Endocrinology Flashcards
Benefits of Tight Glycemic control
- Improves wounds healing
- Reduces rate of infection
- Avoids exacerbating CNS injury associated with ischemia in presence of increased serum glucose
- Decreases risk of dehydration 2/2 osmotic diuresis
Sequelae of long-term uncontrolled Diabetes
- Peripheral and autonomic neuropathy
- CAD
- HTN
- Increased risk of aspiration (gastroparesis)
- Renal insufficiency
What is Carcinoid Syndrome?
A constellation of symptoms including flushing, diarrhea, bronchoconstriction, right heart valvular disease (pulmonic stenosis, tricuspid regurgitation) and hypotension
- D/t excessive amounts of circulating hormones (histamine, bradykinin, serotonin) in the systemic circulation
How is carcinoid syndrome diagnosed?
- 24-hr urine levels of 5-hydroxyindoleacetic acid (5-HIAA)
- PET/CT Scan
- Octreoscan (Scintigraphy)
Why don’t all patients with carcinoid tumors develop carcinoid syndrome?
Most carcinoid tumors are located in GI tract
- vasoactive substances enter portal circulation and removed by liver prior to systemic circulation
Symptoms occur when substance bypass portal system
- Metastasis to liver
- Tumors outside GI tract (pulmonary, ovarian)
What’s the treatment of carcinoid crisis?
- Somatostatin analogue (Octreotide)
2. Optimize intravascular fluid volume
Would you use Succinylcholine in a patient with Carcinoid Syndrome?
No
- Fasciculations and potential histamine release could lead to increased release of vasoactive substances