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Physio II, Exam 2, Lecture 5: Endocrine
Terms in this set (119)
only __% of the pancreas has an endocrine function.
where are the endocrine secretory cells located?
what are the 2 secretory cell types?
in the islets of Langerhans
Alpha and beta
______ endocrine cells produce glucagon (20% of the islet cells).
What is the fasting hormone that regulates the disposition of nutrients between meals
Which endocrine cells produce insulin and make up 65% of islet cells?
Which peptide hormone controls the utilization of nutrients, especially glucose during meals and is stored in the secretory granules
_____ ______ level is the most important regulator of insulin release.
plasma glucose level
What happens to insulin secretion if plasma glucose is < 50 mg/dl?
what if it is > 250 mg/dl?
-no insulin secretion
-maximum insulin secretion
_________ metabolism occurs when insulin acts on the liver muscle and adipose tissue to decrease glucose.
in adipocytes, insulin increases the conversion of glucose to ______________
Insulin will increase or decrease the following:
-______: glycogenesis, glycogen synthase, glycolysis, conversion of glucose to triglycerides in fat
-______: glycogenolysis in the liver
-_______: gluconeogenesis in the liver/muscle/fat
Insulin increases the intracellular ______ of glucose in the liver, muscle, and adipocytes.
_______ and ______ decrease glucagon release.
true or false: hypoglycemia will increase glucagon release
glucagon will increase what 3 things?
Symptoms of diabetes mellitus include:
Glycolated hemoglobin (HbA1c) is a lab test measured to identify the _______ month average plasma glucose concentration.
__________ suppress the excessive hepatic glucose release and treats DM. An example includes ______.
Insulin secretagogues are used to treat what?
what are 2 drug names of this type of agent?
-type II DM
_______ improves insulin sensitivity and treats DM. Examples include ______ and ______.
What is the onset, peak, and duration of the following insulin preparations:
-30 min/ 2-4 hr/ 5-8 hr
-1-2 hr/6-10 hr/10-20 hr
-1-2 hr/ none/ 24 hour
Diabetic ketoacidosis is commonly seen in what type of DM and associated with infection or illness. Treatment includes:
-hydration, insulin, fix electrolytes
Hyperglycemic hyperosmolar syndrome:
-age of patient?
-type of DM?
-signs/symptoms: ______, persistent ______ ______
-dehydration, persistent glycosuria diuresis
what do you give to treat the diabetic complication of nephropathy?
ACE-I help to slow down the progression
What are the following lab values you would see for Diabetic Ketoacidosis?
-serum and urine ketone levels
What are the following lab values you would see for Hyperglycemic Hyperosmolar Syndrome?
_______ ______ may impair gastric secretions and motility leading to gastroparesis in diabetics.
true or false: CV signs such as orthostatic hypotension are rare for diabetics with autonomic neuropathy
what is the leading cause of mortality in diabetics?
CV disease from microvascular complications
List complications that arise from diabetes:
-long term: ____/_____/____/____ pathies
-acidosis or alkalosis?
-________ _______ syndrome
-long term: neuro/nephro/angio/retinopathies
-hyperglycemic hyperosmolar syndrome
______ and _____ are tyrosine based hormones produced by the thyroid gland responsible for regulating metabolism.
-T4 (thyroxine, pro hormone)
which laryngeal nerve innervates the cricoid?
Which hormone is released from the hypothalamus and bind to the anterior pituitary and stimulates TSH
TRH (thyrotropin releasing hormone)
______ is synthesized/stored in the anterior pituitary and is used to diagnose thyroid disorder.
-will it increase or decrease iodine uptake?
-keeps T3 & T4 levels constant via negative or positive feed back at the level of the hypothalamus and pituitary
what is the ratio of T4:T3 for hormone secretion?
which one is 3-4 times more active?
true or false: thyroid hormones are insulin antagonists
true or false: thyroid hormones decrease cholesterol excretion in the bile
false = increases
What is the difference between primary and secondary hyperthyroidism?
-primary: ______TSH, ______T4
-secondary: ______ TSH, T4
-primary: decreased TSH, increased T4
-secondary: increased TSH, T4
Grave's disease and goiter both cause what?
Signs of hyperthyroidism include:
-eye signs (______)
Symptoms of hyperthyroidism include:
name 3 antithyroid drugs. What do they inhibit the formation of?
