Endocrine Flashcards
What two hormones does the posterior pituitary release?
Oxytocin
ADH
What six hormones does the anterior pituitary release?
FLAG PiT
F: follicle-stimulating hormone
L: Luteinizing hormone
A: Adrenocorticotropin
G: growth hormone
P: prolactin
“Ignore I”
T: thyroid-stimulating hormone
What are the primary hypothalamic hormones?
“Let’s Come Together and release”
“Promote Growth (in and out) “
Luteinizing hormone-releasing hormone
Corticotropin-releasing hormone
Thyrotropin-releasing hormone
Prolactin hormone releasing/inhibiting hormone
Growth hormone releasing/inhibiting hormone
Luteinizing hormone -releasing hormone targets what in the anterior pituitary?
Follicle stimulating hormone (FSH)
Luteinizing hormone
Corticotropin-releasing hormone stimulates what in the anterior pituitary?
Andrenocorticotropic hormone (ACTH)
What does the thyrotropin-releasing hormone stimulate in the anterior pit?
Thyroid stimulating hormone (TSH)
What does prolactin-releasing factor and prolactin-inhibiting factor stimulate in the anterior pituitary?
Prolactin (either increase or decrease)
What does the growth hormone releasing/inhibiting hormone stimulate in the anterior pituitary?
Growth hormone (increase or decrease)
What does hypersecretion of follicle stimulating hormone cause?
Early puberty
What does hyposecretion of follicle stimulating hormone create?
Infertility
What does hypersecretion of Luteinizing hormone do?
Early puberty
What does HYPOsecretion of Luteinizing hormone produce?
Infertility
What does hypersecretion of adrenocorticotropic hormone produce?
Cushing’s disease
What does hyposecretion of adrenocorticotropic hormone produce?
Addison’s
Secondary adrenal insufficiency
What does hypersecretion of thyroid stimulating hormone produce?
Hyperthyroidism
What does hyposecretion of thyroid stimulating hormone produce?
Hypothyroid or cretinism
What does hypersecretion of prolactin hormone produce?
Infertility
What does hyposecretion of prolactin hormone produce?
Menstrual dysfunction
What does hypersecretion of growth hormone produce?
Acromegaly
Gigantism
What does hyposecretion of growth hormone produce?
Dwarfism
What two hormones are NOT affected by a negative feedback?
Oxytocin
Prolactin (neural control)
What is syndrome of inappropriate ADH secretion?
Too much ADH
What is diabetes Insipidus?
Too little ADH
What are some traits of SIADH?
HYPOnatremia (< 135)
Euvolemia/hypervolemic
PLASMA ~ osmolarity < 275
URINE ~ hyperosmolar (low volume)
What is the tx for SIADH?
Fluid restriction
Demeclocycline
Give NaCl if symptomatic
What are some traits with Diabetes Insipidus?
Polyuria
PLASMA: euvolemic/hypovolemic
PLASMA: hypertonic > 290
PLASMA Na: > 145
URINE: osmolarity low
Normal Na
What is the treatment for DI?
DDAVP or vasopressin
What does over-secretion of growth hormone AFTER adolescence cause?
ACromegaly
What does over secretion of the growth hormone BEFORE puberty cause?
Gigantism
What are some anesthetic consideration for acromegaly?
Distorted face (diff mask)
Large tongue, teeth ~ diff intubation
Subglottic narrowing ~ smaller ETT
Turbinate enlargement ~ avoid nasal
What is the most common cause of SIADH?
Traumatic brain injury
What is the most common cause of diabetes Insipidus?
Pituitary surgery
What are 4 differing traits of T3 when compared to T4?
Higher potency
Shorter half life
Less protein bound
Smaller concentration in the blood
What are four traits about T4?
Higher concentration in blood
More protein binding
Less potency
Longer half-life
What does T4 and T3 stimulate in the negative feedback loop?
The ANTERIOR PIT! Not the hypothalamus
how does an increased thyroid hormone affect the body?
Increased Thyroid hormone > ^ BMR > ^ O2 consumption > ^ CO2 production
How does HYPER thyroid affect the heart?
Increased inotropy
Increased contractility
Increased lusitropy (rate of relaxation)
Decreased SVR
*** this also increased the number and sensitivity to beta receptors
How does hyperthyroidism affect the resp system?
