childhood

A

Craniopharyngiomas

35
Q

which AI is defined as a hypothalamic decrease in CRH (corticotrophin-releasing hormone) secretion or production

A

Tertiary AI

36
Q

most common cause of Tertiary AI (adrenal insufficiency)

what populations are at risk

A

suppression of the HPA axis from prolonged use of glucocorticoids

usually from rapid steroid taper or abrupt steroid withdrawal

think of those using glucocorticoids to manage their disease

asthma
history of organ transplant
leukemia
neurosurgical (pre- and post op)
nephrotic syndrome
other kidney diseases
collagen vascular diseases such as lupus erythematosus and RA

may take HPA axis until more than 1 month after therapy is stopped

37
Q

In the event that a pt undergoes additional stressors such as a surgical procedure or severe infections, they are assumed to be adrenal deficient for how long after stopping therapy unless what?

A

1 year after

unless a normal ACTH stimulation test is documented

38
Q

what is relative AI

A

every critical ill pt has some degree of relative AI

used when there are high absolute cortisol levels present but they are relatively insufficient to overcome the degree of physiologic stress on the patient

39
Q

critically ill children with catecholamine-resistant shock commonly show

A

absolute and relative AI

40
Q

AI is absent in children with ——- shock

A

fluid-responsive shock

41
Q

neonate and HPA axis

A

immature- can further limit the infants ability to increase cortisol production in response to stress which leads to neonatal AI

42
Q

How do we screen for congenital adrenal hyperplasia (CAH)

A

genetic newborn screening

43
Q

when does CAH usually present

A

first few weeks of life

44
Q

what deficiency is associated with CAH

A

21- hydroxylase deficiency (21-OHD)

45
Q

Males with CAH usually present in a

A

salt-wasting crisis at 1-2 weeks of age

accounts for 95% of all cases

46
Q

what happens in CAH

A

the missing enzyme (21-HD) reduces the production of cortisol and aldosterone by the adrenal glands -> AI

The pituitary perceives there is not enough cortisol so more cholesterol is delivered. Because there is still reduced production of cortisol and aldosterone, the extra cholesterol is converted into androgen

the excess androgen leads to ambiguous genitalia which makes CAH easier to recognize in female infants

47
Q

Positive TSI antibody test is associated with

A

Graves

48
Q

subacute thyroiditis is associated with a _____ ESR

A

high

49
Q

presence of TPO is associated with

A

Hashiomoto’s disease

Critical Care I (27 decks)

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