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158 Cards in this Set
- Front
- Back
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What are the Endocrine glands ?
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pituitary, thyroid, parathyroid, thymus, adrenal, pancreas, testis, ovary, placenta
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Causes growth of almost all cells and tissues
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Growth hormone
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Causes the adrenal cortex to secrete adrenocortical hormones
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Adrenocorticoropin
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Causes the thyroid gland to secrete thyroxine and triiodothyronine
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Thyroid stimulating hormone
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Causes growth of follicles in the ovaries prior to ovulation, promotes the formation of sperm in the testes
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Follicle-stimulating hormone
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Plays an important role in ovulation, causes secretion of female sex hormone by the ovaries and testerosterone by the testes
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Luteinizing hormone
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Promotes development of the breasts and secretion of milk
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Prolactin
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Causes kidneys to retain water
High concentrations cause constriction of blood vessels and elevates blood pressure |
Vasopressin
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Contracts the uterus during birth. Also contracts myoepthelial cells in breasts and thereby expresses milk
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Oxytocin
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Multiple metabolic functions for control of the metabolism of proteins, carbohydrates, and fats
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Cortisol
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Reduces sodium excretion by the kidneys and increase potassium excretion
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Aldosterone
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What are Adrenal cortex hormones
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Cortisol, aldosterone
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What are anterior pituitary hormones?
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Follicle stimulating hormone, luteinizing hormone, prolactin, growth hormone, adrenocoricotropin, thyroid stimulating hormone
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What are posterior pituitary hormones?
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Antidiuretic hormone, Oxytocin
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What are adrenal medulla hormones?
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Catecholamine hormones-adrenaline or epinephrine, noradrenaline or norepinephrine
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What are thyroid gland hormones?
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Thyroxine and tridothyronine
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What increases the rates of chemical reactions in almost all cells of the body?
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Thyroxine and triidothyronine
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What promotes the deposition of calcium in the bones and thereby decreases calcium concentration in the extracellular fluid
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calcitonin
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What controls the calcium ion concentration the extracellular fluid?
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Parathyroid hormone
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How does the parathyroid hormone control Calcium ion concentration in the ECF?
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absorption of calcium from the gut, excretion of calcium by the kidneys, release of calcium from the bones
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What is secreted by the Islet of Langerhans in the Pancreas?
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glucagon, Insulin, Somatostatin
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What increases the release of glucose from the liver into the circulating body fluids?
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Glucagon
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What cells make glucagon?
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Alpha cells
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What cells make insulin?
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Beta cells
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What promotes glucose entry into most cells in the body controlling the rate of metabolism of most carbohydrates?
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Insulin
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What cells make somatostatin?
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Delta cells
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What hormones are secreted by ovaries?
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Estrogens, Progesterone
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What stimulates growth of the male sex organs and promotes the development of male secondary sex characteristics and where is it made?
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testerosterone and made in testes
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What hormones are in placenta?
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human chorionic gonatropin, estrogen, progesterone, human somatommaotropin
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What promotes growth of the corpus luteum and secretions of estrogens and progesterone by the corpus luteum?
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Human chorionic gonatropin hormone
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What creates deveolpment of uterine endometrium in advance of implantation of fertilized ovum, develops renal tissue and organ in fetus, and develops secretory apparatus of mothers breasts?
What stimulates secretion of uterine milk by the uterine endometrial glands and helps promote development of secretory apparatus of breasts? |
Progesterone
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What stimulates the development of the female sex organs, the breasts and various secondary sexual characteristics
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estrogens
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What promotes growth of some fetal tissues and aids in development of mothers breasts?
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Human somatomammotropin
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Chemical substances secreted by the endocrine glands are?
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hormones
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Rapid action by the nervous system is balanced by what?
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slower hormonal action
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What are general hormones?
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epinephrine, norepinephrine, growth hormone, and thyroid hormone
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What are local hormones?
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Acetylcholine, secretin, cholecytstokinin
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What local hormone is a neurotransmitter? What hormone is released at sympathetic, parasympathetic and skeletal nerve endings?
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Aceytlcholine
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What hormone is released by duodenal wall and transported in blood to the pancreas to casue a watery pancreatic secretion?
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Secretin
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What local hormone is released in small intestine and transported to the gall bladder to cause it to contract and to the pancreas to cause enzyme secretion?
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Cholecystokinin
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What are steroid hormones?
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cortisol, aldosterone, estrogen, progesterone, testoterone
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What homone has chemical structure that consists of chains of amino acids? Composed of scores of hundreds of amino acids are called protein hormones.
