Exam 3 - Endocrine Flashcards
What is Addison’s disease?
Adrenocortical insufficiency caused by autoimmune or idiopathic atrophy, inadequate ACTH from the pituitary, or therapeutic use of steroids.
What are the manifestations of Addison’s disease?
Muscle weakness, anorexia, dark pigmentation, hypotension, hypoglycemia, low sodium levels, high potassium levels. Can result in Addisonian crisis.
What is an Addisonian crisis?
Circulatory shock characterized by pallor, apprehension, weak & rapid pulse, rapid respirations, low blood pressure, headache, nausea, abdominal pain, and diarrhea.
What can precipitate an Addisonian crisis?
Overexertion, exposure to cold, acute infection, decrease in salt intake.
What are the assessment and diagnostic findings for Addison’s disease?
Early morning serum cortisol and plasma ACTH tests distinguish between primary and secondary adrenal insufficiency. Elevated ACTH and below normal cortisol levels indicate primary adrenal insufficiency.
What is the management for Addison’s disease?
Restore circulatory status with fluids and steroids, may need antibiotics, lifelong steroid therapy, mineralocorticoid therapy, and additional salt intake.
What is Cushing’s syndrome?
Results from excessive adrenocortical activity, possibly due to corticosteroid use, adrenal cortex hyperplasia, or pituitary tumors.
What are the manifestations of Cushing’s syndrome?
Cataracts, glaucoma, hypertension, heart failure, truncal obesity, moon face, buffalo hump, sodium retention, hypokalemia, hyperglycemia, osteoporosis, and mood alterations.
What are the assessment and diagnostic findings for Cushing’s syndrome?
Overnight dexamethasone suppression test, plasma ACTH measurement, MRI, and CT scans to detect tumors.
What is the medical management for Cushing’s syndrome?
Transsphenoidal hypophysectomy for pituitary source, radiation, adrenalectomy for adrenal hypertrophy, and temporary replacement therapy with hydrocortisone or Florinef.
What are the symptoms of carcinoid syndrome?
Cutaneous flushing, labile blood pressure, diarrhea, bronchospasm, cardiac failure.
What is the treatment for carcinoid syndrome?
Fluid resuscitation, H1 and H2 antagonists, serotonin antagonists, bronchodilators, vasoactive drugs, and octreotide.
What hormones are produced by the thyroid?
T3 and T4
T3 is five times as potent as T4.
What is required for the synthesis of thyroid hormones?
Iodine
What mechanism occurs with excess iodine?
The Wolf-Chaikoff mechanism results in adaptive decline in utilization.
What controls the thyroid gland?
TSH (Thyroid Stimulating Hormone)
What are the main functions of the thyroid?
Cellular metabolism, brain development, normal growth, and affecting every organ in the body.
What is calcitonin and when is it secreted?
Calcitonin is secreted in response to high levels of serum calcium and increases deposition in the bone.
What are the key assessments for thyroid diagnostics?
Inspect gland, observe for goiter, check TSH, serum T3 and T4.
What medications can cloud the accuracy of thyroid tests?
Estrogens, Dilantin, Tagamet, Heparin, amiodarone, PTU, steroids & Lithium.
What does a high radioactive iodine uptake indicate?
Hyperthyroidism
What does a low radioactive iodine uptake indicate?
Hypothyroidism
What is the most common cause of hypothyroidism?
Hashimoto’s thyroiditis
What are some other causes of hypothyroidism?
Previously treated for hyperthyroidism, atrophy of gland with aging, medications, radiation, infiltrative diseases, iodine deficiency or excess, hypothalamic or pituitary abnormality.
What are common symptoms of hypothyroidism?
Fatigue, hair loss, dry skin, brittle nails, numbness and tingling, amenorrhea, weight gain, decreased heart rate & temp, lassitude, cognitive changes, elevated cholesterol, constipation, hypotension.
What is the preferred pharmacologic management for hypothyroidism?
Levothyroxine, with dosage based on TSH.
What should be monitored when starting thyroid replacement therapy?