3. PTU = propylthiouracil
iodothyromines (inhibit synthesis of hormone)
What is an added advantage of PTU?
it inhibits peripheral conversion of T4 to T3
Which drugs are given for symptomatic control of hyperthyroidism?
Which beta blocker can inhibit the conversion of T4 to T3?
What agent can you give that inhibits the release of T4 and T3 to prepare a pt. for surgery or to treat thyrotoxic crisis because the effects are immediate and short lived?
What is an ablative therapy for those not well controlled with medical treatment for hyperthyroidism?
The risk with this is that 40-70% will have _______ and will need to now get thyroid replacement therapy.
For surgical removal of thyroid in elective cases the patient should be on what antithyroid med for _______ to ______ weeks?
in emergency hyperthyroid surgery cases what drugs do you want to give?
-gluco or mineral corticoids?
-IV beta blockers
true or false: glucocorticoids decrease the conversion of T4 to T3
Thyroid storm is typically precipitated by what 3 things?
What can it mimic?
When does this primarily occur?
Thyroid storm is basically a severe form of hyperthyroidism with what other characteristics?
-______/ ____ instability (___ or ___)
-tachycardia/CV instability (CHF or Death)
how do you treat thyroid storm?
-cool patient down (cold fluids, _______, cooling blankets)
-______ infusion with goal HR <_____
-_______ _____ to block the release of T4-T3
-______ or _______ to decrease hormone release
-cortisol or decadron
-Primary: ______ TSH; ________ T4,T3
-Secondary: _______ TSH, T4, T3
-Primary: increased TSH; decreased T4,T3
-Secondary: decreased TSH, T4, T3
synthroid (synthetic levothyroxine) is a treatment for what?
cold intolerance, hypothermia, oliguria, and constipation are all signs or symptoms of what?
symptoms of hypothyroidism
Bradycardia, increased sensitivity to anesthetics, and myocardial depression are all signs or symptoms of what?
signs of hypothyoridism
Signs of hypothyroidism include:
-tachycardia or bradycardia?
-______ sensitivity to anesthetics
-pericardial effusion (____ rub, soft ____ ____)
-low urinary retention
-loss of ___/____ hair
-increased sensitivity to anesthetics
-pericardial effusion (cardiac rub, soft heart tunes)
-loss brow/scalp hair
In Hypothyroidism what lab value may be low or normal in pituitary insufficiency?
what 3 lab abnormalities may be seen with with hypothyroidism?
what is a severe case of hypothyroidism characterized by edema, dry skin, hair loss, and loss of mental and physical vigor where you will see HYPO: thermia/ventilation/natremia/oxygen/tension
HYPERcapnia, and coma
where this is all due to infection that is either cardiac, respiratory or CNS illness or a cold exposure...
myxedema coma (2ndary hypothyroidism)
What is the treatment for a myxedema coma (severe hypothyroidism)?
T3 & T4 replacement
which one has more focus on the eurthyroid state: hyper or hypothyroidism?
what hormone raises serum calcium levels while promoting bone formation?
what hormone will decrease calcium concentration that comes from the thyroid gland?
What is a normal ionized calcium level?
what calcium level indicates hyperparathyroidism?
1.12-1.45 mml/L = 4.54-5.61 mg/dl
renal stones, polyruria, hypertension, constipation, fatigue, mental changes, and bone pain all indicate what electrolyte imbalance?
hypercalcemia from hyperparathyroidism
What is the most common cause of hyperparathyroidism?
how do you treat it?
-parathyroidectomy if they have symptoms/kidney stones/or bone disease
-will you have increased or decreased skeletal muscle weakness?
-polyuria or oliguria?
-Kidney stones present or not?
-Anemia present or not?
-will they have skeletal demineralization and fractures or not?
-will they have increased or decreased pain sensation?
-somnolance present or not?
-conjunctivitiis and calcifications present or not in the eye?