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Peptide hormones
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Which hormones are Peptide or Protein hormones?
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Oxytocin, ADH, GH, Adrenocortictropin, FSH,LH, Prolactin, secretin, cholecytokin, insulin, glucagons, and parathyroid hormones
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What hormones are derived from tyrosine and tryptophan?
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amine hormones such as epinephrine, norepinephrine, thyroxine, triidothyronine
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How are protein hormones formed and stored? How secreted?
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by granular endophasmic reticulum of glandular cells, and this large protein is cleaved several times before the active hormone is formed
the active hormone is stored in the cytopasmic compartment of the endocrine cell specific signal |
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How are thyroid and adrenal medullary hormones formed ?
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formed by the actions of enzymes in the cytoplasmic compartment of the glandular cells
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What are thyroxine and triiodothyronine formed as and by what and how secreted?
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Formed as component parts of a large protein molecule called thyroglubin, tyrosine based hormones stored in large follicules within the thyroid gland
A specific enzyme cleaves the thyroglubulin molecule allowing the thyroid hormones to be released into the blood |
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How are adrenal medullary hormones formed?
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norepinephrine and epinephrine are absorbed into preformed vesicles and stored until they are signaled to be excreted by autonomic nervous system
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Steroid hormones are secreted and stored how?
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Secreted in adrenal cortex, ovaries or testes, stored amounts in glandular cells are smal but larger amounts of precursors molecules are present in cells, secretion due to appropriate stimulation and enzymes in these cells cause the chemical conversions to final hormones
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Where are protein, peptide, and catecholamine hormone receptor?
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In or on the surface of the cell membrane
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Where are steroid hormone receptor located?
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in the cell cytoplasm
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Where are metabolic thyroid hormone receptors at?
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thryoxine and triiodothryonine are located in the cell nucleus
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Specific MOA of steroid hormones at cellular level, what does it form?
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Steroid-receptor complex formed when steroid hormone enters cytoplasm and binds with specific receptor protein and forms messenger RNA from DNA in nucleus and the messenger RNA then stimulates protein synthesis within the cell
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MOA of peptide and protein hormones?
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Activation of intracellular enzyme adenylcyclase and this results in increased production of cyclic AMP(second messenger)which when in the cell alters enzyme activity. Also may act by combining with receptors in the postsynaptic membrane which cause ion channels to open or close and this alters movement and causes a change in membrane permeability
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What ion channels change with peptide and protein hormone MOA and how quickly does it occur?
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K,Na,Ca, and acts rapidly within seconds or minutes
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How does a radioimunoassay work?
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A highly sensitive and specific assay method that uses the comptition bw radiolabeled and unlabeled substances in an antigen-antibody reaction to determine the concentration of the unlabeled substance
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Diameter of pituitary gland and weight?
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1/2 inch in diameter, .5-1 gram in weight
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Where is pituitary gland located?
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sella turica at base of brain and is connected to the hypothalamus by the pituitary stalk
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Is the pituitary gland inside or outside the BBB?
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outside
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What is the pituitary gland seperated into and what is it separated by?
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Anterior pituitary or adenohypophysis and posterior pituitary or neurohypophysis and separated by pars intermedia
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what originates from Rathke's pouch and what is Rathke's pouch?
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Anterior pituitary and it is an embryonic invagination of pharyngeal epithelium
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What percent of the pituitary gland is anterior pituitary gland?
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80%
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What does the anterior pituitary gland secrete?
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growth hormone, adrenocorticotropin hormone(ACTH), thyroid stimulating hormone, follicle stimulating hormone, luteinizing hormone, and prolactin
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What is the principle site of action of Thyrotropin and TSH?
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Thyroid
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What is the principal processes affected with thyrotopin ?
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Growth and secretory activity of thyroid glands
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Where is the principle site of action of follicle stimulating hormone and what is the principlal process affectected?
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ovaries and testes, deveolpment of follicies and secretion of estrogen and development of seminferous tubules, spermatogenesis
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What is the principle site of action of Luteinizing or interstital cell stimulating hormone and what is the principal processes affected?
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Ovaries and testes, ovulation, formation of corpus luteum, secretion of progesterone, secretion of testosteron
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Prolacting of lactogenic or Lluteotropin hormone's principle site of action is and what is the the principal processes affected?
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Mammary glands and ovaries and secretion of milk, maintenance of corpus luteum
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Principle site of action of melanoctye stimulating hormone and principal processes affected?
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Site of action is skin and affects pigmentation
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How is secretion of the anterior pituitary controlled and how does it flow?
