Endocrine (Exam II) Flashcards
What is the purpose of the pancreas?
What general types of cells does it have?
- Digestion, metabolism, utilization & energy storage
- Exocrine & endocrine (Islet of Langherhans)
What types of endocrine cells are there and what principal hormone/substance is produced by each?
- Αlpha (20%): Glucagon
- Βeta (75%): Insulin
- Delta (5%): Somatostatin
What three areas use 85% of glucose? (per lecture)
- Brain
- GI tract
- RBCs
this seems wrong…
What characterizes the pathophysiology of Type I DM?
- T-cell autoimmune destruction of βcells
- 80-90% βeta cell loss
- Insulin required.
What characterizes the pathophysiology of Type II DM?
- β cell insufficiency & insulin resistance
What are the two primary ways that a diabetes diagnosis is made (outside of symptoms)?
- A1C ≥ 6.5%
- Fasting blood glucose ≥ 126 mg/dL
Differentiate biguanides and sulfonylureas in the treatment of diabetes.
- Biguanides (metformin): ↓ gluconeogenesis and ↑ glucose use by muscle and adipose
- Sulfonylureas (glipizide): ↑ insulin secretion from β cells.
What are the signs/symptoms of DKA?
- Tachypnea (Kussmaul respirations)
- N/V
- LOC changes
- Dehydrationkj
What are the signs/symptoms of DKA?
- Tachypnea (Kussmaul respirations)w
- N/V
- LOC changes
- Dehydration
What are the signs/symptoms of DKA?
- Tachypnea (Kussmaul respirations)
- N/V
- LOC changes
- Dehydration
What is the treatment for DKA?
- IVF
- Regular Insulin gtt (BG q1h)
- Replace electrolytes
- Na⁺HCO₃⁻ if pH < 7
How does Hyperosmolar hyperglycemic syndrome differ from DKA?
- Hyperosmolar state w/ metabolic acidosis
- Treatment includes hypotonic saline to treat the ↑mOsm plasma.
What structure connects the two parts of the thyroid?
Isthmus
How many parathyroid glands are there?
how many bitches does Mario get?
4
all of them
What is a normal TSH level?
- 0.4 - 5 milliunits/L
What are syndromes of thyrotoxicosis?
- Fever
- ↑HR
- Dehydration
- LOC changes
- Extreme anxiety
What is the treatment of thyrotoxicosis (thyroid storm)?
- Crystalloids
- Dexamethasone
- Propylthiouracil
- Phenylephrine
- βblockers
A diagnosis of Grave’s disease is consistent with:
A. Somnolence
B. Weight loss
C. Elevated TSH
D. Decreased T₄
B. Weight loss
Anesthetic considerations for syndrome of inappropriate anti-diuretic hormone (SIADH) include:
(Select 2)
A. Measurement of urine osmolality
B. Administration of pre-operative midazolam
C. Stress dosing of dexamethasone
D. Titrating IV fluid
A. Measurement of urine osmolality
D. Titrating IV fluid
All of the anesthetic considerations are indicated in a patient with hyperparathyroidism EXCEPT:
A. Pre-operative ECG
B. Avoiding the use of midazolam pre-operatively.
C. IV fluid administration
D. Administration of 40mg of rocuronium.
D. Administration of 40mg of rocuronium.
Which statement BEST describes acromegaly?
A. An insufficiency of growth hormone.
B. Occurs due to a tumor in the posterior pituitary gland.
C. Hypoglycemia is frequent concern.
D. Decreased amounts of neuromuscular blockers is recommended.
D. Decreased amounts of neuromuscular blockers is recommended.
What hormones/substances are produced in the adrenal cortex?
- Glucocorticoids
- Mineracorticoids
- Androgens
What hormones/substances are produced in the adrenal medulla?
- Epi and NE
What are some bodily functions regulated by cortisol?
- Macromolecule metabolism
- Gluconeogenesis enchancement
- Anti-inflammatory
- BP maintenance
- Appetite promotion
- Na⁺/K⁺ maintenance
What portion of the adrenal gland is secreting excess catecholamines in pheochromocytoma?
- Chromaffin cells of the adrenal medulla
What signs/symptoms present with pheochromocytoma?
- Extreme HTN
- Headache, sweating, pallor, & palpitations
- ECG changes
What EKG changes might be seen with pheochromocytoma?
- ST segment elevation or depression
- Dysrhythmias
What non-competitive α-blocker treats pheochromocytomas?
Does this drug need to be kept on for the surgery?
- Phenoxybenzamine
- No, DC 24-48 hrs prior to surgery.
For a pheochromocytoma, should an α blocker or a β blocker be given?
