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Anesthesia Fast Facts > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Growth Hormone is released by?

A

Anterior Pituitary

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2
Q

GH

A

growth-promotion of tissues
direct anti-insulin actions

GH causes metabolic actions at adipose tissue and muscle, additionally a major target of GH is the liver where it stimulates the liver to produce somatomedin C also called IGF-1.

Imbalanced action of GH and IGF-1 can cause anatomical changes and metabolic dysfunction.

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3
Q

GH metabolic effects

A
  • gluconeogenesis (increase blood sugar) & antagonism of insulin action
  • increased rates of protein synthesis
  • increased lipolysis/AA breakdown
  • sodium and water retention
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4
Q

Gonadotropes

A

LH

FSH

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5
Q

ACTH

A
  • stimulates adrenal cortex secretion and growth

- steriod production

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6
Q

Anterior pituitary hormones

A 
Growth hormone (GH)
Prolactin (PRL)
Gonadotropins, including luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
Adrenocorticotrophic Hormone (ACTH)
Thyroid-stimulating hormone (TSH)

precursor: B-lipotropin

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7
Q

Posterior Pituitary hormones

A

arginine vasopressin

oxytocin

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8
Q

arginine vasopressin

A

promotes H2o retention & regulates plasma osmolarity

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9
Q

oxytocin

A

causes ejection of milk and uterine contraction

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10
Q

prolactin

A

stimulates the secretion of milk and maternal behavior, inhibits ovulation

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11
Q

LH

A

stimulates ovulation in females and testosterone secretion in males

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12
Q

FSH

A

stimulates ovarian follicle growth in females and spermatogenesis in males

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13
Q

TSH

A

stimulates thyroid secretion and growth

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14
Q

B-lipotropin

A

precursor of endorphins

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15
Q

Body homeostasis is controlled by two major regulating systems:

A
  1. nervous system

2. endocrine & hormones

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16
Q

The endocrine system is evaluated by measuring ____ that are regulated ______

A

hormones

usually by a negative feedback system

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17
Q

Hormones can be classified into three major categories:

A

(1) proteins or peptides
(2) tyrosine amino acid derivatives
(3) steroids

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18
Q

The synthesis and secretion of hormones by endocrine glands are regulated by three general control mechanisms:

A

1) neural controls (stress response, pain, smell, touch, sight, taste)
2) biorhythms (circadian, seasonal, life stages)
3) feedback mechanisms (negative feedback)

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19
Q

Anesthetic Implications of Acromegaly

A
  • facial deformities make masking difficult
  • difficult DL d/t large thick tongue, enlarged thyroid, hypertrophy of epiglottis
  • CV complications - HTN, cardiomyopathy
  • coexisting OSA, osteoarthritis, kyphosis
  • impaired HPA axis
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20
Q

Hormones of the Hypothalamus

A

Thyrotropin-releasing hormone (TRH)
Corticotropin-releasing hormone (CRH)
Growth hormone releasing hormone (GHRH)
Growth hormone inhibitory hormone (GHIH) (Somatostatin)
Gonadotropin-releasing hormone (GnRH)
Dopamine or prolactin-inhibiting factor (PIH)

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21
Q

ACTH

A

affects the release of adrenal androgens by the adrenal cortex in the zona reticularis

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22
Q

Pathophys of the Anterior Pituitary

A 
acromegaly
gigantism
dwarfism
sex hormone imbalance
Secondary Cushing disease ( r/t excess ACTH)
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23
Q

Pathophys of the Posterior Pituitary

A

DI

SIADH

24
Q

Recurrent Laryngeal Nerve Sensory/Motor functions

A
  • Sensory innervation below true cords and into upper trachea
  • Motor innervation to all intrinsic laryngeal muscles except cricothyroid (which is external branch of the superior laryngeal nerve)
25
Q

RLN injury

A

Can occur with intubation, neck surgery (thyroid, cervical spine) & positioning injuries (stretching of neck)

If unilaterally injured: VC will be abducted to assume midline position causing stridor and hoarseness.

