Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AS - N935 Advanced Patho II > Endocrine - Adrenal > Flashcards

Endocrine - Adrenal Flashcards

1
Q

Adrenal Gland

A

Cortex 80-90%

Medulla 10-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Adrenal Gland Function

A
  • Blood glucose regulation
  • Protein turnover
  • Fat metabolism
  • Na+/K+/Ca2+ balance
  • CV tone maintenance
  • Modulates tissue response to injury or infection
  • Stress response*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Adrenal Cortex

A

Zona glomerulosa - aldosterone (mineralocorticoid)
Zone fasciculata - cortisol (glucocorticoid)
Zona reticularis - androgenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Adrenal Medulla

A

Epinephrine 80%

Norepinephrine 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cushing’s Syndrome

A

Any excessive cortisol secretion
Exogenous steroids
ACTH dependent or independent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cushing’s Disease

A

Inappropriate ACTH from anterior pituitary secretion
1° pituitary tumor
2° adrenal tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ACTH Dependent

A

Pituitary corticotrophy tumors (microadenomas)
Non-endocrine tumors - lung, kidney, or pancreas
Ectopic corticotrophin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ACTH Independent

A

Benign or malignant adrenocortical tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cushing’s S/S

A 
Sudden weight gain (central)
Facial fat "moon face"
Electrolyte abnormalities
Systemic HTN
Glucose intolerance
Menstrual irregularities
Decreased libido
Skeletal muscle wasting
Depression & insomnia
Osteoporosis
Hypercoagulable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cushing’s Diagnosis

A

Plasma & urine cortisol levels
CRH stimulation test
Dexamethasone suppression test
Inferior petrosal sinus sampling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cushing’s Treatment

A

Surgical
- Transsphenoidal microadenectomy
- Adrenalectomy
Irradiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cushing’s

Anesthetic Management

A

Preop evaluation - HTN, intravascular volume, electrolytes, hypokalemia metabolic alkalosis, CHF, glucose control
Positioning - osteoporosis/osteomalacia vertebral compression fractures
Skeletal muscle weakness - ↓muscle relaxants requirements (maintain 1 twitch)
Cortisol - 100mg IV glucocorticoid intraop
Blood loss - type & screen, CVP, A-line
Anesthetic agents - depress adrenal response to stress & ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cushing’s

Anesthetic Complications

A 
Transsphenoidal microadenomectomy
- VAE
- Transient DI
- Meningitis
Adrenalectomy
- Laparoscopic vs. open
- Pulmonary complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Conn’s Syndrome

A

Excessive aldosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Primary Hyperaldosteronism

A

Excessive aldosterone secretion from functional tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Secondary Hyperaldosteronism

A

↑circulating serum renin stimulates aldosterone release (renovascular HTN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Conn’s S/S

A

Non-specific
Asymptomatic
Systemic HTN (headache, diastolic BP 100-125mmHg) reflects aldosterone induced Na+ retention ↑fluid retention
Hypokalemia - skeletal muscle cramps, weakness, metabolic acidosis

18
Q

Hyperaldosteronism

Anesthetic Considerations

A 
Correct ↓K+
Avoid hyperventilation → hypokalemia
HTN (A-line)
Assess cardiac/renal status
Fluids w/ vasodilators & diuresis
Monitor acid-base balance
Replace exogenous cortisol 100mg/day
19
Q

Addison’s Disease

A

1° adrenal insufficiency
- Most common cause idiopathic/autoimmune
- Asymptomatic until 90% adrenal cortex destroyed
Deficiency all adrenal cortex secretions - mineralocorticoids, glucocorticoids, & androgens

20
Q

Addison’s S/S

A 
Chronic fatigue
Muscle weakness
Hypotension
Weight loss
Anorexia
Nausea/vomiting
Diarrhea
↑BUN
Hyponatremia
Hyperkalemia
Hypoglycemia
Abdominal or back pain
Hyperpigmentation
21
Q

Addison’s Diagnosis

A

Baseline plasma cortisol level <20mcg/dL
Cortisol level <20mcg/dL after ACTH stim test
- Normal response >25mcg/dL
- Positive test indicates adrenal cortex impairment

22
Q

Addisonian Crisis

A 
Steroid-dependent who do not receive ↑dose during stress
Stress → circulatory collapse
- Hypoglycemia
- Electrolyte imbalance
- Depressed mentation
100mg IV cortisol Q4-6H
Inotropic support
23
Q

Addison’s

Anesthetic Considerations

A 
Administer exogenous corticosteroids
Continue steroid dose DOS
Intraop hypotension
- Measure CVP
- Vasopressor
- Fluids
- Cortisol 100mg IV
Measure blood glucose
Monitor electrolytes (avoid LR)
Avoid Etomidate
Inhalational agents sensitive to drug-induced myocardial depression
Titrate muscle relaxants d/t skeletal muscle weakness
24
Q