-prolonged PR, short QT, HTN
-vomiting, ulcer, abdominal pain
Rehydration and ____ ____ (____) can correct symptomatic hypercalcemia before surgery for hyperparathyroidism.
loop diuretic (lasix)
Which electrolyte imbalance is seen with tetany, carpopedal spasms, tingling of lips and hands, muscle and abdominal cramps, psychological changes, defective nails and teeth, cataracts... and is commonly seen after a thyroidectomy or hypomagnesemia.
hypocalcemia causing hypoparathyroidism
Treatment for hypoparathyroidism includes:
-IV _____, PO _____, Vit ____, ______
-IV calcium/oral calcium/Vit D/ Magnesium
what part of the adrenal glad is of mesodermal orgin and produces steroid hormones?
what part of the adrenal gland is of neuroectodermal origin containing chromaffin cells which produces catecholamine hormones.
The OUTER cortex of the adrenal glands consist of zona glomerulosa and zona fasiculata.
-Zona GLOMERULOSA produces _______ (________).
-Zona FASICULATA produces _______
-mineral corticoids (aldosterone)
what is the main disorder you will see with the adrenal gland in the medulla origin?
______ is released by the hypothalamus --> stimulate the anterior pituitary --> secretes ACTH.
CRH (corticotropin-releasing hormone)
______ controls the release of cortisol & aldosterone from the adrenal cortex.
ACTH (adrenocorticotropic hormone)
-does it inhibit or stimulate protein synthesis and gluconeogenesis?
-it antagonizes the effects of what?
-it supports increased energy requirements during what?
true or false: cortisol is a steroidal anti-inflammatory
Cortisol hyper secretion is also called ______ ______.
cortisol secreting tumor causing decreased plasma ACTH is primary or secondary cortisol hyper secretion?
_______ _____ is an ACTH dysfunction from adenoma causing cortisol hyper secretion.
This, as well as being iatrogenic from possible glucocorticoid overdose are examples of primary or secondary cortisol hyper secretion?
Symptoms of Cushing's syndrome (cortisol hypersecretion) include:
-_______ (2ndary hyperinsulinemia)
-skin: bruising, transparent, poor wound healing
-depression of immune function
-trunk and facial obesity
-hyperglycemia (2ndary hyperinsulinemia)
How can you diagnose Cushing's syndrome (cortisol hypersecretion):
-test for exogenous _______ use and elevated 24-hour urinary free cortisol levels
-test for ACTH and cortisol plasma levels
List the treatments for Cushing's syndrome (cortisol hypersecretion):
-remove _____ ____
-meds: ______, _____, ______, low dose ____
-_____ _____ postop
-correct ______, ______ _____
-metyrapone, ketoconazole, mitotane, low dose etomidate
-hypokalemic, metabolic alkalosis
List the medications that can be used to treat Cushing's syndrome (cortisol hypersecretion):
-inhibits cortisol synthesis: _____
-inhibits steroidogenesis: ______
-adrenolytic agent, reduces cortisol: _____
would you give low dose or high dose etomidate to treat Cushing's syndrome?
low dose infusion
hypokalemia and hypertension are classic sign's of what endocrine disorder?
primary hyperaldosteronism = Conn's syndrome
What is responsible for sodium reabsorption and K secretion in the DISTAL tubule and COLLECTING duct?
List the following for Conn syndrome (primary hyperaldosteronism):
-aldosterone producing ______ occurs in 40% of patients
- _______ ______/hyperaldosteronism occurs in 60% of patients
Where does the pathology of primary hyperaldosteronism (Conn Syndrome) occur?
Primary hyperaldosteronism (Conn syndrome) has what effect on the following:
-Na: increased _______, ____
-K and H ions: increased _____ (_______, _____ _______)
-secretion (hypokalemia, metabolic alkalosis)
elevated plasma aldosterone and low plasma renin levels as well as getting a CT/MRI are the best way to diagnose what?
Conn syndrome (primary hyperaldosteronism)
Will see hypokalemic hypotension or hypokalemic hypertension with Conn syndrome (primary hyperaldosteronism)?
How do you treat Conn syndrome (primary hyperaldosteronism)
-unilateral hyperplasia/adenoma/adrenocortical carcinoma: ______
-bilateral hyperplasia: ________ and _______
-spironolactone and eplerenone
what is the most relevant symptom of Addison's disease?
Primary adrenal insufficiency from loss of glucocorticoids and mineralocorticoids where ACTH increases and causes adrenal enlargement is known as what?
