Endocrine Diseases Flashcards by Anna Logan

which hormones are associated with the anterior pituitary?

FLATPeG

FSH
LH
ACTH
TSH
Prolactin
GH

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which hormones are associated with the posterior pituitary?

ADH and Oxytocin

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which thyroid hormone is the most active and most potent?

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pathophysiology of hyperthyroidism

hyperfunction of the thyroid gland

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causes and symptoms of hyperthyroidism

Causes: Graves disease, TSH-secreting pituitary tumors, iatrogenic, thyroiditis
Symptoms: weight loss, fatigue, arrhythmias, anxiety, exopthalmos

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anesthetic complications and treatments for hyperthyroidism

Treatment: medical (antithyroids, beta antagonists) and surgical (total, subtotal, or lobar thyroidectomy)
Anesthesia: anxiolytics, discontinue drugs to increase sympathetic discharge, can have RL nerve damage

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what is a thyrotoxic crisis?

Life-threatening exacerbation of hyperthyroidism that may be caused by trauma, infection, surgery, or medical illness
Most often appears in post-op period, esp. if surgery was emergent

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what are the symptoms and treatments for thyrotoxic crisis?

Symptoms – anxiety, fever, tachycardia, cardiovascular instability
Treatment – immediate: supportive; then decrease circulating hormone levels

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what can thyrotoxic crisis mimic?

malignant hyperthermia

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pathophysiology of hypothyroidism

Primary: dysfunction/destruction of thyroid tissue
Secondary:Hypothalamic-pituitary axis dysfunction
Autoimmune – Hashimoto’s thyroiditis
Iatrogenic – thyroidectomy, antithyroid medications

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symptoms and treatments for hypothyroidism

Symptoms: lethargy, weight gain, cold intolerance, hypoactive reflexes (high TSH, low T3/T4)
Treatment: PO T4 (Synthroid)

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anesthesia complications of hypothyroidism

hypotension intraop
decreased gastric emptying
slow to wake up
*myxedema coma (precipitated by stress)

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pathophysiology of hyperparathyroidism

Primary: adenoma, carcioma, hyperplasia of parathyroid glands (which stimulate calcium circulation in blood)
Secondary: Compensatory increase in PTH secretion due to hypocalcemia (by renal disease or GI malabsorption)

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symptoms and treatment for hyperparathyroidism

Symptoms: usually due to hypercalcemia (renal stones, hypertension, constipation, fatigue)

Treatment: may be medical or surgical

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anesthetic considerations for hyperparathyroidism

decreased response to NMB means an increased requirement 
during parathyroidectomy (constant Ca2+ checks)

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pathophysiology of hypoparathyroidism

decreased PTH (almost always iatrogenic)

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symptoms and treatment for hypoparathyroidism

Symptoms: (result from hypocalcemia), muscle and abdominal cramps, irritability, chvostek’s sign

Treatment: Ca2+ infusion

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what are patients with hypoparathyroidism prone to intraop?

hypotension

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pathophysiology for DiGeorge Syndrome (congenital thymic hypoplasia)

hypoplasia/aplasia of parathyroid and thymus

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considerations of DiGeorge syndrome

small jaw, prone to infection

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what is the function of glucocorticoids?

anti-inflammatory, help fight stress, increase glucose

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what is the function of minerocorticoids?

(aldosterone) Na+ reabsorption, K+ secretion –> water retention

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where are glucocorticoids and minerocorticoids produced?

adrenal glands

pathophysiology of cushing’s syndrome

excessive cortisol (abnormal adrenocortical tissue, microadenoma, small-cell lung carcinoma)

symptoms and treatment of cushing's syndrome

Symptoms: obesity, hypertension, muscle wasting and weakness, glucose intolerance Treatment: radiotherapy, transsphenoidal resection (if microadenoma is the cause)

anesthetic considerations for cushing's syndrome?