Angina may occur due to enhanced catecholamine effect in CAD; start at low dose.
What is myxedema?
Accumulation of mucopolysaccharides in subcutaneous and interstitial tissues, extreme form of hypothyroidism.
What are the signs and symptoms of myxedema?
Lethargy, intolerance to cold, bradycardia, peripheral vasoconstriction, adrenocortical atrophy, hyponatremia.
What is the anesthetic management for hypothyroid patients?
Preoperative supplemental hydrocortisone, induction with ketamine, maintenance with ultrashort acting drugs.
What is hyperthyroidism and its extreme form?
Hyperthyroidism is excessive thyroid hormone production; its extreme form is Grave’s disease.
What are common manifestations of hyperthyroidism?
Nervousness, irritability, palpitations, heat intolerance, skin flushing, tremors, possibly exophthalmos.
What are the assessment findings for hyperthyroidism?
Thyroid thrill or bruit, enlarged thyroid, decreased TSH, increased free T4, increased radioactive iodine uptake.
What is the management for hyperthyroidism?
Reduce thyroid hyperactivity using radioactive iodine, antithyroid medications, or surgery; beta blockers may also be used.
What are the signs and symptoms of a thyroid storm?
High fever, tachycardia, delirium, chest pain, dyspnea, palpitations, weight loss, diarrhea, abdominal pain.
What is the management for thyroid storm?
Oxygen, IV fluids with dextrose, hypothermic measures, steroids, iodine, beta blockers, or Tapazole.
What are the antithyroid medications?
PTU (propylthiouracil), Tapazole (methimazole), Sodium Iodide, SSKI, Dexamethasone.
What are the intraoperative hazards of thyroidectomy?
Circulatory disturbances, thyroid storm, cooled saline infusion, esmolol.
What is the function of parathormone?
Parathormone maintains sufficient serum calcium levels.
What can excess calcium cause?
Excess calcium can bind with phosphate and precipitate in various organs, potentially causing pancreatitis.
What are the manifestations of hyperparathyroidism?
Manifestations may include apathy, fatigue, muscle weakness, nausea, vomiting, constipation, hypertension, and cardiac dysrhythmias.
Excess calcium in the brain can lead to psychoses.
What are the common complications of hyperparathyroidism?
Complications include renal lithiasis, bone demineralization, peptic ulcers, and pancreatitis.
What are the assessment findings for hyperparathyroidism?
Persistent elevated calcium levels, elevated serum parathormone level, decreased bone density, and diagnostic imaging may be used.
What is the recommended treatment for hyperparathyroidism?
Surgical removal is the recommended treatment.
What is a hypercalcemic crisis?
A hypercalcemic crisis is seen with calcium levels >15mg/dL and can result in life-threatening symptoms.
What are the treatments for hypercalcemic crisis?
Treatments include hydration, loop diuretics, phosphate therapy, and calcitonin or mithramycin.
What causes hypoparathyroidism?
Hypoparathyroidism most often occurs after removal of the thyroid or parathyroid glands or following radical neck surgery.
What are the clinical manifestations of hypoparathyroidism?
Clinical manifestations include irritability of the neuromuscular system, tetany, numbness, tingling, cramps, laryngeal spasm, bronchospasm, and seizures.
What are the assessment findings for hypoparathyroidism?
Trousseau’s sign, Chvostek’s sign, calcium levels of 5–6 mg/dL or lower, and decreased serum phosphate levels.
What is the management goal for hypoparathyroidism?
The goal is to restore calcium levels to 9–10 mg/dL.
What immediate treatment may be needed for hypoparathyroidism?
IV calcium gluconate may be needed for immediate treatment.
What precautions should be taken post-operatively for hypoparathyroidism?
Monitor for tetany, seizures, and respiratory difficulties.
What are the types of Diabetes Mellitus?
Diabetes Mellitus can be classified into Insulin-Dependent Diabetes Mellitus (IDDM) and Non-Insulin Dependent Diabetes Mellitus (NIDDM).
What are the nutritional characteristics of IDDM and NIDDM?
IDDM is typically associated with thin nutrition, while NIDDM is associated with obesity.
How does blood glucose vary in IDDM and NIDDM?
In IDDM, blood glucose levels are variable, whereas in NIDDM, they are stable.
Is ketoacidosis common in IDDM or NIDDM?
Ketoacidosis is common in IDDM and uncommon in NIDDM.
Does IDDM require insulin?
Yes, IDDM requires insulin, while NIDDM does not always require it.
What is the age of onset for IDDM?
The age of onset for IDDM is typically around 16 years old, with an abrupt onset.
What is the age of onset for NIDDM?
The age of onset for NIDDM is generally greater than 35 years old, with a gradual onset.
What are some manifestations of Diabetes Mellitus?
Manifestations include polyphagia, polydipsia, polyuria, ketoacidosis, autonomic neuropathy, and various vascular pathologies.
What is the traditional approach for preoperative insulin management?
The traditional approach involves giving 1/4 to 1/2 the daily dose of intermediate-acting insulin subcutaneously and starting IV glucose at 5-10 g/h.
What is the continuous IV infusion method for preoperative insulin?
Place 50 U of Regular Insulin in 1000 ml NS, give 10 ml/h, and adjust infusion rate to maintain glucose levels at 120-180 mg/dl.
What is Diabetes Insipidus?
Diabetes Insipidus is a deficiency of ADH, leading to excessive thirst and large volumes of dilute urine.
What are the causes of Diabetes Insipidus?
Causes include brain tumors, head trauma, CNS infections, and surgical ablation or radiation.
What is nephrogenic DI?
Nephrogenic DI is related to the failure of renal tubules to respond to ADH and can be caused by hypokalemia, hypercalcemia, and certain medications.
What are the diagnostic findings for Diabetes Insipidus?
Diagnostic findings include fluid deprivation tests and monitoring serum and urine osmolality and ADH levels.
What is the pharmacologic treatment for Diabetes Insipidus?
DDAVP (intranasal) is commonly used, and thiazide diuretics may be utilized in mild cases.
What is Pheochromocytoma?
Pheochromocytoma is usually a benign tumor originating from the chromaffin cells of the adrenal medulla.
What are the clinical manifestations of Pheochromocytoma?
Manifestations include headache, diaphoresis, palpitations, hypertension, and hyperglycemia.
What are the assessment findings for Pheochromocytoma?
Assessment includes elevated urinary catecholamines and metanephrine levels.
What is the management for Pheochromocytoma?
Management includes elevated HOB, nitroprusside, calcium channel blockers, and surgical intervention.
What are corticosteroids?
Corticosteroids include hydrocortisone, cortisone, prednisone, and others, used for various inflammatory and autoimmune conditions.
What are the indications for corticosteroid therapy?
Indications include RA, asthma, MS, COPD exacerbations, lupus, and other autoimmune disorders.
What are the side effects of corticosteroids?
Side effects include hypertension, increased infection risk, glaucoma, muscle wasting, and hyperglycemia.
What are the glands of the endocrine system?
The endocrine system includes the hypothalamus, pituitary gland, thyroid, parathyroids, adrenals, pancreas, ovaries, testes, kidneys, thymus, and pineal gland.
What hormones are produced by the hypothalamus?
The hypothalamus produces releasing and inhibiting hormones such as corticotropin-releasing hormone and growth hormone-releasing hormone.
What hormones are produced by the anterior pituitary?
The anterior pituitary produces growth hormone, ACTH, TSH, FSH, LH, and prolactin.
What hormones are secreted by the adrenal cortex?
The adrenal cortex secretes mineralocorticoids (aldosterone), glucocorticoids (cortisol), and adrenal androgens.
What is the role of insulin?
Insulin regulates blood sugar levels by promoting glucose uptake in cells.
What is the function of the pineal gland?
The pineal gland releases melatonin, affecting sleep, fertility, and aging.
What are prostaglandins?
Prostaglandins work locally and affect fertility, blood clotting, and body temperature.
