Bb Endocrine 2

Front 1

What are symptoms of addisons?

Back 1

1. hypotension,
2. fluid depletion,
3. hyperkalemia,
4. hyponatremia

Front 2

Compare potency of steroids?

Back 2

cortisol = solucortef/hydrocortisone: 1
prednisone: 4;
solumedrol/methylprednisolone): 5;
dexamethasone: 25

Front 3

What are indications for an adrenalectomy?

Back 3

1. adrenal adenoma or carcinoma,
2. pheochromocytoma,
3. palliation for metastatic cancer

Front 4

What is the dexamethasone suppression test?

Back 4

dexamethasone is given at bedtime, cortisol is checked in the AM with normal being <5mcg/100mL

Front 5

How much cortisol is secreted by the adrenals normally? under stress?

Back 5

normal-115-185mg/day
stress-200-500mg/day

Front 6

Where are catecholamines produced? What stores catecholamines?

Back 6

catecholamines are produced and released by the adrenal medulla in response to stress
-chromaffin tissues located in the adrenal medulla

Front 7

Where is the majority of the chromaffin granules that store norepi and epi located?

Back 7

70% adrenal medulla,
30% sympathetic chain - organ of Zuckerkandl

Front 8

How do catecholamines affect glucose levels?

Back 8

catecholamines are hyperglycemic, glycogenolytic, lipolytic

Front 9

What are the cardinal signs of pheochromocytoma?

Back 9

1. paroxysmal htn,
2. orthostatic hypotension and
3. hypovolemia,
4. palpitations,
5. headache,
6. sweating,
7. N/V

Front 10

How do you diagnose pheochromocytoma?

Back 10

1. 24 hour urine for catecholamines - VMA, metanephrines,
2. also serial serum catecholamines,
3. if 24 hours urine is positive do CT scan

Front 11

What is the rozen criteria for surgical readiness for pheochromocytoma?

Back 11

blood pressure control:
1. no in hospital blood pressure >165/90,
2. no orthostatic BP<80/40,
EKG criteria:
1. no ST changes for 2 weeks,
2, <1 PVCs in 5 min

Front 12

What preop preparation should you do in patients with pheochromocytoma?

Back 12

correction of hypovolemia and HTN
-management includes fluids, phenoxybenzamine, and propranolol - admin alpha blocker before beta blocker

Front 13

How long does stability of htn take after starting a patient with pheochromocytoma on both alpha and beta blockers?

Back 13

2 weeks

Front 14

What are the advantages of selective alpha 1 antagonists versus nonselective? What are examples of each?

Back 14

-selective alpha 1 blockers: doxazosin, terazosin, prazosin, limit the reflex tachycardia thus eliminating the need for preop beta blockers;
-nonselective: phentolamine, phenoxybenzaprine

Front 15

What alpha blockers used for pheochromocytoma are short acting and which ones are long acting?

Back 15

short acting: terazosin, prazosin, phentolamine;
long acting: doxazosin, phenoxybenzaprine

Front 16

What volatile anesthetic should you avoid in patients with pheochromocytoma?

Back 16

halothane, sensitizes the heart to catecholamines

Front 17

What are the typical intraop problems in patients with pheochromocytoma getting the adrenal gland removed?

Back 17

htn before vein is ligated,
hypotension afterwards

Front 18

How long does it take for the blood pressure to normalize after an adrenalectomy in patients with pheochromocytoma?

Back 18

3 days (75% normotensive by this time)

Front 19

Why do you give patients with DKA potassium even if their serum K is normal?

Back 19

acidosis masks the presence of total body potassium depletion
-these pts can be profoundly depleted of K yet their serum levels are not often markedly low bc of the acidosis

Front 20

What nerve is often involved in peripheral neuropathy in diabetics?

Back 20

lateral femoral cutaneous

Front 21

What are symptoms of hypoglycemia in the OR?

Back 21

htn, tachycardia, sweating, and cold-clammy skin

Front 22

How should you treat hypoglycemia in the OR?

Back 22

D5NS (50g/L)

Front 23

What should you consider in a patient with hypoglycemia?

Back 23

hepatoma

Front 24

What factors increase insulin requirement

Back 24

1. stress
2. steroids,
3. thyroid drugs,
4. oral contraceptives,
5. thiazides,
6. high carb diet,
7. infection,

Front 25

What factors decrease insulin requirement?

Back 25

1. exercise,
2. aspirin,
3. alcohol

Front 26

What are the main manifestations of ketoacidosis?

