Term
| What type of things can lead to adrenal insufficiency? |
|
Definition
Atrophy from use of steroids
Hypopituitarism, or hypophysectomy
Surgical removal of adrenal glands
Destruction of cortical tissue from hemorrhage, infarction, TB, or carcinoma |
|
|
Term
| What signs and symptoms are associated with an adrenal crisis (acute adrenal insufficiency)? |
|
Definition
Hypotension
Vascular collapse
hypovolemia
Low Na
Increased K
Hypoglycemia |
|
|
Term
| With Addison's disease, what are the signs and symptoms of chronic adrenal insufficiency? |
|
Definition
Weight loss
Abdominal pain
Weakness
fatigue
hyperpigmentation
hypoglycemia |
|
|
Term
| What are the s/s of mineral corticoid deficiency associated with Addison's disease? |
|
Definition
Hypovolemia
Postural hypotension and syncope
Hyponatremia
Hyperkalemia
Metabolic acidosis
Lethargy |
|
|
Term
| What is the treatment for Addison's disease? |
|
Definition
Hormone replacement
Cortisone 12.5 to 50 mg/d
9 flourohydrocortisone (Florinef) .1-.2 mg/d
Treat hypovolemia, hyperkalemia, and hyponatremia |
|
|
Term
| Because of the treatment for Addison's disease, what can happen when patient's are exposed to additional stress, such as infection or surgery? |
|
Definition
|
|
Term
When should you supplement steroids perioperatively?
|
|
Definition
| With any patient that has received corticosteroids for more than 1 week within the last year. |
|
|
Term
How much cortisol does the normal adrenal gland produce daily?
How do you dose steroids for surgery? |
|
Definition
20 mg/day
Minor surgery: 100 mg hydrocortisone pre-op
Major surgery: 100 mg hydrocortisone pre-op, 100 mg intra-op, and 100 mg post-op |
|
|
Term
What hormones are associated with the anterior pituitary?
What about the posterior pituitary? |
|
Definition
Anterior: growth hormone, ACTH, thyroid stimulating hormone, follicle stimulating hormone, prolactin
Posterior: ADH, oxytocin |
|
|
Term
| What is acromegaly, and what are the associated complications? |
|
Definition
Excessive growth hormone
Peripheral neuropathy
HTN
dysrhythmias
CHF |
|
|
Term
| What anesthesia assessment is extremely important for someone with acromegaly? |
|
Definition
| A good airway assessment. The patients will likely have a large jaw, and will probably need a bigger blade. |
|
|
Term
Adrenocorticotrophic hormone--ACTH--stimulates the adrenal cortex, leading to the release of what substances?
What dose excess ACTH cause? |
|
Definition
Corticosteroids and some aldosterone
Cushings |
|
|
Term
| What happens with decreased levels of ACTH? |
|
Definition
| Atrophy of the adrenal cortex |
|
|
Term
|
Definition
| It increases the permeability of the renal collecting ducts to water |
|
|
Term
When the pituitary is damaged or removed, lack of ADH leads to what condition?
Clinically, when might we see this? |
|
Definition
Diabetes Insipidus--large volumes of dilute urine.
Can occur with brain or pituitary tumors, head trauma, or following cranial surgery. |
|
|
