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
- 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 symptoms 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
- Mineralcorticoids
- 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
- Immune response
- 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 drugs (other than phenoxybenzamine) can be utilized for treatment of pheochromocytomas?
- 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
What are the primary anesthetic considerations with Cushing syndrome?
- Glucose and blood pressure control
- Muscle weakness
- K⁺ replacement
What syndrome is characterized by the following symptoms?
- Hypokalemic HTN
- Muscle weakness
- 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 does this result in?
Primary Adrenal Insufficiency
- ↓ 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?
- Corticotropin Releasing hormone (CRH)
- 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 desmopressin.
If the patient responds to administered desmopressin, then you know that the kidney’s are fine and its neurogenic DI.
What characterizes neurogenic diabetes insipidus?
How is it treated?
- Lack of synthesis and release of ADH from the neurohypophysis.
- Treated with desmopressin (DDAVP)
What characterizes nephrogenic diabetes insipidus?
How is it treated?
- Resistance of renal tubules to endogenous ADH.
- NSAIDs and thiazide 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