If bilaterally paralyzed: VCs will be abducted to close to the midline, causing obstruction & aphonia. Aspiration risk, and can be airway emergency.

26
Q

Parathyroid gland pathophys: labs to obtain pre-op

A

Serum Ca++, Phos, Mag

27
Q

neural integrity monitor (NIM) electromyogram (EMG) tracheal tube

A
  • this unique tracheal tube must be positioned so that its color-coded (blue) contact band is appropriately placed between the vocal cords
  • nerve monitoring system alerts you with visual and audible tones identify nerves and verify integrity of the nerves during surgery
  • utilized, for the head and neck procedures, when laryngeal nerves (LNs) could be injured during the process of surgical dissection. It is particularly useful for identifying the recurrent LN
28
Q

Thyroid Hormones

A

thyroxine (T4), triiodothyronine (T3), & calcitonin

  • Play a major role in normal growth and development
  • Play a chief role in cellular energy metabolism
29
Q

S/S Hypothyroidism

A
  • usually symptoms are often nonspecific.
  • fatigue, lethargy, weakness, joint pain, muscle aches, cold intlerance, constipation, change in voice, and weight gain.
  • skin is usually dry and the hair brittle.
  • bradycardia, low ECG voltage, and symptoms of heart failure
30
Q

Untreated severe hypothyroidism

A

may progress to myxedema and include electrolyte disturbance, hypoventilation, hypothermia, and coma.

31
Q

hyperthyroidism is commonly caused by

A

Graves disease, an autoimmune condition in which thyrotropin receptor antibodies continuously mimic the effect of thyroid-stimulating hormone (TSH)

32
Q

S/S hyperthyroidism

A

signs and symptoms of hyperthyroidism are cardiac, neurologic, and constitutional.

CV

  • increased cardiac sensitivity to catecholamines, resulting in hypertension and tachyarrhythmias
  • high-output congestive heart failure or angina, in the absence of coronary plaque

CNS

  • Tremor, hyperreflexia, and irritability are common.
  • Periodic paralysis, characterized by hypokalemia and proximal muscle weakness, may also occur.
  • Fever and heat intolerance are common.

GI
-nausea, vomiting, and diarrhea as well as hepatic dysfunction and jaundice.

33
Q

a life-threatening severe form of hyperthyroidism

A

Thyroid storm

  • S/S
  • Hyperpyrexia (+/- 41 degrees C), cardiac dysfunction, tachycardia, arrhythmias, myocardial ischemia, weakness, delirium & altered mental status, hyperglycemia, hypercalcemia, hyperbilirubinemia, seizures, coma
34
Q

Outer cortex of adrenal medulla secretes three major classes of steriods:

A

mineralocorticoids, glucocorticoids, and androgens

the 2 important ones are cortisol (glucocorticoid) and aldosterone (mineralocorticoid)

35
Q

hypothalamic-pituitary-adrenal (HPA) axis overview

A
  • a major neuroendocrine pathway relevant to the stress response
  • chronic administration of corticosteroids suppresses CRH and leads to atrophy of HPA
  • in those patients, stressful events during the perioperative period might evoke life-threatening hypotension
  • therefore, it is common to administer exogenous corticosteroids (based on the magnitude of stress) to patients considered at risk for suppression of HPA axis
36
Q

Addison disease

A

Glucocorticoid deficiency / Hypoaldosteronism

37
Q

Cushing Syndrome

A

Glucocorticoid excess

38
Q

Corticosteroid therapeutic uses:

A

Reactive airway disease

  • Asthma, COPD - Inflammatory conditions
  • Inhaled glucocorticoids agents of choice
  • Reduce symptoms, improves quality of life, decreases exacerbations

Neuro Critical Care

  • Dexamethasone has clinical applications in patients with tumors, bacterial meningitis and prevention or tx of cerebral edema
  • Tumors- Initiated to reduce vasogenic edema.

