Endocrine Diseases Flashcards
which hormones are associated with the anterior pituitary?
FLATPeG
FSH LH ACTH TSH Prolactin GH
which hormones are associated with the posterior pituitary?
ADH and Oxytocin
which thyroid hormone is the most active and most potent?
T3
pathophysiology of hyperthyroidism
hyperfunction of the thyroid gland
causes and symptoms of hyperthyroidism
Causes: Graves disease, TSH-secreting pituitary tumors, iatrogenic, thyroiditis
Symptoms: weight loss, fatigue, arrhythmias, anxiety, exopthalmos
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
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
what are the symptoms and treatments for thyrotoxic crisis?
Symptoms – anxiety, fever, tachycardia, cardiovascular instability
Treatment – immediate: supportive; then decrease circulating hormone levels
what can thyrotoxic crisis mimic?
malignant hyperthermia
pathophysiology of hypothyroidism
Primary: dysfunction/destruction of thyroid tissue
Secondary:Hypothalamic-pituitary axis dysfunction
Autoimmune – Hashimoto’s thyroiditis
Iatrogenic – thyroidectomy, antithyroid medications
symptoms and treatments for hypothyroidism
Symptoms: lethargy, weight gain, cold intolerance, hypoactive reflexes (high TSH, low T3/T4)
Treatment: PO T4 (Synthroid)
anesthesia complications of hypothyroidism
hypotension intraop
decreased gastric emptying
slow to wake up
*myxedema coma (precipitated by stress)
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)
symptoms and treatment for hyperparathyroidism
Symptoms: usually due to hypercalcemia (renal stones, hypertension, constipation, fatigue)
Treatment: may be medical or surgical
anesthetic considerations for hyperparathyroidism
decreased response to NMB means an increased requirement during parathyroidectomy (constant Ca2+ checks)
pathophysiology of hypoparathyroidism
decreased PTH (almost always iatrogenic)
symptoms and treatment for hypoparathyroidism
Symptoms: (result from hypocalcemia), muscle and abdominal cramps, irritability, chvostek’s sign
Treatment: Ca2+ infusion
what are patients with hypoparathyroidism prone to intraop?
hypotension
pathophysiology for DiGeorge Syndrome (congenital thymic hypoplasia)
hypoplasia/aplasia of parathyroid and thymus
considerations of DiGeorge syndrome
small jaw, prone to infection
what is the function of glucocorticoids?
anti-inflammatory, help fight stress, increase glucose
what is the function of minerocorticoids?
(aldosterone) Na+ reabsorption, K+ secretion –> water retention
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
