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Endocrine Flashcards

1
Q

Systemic hormones involved in hypothalamic negative feedback systems

A

T3 regulates TRH release
Cortisol regulates CRH
Testosterone, progesterone, and estrogen regulate LHRH
GH and Insulin GF-1 regulate GHRH and GHIH release

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2
Q

Causes of DI

A 
Pituitary surgery (Most common)
TBI or SAH
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3
Q

Causes of SIADH

A

TBI or SAH (most common)
Non-small cell lung CA
Noncancerous lung disease
Carbamazepine (anticonvulsant)

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4
Q

Treatment for SIADH

A

Fluid restriction

Hypertonic saline if Na

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5
Q

Treatment for DI

A

DDAVP / Vasopressin

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6
Q

Thyroid gland releases these three hormones

A

1) T4 (thyroxine) (pro-hormone)
2) T3 (Triiodothyronine) (ACTIVE hormone)
3) Calcitonin

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7
Q

Release of thyroid stimulating hormone from the pituitary tells the thyroid gland to do what two things?

A

1) Make T4 and T3 (requires iodine)

2) Tells the follicular tissue to make thyroglobulin colloid (does NOT require iodine)

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8
Q

CV effects of hyperthyroidism

A

Will see an increase in the number and sensitivity of B receptors

  • Increased everything heart (HR, inotropy, CO, etc)
  • Decreased SVR (B2)
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9
Q

GI effects of hyperthyroidism

A

DIARRHEA

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10
Q

Metabolic effects of hyperthyroidism

A

Increased BMR
Utilization of fat stores –> weight loss
Protein breakdown for energy (muscle wasting and weakness)
Release of glucose for energy (increased gluconeogenesis, insulin release, and glucose uptake)

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11
Q

Cause of tremors in hyperthyroidism

A

Increased sensitivity of neuronal synapses in the spinal cord

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12
Q

Most common cause of hypothyroidism

A

Hashimoto’s thyroiditis

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13
Q

Diagnosis of hyperthyroidism

A

High T3 and T4

Low TSH

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14
Q

Diagnosis of hypothyroidism

A

Low T3 and T4

High TSH

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15
Q

Timing of thyroid storm

A

Usually 6-18 hours post-op

Can happen in both hyperthyroid AND euthyroid patients

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16
Q

This medication can induce hyperthyroidism OR hypothyroidism

A

Amiodarone (contains a lot of iodine)

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17
Q

Why is esmolol a good choice for hyperthyroid patients?

A

They have increased Beta receptors
Short acting
Inhibits the conversion of T4 to T3

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18
Q

MOA and examples of thioamides and what are their SEs?

A

Examples:

  • PTU
  • Mathimazole
  • Carbimazole

MOA:

  • Inhibits TH synthesis by blocking the addition of iodine to the tyrosine residues on thyroglobulin
  • Also prevents peripheral conversion of T4 to T3 (like BBs)
  • Takes 6-7 weeks to work
  • PO form only

Serious SE:

  • Hepatitis
  • Agranulocytosis
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19
Q

These medications should be avoided in the pt with hyperthyroidism

A

Anything that activates the SNS!
- Anticholinergics, ketamine, pancuronium, etc

Also avoid hypoxia and hypercarbia because these can stimulate the SNS as well

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20
Q

S/S of thyroid storm

A 
Fever > 38.5C
Tachycardia and tachyarrhythmias 
HTN
CHF
Shock
Confusion and agitation
N/V
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21
Q

Under anesthesia, thyroid storm may mimic

A

MH
Pheochromocytoma
Neuroleptic malignant syndrome
Light anesthesia

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22
Q

Management of thyroid storm

A 
Manage hemodynamics (BBs)
Treat fever (active cooling and tylenol)
PTU or methimazole (crushed via NGT)
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23
Q

Anesthetic considerations for hypothyroidism

A
  • Risk of airway obstruction (large tongue, swollen cords, possible goiter)
  • Delayed gastric emptying
  • Hypodynamic circulation (opposite of hyperthyroid)
  • Hemodynamic support is best with drugs that improve myocardial performance (i.e- NOT phenylephrine)
  • Muscle weakness = sensitivity to NMBs)
  • D5NS for glucose and to combat hyponatremia
24
Q

