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Advanced Principles of Anesthesia > Endocrine System > Flashcards

Endocrine System Flashcards

1
Q

Adrenal Medulla?

A

Preganglionic SNS neurons release ACh, which binds to nicotinic receptors of adrenal medullary cells –> stimulating the secretion of catecholamines (80% EPI, 20% NE)

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2
Q

What are the effects of Aldosterone?

A
  • enhances sodium reabsorption in exchange for K+ and H+
  • The net effect is fluid retention and expansion of the extracellular space, with a reduction in serum potassium concentration and metabolic alkalosis.
  • Regulates intravascular volume
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3
Q

What stimulates Aldosterone release?

A
  • Angiotensin II
  • Hyperkalemia
  • Hyponatremia
  • Increased ACTH (minor influence)
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4
Q

What is Conn Syndrome?

A

Mineralocorticoid excess / Hyperaldosteronism

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5
Q

The HPA (Hypothalamus-Pituitary-Adrenal Axis) is stimulated by …?

A

surgery, trauma, burns, exercise

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6
Q

What is the normal endogenous production of cortisol in non-stressed conditions?

A

15-30 mg/day (Normal is 20 mg/day)

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7
Q

Stress increases cortisol output to …?

A

60-100 mg/day

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8
Q

Name 5 actions of cortisol.

A
  1. Facilitates conversion of NE to EPI in adrenal medulla, inhibits production of endothelial prostacyclin (PGI2) responsible for vasodilation
  2. Retention of Na and excretion of K
  3. Enhances gluconeogenesis from protein breakdown and lipolysis
  4. Inhibits peripheral glucose utilization
  5. Anti-inflammatory and anti-allergic effects
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9
Q

What is Cushing’s Disease?

A

A tumor/adenoma in the pituitary gland that produces large amounts of ACTH, which in turn elevates cortisol levels

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10
Q

What is Cushing’s syndrome?

A

Most commonly caused by the administration of glucocorticoids used to treat other diseases

Ectopic ACTH syndrome - ACTH production by a nonpituitary tumor ex. Small Cell Lung carcinoma

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11
Q

What is adrenal insufficiency?

A
  • the destruction of all of the cortical zones - decreased production of mineralocorticoids, glucocorticoids, and androgens.
  • Adrenal insufficiency is a chronic state, but can deteriorate into acute adrenal crisis if the patient is faced with additional stress (infection, illness, sepsis, or surgery)
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12
Q

What is Primary adrenal insufficiency (Addison’s)?

A
  • the adrenal glands don’t secrete enough steroid hormone

- cause: autoimune destruction of both adrenal glands (most common), HIV, TB

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13
Q

What is Secondary adrenal insufficiency?

A
  • decreased CRH or ACTH release

- cause: exogenous steroid administration (most common) or HPA disease d/t tumor, infection, surgery, radiation

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14
Q

Exogenous steroid supplementation suppresses…?

A
  • ACTH release from the anterior pituitary gland
  • Some patients on chronic steroid therapy won’t be able to increase cortisol release in response to perioperative stress.
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15
Q

What patients require stress-dose steroids for surgery?

A

All patients who have received suppressive doses _>20mg Cortisol for 5 days-2 weeks in the last 12 months

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16
Q

Minor surgeries should receive _____mg Hydrocortisone dose?

A

25 mg IV

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17
Q

Moderate surgeries should receive _____mg Hydrocortisone dose?

A

50-75 mg IV

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18
Q

Major surgeries should receive _____mg Hydrocortisone dose?

A

100-150 mg IV

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19
Q

What does “High Powered MD - 20-5-4-1” stand for?

A

Hydrocortisone - 20 mg
Prednisone/Prednisolone - 5 mg
Methylprednisolone - 4 mg
Dexamethasone - 1 mg

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20
Q

Name the steps in catecholamine synthesis.

A

Tyrosine-(tyrosine hydroxylase)-DOPA-(DOPA decarboxylase)-Dopamine-(dopamine-B-hydroxylase)-Norepinephrine-(PMN)-Epinephrine

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21
Q

What is a Pheochromocytoma?

A

Catecholamine-secreting tumors of the sympathetic nervous system

*originate either in the adrenal medulla of a single adrenal gland or are extra-adrenal located in chromaffin tissue

22
Q

The average pheochromocytoma contains how much NE?

A

100-800 mg

23
Q

What is the classic triad of symptoms for Pheochromocytoma?

