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6901 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

3 types of hormones

A
  • peptide/protein: stored in granules then released: insulin, ADH GH
  • amino/amino: catecholamines, thyroxine
  • lipids: derived from cholesterol, not stored, usually bound to plasma proteins: steroid
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2
Q

hormone control mechanisms (3)

A
  • neural
  • biorhythms
  • feedback
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3
Q

endocrine system

A
  • regulation of behavior
  • growth
  • metabolism
  • fluid status
  • development
  • reproduction
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4
Q

pituitary gland

A
  • pea-sized gland in sella turcica (sphenoid bone)

- connected to hypothalamus by hypophyseal stalk

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5
Q

anterior pituitary gland

A
  • 80% of pituitary
  • communicates with hypothalamus via vascular system
  • GH, TSH, ACTH, FSH, LH, prolactin
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6
Q

posterior pituitary gland

A
  • communicates with hypothalamus via neural pathways (hormones already synthesized)
  • ADH, oxytocin
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7
Q

panhypopituitarism

A
  • lack of all pituitary hormones

- more common than a decrease in a single hormone

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8
Q

pituitary gland: hyposecretion - causes

A
  • large nonfunctional pituitary tumors
  • postpartum shock
  • irradiation
  • trauma
  • hypophysectomy
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9
Q

pituitary gland: hyposecretion - treatment

A
  • require thyroid and steroid replacement peri-op
  • diabetes insipidus after removal: have vasopressin
  • surgical approach is transphenoidal
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10
Q

anterior pituitary: hyposecretion - transphenoidal approach considerations

A
  • sitting position
  • precordial doppler and EtCO2 monitoring for air embolism
  • smooth intubation and extubation
  • quick emergence to allow for neuro checks
  • no N2O
  • intraoperative muscle relaxation
  • will have nasal packing
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11
Q

anterior pituitary: hyposecretion - transphenoidal approach complications

A
  • CSF leak
  • meningitis
  • ischemic stroke
  • visual loss
  • diabetes insipidus
  • hyponatremia
  • epistaxis
  • cranial nerve damage
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12
Q

anterior pituitary: hypersecretion of growth hormone - acromegaly

A
  • bones and organs are enlarged
  • lung volumes increase with increased extrathoracic obstruction
  • coarse facial features
  • glucose intolerance and diabetes
  • cardiac problems

**caution with airway: mask fit difficult, smaller ETT due to larger vocal cords, OSA, difficult DL

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13
Q

posterior pituitary: ADH release

A
  • 284 mOsm/L
  • 10-20% decrease in plasma volume or BP: baroreceptors send signal via vagal and glossopharyngeal nerves
  • pain
  • emotional stress
  • nausea

**surgery increases ADH release

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14
Q

posterior pituitary: diabetes insipidus treatment

A
  • neurogenic versus nephrogenic
  • vasopressin (short term), desmopressin (long term)
  • monitor plamsa osm, UOP, Na qh
  • isotonic fluids if serum osm < 290, hypotonic if >290
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15
Q

posterior pituitary: SIADH treatment

A
  • fluid restriction

- hypertonic saline with lasix

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16
Q

what is the rate limiting step in thyroid hormone formation?

A

iodide trapping - which is under the control of TSH

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17
Q

thyroid gland: effects of hormone

A
  • increased metabolic rate and heat production
  • increased O2 consumption
  • increased heart, liver, kidney function
  • role in growth and development
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18
Q

thyroid gland: hormones secreted

A
  • T4: most abundant, less potent, non-active
  • T3: less abundant, more potent, active
  • calcitonin: regulates short term calcium
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19
Q

thyroid gland: nerves nearby

A
  • recurrent laryngeal

- external motor branch of superior laryngeal

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20
Q

thyroid gland: location

A
  • below larynx

- both sides and anterior of trachea

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21
Q

thyroid gland: thyrotoxicosis S/S

A
  • goiter
  • tachycardia
  • heat intolerance
  • weight loss
  • eye signs
  • a-fib
  • skeletal muscle weakness
  • anxiety
  • tremor
  • insomnia
  • fatigue
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22
Q

thyroid gland: thyrotoxicosis diagnosis

A
  • low TSH

- high T4

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23
Q

thyroid gland: thyrotoxicosis treatment

A
  • inhibit hormone synthesis (methimazole, propylthiouracil)
  • prevent hormone release (potassium, sodium iodine)
  • mask adrenergic overactivity
  • radioactive iodine
  • surgical removal
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24
Q

thyroid gland: thyrotoxicosis preoperative management

A
  • needs to be euthyroid
  • continue antithyroid and BB
  • assess airway: enlarged thyroid can cause tracheal deviation
  • blood volume increased, PVR decreased, pulse pressure wide
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25
Q