- Both; but give the α-blocker before the β-blocker.
What drug’s other than phenoxybenzamine be utilized for treatment of pheochromocytoma’s?
- Prazosin (α1 competitive blocker)
- Metyrosine (catecholamine synthesis blocker)
- CCBs
- ACE-inhibitors
What is Cushing syndrome?
Hypercortisolism
- Overproduction of ACTH → excess cortisol
What signs/symptoms might be seen with cushing syndrome?
- Truncal obesity
- Hyperglycemia
- HTN
- Muscle weakness
- Osteoporosis
- Hypokalemia
How is Cushing’s syndrome treated surgically?
- Transphenoidal microadenomectomy
- Anterior pituitary resection
What are the primary anesthetics considerations with Cushing syndrome?
- Glucose and blood pressure control
- Muscle weakness
- K⁺ replacement
What syndrome is characterized by the following symptoms?
- Hypokalemic HTN
- Muscle weakenss
- Headaches
- Polyuria/Nocturia
Conn syndrome (Primary Hyperaldosteronism)
Excess of __________ defines Conn syndrome.
Aldosterone (mineralcorticoid)
What are the treatments and anesthetic considerations associated with Conn’s syndrome?
- HTN control
- Restrict Na⁺ intake
- Spironolactone
- K⁺ replacement
- Volume replacement
What is the underlying pathophysiology of Addison’s disease?
What often causes it?
Primary Adrenal insufficiency
- Bilateral adrenal destruction
- ↓ mineral- and glucocorticoids
- ↓ androgens
What are the signs/symptoms of Addison’s disease?
- Fatigue
- Weakness
- Anorexia
- N/V
- Hyperpigmentation“tan-look**
- Low Na⁺ & volume
- ↑ K⁺
What are the anesthetic considerations associated with primary adrenal insufficiency?
- Preoperative glucocorticoid coverage
- Electrolytes/hydration
- ↓ doses of narcotics
What does parathyroid hormone control?
- Ca⁺⁺ levels
- Bone remodeling
- Vitamin D
What should total serum Ca⁺⁺ be?
Give mg/dL and mEq/L
- 9.5 - 10.5 mg/dL
- 4.5 - 5.5 mEq/L (roughly half)
What should ionized serum Ca⁺⁺ be?
Give mg/dL and mEq/L
- 4.8 - 5.6 mg/dL
- 2.3 - 2.5 mEq/L (roughly half)
What is the primary symptom of hyperparathyroidism?
- Hypercalcemia (serum Ca⁺⁺ > 5.5 mEq/L)
What is the treatment for hyperparathyroidism?
- Parathyroidectomy
What are anesthetic considerations for hyperparathyroidism?
- NMBDs are unpredictable
- Positioning
- Confusion
- EKG changes
What are the signs/symptoms of hypoparathyroidism?
- Fatigue
- Seizures
- Tetany & muscle spasms
- Stridor
- Prolonged QT
What two hormones are produced by the neurohypophysis?
- Vasopressin
- Oxytocin
What hormones are produced by the adenohypophysis?
- ACTH
- TRH
- Gonadotropin releasing hormone
- Growth hormone releasing hormone
- Dopamine
- Somatostatin
What causes acromegaly?
- Excessive growth hormone (GH) secretion
What airway symptoms are seen with acromegaly?
Tongue and epiglottic enlargement
What is the treatment for acromegaly?
Transphenoidal surgery
What anesthetic considerations exist for acromegaly?
- Airway obstruction
- Hoarseness, stridor
- Muscle weakness
- Blood glucose monitoring needed.
What differentiates neurogenic vs nephrogenic diabetes insipidus?
- Patient response to DDAVP
What characterizes neurogenic diabetes insipidus?
How is it treated?
- Lack of synthesis and release of ADH from the neurohypophysis.
- Treated with DDAVP
What characterizes nephrogenic diabetes insipidus?
- Resistance of renal tubules to ADH.
- Treated with Diuretics
What symptoms/signs would be seen with diabetes insipidus?
- Dilute urine (duh)
- Polydipsia
- ↑ serum osmolality
- AMS/seizures
- Fatigue
- Hemodynamic instability
What syndrome is characterized by excessive secretion of ADH?
- Syndrome of Inappropriate ADH (SIADH)
What kind of lab changes are seen with SIADH?
- Hyponatremia
- ↓ serum osmolality
- ↑ urine osmolality
What is the treatment for SIADH?
- Free water restriction
- Demeclocycline
What are anesthetic considerations for SIADH?
- Frequently measure urine and plasma osmolality.
- Keep an eye on Na⁺ levels
- Avoid IVF when possible