tend to be volume overloaded and hypokalemic (often obese)

pathophysiology of Conn syndrome

excessive secretion of aldosterone, usually by a tumor, bilateral carcinoma of adrenals (more common in females)

symptoms and treatments for Conn syndrome

headache, muscle cramps, metabolic alkalosis, HTN, hypokalemic, fluid overload treatment: supplemental K+, excision of gland, spironolactone (K+ sparing diuretic)

in what dosage is K+ given peripherally and centrally?

periph: 10 mEq Central: 20 mEq

pathophysiology for hypoaldosteronism

congenital deficiency of aldosterone synthase, hyporeninemia, unilateral adrenalectomy

symptoms of hypoaldosteronism

Hyperkalemia without renal insufficiency (that may result in heart block) , hyperchloremic metabolic acidosis

pathophysiology of adrenocorticoid deficiency

Primary (Addison’s Disease) --> have to lose 90% of tissue to see it, usually autoimmune Secondary (Cortisol deficiency with normal aldosterone)

symptoms and treatment for adrenocorticoid deficiency

Symptoms: hypotension, hyponatremia, hypovolemia, hyperkalemia, fatigue, weight loss Treatment: steroid administration "stress dose" 100 mg hydrocortisone q 6h

what induction drug should you not give to adrenocorticoid deficient patients?

etomidate

pathophysiology of pheochromocytoma

catecholamine-secreting tumor of the adrenal medulla

symptoms and treatment for pheochromocytoma

Symptoms: sudden onset of malignant hypertension, cardiac dysrhythmias, headache, perspiration Treatment: excision of the tumor

perioperative considerations for pheochromocytomas

hemodynamic instability; will become hypotensive once tumor is removed

pathophysiology for acromegaly

excessive GH, usually because of tumor

symptoms and treatments for acromegaly

Symptoms: skeletal, connective, and soft tissue overgrowth; papilledema; headache; hoarseness?; stridor? Treatment: surgical or medical

what is an important consideration for pts with acromegaly?

airway management!

pathophysiology and causes for diabetes insipidus

deficiency or resistance to vasopressin (helps body retain H2O) Causes: neurogenic (lack of vasopressin secretion) or nephrogenic (decreased response to vasopressin)

symptoms of diabetes insipidus

extreme thirst, excessive urination (very dilute)

what is the number one endocrine disease?

diabetes mellitus

what is diabetes mellitus?

Chronic disease caused by abnormal glucose metabolism that results in predictable long-term morbidity

in the islet of langerhans, what is produced by the beta cells and by the alpha cells?

beta: insulin alpha: glucagon

what are the effects of insulin secretion?

``` ↑ glucose uptake ↑ glycogen synthesis ↑ protein synthesis and storage ↑ fat synthesis and storage ↓ gluconeogenesis ```

what are the effects of glucagon secretion?

↑ glucose output from liver ↑ glycogenolysis ↑ gluconeogenesis (from amino acids) ↑ adipose cell lipase

what is the pathophysiology of DM?

Causes: decreased secretion of insulin from beta cells or increased resistance of receptors to circulating insulin Heredity Obesity

90% of all DM cases are what type?

``` Type II (elderly and obese) -insulin resistant ```

what is the "triad" of symptoms for DM?

PolyDipsia PolyPhagia PolyUrea

long term complications of DM

``` Hypertension Coronary artery disease Myocardial infarction Congestive heart failure Diastolic dysfunction Vascular disease Neuropathy Renal failure ```

what is DKA?

Diabetic Ketoacidosis

what causes DKA?

decreased insulin activity → metabolism of free fatty acids → accumulation of organic acids by-products

what are the clinical signs and treatments for DKA?

``` Clinical Signs -Tachypnea -Fatigue -Abdominal pain -Polyuria -N/V -Altered mental status Treatment: hypovolemia w/ NS; insulin, check electrolytes ```

1 unit of insulin is said to lower blood sugar _______ mg/dL

25-30