Endocrine 4 Flashcards

1
Q

_________ are bone cells that promote bone deposition

A

Osteoblasts

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2
Q

__________ are bone cells that promote bone resorption

A

Osteoclasts

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3
Q

Osteoblasts add Ca2+ to the bone which

A

reduces the ionized Ca2+ concentration in the blood

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4
Q

Describe the process for decreased Ca2+ levels

A

parathyroid glands release PTH–> osteoclasts release Ca2+ from bone–> Ca2+ is reabsorbed by the kidneys–> Ca2+ absorption in the small intestine increases vitamin D synthesis–> Ca2+ level in blood increases

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5
Q

Describe the process for increased Ca2+ levels

A

thyroid gland releases calcitonin–> osteoclast activity is inhibited–> Ca2+ reabsorption in the kidneys decreases–> ca2+ level in blood decreases

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6
Q

After the parathyroid gland is removed, a decline in ________ indicates successful removal

A

PTH level

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7
Q

Signs and symptoms of hypoparathyroidism include

A

hypotension
myocardial depression
long QT interval
tetany
seizures
paresthesias
muscle spasms
abdominal cramping

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8
Q

Signs and symptoms of hyperparathyroidism include

A

hypertension
short QT interval
confusion
lethargy
psychosis
bone pain
osteopenia
pathologic fractures
muscle weakness
anorexia
N/V
abdominal pain
peptic ulcer disease
pancreatitis
polyuria
polydipsia
kidney stones

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9
Q

Match each region of the adrenal gland with the class of hormones it produces:
zona glomerulosa
adrenal medulla
zona reticularis
zona fasciculata
androgens
catecholamines
mineralocorticoids
glucocorticoids

A

Zona fasciculata- glucocorticoids
zona glomerulosa- mineralocorticoids
zona reticularis- androgens
adrenal medulla- catecholamines

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10
Q

The adrenal gland is divided into

A

the cortex and the medulla

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11
Q

The cortex synthesizes and releases 3 classes of steroids:

A

mineralocorticoids (aldosterone)
glucocorticoids (cortisol)
androgens (sex hormones)

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12
Q

The medulla synthesizes and releases 2 cathecolamines:

A

epinephrine (80%)
norepinephrine (20%)

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13
Q

Aldosterone release is caused by

A

RAAS activation
hyperkalemia
hyponatremia

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14
Q

Aldosterone stimulates the kidney to

A

conserve sodium and water and excrete potassium and hydrogen

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15
Q

_________ increases cortisol production

A

Stress

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16
Q

Increased cortisol initiates

A

gluconeogenesis, protein catabolism, and fatty acid mobilization

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17
Q

Cortisol mitigates ____________ by reducing cytokine release

A

the inflammatory cascade

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18
Q

Cortisol imrpoves

A

myocardial performance

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19
Q

The zona glomerulosa secretes

A

mineralocorticoids

20
Q

The zone fasciculata secretes

A

glucocorticoids

21
Q

The zona reticularis secretes

A

androgens

22
Q

The medulla secretes

A

catecholamines

23
Q

Cortisol production is

A

15-30 mg/day

24
Q

Normal serum cortisol levels are

A

12 mcg/dL

25
Q

Cortisol is required for the vasculature to respond to

A

the vasoconstrictive effects of catecholamines

26
Q

How does cortisol production change in response to perioperative stress?

A

major perioperative stress can increase cortisol production upwards of 100 mg/day with a serum level up to 30-50 mcg/dL

27
Q

What are the hemodynamic effects of cortisol?

A

cortisol improves myocardial performance by increasing the number and sensitivity of beta receptors on the myocardium

28
Q

Order each drug in terms of its glucocorticoid potency
dexamethasone
aldosterone
methylprednisolone
aldosterone

A

dexamethasone
methylprednisolone
cortisol
aldosterone

29
Q

_________ has equal glucocorticoid and mineralocorticoid effects

A

Cortisol

30
Q

______ does NOT have glucocorticoid effects

A

aldosterone

31
Q

_________ is an analog of cortisol, making it a good choice to treat adrenocortical insufficiency (Addison’s disease)

A

Prednisone

32
Q

The following do NOT have mineralocorticoid effects

A

dexamethasone
betamethasone
triamcinolone

33
Q

Triamcinolone is commonly adminsitered

A

in the epidural space to treat lumbar disc disease

34
Q

Triamcinolone is unique because it is associated with

A

a higher incidence of skeletal muscle weakness & more likely to cause sedation and anorexia

35
Q

What are the 3 most relevant endogenous steroids?

A

cortisol
aldosterone
cortisone

36
Q

Primary hyperaldosteronism is caused by

A

excessive aldosterone release

37
Q

Primary hyperaldosteronism is known as

A

Conn’s syndrome

38
Q

Etiologies of primary hyperaldosteronism include

A

aldosteronoma
pheochromocytoma
primary hyperthyroidism

39
Q

_____________________ causes a syndrome that highly resembles hyperaldosteronism

A

Long-term licorice ingestion

40
Q

Anesthetic considerations for the patient with Conn’s syndrome inclue

A

hypertension & hypokalemia

41
Q

What’s the difference between primary and secondary hyperaldosteronism?

A

primary: aldosterone release from adrenal gland
secondary: stimulus from extra-renal location

42
Q

Clinical features of Conn’s syndrome include

A

hypertension
hypokalemia
metabolic alkalosis (H+ wasting)

43
Q

Treatment of Conn’s syndrome includes

A

removal of aldosterone secreting tumor
aldosterone antagonists (spironolactone or eplerenone)
potassium supplementation
Na+ restriction

44
Q

S/sx of hypokalemia include

A

muscle weakness/cramping
increased sensitivity to non-depolarizing NMBs
U wave on EKG
avoid hyperventilation

45
Q

Name a cause of secondary hyperaldosteronism

A

renovascular hypertension