thyroid gland: thyrotoxicosis intraoperative management

A
  • avoid SNS stimulation (no ketamine, pancuronium, atropine)
  • monitor core temperature
  • treat hypotension with direct-acting vasopressors
  • avoid hypercarbia and hypoxia (because they stimulate SNS)
  • increased incidence of myopathies and myasthenia gravis: no muscle relaxants after induction
  • ETT with NIM (+ electrodes on vocal cords)
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26
Q

thyroid gland: thyroid storm occurrence time

A
  • anytime in peri-op period

- most likely 6-18 hours post-op

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27
Q

thyroid gland: thyroid storm versus malignant hyperthermia

A

-malignant hyperthermia has sudden rise in EtCO2 and trismus

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28
Q

thyroid gland: thyroid storm treatment

A
  • iv hydration with glucose-containing fluids
  • Tylenol (cooling)
  • BB
  • potassium iodide
  • correct electrolyte and acid-vase imbalances
  • antithyroid drugs
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29
Q

thyroid gland: recurrent laryngeal nerve palsy

A
  • unilateral: hoarseness

- bilateral: aphonia and stridor = immediately reintubate

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30
Q

thyroid gland: hypothyroidism S/S

A
  • myxedema
  • lethargy
  • hypotension
  • bradycardia
  • CHF
  • gastroparesis
  • hypothermia
  • hypoventilation
  • hyponatremia
  • poor mentation
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31
Q

thyroid gland: hypothyroidism diagnosis

A
  • low T4

- high TSH

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32
Q

thyroid gland: hypothyroidism preoperative assessment

A
  • myocardial function and baroreceptors may be depressed

- airway evaluation: large thyroid gland and tongue, myxedematous

33
Q

thyroid gland: hypothyroidism peri-operative

A
  • -hypotension: reduced plasma volume
  • sensitive to non-depolarizers
  • less sensitive to inotropic drugs
  • slower GI emptying
  • monitor core temperature
  • risk for hypoxia and hypercarbia
34
Q

thyroid gland: myxedemia

A
  • high risk of anesthetic complications
  • hypothyroidism, hypothermic, hypoventilation, hyponatremic
  • only life-saving surgeries
35
Q

90% of the time hyperparathyroidism is due to _____

A

adenoma

36
Q

parathyroid gland: hyperparathyroidism diagnosis

A

-high Ca and PTH levels

37
Q

parathyroid gland: hyperparathyroidism S/S

A
  • profound muscle weakness
  • confusion
  • N/V
  • lethargy
  • calcifications
38
Q

parathyroid gland: hyperparathyroidism treatment

A
  • hypercalcemia if treated with isotonic saline and loop diuretics
  • surgical removal
39
Q

parathyroid gland: hyperparathyroidism operative considerations

A
  • dehydration
  • avoid preop sedatives
  • hyperventilation decreases ionized calcium, more calcium is bound
  • sensitive to NM blockers (especially sux)
  • treat arrhythmias and HTN with calcium channel blockers
40
Q

parathyroid gland: hypoparathyroidism operative consideration

A
  • potential for hypocalcemia and laryngospasm

- avoid hyperventilation decreases ionized calcium

41
Q

pancreas - secretory cells

A

islets of langerhans

beta=insulin
alpha=glucagon
delta=somatostatin
F cell=pancreatic polypeptides

42
Q

average patient with diabetes will spend ____ more time in the hospital recovering from surgery

A

50%

43
Q

diabetes: chronic complications

A
  • HTN
  • peripheral, retinal, and cerebral vascular disease
  • increased risk of silent MI
  • autonomic neuropathy
  • renal failure
44
Q

diabetes: anesthesia considerations

A
  • evaluate end order damage
  • evaluate cardiac status
  • gastroparesis with delayed gastric emptying
  • impaired respiratory response to hypoxia
  • limited-mobility joint syndrome
  • neuropathies
  • kidney function
45
Q

diabetes: cardiac-diabetic autonomic neuropathy

A
  • HTN
  • orthostatic hypotension
  • lack of HR variability
  • resting tachycardia
  • lack of sweating
  • silent MI
  • asymptomatic hypoglycemia
  • reduced HR response to atropine or propranolol
46
Q

diabetes: anesthesia care

A
  • first case of day
  • fluids=normal saline, no lactated ringers
  • half or hold dose
  • measure glucose
47
Q

diabetes: metformin

A
  • hypotension
  • renal impairment
  • lactic acidosis

*hold 48 hours prior to surgery

48
Q

diabetes: avoid ____ when patient takes NPH because it causes _____

A

protamine – anaphylaxis

49
Q

diabetes: hypoglycemia S/S

A
  • diaphoresis
  • tachycardia
  • nervousness
  • confusion
50
Q

diabetes: hypoglycemia treatment

A

-25-50 mL of D50, followed by D5 drip

51
Q

in a 70kg pt, ___ mL of ____ can be expected to raise the blood glucose concentration by _____ mg/dL