Increased BMR > ^ O2 consumption ^ Ve (Increased RR)
How does hyperthyroidism affect the MAC?
Does not affect MAC
How does hyperthyroidism affect the GI system?
Hypermotility
How does hyperthyroidism affect the musculoskeletal?
Tremors
What is the diagnosis for hyperthyroidism?
Low TSH and high T3 and T4
What is the diagnosis for HYPOthyroidism?
High TSH, low T3 and T4
what is the most common cause of HYPERthyroidism?
Graves’s disease
What is the most common cause of HYPOthroidism?
Hashimoto’s thyroiditis
What is a complication of severe hypothyroidism?
Myxedema coma
Emergency surgery of a patient with hyperthyroid warrants administration of what?
Beta-blockers, glucocorticoids, potassium iodine and PTU should be started at this time
If a patient has a goiter, how should you anticipate the airway?
Awake intubation
When does hypocalcemia following Thyroid surgery usually occur?
24-48 hours after surgery
What is thyroid storm?
Medical emergency ~typically happens 6-18 hrs after surgery
Fever > 38.5
Tachycardia/afib
HTN
CHF
Shock
N&V
How do you manage thyroid storm?
Remember the 4 Bs
Block synthesis ~ PTU
Block Release ~ radioactive iodine
Block Conversion of T4 to T3 ~ PTU/propranolol
Block beta receptors ~ esmolol
What is the medical management for hypothyroidism?
Levothyroxine (synthetic T4)
Is an inhalation induction fast or slower with hypothyroidism?
FASTER
How does hypothyroidism affect MAC?
It doesn’t
What do osteoblasts do?
Bones cells that PROMOTE BONE DEPOSITION ~ they add Ca to the bone > reducing serum ionized Ca
What do osteoclasts do?!
Promote bone RESORPTION ~ remove Ca from bone to increase free ionized Ca
What is PTH MOA?
Site of release: parathyroid
Effect: ^ ionized Ca
^ Ca resorption from bone
Activates Calcitriol (increases Ca absorption in the gut)
^ Ava reabsorption from kidneys
What is Calcitonin MOA?
Site of release: thyroid gland
Effect: decreases ionized Ca
Increased Ca deposition (into bone)
Increases phosphate
What is the most common cause of hypercalcemia?
Primary hyperparathyroidism
What is the most common cause of secondary hyperparathyroidism?
Chronic kidney disease
(Remember renal osteodystrophy)
What is the most common cause of primary hypoparathyroidism?
Iatrogenic gland removal during thyroidectomy
What does the zona glomerulosa contain?
Mineralcorticoids (aldosterone)
“Minerals glow ~ merulosa”
What does the zona fasciculata contain?
Glucocorticoids
“Glucose/steroids make you fast ~ciculata”
What does the zona reticularis contain?
Androgens
“Reticular = testicular
What is the mnemonic for the adrenal cortex?
Glomerulosa ~ SALT
Fasciculata ~ SUGAR
Reticularis ~ SEX
What two catecholamines does the adrenal medulla create?
Epi (80%)
Norepinephrine (20%)
What 3 things is Aldosterone release increased by?
RAAS
Hyperkalemia
Hyponatremia
What is the primary glucocorticoid?
Cortisol
How does cortisol improve hemodynamics?
Increases the number and sensitivity of beta receptors on the myocardium ~ also required for the vasculature to respond to catecholamines
What medication is an analog of cortisol making it a perfect med to treat adrenocortical insufficiency (ADDISONS?
Prednisone
Equivalent dose is 5 mg
Which three synthetic steroids have ZERO mineralocorticoid effects?
Dexamethasone, betamethasone, and triamcinolone
What are the 3 most relevant endogenous steroids?
Cortisol
Cortisone
Aldosterone
What is cushing’s disease?
Excessive cortisol
What is addison’s disease?
Insuffiencient cortisol
What is Conn’s syndrome?
Excess aldosterone
What are the clinical features of Conn’s syndrome?
Increased aldosterone
Hypokalemia
HTN
Metabolic Alkalosis
Ingestion of what can mimic hyperaldosteronism?
Licorice!
What is an ACTH-dependent cause of Cushing disease?
Increase in ACTH stimulate cortisol release ~ pituitary adenoma
What is an ACTH-independent cause of Cushing’s disease?
