Term
| What is the medulla of the adrenal gland responsible for producing? |
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Definition
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Term
| What is the cortex of the adrenal gland responsible for producing? |
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Definition
| *Glucocorticoids, Mineralcorticoids, and androgens |
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Term
| What is the hormone responsible for the regulation of extracellular fluid volume? |
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Definition
| *Aldosterone (Mineralcorticoids) |
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Term
| How does aldosterone work? |
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Definition
*Works in the distal renal tubules by controlling sodium resorption and excretion.
*Increases serum Na and decreases serum K |
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Term
| How is aldosterone secretion stimulated? |
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Definition
*Angiotension (AT II) strongest stimulus (most important predictor of volume status)
*ACTH
*Hypotension
*CHF
*Surgery
*Serum Potassium levels
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Term
| What is cortisol and what are its main functions? |
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Definition
*(Hydrocortisone) Glucocorticoid
*Functions: Carbohydrate metabolism, protein metabolism, fat metabolism, stress response, anti-inflammatory response. |
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Term
| What are the anesthetic considerations for patients with aldosteronism? |
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Definition
*Fluid and electrolyte correction (K+, Ca++)
*Aldactone (K+ sparing diuretic)- aldosterone antagonist |
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Term
| How much cortisol does the normal adult secrete? |
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Definition
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Term
| What is a normal oral dose of hydrocortisone and prednisone? |
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Definition
*20-30mg daily Hydrocortisone
*5mg/am, 2.5mg/pm Prednisone |
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Term
| Pharmacologic doses are used as ____________ that is just enough to provide higher than normal physiologic hormone levels to get a desired effect. |
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Definition
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Term
| Patients with acute adrenal insufficiency will diminish the body's ability to appropriately respond to a stressful situation such as..... |
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Definition
*Surgery
*Trauma
*Infection |
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Term
| If a patient cannot properly respond to physiologic demands it may lead to devastating physiologic consequences to a patient such as: |
|
Definition
*Circulatory collapse
*Hypoglycemia
*Hypotension
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Term
| What is considered "too much" steroid use and thus elicits the need for a replacement stress dose? |
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Definition
| *The patient should be considered unable to adequately respond to a stressor if they have received 5mg of prednisone for more than 2 weeks in the past 12 months. |
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Term
| Most exogenous steroids possess both _____ and ________ properties. Agents differ mainly by their _______ and their ____________. |
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Definition
*mineral
*glucocorticoid
*glucocorticoid
*Potency |
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Term
| Oral Hydrocortisone is used primarily for ______________ therapy. Usually a daily dose of ________mg is used. |
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Definition
*Physiologic replacement
*20-30mg |
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Term
| In complete absence of adrenal secretion the synthetic mineralcorticoid ___________ may be added. |
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Definition
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Term
| What are the high dose and low dose recommended regimes for patients receiving steriod replacement for surgery? |
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Definition
*Low dose:
-25mg of hydrocortisone on induction
-100mg hydrocortisone preop, 100mg intraop, 100mg post op evening. |
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Term
| What steroids are avoided in hepatic failure? |
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Definition
| *Prednisone and cortisone |
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Term
| What is a good treatment for Hyperaldosteronism? |
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Definition
| *Can use aldactone (a K sparing diuretic) an aldosterone antagonist |
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Term
| What are clinical manifestations of an aldosterone deficiency? |
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Definition
*Hyperkalemic
*Acidotic
*Hypotensive |
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Term
| What is used for the treatment of an Aldosterone deficiency? |
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Definition
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Term
| How is the synthesis and release of glucocorticoids controlled? |
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Definition
| *By the hormones released from the hypothalamus and pituitary gland (Pituitary Adrenocortico Axis) |
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Term
| When is cortisol secreted? |
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Definition
| *When cortisol levels drop below a set point, the hypothalamus releases CRH which stimulates ACTH release from the pituitary which stimulates the adrenals to release cortisol. |
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Term
| What happens when cortisol levels rise to regulate further release? |
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Definition
*CRH and ACTH secretion is inhibited
*Negative feedback system |
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Term
| Cortisol is responsible for ________ Metabolism. |
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Definition
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Term
| Aldosterone is a large factor in __________ regulation. |
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Definition
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Term
| What hormone that is released from the anterior pituitary regulates glucose? |
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Definition
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Term
| How are glucocorticoids metabolized? |
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Definition
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Term
| What is the most potent regulator of ACTH? |
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Definition
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