Endocrine (Exam II) Flashcards by Cristina Morales

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)

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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

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What three areas use 85% of glucose? (per lecture)

Brain
GI tract
RBCs

this seems wrong…

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What characterizes the pathophysiology of Type I DM?

T-cell autoimmune destruction of βcells
80-90% βeta cell loss
Insulin required.

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What characterizes the pathophysiology of Type II DM?

β cell insufficiency & insulin resistance

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What are the two primary ways that a diabetes diagnosis is made (outside of symptoms)?

A_1C ≥ 6.5%
Fasting blood glucose ≥ 126 mg/dL

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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.

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What are the signs/symptoms of DKA?

Tachypnea (Kussmaul respirations)
N/V
LOC changes
Dehydrationkj

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What are the signs/symptoms of DKA?

Tachypnea (Kussmaul respirations)w
N/V
LOC changes
Dehydration

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What are the signs/symptoms of DKA?

Tachypnea (Kussmaul respirations)
N/V
LOC changes
Dehydration

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What is the treatment for DKA?

IVF
Regular Insulin gtt (BG q1h)
Replace electrolytes
Na⁺HCO₃⁻ if pH < 7

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How does Hyperosmolar hyperglycemic syndrome differ from DKA?

Hyperosmolar state w/ metabolic acidosis
Treatment includes hypotonic saline to treat the ↑mOsm plasma.

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What structure connects the two parts of the thyroid?

Isthmus

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How many parathyroid glands are there?

_{how many bitches does Mario get?}

_{all of them}

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What is a normal TSH level?

0.4 - 5 milliunits/L

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What are syndromes of thyrotoxicosis?

Fever
↑HR
Dehydration
LOC changes
Extreme anxiety

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What is the treatment of thyrotoxicosis (thyroid storm)?

Crystalloids
Dexamethasone
Propylthiouracil
Phenylephrine
βblockers

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A diagnosis of Grave’s disease is consistent with:

A. Somnolence
B. Weight loss
C. Elevated TSH
D. Decreased T₄

B. Weight loss

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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

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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.

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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.

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What hormones/substances are produced in the adrenal cortex?

Glucocorticoids
Mineracorticoids
Androgens

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What hormones/substances are produced in the adrenal medulla?

Epi and NE

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What are some bodily functions regulated by cortisol?

Macromolecule metabolism
Gluconeogenesis enchancement
Anti-inflammatory
BP maintenance
Appetite promotion
Na⁺/K⁺ maintenance

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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