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Contolled by hypothalamic releasing and inhibiting hormones secreted in the hypothalamus and then transported to the anterior pituitary gland through hypophysial portal system
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What is the outgrowth of the hypothalamus?
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Posterior pituitary
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The posterior pituitary is linked to the hypothalamus by what?
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nerve fibers
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What hormones are stored in the posterior pituitary?
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antidiuretic or vasopressin and oxytocin
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What is the principal site of action and prinicipal processes affected by ADH?
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Kidney, arterioles, reabsorption of water, water balance, raises BP by contracting arterioles
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What is the principle site of action of oxytocian and prinicipal processes affected?
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Uterus, breast, contraction and expression of milk
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where is ADH formed?
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Supraoptic nuclei of hypothalamus
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What does ADH act on and what happens?
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acts on renal collecting ducts to increase absorption of water from kidney tubules. Acts to increase urine osmolarity, decrease serum osmolarity and increase blood volume
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Why is ADH secreted?
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in response to increase in plasma osmolarity or plasma Na ion concentration, but also a decrease in blood volume or blood pressure, pain emotional stress, nausea, postive pressure ventilation, d
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What do high levels of ADH cause?
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potent systemic vasoconstriction,
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What does ADH promote?
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hemostasis by increasing circulating von Willenbrand factor and factor VIII
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What does ETOH cause to ADH?
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inhibits ADH
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What powerfully stimulates the pregnant uterus and by what type of feedback?
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oxytocin by positive feedback
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What causes release of oxytocin that leads to expression of milk?
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Sensory nervous stimulation
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How does the hypothalamus cause secretion of hormones from the anterior pituitary?
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Hypothalamus releases hormone chemical messesengers that has a coresponding anterior pituitary target cell that is released into the median eminence and travels from the eminence down the pituitary stalk in a specialized vascular system called the hypothalamic hypophyseal portal vessel and this causes the secretion of the hormone from the anterior pituitary
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Where is oxytocin synthesized?
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paraventricular nuclei of hypothalamus
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What causes release of hormones that are stored in the posterior pituitary?
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nerve signals
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What are the inhibitory hormones of the hypothalamus?
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prolactin inhibiting factor, growth hormone inhibiting factor, melanocyte stimulating hormone inhibitory factor
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What are the stimulating hormones of the hypothalamus?
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thyrotropin, cortitropin, growth hormone, gonadotropin releasing hormone and follicle stimulating hormone, melanocyte stimulating hormone and prolactin releasing hormone factor
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What is the most common type of patient with adenoma?
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middle aged women
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Tumors that secrete hormones are called what? Tumors that dont are called what? Ones that do both are called what?>
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secreting
non secreting mixed |
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Occurs when tumor size reaches a stage where it begins to exert pressure on surrounding surfaces?
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mass effect
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Sudden hemorrhage and infarction of pituitary gland caused by rapid expansion of tumor?
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pituitary apoplexy
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How are pitutitary tumors diagnosed?
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clinical manifestation of abnormal hormone production, ct and MRI, angiogram to visualize location of internal carotids, 24 hr urine to assess pituitary function
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What is pituitary tumor treatment?
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surgical intervention most common, radiological therapy to decrease size and secretions, and pharmacological therapy to decrease size
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drugs used for pharmacological therapy of pituitary tumors are?
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bromociptine mesylate and octreotide acetate
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Treatment of panhypopituitaryism is what?
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replace with specific hormone
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All of major pituitary hormones besides what exerts their principle effects by stimulating target glands
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growth hormone, exerts on all tissues
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What is GH effect on bones?
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produces linear bone growth by stimulating epiphyseal cartilage and growth plate of long bones
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What does GH do to protein synthesis, fatty acids, and glucose?
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Increases protein synthesis, increased mobilization of fatty acids from adipose tissue, and decreased rate glucose utilization
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Due to GH fat mobilization can be so great that large quanties of what is formed by the liver which leads to fatty liver-called what?
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acetoacetic acid and called ketogenic effect
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When is GH secretion the highest?
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at sleep and with exercise
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What happens with decreased GH in childhood?
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dwarfism, appropriate proportions, but rate of development decreased
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What are clinical features of achondroplasia
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short limb length, large head with prominent forehead, flattened mid face with a depresed nasal bridge and prominent mandible, trunk length, intelligence and life span are normal
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common procedures of achondroplasia?
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PE tubes, decompression suboccipital craniotomy, CSF shunting, obstretrical
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Anesthetic concerns achondroplasia are?
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Intubation due to instability of first two cervical vertebrae, ventilation due to abnormal curvature of the spine which may impair lung epansion
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Gigantism is caused by what?