Symptoms of Addison's disease (primary adrenocortical insufficiency) include:
-Anorexia & weight loss
-______glycemia & ______ insulin sensitivity
-Hypovolemia & hyponatremia
-Weakness & fatigue (loss of muscle glycogen)
-Metabolic ______ and _______kalemia ***
-Hypoglycemia & increased insulin sensitivity
-Metabolic acidosis and hyperkalemia
Diagnosis of Addison's disease (primary adrenocortical insufficiency) includes:
-decreased plasma _____ w/ _____ stimulation
-decreased plasma CORTISOL w/ ACTH stimulation
The most common cause of adrenocorticol insufficiency is what?
exogenous steroids (during periods of stress)
_____ ______ is the treatment for patient with Addison's disease (adrenocortical insufficiency).
Cortisol and cortisone are long or short acting steroids? what is the dose for either?
cortisol = 20 mg
cortisone = 25 mg
What are the 4 intermediate acting steroids and what is the dose?
-prednisone = 5
-prednisolone = 5
-methylprednisolone = 4
-tramicinolone = 4
what is the only long acting steroid? what is the dose?
-dexamethasone (decadron) = .75 mg
How much hyrdrocortisone would you give for the following:
1. superficial surgery (biopsy)
2. minor surgery (hernia)
3. moderate surgery (lap chole)
4. major surgery (Whipple)
5. ICU (sepsis)
2. 25 mg
3. 50-75 mg (taper 1-2 days)
4. 100-150 mg (taper 1-2 days)
5. 50-100 mg q 6-8 hr for 2 days to 1 week... then slow taper
Where is epinephrine stored?
in the vesicles in the adrenal medulla chromaffin cells
_______ cells are neuroendocrine cells innervated by the SNS. Ach depolarizes --> increase intracellular Ca --> releases Epi
Is a single or double adrenal gland catecholamine secreting tumor of pheochromocytoma more common?
Familial pheochromocytoma can be part of MEN syndrome (multiple endocrine neoplasia), list the following:
-MEN 1: _______ adenoma, parathyroid ______, _______ tumors
-MEN 2A: parathyroid _______, ________ ________ carcinoma, pheochromocytoma
-MEN 2B: mucosal neuromas, _______ body habitus, _____ ______ carcinoma, pheochromocytoma
-MEN 1: pit. adenoma, parathyroid hyperplasia, pancreatic tumors
-MEN 2A: parathyroid hyperplasia, medullary thyroid carcinoma, pheochromocytoma
-MEN 2B: mucosal neuromas, marfanoid body habitus, medullary thyroid carcinoma, pheochromocytoma
Paroxysmal hypertension, headaches, sweating, and palpitations are all clinical manifestations of what endocrine disorder?
_________ converts NE --> Epi (cortisol is needed for this to occur)
Norepi and Epi both use COMT and MAO to create what 2 new chemical structures?
Those 2 chemical structures use MAO to create what same chemical structure?
and metanephrine (Epi)
-VMA (vanillylmandelic acid)
-more common: NE or Epi?
-alpha agonist: ____
-beta activity: ____
-more common: NE
-alpha agonist: NE
-beta activity: Epi
How can you diagnose pheochromocytoma?
-24 hour urine test for ________ and ________
-plasma _______ and _______
-metanephrines and catecholamines
-metanephrines and normetanephrine
_____ blocker, ______ replacement and _______ can be given in pre-op to control pheochromocytoma.
-how does it affect hematocrit?
-how long do you keep a patient on this before surgery for pheochromocytoma?
-3 days-2 weeks
true or false: you can start a beta blockade before an alpha blockade for pheochromocytoma
false = you start beta blockade AFTER alpha = could cause blockage of B2 vasodilators and lead to unopposed alpha agonist... what we don't want.
If tachycardia persists or other dysrhythmias are present after alpha blockage from a phechormocytoma, what do you do next
give a beta blocker
Intraop management of pheochromocytoma includes:
-IV meds: _____, ______, _____
-avoid drugs that release catecholamines: _____, _____, _____, _____, _____
-avoid histamine release
-IV meds: nicardipine, SNP, esmolol
-ephedrine, ketamine, pain, hypoxia, hypercarbia
Intra/post-op problems that could occur with pheochromocytoma is hypotension. What treatments should you consider:
-large volumes of _____
-large volumes of fluid
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