Endocrine 2 Flashcards
Anesthetic considerations for the patient with diabetes insipidus include:
a. sodium restriction
b. DDAVP
c. three percent sodium chloride
d. demeclocycline
b. DDAVP
The most common cause of diabetes insipidus is
pituitary surgery
Syndrome of inappropriate ADH secretion is caused by
an excessive level of ADH in the blood
Diabetes insipidus is caused by
too little ADH in the blood
The most common cause of SIADH is
traumatic brain injury
Describe urine output for SIADH
low urine output
Describe urine output for DI.
high urine output
Treatment of SIADH includes
fluid restriction, demeclocycline, and hypertonic saline if the patient is severely hyponatremic
Treatment of DI includes
DDAVP or vasopressin along with supportive measures
__________ can complicate airway management
Acromegaly
Considerations with acromegaly include
distorted facial features (difficult mask)
large tongue, teeth, and epiglottis (difficult laryngoscopy
subglottic narrowing and vocal cord enlargement (difficult ETT placement)
turbinate enlargement (risk of epistaxis)
Comorbidities associated with acromegaly include
glucose intolerance
OSA
CAD
skeletal muscle weakness
entrapment neuropathies
Other conditions that can cause SIADH include
cancer (small-cell lung carcinoma)
noncancerous lung disease
carbamazepine
Other conditions that can cause DI include
TBI
SAH
Acromegaly results from
over secretion of growth hormone after adolescence
Nearly all cases of acromegaly are caused by
pituitary adenoma
When compared to T4, which statements BEST describe T3? (select 2)
a. shorter half-life
b. higher concentration in the blood
c. more protein-bound
d. higher potency
a. shorter half-life
d. higher potency
The thyroid gland stores and secretes three hormones:
T4= thyroxine
T3= triiodothyronine
calcitonin
Thyroxine is a
prohormone synthesized from tyrosine
Triiodothyronine is an
active thyroid hormone
Calcitonin leads to
reduced serum Ca2+
The thyroid requires ______ to synthesize T3 and T4
iodine
When iodine is not available due to __________, the thyroid gland cannot
dietary deficiency; produce enough T3 and T4
The recurrent laryngeal nerve courses along
the lateral border of each thyroid lobe
RLN is at risk for injury during
thyroid or parathyroid surgery
Describe the source of T4 & T3
T4 is directly released from the thyroid
T3 is mostly extra-thyroid conversion of T4 to T3
Which has more protein binding T4 or T3
T4
Which has more potency T4 or T3?
T3
Which has a shorter half-life?
T3
In the patient with hypoactive thyroid, there
isn’t enough thyroid hormone to suppress TSH so TSH remains chronically elevated–> goiter
The following are consequences of excess thyroid hormone EXCEPT:
a. vasodilation
b. diarrhea
c. hypoventilation
d. tremors
c. hypoventilation
Increased thyroid hormone–> ___BMR–> ______O2 consumption –> ______ Co2 production
increases all of them
Thyroid hormone increases
myocardial performance independent of ANS input- increased HR, increased contractility, increased lusitropy, and decreased SVR
Thyroid disorders ______ MAC
do NOT
Instead of affecting MAC, thyroid disorders affect
cardiac output which impacts the speed of anesthetic onset
How do hypothyroidism and hyperthyroidism affect the speed of anesthetic onset?
hypothyroidism–> increases speed of onset
hyperthyroidism–> reduces the speed of onset
_________ is the most common cause of hyperthyroidism
Grave’s disease
____________ is the most common cause of hypothyroidism
Hashimoto’s thyroiditis
Etiologies of hyperthyroidism include
Grave’s disease
MG
multinodular goiter
carcinoma
pregnancy
pituitary adenoma
amiodarone
Diagnosis of hyperthyroidism includes
Low TSH
high T3 & T4
Cardiac symptoms of hyperthyroidism include
hypertension
tachyarrhythmias
atrial fibrillation
Pulmonary symptoms of hyperthyroidism include
increased minute ventilation
General findings of hyperthyroidism include
goiter
weight loss
muscle weakness
moist and warm skin
heat intolerance
fine hair
diarrhea
tremor
exophthalmos
hypercalcemia
Etiologies of hypothyroidism include
Hashimoto’s thyroiditis
iodine deficiency
hypothalamic-pituitary dysfunction
neck radiation
thyroidectomy
amiodarone
Diagnosis of hypothyroidism includes
high TSH and low T3 and T4
Cardiac symptoms of hypothyroidism include
peripheral vasoconstriction
decreased heart rate
decreased contractility
heart failure
pericardial effusion
Pulmonary symptoms of hypothyroidism include
decreased minute ventilation
reduced response to hypoxia
reduced response to hypercarbia
pleural effusion
General findings with hypothyroidism include
goiter
weight gain
muscle fatigue/lethargy
dry and thick skin
cold intolerance
dry, brittle hair
constipation
delayed gastric emptying
large tongue
What is thyroid storm?
in response to stressful events the thyroid glands increase hormone output
When can thyroid storm occur?
hyper and euthyroid patients
During the perioperative period, thyroid storm is most likely to happen
6-18 hours after surgery
_________ is a complication of severe hypothyroidism
myxedeme coma
_______ is a complication of neonatal hypothyroidism that leads to limited physical and mental development
Cretinism