Tumor releases cortisol regardless of ACTH
Adrenal cortex is messed up!
What are some glucocorticoid effects in Cushing’s disease?
HYPERglycemia
Weight gain (moon face, hump, central obesity)
Risk of infection
Osteoporosis musc weakness
What are some of the mineralocorticoid effects in Cushing’s disease?
Hypokalemia
HTN
Metabolic alkalosis
What are some of the androgens effects in Cushing’s disease?
Women become masculinized (hirsutism)
Men become feminized (impotence)
What is the treatment for Cushing’s disease?
Depends on type
Transsphenoidal resection if the pituitary gland (pituitary problem)
Adrenalectomy (if adrenal tumor)
What is Addison’s disease?
Primary Adrenal insufficiency (destruction of all cortical zones)
Autoimmune destruction of both adrenal glands > glands don’t secrete enough steroid hormones
Decreased production in all the zones! GFR!!
What is Acute adrenal crisis?
Medical emergency
Chronic adrenal insufficiency faced with a stressful moment.
Hemodynamic instability
Fever
Hypoglycemia
Impaired mental state
What are some features of Addison’s/AI?
Hypotension
Hypoglycemia
Hyperkalemia
Muscle weakness/fatigue
Metabolic acidosis
**hyperpigmentation
How do you treat acute adrenal crisis?
Steroid replacement therapy (hydrocortisone ~ 100 + 100-200 q 24h)
ECF volume expansion (D5NS)
Hemodynamic support
What would be the preoperative hydrocortisone dose for a superficial surgery? This is with a patient in continuous steroid therapy
None
What would be the preoperative hydrocortisone dose for a minor surgery? This is with a patient in continuous steroid therapy
25 mg IV
What would be the preoperative hydrocortisone dose for a moderate surgery? This is with a patient in continuous steroid therapy
50-75mg
What would be the preoperative hydrocortisone dose for a major surgery? This is with a patient in continuous steroid therapy
100 mg
What cell produces glucagon?
Alpha cells
What cells produce insulin?
Beta cells
What cells produce somatostatin?
Delta cells
What cells produce pancreatic polypeptide?
PP cells
What are some things that stimulate insulin release?
Anything that raises glucose will stimulate insulin release.
PNS stimulation (after eating a meal)
SNS stimulation
Beta agonists
Cortisol
catecholamines
What are some things that reduce insulin release?
Anything that reduces blood glucose will inhibit insulin.
Volatile anesthetics
Beta antagonists
What are some things that stimulate glucagon release?
Anything that reduces blood glucose will stimulate glucagon release
Hypoglycemia
Stress
Trauma
Sepsis
Beta agonists
What are some things that reduce glucagon release?
Anything that increases blood glucose will inhibit glucagon release
Somatostatin/insulin
What are some other indications for glucagon?
Glucagon increases myocardial contractility by increasing cAMP
Great for beta blocker overdose
CHF
Low CO after CPB
Improving MAP with anaphylaxis
What is somatostatin?
Growth hormone-inhibiting hormone ~ regulates hormone output from the islet cells.
Released by pancreatic delta cells
Inhibits insulin and glucagon
Inhibits splanchnic blood flow, gastric motility, and gall bladder contraction
What does pancreatic polypeptide do?
Inhibits pancreatic exocrine secretion, gallbladder contraction, gastric acid secretion, and gastric motility
Which two organs don’t need insulin for glucose uptake?
Brian and liver
What is the criteria for diabetes?
Fasting plasma glucose > 120
Random glucose > 200 (with symptoms)
Two-hour plasma glucose > 200 mg/dL during oral glucose test
A1C > 6.5%
What is type 1 DM characterized by?
Lack of insulin production
What is type II DM characterized by?
Lack of insulin + insulin resistance
What are the characteristics of metabolic syndrome?
Fasting glucose of 100-110
Abdominal obesity (> 40 in in men; > 35 in women)
Triglyceride > 150
HDL < 40 in M; < 50 in F
BP > 130/85
What is the BBG for a DMI patient in diabetic ketoacidosis?
> 250
What is the BBG for a DM II patient in hyperglycemia hyperosmolar state?
> 600 mg/dL
What is the classic triad of symptoms associated with diabetes mellitus?