A

paroxysmal HTN, diaphoresis, palpitations

24
Q

What chemical will be found in the urine of NE secreting Pheochromocytomas?

A

Vanillylmandelic acid

25
Q

What chemical will be found int he urine of EPI secreting Pheochromocytomas?

A

Metanephrine

26
Q

The posterior pituitary is known as _____?

A

Neurohypophysis

27
Q

The posterior pituitary secretes:_______?

A

ADH and Oxytocin

28
Q

The anterior pituitary is known as:______?

A

Adenohypophysis

29
Q

The anterior pituitary secretes:_____?

A 
"FLAT PiG"
ACTH
TSH
FSH
LH
GH
Prolactin
30
Q

What is Neurogenic (Central) DI?

A

Not enough ADH is synthesized

31
Q

What is Nephrogenic DI?

A

The renal tubules and collecting ducts become resistant to vasopressin

32
Q

What is an anesthesia consideration for pts with Acromegaly?

A

Use a smaller ETT than usual d/t airway narrowing

33
Q

What is Carcinoid Syndrome?

A

Symptoms caused by the secretion of vasoactive substances from enterchromaffin cells. Usually associated with tumors of the GI tract.

*When hepatic function is normal, carcinoid hormones are cleared by the liver; when significant liver dysfunction occurs, these hormones are not cleared by the liver, they enter systemic circulation and cause systemic effects.

34
Q

What substances are secreted by carcinoid tumors?

A

Serotonin
Kinins and Kallikriens
Histamine

35
Q

What are the most common S/S of Carcinoid Syndrome?

A

Flushing and diarrhea

36
Q

How is carcinoid Syndrome diagnosed?

A

The presence of serotonin metabolites in urine or elevated plasma levels of chromogranin A

37
Q

What drug can be administered in carcinoid syndrome?

A
  • Somatostatin (Octreotide or lanreotide): inhibits the release of vasoactive substances from carcinoid tumors
  • Antihistamines
  • 5-HT3 antagonists
  • Steroids
38
Q

What is Obesity Hypoventilation Syndrome (Pickwickian Syndrome)?

A
  • The respiratory center in the medulla fails to respond to hypercarbia appropriately
  • long-term consequence of untreated OSA
  • Classic presentation: Episodes of apnea during sleep without any respiratory effort
39
Q

What comprises the adrenal cortex and what does each layer secrete?

A
  1. zona glomerulosa - aldosterone (mineralocorticoids)
  2. zona fasciculata - cortisol (glucocorticoids)
  3. zona reticularis - androgens
40
Q

How is OHS diagnosed?

A

BMI > 30
Awake PaCO2 > 45 mmHg
Dysfunctional breathing during sleep

41
Q

The adrenal gland requires _____, which is then converted biochemically into steroid hormones.

A

cholesterol

42
Q

What is the most common steroid synthesis problem?

A

Congenital adrenal hyperplasia

Various forms (21-hydroxylase, 17 a -hydroxylase, 11 b -hydroxylase, 3b-hydroxysteroid dehydrogenase)

43
Q

What medications interfere with steroid synthesis enzymes?

A

ketoconazole

44
Q

What medications accelerate the normal breakdown of hormones by the liver?

A

rifampicin, phenytoin

45
Q

How does etomidate suppress adrenal function?

A

By inhibiting enzymes essential for production of corticoid steroid hormones

46
Q

What is the cosyntropin provocative testing of the HPA?

A

A synthetic ACTH is administered to assess the ability of the adrenal gland to accelerate production of cortisol.

  • Baseline cortisol levels are drawn (normal 6-18 ug/dL)
  • Administer 0.25 mg of cosyntropin
  • Draw cortisol levels at 30 min and 1 hour
  • Responders >9, Nonresponders
47
Q

Why do we give stress-dose steroids in anesthesia?

A

Blood pressure

48
Q

What is the most frequent cause of death for Pheochromocytoma pts postop?

A

Hypotension - require large volumes of fluid because peripheral vasculature is unresponsive to the lover catecholamine levels

49
Q

What is the function of ADH?

A

Controls water secretion and extracellular fluid osmolality

Controversially more potent vasoconstrictor than angiotensin II

50
Q

What is the function of Oxytocin?

A

promotes milk letdown and uterine smooth muscle contraction

51
Q

What medication is sometimes given in central DI?

A

Carbamazepine

Advanced Principles of Anesthesia (3 decks)

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