Endocrine

Question 1

What is the blood supply to the adrenal glands?

Answer 1

3 arteries

1 draining vein

Question 2

Which g-proteins are the adrenergic receptors coupled to?

Answer 2

beta-1 and beta-2: Ga_s

alpha-1: Ga_q

alpha-2: Ga_i

Question 3

What is the “rule of 10” for pheochromocytoma?

Answer 3

10% bilateral

10% extra-adrenal

10% familial (MEN type II, von Hippel-Lindau, neurofibromatosis)

10% malignant

Question 4

What is the pharmacologic preparation for pheochromocytoma removal?

Answer 4

alpha blockade (phenoxybenzamine or nicardipine)

encourage salt and fluid intake (avoid postural hypotension)

beta blockade after alpha blockade

Question 5

What kinds of drugs should be avoided during pheochromocytoma surgery?

Answer 5

histamine release (morphine)

catecholamine release (pancuronium, ketamine, ephedrine)

Question 6

What are currently the most commonly used drugs to treat hypertension during pheochromocytoma surgery?

Answer 6

nicardipine

phentolamine

Question 7

What happens to the norepinephrine requirement after pheochromocytoma removal?

Answer 7

increased, due to receptor insensitivity

(addition of vasopressin is helpful)

Question 8

How can you assess a diabetic patient for stiff joint syndrome and possible difficult intubation?

Answer 8

“prayer sign” - inability to oppose palmar surfaces may indicated need for smaller ETT and difficult airway equipment