Minor Surgery Cortisol

A

25mg hydrocortisone

25
Q

Major Surgery Cortisol

A

100mg bolus followed by infusion at 10mg/hr
OR
100mg Q6H

26
Q

Hypoaldosteronism

A

Congenital aldosterone deficiency
Hyporeninemia loss angiotensin stim
Non-steroidal inhibit prostaglandin synthesis - inhibit renin release & exacerbate condition in renal insufficiency

27
Q

Hypoaldosteronism S/S

A

Hyperkalemic acidosis
Severe hyperkalemia
Hyponatremia
Myocardial conduction defects

28
Q

Hypoaldosteronism Treatment

A

Mineralocorticoid-fludrocortisone

Liberal Na+ intake

29
Q

Pheochromocytoma

A

Catecholamine-secreting tumor
Originates in adrenal medulla & related tissues
Most common young to mid-adult life

30
Q

Pheochromocytoma S/S

A 
1° 
- HTN continuous or paroxysmal
- Headache
- Diaphoresis/pallor
- Palpitations or tachycardia
Associated S/S
- Orthostatic hypotension d/t volume depletion
- Anxiety
- Tremors
- Chest pain
- Epigastric pain
- Flushing
- Painless hematuria
31
Q

Pheochromocytoma

Duration & Frequency

A

1hr or less

Daily to once every few months

32
Q

Pheochromocytoma Diagnosis

A 
Urine tests
Plasma levels*
NE/Epi breakdown products
- Normetanephrine >400
- Metanephrine >220
CT/MRI
33
Q

Pheochromocytoma Treatment

A 
Surgical excision
α blockade
- Phenoxybenzamine α 1&2
- Prazosin selective α1
Restore intravascular volume ↓Hct
Insulin release
Persistent tachycardia β blockade (Esmolol)
DO NOT ADMINISTER NON-SELECTIVE β BLOCKADE W/O α BLOCKADE (unable to maintain CO)
34
Q

Pheochromocytoma

Preop Considerations

A

Optimize the patient
↑SVR → myocardial ischemia, ventricular hypertrophy, CHF, cardiomyopathy
Cerebral hemorrhage history
Hyperglycemia ↓circulating insulin w/ ↑glycogenolysis
Blood pressure <165/90 48hours prior to surgery
Standing BP >80/45
EKG w/o ST or T wave changes
<1 PVC Q5min

35
Q

Pheochromocytoma

Anesthetic Considerations

A 
Communication w/ surgeon
Continue adrenergic blockade
Fluid management:
- Pre-hydrate hypovolemia
- Falsely ↑Hct
- Type & cross
- Renal function
- Fluid replacement plan
Benzodiazepine & opioid pre-medication
A-line
36
Q

Pheochromocytoma

Induction & Laryngoscopy

A 
Lidocaine 1-2mg/kg
Opioid (no Morphine d/t histamine & catecholamine release) to blunt SNS response
- Sufentanil 0.5-1mcg/kg
- Fentanyl 3-5mcg/kg
Propofol 3mg/kg
Nitroprusside 1-2mcg/kg
Phentolamine α blocker
Esmolol β blocker
Avoid drugs that release histamine
37
Q

Pheochromocytoma

Intraop Considerations

A

MAC 1.5-2
Combined general anesthetic w/ continuous lumbar epidural
Muscle relaxant - Vecuronium or Rocuronium
Surgical ligation tumor venous drainage ↓catechols → prepare for hypotension
- DC antihypertensives
- ↓volatile inhalational agent
- Volume 1st
- Administer pressors (phenylephrine or norepinephrine)
NE infusion until vasculature adapts to ↓α stim

38
Q

Pheochromocytoma

Cardiovascular Control

A 
Nitroprusside preferred 
Phentolamine - tachyphylaxis, tachycardia, & longer duration
Magnesium sulfate
Ca2+ channel blockers
Esmolol preferred 
Labetalol
Metoprolol
39
Q

Pheochromocytoma

AVOID

A

Histamine releasers (Morphine or Atracurium)
Halothane - sensitizes myocardium → epinephrine
Succinylcholine fasciculations → catechol release from tumor
Avoid ↑HR (Pancuronium or Atropine)
Metoclopramide → catechol release

40
Q

Pheochromocytoma

Postop Considerations

A

Adequate analgesia - PCA & opioids
50% patients remain HTN
- Elevated catecholamine levels 10 days postop
- Continue antihypertensive therapy
Early extubation (young, no lung involvement)
Hypoglycemia d/t excess insulin release & ineffective lipolysis & glycogenolysis
Steroid supplementation d/t adrenal manipulation
Postop HTN > 10 days
- Occult tumors (repeat surgery)
- Volume overload
- Continue monitoring

AS - N935 Advanced Patho II (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions