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NUNA 684 Advanced Pathophysiology > Exam III: Pituitary, SIADH, DI, Adrenal Disorders > Flashcards

Exam III: Pituitary, SIADH, DI, Adrenal Disorders Flashcards

1
Q

Endocrine System (ES)

One of two homeostatic regulating systems
____ and ____ Systems
Work _____ to control response to stress

A

Nervous and Endocrine
together

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2
Q

ES is regulation of (5)

A

Behavior, metabolism, growth, fluid & electrolytes

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3
Q

Endocrine Gland: secrete hormones into ____ ____ (6 endocrine glands)

A

extracellular fluid
Pituitary, thyroid, parathyroid, pancreas, ovaries, adrenal

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4
Q

Exocrine Gland: secretes into ____. (2 types)

A

ducts
salivary, sweat glands

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5
Q

Hypothalamus controls ____ ____ secretion

A

pituitary hormone

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6
Q

Anterior Pituitary secretes ___ hormones

A

six

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7
Q

Hypothalamus sends hormones via ____ ____ ____ connection to anterior pituitary

A

hypophyseal portal vein

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8
Q

Hypothalamus, Pituitary, Adrenal (HPA) axis
Hypothalamus stimulates or inhibits hormone secretion based on a ___ ___ ___

A

negative feedback loop

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9
Q

Posterior Pituitary Gland - Terminal neuronal tissue originating in ______

A

hypothalamus

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10
Q

Two hormones synthesized in hypothalamus, secreted to and stored in the posterior pituitary

A

Vasopressin (Antidiuretic Hormone)
Oxytocin

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11
Q

Vasopressin (Antidiuretic Hormone)
Causes kidney to reabsorb water (___ receptor)
Secretion based on ____ ____ ____ to increased plasma osmolarity
Potent vasoconstriction (___ receptor)

A

V2
hypothalmic osmoreceptor response
V1

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12
Q

Oxytocin
causes ____ to contract
causes ____ ____ ejection

A

uterus
breast milk

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13
Q

Physiological response to surgical stress: (3)

A

increased CRH, ACTH, and cortisol secretion

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14
Q

Increased cortisol secretion
Increases at ____ ____
Continues through ___ ___ period

A

surgical incision
post op

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15
Q

ACTH stimulates ____ & ____ secretion

A

androgens & glucocorticoid

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16
Q

Zona glomerulosa secretes: *not stimulated by ACTH
_____: ______

A

Mineralocorticoids: aldosterone

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17
Q

Zona fasciculata secretes:
____: ______

A

Glucocorticoids: cortisol

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18
Q

Zona reticularis secretes:
_____: _____(anabolic steroid)

A

Androgens:dehydroepiandrosterone

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19
Q

Adrenal medulla:
Chromafin cells secrete:
_____: ____, ____, and ____

A

Catecholamines: norepi, epi, and dopamine

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20
Q

____ (____): primary glucocorticoid (95%)

A

Cortisol (hydrocortisone)

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21
Q

Cortisol production: __/__ ____ under normal conditions
Cortisol receptors on all cells: primary target tissues are ____, ____, ____ ____

A

15-30 mg/day
liver, adipose, skeletal muscle

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22
Q

___ & ____ _____ & ___ ____ levels stimulate release
Hypothalamus (CRH)-> Anterior Pituitary (ACTH)-> blood-> adrenal cortex-> cortisol

A

Physical & mental stress & low glucocorticoid

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23
Q

Cortisol Stimulates ____, _____ (diabetogenic effect)
Heavily affects ____ causing increased output of glucose
↑Free ___ ___ mobilization

A

gluconeogenesis, glycogenolysis
liver
fatty acid

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24
Q

Inhibits collagen formation causing collagen loss:
___ and ____ thins
↓Protein synthesis, ↓ ___ ___ ___ by muscles, ↑protein catabolism

A

Skin and hair
amino acid uptake

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25
Q

Reduced ____/____ response
Reduces ____ release
Lysosomal membrane _____ preventing leaky cells

A

inflammatory/immune
histamine
stabilizing

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26
Q

Osteoporosis: reduced _____ absorption

A

calcium

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27
Q

Cortisol - Raises blood pressure:
___ reabsorption, ___ excretion

A

Na+
K+

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28
Q

Cortisol - Raises blood pressure:
____ effects cause water retention

A

ADH

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29
Q

Cortisol - Raises blood pressure:
Facilitates ____ synthesis

A

catecholamine

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30
Q

Cortisol - Raises blood pressure:
___ receptor synthesis, regulation,

A

Beta

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31
Q

Cortisol - Raises blood pressure:
↑ vascular sensitivity to _____ and exogenous _____
Increased vascular tone, cardiac contractility
Without cortisol, ____ ____ occurs

A

catecholamines
sympathomimetics
cardiovascular collapse

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32
Q

Produces mineralocorticoid (aldosterone) effects:
Cortisol is molecularly similar to _____
Increased affinity for ______ receptor
Mineralocorticoid target tissue enzyme prohibits overstimulation of the receptor by cortisol

A

aldosterone
mineralocorticoid

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33
Q

cortisol - alteration in ____

A

mood

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34
Q

cortisol - increased ____

A

apetite

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35
Q

Glucocorticoid Excess (Cushing’s Syndrome)
ACTH ____:
↑ACTH by ___ ____(75% of endogenous causes)

A

dependent
pituitary adenoma

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36
Q

Glucocorticoid Excess (Cushing’s Syndrome)
ACTH independent:
adrenal tumor, adrenal carcinoma
Superphysiologic doses of ___ ____ (most common cause)
used for controlling inflammatory or autoimmune conditions such as ___, ____, ____, ____

A

exogenous steroids
asthma, bronchitis, arthritis, lupus, MS

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37
Q

Glucocorticoid Excess (Cushing’s Syndrome)
Ectopic production:↑ACTH from __-___ ____

A

non-pituitary tumors

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38
Q

Glucocorticoid Excess (Cushing’s Syndrome)
Increased glucocorticoids can also produce some mineralocorticoid effects:
____, ____

A

Hypokalemia, Hypertension

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39
Q

Glucocorticoid Excess (Cushing’s Syndrome)
Inability to tolerate stress of ___ ___

A

normal activity

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40
Q

Glucocorticoid Excess (Cushing’s Syndrome)
____ intolerance

A

glucose

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41
Q

Glucocorticoid Excess (Cushing’s Syndrome)
___ ____ change

A

mental status

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42
Q

Glucocorticoid Excess (Cushing’s Syndrome)
catabolic effects (4)

A

Catabolic effects:
muscle atrophy & wasting, thin skin, osteoporosis

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43
Q

Anesthesia Mgmt of Glucocorticoid Excess
Usually ____, ____, _____
_____: reduces intravascular volume, ↑’s K+

A

hypertensive, hyperglycemic, hypokalemic
Spironolactone

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44
Q

Anesthesia Mgmt of Glucocorticoid Excess
Positioning concerns:
Pathological ____ risks: careful positioning
___ ___ skin: don’t pinch, tear, use paper tape

A

fracture
Frail thin

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45
Q

Anesthesia Mgmt of Glucocorticoid Excess
Increased risks of ____: immunosuppressed, aseptic technique

A

infection

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46
Q

Anesthesia Mgmt of Glucocorticoid Excess
___ ___ weakness:
Mechanical ____ is indicated due to profound weakness
Potential increased sensitivity to ____ due to ↓K+

A

Skeletal muscle
ventilation
paralytics

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47
Q

Anesthesia Mgmt of Glucocorticoid Excess
Realize increased risks of ____ event (DVT, PE)

A

thromboembolic

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48
Q

Anesthesia Mgmt of Glucocorticoid Excess
__ ____ may temporarily suppress cortisol release

A

IV Etomidate

49
Q

Adrenocortical Insufficiency (AI) (Addison’s Disease)
___ types

50
Q

Adrenocortical Insufficiency (AI) (Addison’s Disease)
Type 1 - ___ ___ insufficiency:
Destruction of the adrenal gland
TB, HIV, malignancy, autoimmune diseases
___ ACTH secretion from pituitary
Both mineralocortoid and glucocorticoid are ____
Clinical signs due to ____ deficiency

A

Primary adrenal
Normal
deficient
aldosterone

51
Q

Adrenocortical Insufficiency (AI) (Addison’s Disease)
Type 2 - Secondary adrenal insufficiency:
Inadequate ___ ___ from pituitary
Most often from negative feedback from administration of ___ ____ (adrenal suppression)
Mineralocorticoid secretion _____ (Na+ K+ & volume are normal)

A

ACTH secretion
exogenous glucocorticoids
unaffected

52
Q

Adrenocortical Insufficiency (AI) (Addison’s Disease)
Type 3 - Acute adrenal insufficiency:
____-____ patients not receiving glucocorticoids during stress (surgery, trauma, infection)
Patients receiving ____

A

Steroid-dependent
etomidate

53
Q

Signs of Acute Adrenal Crisis
____ collapse - ____ instability and hypotension

A

CV
hemodynamic

54
Q

Signs of Acute Adrenal Crisis
Severe ___ ___ weakness

A

skeletal muscle

55
Q

Signs of Acute Adrenal Crisis
Hypo____, Hyper____

A

Hyponatremia, Hyperkalemia

56
Q

Signs of Acute Adrenal Crisis
Nausea,(due to _____) Fever

A

hypovolemia

57
Q

Signs of Acute Adrenal Crisis
____ mental status

58
Q

Anesthesia Mgmt of Adrenocortical Insufficiency
Correct __, ___, and glucose abnormalities

59
Q

Anesthesia Mgmt of Adrenocortical Insufficiency
Avoid ____ (even single dose affects susceptible pts.)

60
Q

Anesthesia Mgmt of Adrenocortical Insufficiency
Correct volume depletion with ____ ___

A

normal saline

61
Q

Anesthesia Mgmt of Adrenocortical Insufficiency
Inotropic or vasopressor support if ____ ____

A

hemodynamically unstable

62
Q

Anesthesia Mgmt of Adrenocortical Insufficiency
Glucocorticoid replacement:
Replace if on____ prednisone equivalent for > 2 weeks during the last ___ ____
100 mg Hydrocortisone q8hr followed by ____ over _____
This dosing is adequate to correct mineralocorticoid deficiency

A

≥ 5mg/day
12 months
100-200mg over 24 hrs

63
Q

Mineralocorticoids (Aldosterone)
Aldosterone: primary mineralocorticoid (90%)
Produce ____ ____

A

100-150 mcg/day

64
Q

Mineralocorticoids (Aldosterone)
Extracellular ___ & ____ regulation
K+ ____ coupled with Na+ ____

A

sodium & potassium
secretion
reabsorption

65
Q

Mineralocorticoids (Aldosterone)
Maintains total body ___ balance

66
Q

Mineralocorticoids (Aldosterone)
Secretion by adrenal cortex but NOT primarily based on ____

67
Q

Mineralocorticoids (Aldosterone)
Secretion based on 4 stimulants (greatest to least)

A

Angiotension II (decreased blood pressure, hypovolemic states)
Hyperkalemia
Hyponatremia
ACTH

68
Q

Circulatory support by the Renin system
Renin is released from the granular cells of the afferent arteriole of kidney in response to: (3)

A

Pressure decrease hypovolemia beta-1 adrenergic stimulation

69
Q

Circulatory support by the Renin system
____ converts angiotensinogen to angiotensin I

70
Q

Circulatory support by the Renin system
Angiotensin-converting enzyme (ACE) from the ____ converts angiotensin II (potent ____)

A

lungs
vasoconstrictor

71
Q

Circulatory support by the Renin system
Angiotensin II stimulates ____ ____ directly from the adrenal cortex

A

aldosterone release

72
Q

Circulatory support by the Renin system
Angiotensin II also stimulates _____ release from posterior pituitary

A

vasopressin

73
Q

Primary Aldosteronism (Conn’s Syndrome)
↑secretion ____ stimulation (adrenal hypersecretion)
Usually adenoma, hyperplasia or rarely carcinoma
Renin levels are ____ due to ___ ____ from HTN

A

without
low due to negative feedback

74
Q

Secondary Aldosteronism:
Stimulation comes from ____ the adrenal gland
Usually because of increased circulating ____ levels
Some conditions stimulate renin-angiotensin system leading to ↑ aldosterone secretion:
CHF, HoTN, hepatic cirrhosis, ascites, nephrotic syndrome

A

outside
renin

75
Q

Treat HTN and fluid volume overload:
Na+ levels are usually NOT elevated due to ↑water retention
Spironolactone: ____ antagonist
Antihypertensive properties
Helps with ___ ____

A

aldosterone
K+ correction

76
Q

Consider presence of LV ____, LV _____

A

hypertrophy
dysfunction

77
Q

Evaluate electrolytes:
Replace ___ ___ slowly IV
May have increased sensitivity to ___-____ agents
Muscle weakness and cramps
Evaluate EKG for presence of __ ____
Avoid ___ventilation

A

depleted K+
non-depolarizing
U wave
hyper

78
Q

Aldosterone Deficiency
extremely ___

79
Q

Aldosterone Deficiency
____ without renal insufficiency usually indicates hypoaldosteronism
Deficiency of aldosterone synthetase
Hypo____
ACE inhibitor-induced reduction in angiotensin

A

Hyperkalemia
reninemia

80
Q

Aldosterone Deficiency - hypo____, hypo_____

A

Hypotension, Hyponatremia

81
Q

Aldosterone Deficiency
Treatment with ___ and _____

A

Na+ and corticosteroids

82
Q

Growth Hormone Hypersecretion
Usually caused by ____ ___
GH promotes growth, promotes a ____ effect

A

pituitary adenoma
diabetogenic

83
Q

Growth hormone hypersecretion -
___ ___ deposited on existing bone
↑Hands, feet, vertebrae, kyphoscoliosis, arthritis
Entrapment neuropathy: ___ ___ syndrome
___ ___ collateral flow impediment

A

New bone
carpal tunnel syndrome
Radial artery

84
Q

Growth Hormone Hypersecretion
___ ___ ___ occurs
↑Nose, mandible, supraorbital ridge
Dental ____

A

Soft tissue overgrowth
malocclusion

85
Q

Growth Hormone Hypersecretion
Organ overgrowth occurs
↑___, ____, ____
Increased pulmonary volumes

A

Liver, heart kidney, spleen

86
Q

Growth Hormone Hypersecretion Symptoms
____ intolerance

87
Q

Growth Hormone Hypersecretion Symptoms
Symptomatic _____ disease
Biventricular concentric hypertrophy
Diastolic dysfunction, CHF, arrhythmias

88
Q

Growth Hormone Hypersecretion Symptoms
↑glucose: GH ____ resistance effects

89
Q

Growth Hormone Hypersecretion Symptoms
Enlarging tumor: ↑___, ___ ___ compression

A

ICP, optic nerve compression

90
Q

Anesthesia Management of Acromegally
Consider existence of ___ disease ___, hypertrophy

A

cardiac
CAD

91
Q

Anesthesia Management of Acromegally
Thorough Airway Assessment:
Dyspnea, stridor,hoarseness indicate ____ ____
↑tongue, teeth, pharyngeal tissue, epiglottis:
Fiberoptic or glidescope (diff airway__-__ ____ occurrence)
___ have sleep apnea
↑Facial features: difficult mask fit
Subglottic narrowing, ↑vocal cords: use smaller ETT
↑Nasal turbinates: caution with ___ ____ or nasal trumpets

A

airway difficulty
4-5x higher
60%
nasal intubation

92
Q

Anesthesia Management of Acromegally
Blood glucose level (glucose ____, _____)

A

intolerance
prediabetic

93
Q

Anesthesia Management of Acromegally
Wrist positioning & ___ ____ ____ concerns

A

Radial artery circulation

94
Q

Antidiuretic Hormone (ADH)
ADH: primary regulator of ___ ___
Plasma ____ regulates release

A

water balance
osmolarity

95
Q

Antidiuretic Hormone (ADH)
ADH acts on ___ and ___ receptors:

96
Q

Antidiuretic Hormone (ADH)
High levels of ADH stimulate V1 receptors:
Potent vasoconstriction: (3)