Aldosterone release is increased by

A

RAAS Activation
Hyponatremia
Hyperkalemia

25
Effects of aldosterone in the kidney
Reabsorption of Na Excretion of K+ and H+ Net effect is increasing intravascular volume NO effect on osmolarity (this is controlled by ADH)
26
Physiologic effects of cortisol
Remember, this binds to steroid receptors within the cell to alter DNA transcription and protein synthesis. Takes a while to start working. THREE BIG THINGS 1) Energy mobilization - Gluconeogenesis (in liver from amino acids) - Protein catabolism (to make glucose) - FFA mobilization (to make glucose) 2) Anti-inflammatory effects - Stabilizes the membranes of lysosomes, which reduces cytokine release - Decreased amount of eosinophils and lymphocytes in the blood 3) Increased response to catecholamines - Improves cardiac performance by increasing the number and sensitivity of Beta receptors on the myocardium - Cortisol is also needed to BVs to respond well to catecholamines Also has androgenic effects
27
Normal cortisol production per day
15-30mg per day | May increase to 100mg per day after major surgery
28
Cortisol's mineral/glucocorticoid effects
Has EQUAL glucocorticoid and mineralcorticoid effects
29
These steroids have the strongest glucocorticoid effects
Dexamethasone and betamethasone
30
This is the strongest mineralcorticoid
Aldosterone | Also has NO glucocorticoid effect
31
Cortisol vs. cortisone
Cortisol and cortisone BOTH have equal gluc/min properties. Cortisone is 0.8x as potent
32
These glucocorticoids have NO mineralocorticoid effects
Dexamethasone, betamethasone, and triamcinolone
33
Treatment of Conn's Syndrome
- Aldosterone antagonist (Spironolactone or elperenone) - K+ supplementation - Na+ restriction
34
S/S of Cushing's Syndrome
Break it down by cortisol's clinical effects 1) Glucocorticoid effects - Hyperglycemia - Increased risk of infection - Weight gain - Osteoporosis - Muscle weakness (catabolism to make glucose) - Mood disorder 2) Mineralocorticoid effects - Think of effects of too much aldosterone, Na reabsorption, and K+ and H+ excretion: - HTN - Hypokalemia - Metabolic alkalosis 3) Androgenic effects - Women become masculinized - Men become feminized
35
Anesthetic implications for Cushin's disease
- Infection risk - Position with osteoporosis - Consider supplemental steroids - DI may develop after removal of anterior pituitary
36
Most common cause of Addison's disease
Chronic steroid administration
37
S/S of Addison's disease
Opposite of Cushing's - Hypoglycemia - Anorexia and weight loss - Fatigue and muscle weakness - HypoTN - N/V - Hyperpigmentation of the knees, elbows, knuckles, lips, and buccal mucosa Acute adrenal crisis - Hemodynamic instability and collapse - Hypoglycemia - Fever - Impaired mental status
38
Treatment of acute adrenal crisis
- Exogenous steroids (Hydrocortisone) - ECF expansion (D5LR) - Hemodynamic support
39
This steroid is given for those who need supplemental steroid peri-op
Hydrocortisone
40
What does insulin tell the body to do?
Time to store energy! Released when we eat. So it tells the body we have a surplus, and it's time to store it for the future. - Increases uptake into skeletal muscle, liver, and fat - Glycogen formation - Fat formation - Encouraging protein synthesis
41
Diagnosis of DM
Fasting glucose > 125 Randome glucose level > 200 Two hour plasma glucose > 200 during glucose tolerance test HbA1C > 6.5
42
Metabolic syndrome diagnosis
At least 3 of the following: - Fasting glucose > 110 - Abdominal obesity (>40 inches for men and 35 for women) - TG > 150 - HDL 130/85
43
ANS dysfunction in DM
- Painless MI - Reduced vagal tone --> tachycardia - Risk of dysrhythmias - Orthostatic hypoTN - Impaired compensation to hypoxia and hypercarbia - Delayed gastric emptying - Impaired thermoregulation (risk of hypothermia) - Constipation and diarrhea
44
Give an example of a biguanide and how do they work? Give some key facts about this class of drugs
Metformin MOA: - Inhibits gluconeogenesis - Inhibits glycogenolysis - Decreases peripheral insulin resistance Key facts: - NO risk of hypoglycemia*** - Discontinue 48 hours prior to surgery - Risk of acidosis 2/2 increased anaerobic metabolism - Increased risk of lactic acidosis with drug accumulation (so avoid if liver or renal dz, acute MI, contrast being given, etc) - May cause vitamin B12 deficiency - Used for PCOS
45
Give an example of a sulfonylurea and how do they work? Give some key facts about this class of drugs
Examples: - Glipizide - Glyburide - Glimepiride MOA: - Stimulates release of insulin from beta cells Facts: - Risk of hypoglycemia! - Avoid in sulfa allergies - D/C 48 hours prior to surgery
46
These classes of oral hypoglycemics do NOT carry a risk of hypoglycemia
- Biguanides - Alpha-glucosidase inhibitors - Thiazolidinediones
47
These are VERY RAPID acting insulins
Lispro Aspart Glulisine All have onset of 5-15 minutes All peak 45-75 minutes All have duration of 2-4 hours
48
Insulin resistance occurs once daily insulin requirement excess ____ units/day
100
49
These drugs make insulin induced hypoglycemia even worse
MAOIs ASA Tetrycycline
50
Common S/S of carcinoid syndrome
If carcinoid hormones are NOT cleared by the liver, then they cause: - Flushing and diarrhea (Most common!!) From histamine: - Bronchoconstriction - Vasodilation (flushing) - HypoTN From kinins and kallikrein: - Bronchoconstriction - Vasodilation and flushing - HypoTN - Exacerbates histamine release From serotonin: - Bronchoconstriction - Vasoconstriction - HTN - SVT - Increased GI motility
51
S/S of carcinoid crisis
Tachy HTN or HypoTN Intense flushing Abd pain and diarrhea
52
Drugs to give and avoid in carcinoid patients
GIVE: - Somatostatin (Octreotide) - Antihistamines - Serotonin antagonists - Steroids - Pressors for hypoTN (phenylephrine and vasopressin) AVOID: - Histamine releasing drugs - Sux (fasciculations can cause hormone release from tumor) - Exogenous catecholamines may worsen hormone release - Anything that stimulates the SNS (ephedrine and ketamine)
53
When is GH released?
- Fasting - Hypoglycemia - Decreased FFAs - Increased amino acids - Sleep - Stress and anxiety - GHRH from pituitary - Dopamine - Estrogen - Alpha agonists
54
Most common cause of cushing's syndrome
Chronic glucocorticoid therapy
55
Effects of GH (somatotropin)
- Facilitates growth everywhere in the body - Increases protein synthesis - Enhances use of FFAs for energy

Board Exam (21 decks)

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