Polydipsia
Polyuria
Dehydration
What sign is suggestive of an increased risk of difficult intubation in the DM patient?
Prayer sign.
What are four CV changes in a diabetic patient with autonomic neuropathy?
Orthostatic hypotension
Reduced vagal tone ~ tachycardia
Painless myocardial ischemia
Risk of dysrhythmias
What are the 3 main medications used to treat peripheral neuropathy?
Anticonvulsants
NSAIDs
Antidepressants
What are biguanides?
Metformin
Inhibit gluconeogensis and glycogenolysis in the liver and decrease insulin resistance
***THESE DO NOT CAUSE HYPOGLYCEMIA
What are the risks of biguanides?
Lactic acidosis
May cause vitamin B12 deficiency
Discontinue > 24 hours before surgery
What are Sulfonylureas?
End with “ide” ~ taking a “ride” on the Surf”
Stimulate insulin secretion from beta cells
What are the risk of sulfonylureas?
***RISK OF HYPOGLYCEMIA
avoid if sulfa allergy
^ cardiac morbidity in high-risk patients (inhibits myocardial conditioning)
***discontinue 24-48 hours before surgery
What are megalitinides?
End in “glinide” ~ “GLIDING in a MEGA LIT room”
Stimulate insulin secretion from beta cells
What are some risks with megalitinides?
HYPOGLYCEMIA
What are Thiazolidinediones?
“Get in the ZONE, the THIAZONE”
**rosiglitazone
Decreased peripheral insulin resistance and increased hepatic glucose utilitization
What are the risks of thiazolidinediones?
***NO HYPOGLYCEMIA
contraindicated in liver failure
Expands ECF~ risk of edema
Which oral hypoglycemia agents cause hypoglycemia?
Sulfonylurea
Megalitinides
Glucagon-like peptide-1receptor agonists
Dipeptidyl-peptides-4 inhibitors
Amylin Agonists (with insulin)
What is the only insulin that can be given IV?
Rapid acting ~ Regular insulin
How much total insulin output is there in a day?
40 U/day
Stimulation of what increases insulin secretion?
PNS stimulation
Beta-2
Stimulation of what decreases insulin secretion?
Alpha-2 stimulation
What is very rapid-acting insulin? What is it’s onset, peak, and Duraiton?
(Lispro, insulin aspart, glulisine)
O: 5-10
P: 45-75 mins
D: 3 hours
What is rapid-acting insulin? What is it’s onset, peak, and Duraiton?
Regular
O: 30 mins
P: 3 hours
D: 6-7 hrs
What is intermediate-acting insulin? What is it’s onset, peak, and Duraiton?
NPH
O: 2 hours
P: 6ish hours
D: 20ish hours
What is long acting insulin? What is it’s onset, peak, and Duraiton?
Detemir
Glargine
O: 2 hours
P: 7ish
D: 24
What is ultra-long acting insulin? What is it’s onset, peak, and Duraiton?
Degludec
O: 2 hours
P: ~
D: 40 hours
What are the goals of insulin therapy?
A1C < 7%
Before a meal ~ BBG 70-130
After a meal ~BBG < 180
What are the S&S of hypoglycemia?
SNS response
(Tachycardia, increased BP, diaphoresis)
BUT Brian requires glucose too ~ seizures, coma, brain damage, death
What drugs should you avoid in carcinoid syndrome?
Avoid drugs that precipitate hormone release ~
drugs that:
> release histamine (morphine)
> stimulate the SNS (ketamine)
> augment hormone increase (norepinephrine)
What is the primary treatment for carcinoid syndrome?
Octreotide
What are the most common signs of carcinoid syndrome?
Flushing and diarrhea
What are the 3 main hormones involved in carcinoid syndrome?
Histamine
Kinins and Kallikrein
Serotonin
What drugs should you give during carcinoid crisis?
Somatostatin (octreotide)
Antihistamines
5-HT3 antagonists
Steroids
Phenylephrine or vasopressin for hypotension
What drugs should you avoid in carcinoid syndrome?
Histamine-releasing drugs (morphine, meperidine, Atracurium, and sux)
Exogenous catecholamines
Sympathomimetic agents
Which drugs antagonize the hypoglycemia effect of insulin?
Epinephrine
Glucagon