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large amount GH produced in childhood due to over activity of acidophillic growth hormone producing cell which produces all body tissues to grow rapidly including long bones, usually before adolescence before epiephysis of long bone has fused
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Acromegaly is caused by?
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acidophilic tumor after adolenscence the bones can not grow but soft tissue continues to grow and bones become thicker
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What bones are enlarged with Acromegaly?
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hands and feet, nose, bosses of forehead, suborbital ridges, lower jaw with forward protrusion of the chin and lower teeth, portions of vertebrae with causes kyphosis and arthritis
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What organs are enlarged with Acromegaly?
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tongue, heart, spleen, liver, kidney
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What are Anesthesia concerns with Acromegaly?
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1.mandible increaes in thickness and length 2.overgrowth of tissue of the upper airway tongue and epiglottis,
3.abnormal movement of the vocal cords with thickening and paralysis of recurrent laryngeal nerve so aspiration a concern 4.stridor or a history of dyspnea is suggestive of larynx involvement and subglottic stenosis, 5.subglottic diameter of trachea can be reduces and nasal turbinate enlargement 6.peripheral neuropathy due to trapping of nerves by skeletal, connective, and soft tissue overgrowth 7.compromissed flow through ulnar artery in patients with carpal tunnel 8. Hypertension leading to CHF 9. increased incidence of Cad, arrhythmias, and cardiomegaly 10. lung volumes are increased and VQ mismatch inreased 11. glucose intolerance due to pituitary diabetes 12. Osteoarthritis and osteroporosis 13. Skeletal muscle weakness 14. Hypoadrenal status due to inhibited adrenocorticotropic hormone secretion |
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Does insulin work with pituitary diabetes?
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No, insulin is insensitive bc the glucose increase stimulatation of the beta cells of the islets of Langerhans to the point that they burn out
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Most common abnormality associated with pituitary tumor is?
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increased prolactin secretion
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Signs and symptoms of increaed prolactin are?
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galactorrhea, amenorrhea, infertility, impotence and decreased libido in men
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Treatment of excessive prolactin secretion is?
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surgery and bromocriptine
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Cushing can be caused by what?
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high levels of ACTH or adrenocorticotropin which leads the adrenal cortex to produce excessive amounts cortisol or benign or malignant adrenocortical tumors
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Most common cause cushings is?
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benign or malignant adrenocortical tumors
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Signs and symptoms of cushings are?
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moon face, buffalo hump, purple straie
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Physilogic effects of excess cortisol from Cushings are?
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HTN, hyperglycemia, skeletal muscle weakenss, osteoprosis, central obesity, menstrual disturbance, poor wound healing susceptibility to infection
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Anesthesia considerations with cushings are?
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fluid retention, insomnia, depression, mania, psychosis, womens with high amount masculinization, and men with high degree feminization
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Preferred treatment pituitary tumors<10mm is?
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transsphenoidal surgery
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Advantages transphonoidal surgery is?
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decreased incidence of diabetes insipidus, elimination of frontal lobe retraction, magnified visualization
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Disadvantages of transsphenoidal surgery are?
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accumulation of blood and tissue debris in pharynx and stomach
hemorrhage inability to visualize structures adjacent to tumors CSF leak, meningitis pituitary hypofunction so give glucocorticoids diabetes insipidus |
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Transspheoidal contraindicatios are?
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highly vascular lesion
illdefined carotid artery w/angiogram recurring tumor suprasellar so extends superior to sella tunica |
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Preop considerations of transspehnoidal surgery are?
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assess baseline endocrine function
large venous access be conservative with sedatives due to airway obstruction consider steroid coverage control ventilation 25-30 CO2 venous air embolism epinephrine injected by surgeon visual evoked potentials Lumbar intrathecal catheter to drain CSF |
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Transsphenoidal surgery complications are what?
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cerebral ischemia, hemorrhages, visual field changes, diabetes insipidus, if all tumor is not removed then irradiation is offered
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What are diseases of posterior pituitary?
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SIADH and diabetes insipidus
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Characterized by high circulating levels of ADH relative to plasma osmolarity and serum Na concentration
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SIADH
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SIADH results in?
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hyponatremia and fluid retention
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SIADH is caused by?
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CNS lesions, trauma, or infection, drugs, pulmonary infections, porphyria, hypothyroidism, adrenal insufficiency, ectopic production of tumors
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Drugs that can cause SIADH are?
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nicotine, narcotis, chlorpropamide, vincristine, vinblastine, thiazide diuretics, phenothiazines
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Clinical features of SIADH are?