Other uses: N/V prophylaxis, immunosuppression, tx of inflammatory conditions, airway edema, allergic reactions

39
Q

Catecholamines are produced in what part of the adrenal gland?

A

adrenal medulla

40
Q

Synthesis of catecholamines

A

Tyrosine ⇒ L-DOPA (L-3,4-dihydroxyphenylalanine) ⇒ dopamine ⇒ norepinephrine ⇒ epinephrine.

41
Q

catecholamine reuptake and degradation

A
  • Undergo reuptake at extraneuronal sites
  • Degradation by Catechol-o-methyltransferase (COMT) or monoamine oxidase (MAO).
  • This degradation takes place mostly in liver
  • Produces the metabolite Vanillylmandelic acid (VMA)
  • VMA is excreted in the urine and can be measured to assess cumulative catecholamine secretion!
42
Q

Pheochromocytoma

A

Tumor within the adrenal medulla that secretes catecholamines (NE, Epi, and less frequency dopamine)

43
Q

Intraoperative management of Pheo

A
  • control HTN prior to surgery, preoperative alpha-blockade to prevent intraoperative hypertensive crisis
  • surgical stimulation, laryngoscopy may cause exaggerated hemodynamic swings
  • infusions of vasoactive should be available, avoiding drugs that cause catecholamine or histamine release
  • once tumor is out prepare for hypotension and have pressors available
44
Q

DKA

A

Diabetic Ketoacidosis

  • precipitated by a lack of insulin in DM type 1
  • An acute life-threatening metabolic derangement characterized by increased blood glucose and ketone body formation along with w/ anion gap metabolic acidosis.
45
Q

HHS

A

Hyperglycemic Hyperosmolar State

  • DM type II
  • hyperosmolar condition triggered by a hyperglycemic event
  • leads to lactic acidosis, severe hyperglycemia, glucosuria
46
Q

Sulfonylurea examples:

A

glipizide, glyburide, glimepiride

47
Q

Sulfonylurea MOA

A
  • increase insulin release from the beta cells in the pancreas (require functioning beta cells)
  • decrease the hepatic clearance of insulin in the liver
48
Q

Biguanides (Metformin) MOA

A

-decreases serum glucose by decreasing gluconeogenesis (glucose production in the liver) & it also has an insulin-sensitizing effect and increases peripheral tissue insulin sensitivity and uptake

49
Q

Thiazolidinediones examples:

A

rosiglitazone, pioglitazone

50
Q

Thiazolidinediones MOA

A
  • decrease hepatic glucose production, nd incease inulin sensitivity of adipose tissue, skeletal muscle, and the liver.
  • By reducing circulating fat concentrations, they as a result, increase the dependence of the body on carbohydrates/glucose use
51
Q

Rapid-acting insulin:

A
  • aspart (novalog)
  • lispro (humalog)
  • glulisine (apidra)
  • regular (humulin R, Novolin R)
52
Q

Intermediate-acting insulin:

A

NPH

53
Q

Long-Acting insulin:

A
  • detemir (levemir)
  • glargine (lantus)
  • glargine (toujeo)
54
Q

Somatostatin analog examples:

A

Octreotide and Lanreotide

55
Q

Somatostatin analog MOA

A

-Act as INHIBITORS of the release of TSH and Growth Hormone (GH) from the pituitary, of insulin and glucagon from pancreas, and vasoactive peptides from the GI tract.

  • Clinical Application
  • Somatostatin analogs are used in the perioperative period to block hormone release in neuroendocrine tumors.
  • Most often given IV as a continuous infusion in hospital. Can be given SQ.

-Can also be given in 50-100 mcg boluses in response to hemodynamic instability related to vasoactive mediators (carcinoid crisis)

Anesthesia Fast Facts (24 decks)

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