A

coronary, splanchnic, renal vascular beds

97
Q

Antidiuretic Hormone (ADH)
___ ___ of ADH stimulate V2 receptor on renal collecting ducts:
Increases water reabsorption through channels (aquaporins)
Collecting duct impermeable to water reabsorption ___ ___
Increased water loss -> ____ occurs

A

Low levels
without ADH
dehydration

98
Q

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Hypersecretion of ADH/vasopressin not caused by ___ ____

A

increased osmolarity

99
Q

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Causes:

A

Hypothyroidism, head trauma, intracranial tumors
Pituitary surgery
Pulmonary infection
Small-cell carcinoma of lung (common)

100
Q

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Increased renal reabsorption of water:
Hypo____ & plasma hypotonicity
Increased ___ & ____ fluid volumes
Hemodilution and water weight gain
Urine is ____ with low urine output

A

natremia
intra and extracellular
hypertonic

101
Q

Clinical Signs of SIADH
No ____ and no peripheral edema

A

hypertension

102
Q

SIADH
Clinical signs result from water intoxication:

A

Hyponatremia
Brain edema
Primarily CNS signs
Lethargy, headache, AMS, seizure

103
Q

Anesthesia Management of SIADH
Assess and manage volume status:
Fluid restriction: ________
____ saline solutions

A

800-1000ml/day
Isotonic

104
Q

Anesthesia Management of SIADH
Severe _____:
Hypertonic saline (3%) infusion if Na+ ____ & ____
Infuse slow to prevent ____ ____ ____ syndrome

A

hyponatremina
<115 & symptomatic
central pontine demyelination

105
Q

Anesthesia Management of SIADH
_____ (____) antagonizes vasopressin on renal tubules

A

Demecloycycline (tetracycline)

106
Q

Anesthesia Management of SIADH
Prevent nausea: Nausea potent stimulant of ____

107
Q

Neurogenic (central DI):
Inadequate secretion of ADH/vasopressin from ___ ___ ___.
Causes (2)

A

posterior pituitary lobe

Severe head trauma,brain tumors
Pituitary surgery - Temporary: usually resolves in 5-7 days

108
Q

Nephrogenic DI:
Inability of renal collecting duct receptors to respond to ADH: ___ ___ ____

A

reduced receptor sensitivity

109
Q

Nephrogenic DI:
causes:

A

Genetic mutations
Hypercalcemia, hypokalemia,
Medicine induced nephrotoxicity
Ethanol inhibits response or release (alcohol consumption ↑’s urine output)
Demeclocycline, dilantin, chlorpromazine (thorazine), lithium inhibit ADH response or release

110
Q

Diabetes Insipidus (DI)
Response to ___ (____ ____) distinguishes between the two
____ corrects neurogenic cause and concentrated urine but will not correct nephrogenic cause

A

DDAVP (vasopressin analogue)
DDAVP

111
Q

Diabetes Insipidus (DI)
primary sign

A

Polyuria is the primary sign

112
Q

Diabetes Insipidus (DI) signs:
Dehydration, hyper____
____ urine osmolarity
High plasma osmolarity (> ______)

A

natremia
Low
290 mOsm/L

113
Q

Diabetes Insipidus (DI) signs:
___dipsia

A

Polydipsia (increased thirst)

114
Q

Diabetes Insipidus (DI) CNS signs (4)

A

Hyperreflexia, weakness, lethargy, seizures

115
Q

Anes Mngmnt Diabetes Insipidus (DI)
Neurogenic:
DDAVP: ____ analogue
Desmopressin _____

A

vasopressin
intranasally

116
Q

Anes Mngmnt Diabetes Insipidus (DI)
Nephrogenic:
____: an oral sulfonylurea hypoglycemic (Diabinese) enhances effects of ADH on renal tubules

A

Chlorpropamide

117
Q

Anes Mngmnt Diabetes Insipidus (DI)
____ fluid volume status

118
Q

Anes Mngmnt Diabetes Insipidus (DI)
Evaluate electrolytes ___ & ____

A

Na+ and K+

119
Q

Anes Mngmnt Diabetes Insipidus (DI)
Monitor ____

NUNA 684 Advanced Pathophysiology (16 decks)

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