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most related to water intoxication, hyponatremia, and resulting brain edema
-weight gain -weakness -lethargy, headache, and nausea -mental confusion with progression to convulsion and coma |
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Urine sodium with SIADH is ?
Serum sodium is? |
>20mEq/L-concentrated urine
<130mEq/L |
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BUN, creatinine, and albumin are high or low with SIADH?
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low
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Plasma osmolarity with SIADH is?
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<270mOsm/L
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Diagnosis of SIADH?
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Evaluate hyponatremia by water loading bc pts with SIADH are unable to excrete dilute urine even after water loading
Assay of ADH in blood can confirm diagnosis |
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Treatment SIADH is?
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Fluid resitriction of 500-800ml/d
IV administration of hypertonic 3% saline Drugs blocking effects of ADH |
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Drugs that block effects of ADH and treat SIADH are?
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lithium demethychoretracycline which interferes with the ability of the renal tubules to concentrate urine
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Over rapid correction of chronic hyponatremia can result is what?
at what rate? |
central pontine mylinolysis, a fatal neurological disorder
Dont drop Na greater than 12mmol/L in 24 hrs |
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Anesthetic concerns with SIADH are?
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Monitor volume status with CVP or PA catheter
Fluid resitriction if tolerated using isotonic solutions Monitor UOP, urine osmolarity, plasma osmolarity, and serum Na concentrations |
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Lack of ADH or inadequate secretion from the posterior pituitary lobe or the inability of renal collecting duct receptors to respond to ADH is called?
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Diabetes Insipidus or DI
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DI with head trauma, neurosurgical procedures with trauma to mediam eminence, pituitary stalk, or posterior pituitary lobe, infiltrating pituitary lesions, and brain tumors is called what?
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Neurogenic DI
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DI due to X-linked trait, or may occur in association with hypercalcemia, hypokalemia, and medication induced nephrotoxicity is called?
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Nephrogenic DI
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Drugs than can cause Nephrogenic DI are?
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ethanol, phenytoin, cholorpromazapine, and lithium
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Concentrates urine in the presence of neurogenic, but not nephrogenic, diabetes insipitus. Used to diagnosis which type.
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Desmopressin or Vasopressin or ADH
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Signs and symptoms of DI are?
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polydipsia hallmark
high urine output of poorly concentrated urine despite an increased serum osmolarity neurologic symptoms of hyponatremia such as hyperreflexia, weakness, lethargy, seizures, and coma |
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With DI serum osmolarities and serum Na concentrations are what?
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greater than 290mOsm/L and serum sodium are >145Meq/L
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DI due to intracranial trauma comes apparent when and when does recovery occur?
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becomes apparant several days after injury and resolves spontaneously within 24 hrs
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DI after pituitary gland surgery is due to what and lasts how long?
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due to reversible trauma of the posterior pituitary and usually transient
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With complete ADH deficiency how do you treat?
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with vasopressing for short term therapy and desmopressing for long term therapy
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What are thinks to think about when giving vasopressin or desmopressing to patients for DI?
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pts w/ CAD or HTn, they decrease tissue oxygenation by decreasing SVR and HR, in surgery monitor ECG for changes indicative of MI
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With mild-moderate DI how do you treat it and when?
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dont need vasopressin unless plasma osmolality rises above 290mOsm/L
Use medications that either augment the release of ADH or increase receptor response to ADH |
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Anesthesia implications preoperative with DI are?
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Do plasma electrolytes, renal function, and plasma osmolarity, restore intravascular volume slowly over 24-48 hrs
Surgical patient with complete DI is commonly managed with vasopressin drip |
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What is vasopressin drip rate?
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0.1-0.1U/h
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Anesthesia implications in surgery and postop with DI are?
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Plasma osmolarity, UOP, and serum Na concentration measured hourly and in immediate post op period, isotonic fluids are used safely intra-op
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What occurs commonly in brain dead organ donors and signs and symptoms are?
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DI, polyuria, dehydration, hyperosmolality, hypernatremia
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If absence of DI in a brain dead organ donor you may think what?
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that there is some flow to supraoptic and paraventricular region of the brain so that ADH is being formed
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Treatment of Central DI in organ donor brain dead pt is?
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hypotonic solutions to replace urine output with massive polyrua(>4ml/kg/hr)
replacement therapy with ADH should commence as it conserves intravascular volume and supports vascular tone |
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In brain dead organ donors with Central DI you should prevent what ?
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acidosis
hypernatremia, hypokalemia hypophosphatemia hypomagnesemia hyperchloremia |