Back 26

1. acidosis,
2. hyperglycemia,
3. glucosuria,
4. dehydration

Front 27

When should you start giving potassium when treating DKA?

Back 27

when Urine output is established (>1 cc/kg/hr)

Front 28

When should you give bicarb to DKA patients and why?

Back 28

pH<7.1;
- myocardial depression can be severe in diabetic patients if pH<7.1

Front 29

Why do type 1 DM patients tend to develop ketosis during the stress of surgery?

Back 29

catelcholamines, cortisol, ACTH, and glucagon all increase under the stress of anesthesia and all of these increase plasma glucose

Front 30

what are neonatal problems associated with maternal diabetes?

Back 30

1. respiratory distress syndrome - due to inhibitory effects of chronic hyperinsulinemia on surfactant production
2. cardiomegaly,
3. congenital abnormalities are more frequent;
4. hypoglycemia
5. macrosomia - due to chronic hyperinsulinemia and increased glycogen synthesis, lipogenesis, and protein synthesis

Front 31

What are the components involved in the development of hyperosmolar hyperglycemic non-ketotic coma?

Back 31

1. insulin deficiency - liver insulin levels are high enough to permit the metabolism of free fatty acids so you don't see DKA
2. renal deficiency-insufficiency - impairs the ability to excrete glucose and leads to hyperosmolarity,
3. thirst deficiency

Front 32

What are lab findings in hyperosmolar hyperglycemic non-ketotic coma?

Back 32

1. glucose >600,
2. osmolality>300-350,
3. pH>7.3,
4. ketones in serum or urine are minimal or absent

Front 33

How do you treat patients with hyperosmolar hyperglycemic non-ketotic coma?

Back 33

1. hydrate - usually 6-8L dehydrated
2. insulin - don't treat too aggressively bc you don't want a quick shift of free water into the brain as hyperosmolarity decreases
3. when urine output is reestablished potassium should be given

Front 34

What hormones increase with the stress of anesthesia and surgery?

Back 34

1. ACTH,
2. ADH,
3. aldosterone,
4. catecholamines,
5. cortisol,
6. glucagon,
7. thyroid hormone

Front 35

Where in the hypothalamus is ADH and oxytocin produced?

Back 35

- oxytocin - paraventricular nuclei
- ADH - supraoptic nuclei

Front 36

What type of change in serum osmolality causes a release of ADH?

Back 36

An increase in plasma osmolality of only 10 mosm (from normal of 285 to 295)

Front 37

What are factors associated with SIADH?

Back 37

1. postop period up to 96 hrs
2. PPV
3. endocrine disorders - pituitary injury, adrenal cortical insufficiency
4. carcinoma of the lung
5. infection, hemorrhage, trauma
6. drugs - chloropropamide, opioids, diuretics, antimetabolites

Front 38

How does lithium effect ADH?

Back 38

it inhibits the action of ADH on the collecting duct of the renal tubule -> diabetes insipidus

Front 39

What is the function of PTH?

Back 39

maintains extracellular Ca concentration by causing bone reabsorption, renal ca reabsorption, and increasing intestinal absorption

Front 40

When does primary hyperparathyroidism occur most commonly?

Back 40

in women over age 60 and is most commonly secondary to an adenoma

Front 41

What is the nadir of Ca?

Back 41

3-7 days

Front 42

What are the mechanisms responsible for hypocalcemia?

Back 42

1. hypoparathyroidism
2. hungry bone syndrome - results in rapid remineralization

Front 43

3 classes of hypothyroidism

Back 43

1. primary hypothyroidism - involves thyroid gland destruction from subtotal thyroidectomy, radioactive iodine therapy, neck irradiation, or chronic inflammation (Hashimotos thyroiditis)
2. Secondary hypothyroidism - hypothalmic or anterior pituitary dysfunction
3. thyroid gland hormone deficiency

Front 44

What is hypothyroidism called in the neonate? What is the result?

Back 44

Cretinism - mental and physical retardation

Front 45

What are the effects of hypothyroidism on the circulatory system?

Back 45

1. decreased HR
2. decreased stroke volume
3. increased SVR
4. 40% reduction in cardiac output
5. peripheral vasoconstriction - accounts for the cold dry skin

Front 46

What characterizes myxedema coma?

Back 46

It is hypothyroidism in severe form

1. CHF

2. hypoventilation - myxedematious infiltration of muscles of respiration

3. hypothermia - due to diminished response to the calorigenic effects of catecholamines

4. depressed consciousness