A

15 mL

d50

30 mg/dL

52
Q

diabetes: diabetic ketoacidosis

A
  • type 1
  • volume depletion and hyperglycemia
  • fruity odor to breath
  • Kussmaul respirations
  • metabolic acidosis
  • coma
53
Q

diabetes: diabetic ketoacidosis triad

A
  • hyperglycemia
  • acidemia
  • ketonemia
54
Q

diabetes: diabetic ketoacidosis and hyperglycemia hyperosmolar state treatment

A
  • IV insulin
  • fluids
  • correct electrolyte and acid/base imbalances
55
Q

diabetes: hyperglycemia hyperosmolar state

A
  • type II
  • glucose > 600
  • hypovolemia and hypotension
  • seizures, coma
  • tachycardia
56
Q

adrenal glands: hormones

A

adrenal cortex: mineralcorticoids (aldosterone), glucocorticoids (cortisol), androgens

adrenal medulla: catecholamines (norepinephrine, epinephrine)

57
Q

adrenal glands: cortisol function (4)

A
  • gluconeogenesis
  • protein mobilization
  • fat mobilization
  • stabilizes lysosomes
58
Q

adrenal glands: hyperaldosteronism types

A
  • primary (Conn syndrome): from adrenal adenoma

- secondary: increased renin production

59
Q

adrenal glands: hyperaldosteronism anesthetic plan

A
  • correct fluid/electrolyte balance
  • HTN: spironolactone is aldosterone antagonist
  • avoid hyperventilation because it drives K into cells
  • monitor EKG and muscle relaxants due to low K
60
Q

adrenal glands: Cushing syndrome anesthetic plan

A
  • correct fluid/electrolyte balance
  • care with skin and positioning
  • increased infection risk
  • supplement steroids
61
Q

adrenal glands: Addison’s disease anesthetic plan

A
  • correct fluid/electrolyte balance

- steroid replacement

62
Q

adrenal glands: Addison’s disease S/S

A
  • all 3 hormones deficient
  • hyperpigmentation
  • weight loss, fatigue, weakness
  • hypotension, hyponatremia, hyperkalemia, hypoglycemia
63
Q

what induction medication should be avoided in Addison’s disease and why

A

-etomidate: interferes with steroids

64
Q

adrenal glands: pheochromocytoma definition

A
  • catecholamine-secreting tumor

- can be malignant, bilateral, and extra-adrenal

65
Q

adrenal glands: pheochromocytoma S/S (4)

A
  • paroxysmal headache
  • hypertension
  • sweating
  • palpitations
66
Q

adrenal glands: pheochromocytoma diagnosis

A
  • urine metanephrine level: false positive due to coffee, tricycles, phenoxybenzamines
  • suppression test: clonidine decreases catecholamines that are neurogenically controlled
67
Q

adrenal glands: pheochromocytoma pre-operative

A
  1. alpha blocker (phenoxybenzamine titrate to 1 mg/kg by 10-20 mg every 2-3 days)
  2. beta blocker
68
Q

adrenal glands: pheochromocytoma pre-operative treatment endpoints

A
  • BP <160/90
  • <1 PVC q5min
  • presence of orthostatic hypotension
  • absence of EKG changes for 1 week
  • HCT <5% for adequate intravascular volume expansion
69
Q

adrenal glands: pheochromocytoma anesthetic considerations

A
  • A-line
  • 2 large bore IV
  • CVP
  • deep intubation
  • Foley
  • anticipate labile BP, avoid SNS stimulation (ketamine, ephedrine) and histamine release (morphine, atracurium)
70
Q

multiple endocrine neoplasia: MEN 1

A
  • parathyroid
  • pancreatic
  • pituitary
71
Q

multiple endocrine neoplasia: MEN 2

A
  • medullary thyroid
  • pheochromocytoma
  • parathyroid
72
Q

multiple endocrine neoplasia: MEN 3

A
  • mucosal neuromas
  • pheochromocytoma
  • medullary thyroid
73
Q

carcinoid syndrome: definition

A
  • complex of S/S caused by the secretion of vasoactive substances from enterochromaffin cells
  • serotonin (constrict), histamine (dilate), kallikrein (dilate)
  • mainly in GI tract
74
Q

carcinoid syndrome: S/S (5)

A
  • R sided heart failure
  • dramatic BP swings
  • cutaneous flushing
  • bronchospasm
  • diarrhea and abdominal pain
75
Q

carcinoid syndrome: pre-operative

A
  • histamine blocker
  • octreotide (2 weeks)
  • evaluate extra-intestinal manifestations
76
Q

carcinoid syndrome: anesthetic considerations

A
  • A-line
  • 2 large bore IV
  • CVP
  • deep intubation
  • steroids, histamine blockers
  • avoid histamine releasing substances
  • vasopressin for refractory hypotension
  • have octreotide available
77
Q

liver’s role in carbohydrate metabolism (3)

A
  • glycogenesis
  • glycogenolysis
  • gluconeogenesis
78
Q

glucose transporters (4)

A

GLUT 1: all cells, RBCs, BBB
GLUT 2: renal, GI
GLUT 3: neurons
GLUT 4: adipose, muscle

6901 (18 decks)

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