Assessment and therapy of selected endocrine disorders
Section snippets
Diabetes mellitus
Diabetes mellitus is the most commonly encountered endocrinopathy in western society, developing in roughly 15 to 20 million Americans or 7% to 8% of the population of the United States. Ninety percent of the diabetics in the United States have type 2 diabetes, and the remainder type 1 [2], [3]. There is strong longitudinal data that long-term glycemic control limits development of some complications of diabetes. Recently a growing body of evidence supports the benefits of euglycemia in
Hypothyrdoidism
Hypothyroidism is a common condition in the United States, affecting approximately 1% of all patients and 5% of the population over age 50 [27]. Hypothyroidism develops 10 times more often commonly in females than males. The most likely cause of hypothyroidism is iatrogenic secondary to either surgical resection or radioactive ablation of the gland as part of treatment for hyperthyroidism. Hashimoto's thyroiditis is the most common noniatrogenic cause of hypothyroidism. If Hashimoto's is
Hypothalamic–pituitary-adrenal axis
The hypothalamic–pituitary-adrenal axis (HPA) regulates adrenal output of glucocorticoids, which are intricately involved with the metabolism and production of nutritional substrates and maintenance and regulation of immune and circulatory function. Hypothalamic release of corticotrophin releasing hormone stimulates the pituitary to produce ACTH. ACTH output from the anterior pituitary subsequently stimulates the adrenal cortex to produce cortisol, which completes the cycle by providing
Pheochromocytoma
Pheochromocytomas are chromaffin cell tumors that secrete excessive amounts of catecholamines. Patients develop secondary hypertension, which is often paroxysmal, and the classic triad of headaches, sweating, and palpitations. Anxiety and panic attacks may also be seen [36]. Most pheochromocytomas are located in the adrenal medulla. Classical teaching is that 10% of patients will have bilateral adrenal tumors, 10% will be extraadrenal, and less than 10% are malignant [38], [39]. Most
Summary
Diabetes remains the most commonly encountered endocrinopathy with the incidence of type 2 doubling in the past decade. The prevalence of diabetes is projected to continue to increase dramatically over the next several decades unless major public health initiatives are successful in stemming this growth. Both type 1 and 2 diabetics more frequently require surgical and critical care than their non-diabetic counterparts. Type 1 and 2 diabetics also sustain greater perioperative morbidity and
References (48)
- et al.
Perioperative management of type 1 diabetes mellitus
Endocrinol Metab Clinics
(2003) - et al.
Inpatient management of diabetes mellitus
Am J Med
(2002) - et al.
Upper airway diseases and airway management: a synopsis
Anesth Clin North Am
(2002) Hospital management of diabetes
Endocrinol Metab Clin N Am
(2000)Perioperative medication management
Med Clin N Am
(2003)- et al.
Comparison of a continuous glucose-insulin-potassium infusion versus intermittent bolus application of insulin on perioperative glucose control and hormone status in insulin-treated type 2 diabetics
J Clin Anesth
(2001) Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients
Mayo Clin Proceed
(2003)Management of hypothyroidism and hyperthyroidism in the intensive care unit
Crit Care Clin
(2001)- et al.
Perioperative evaluation and management of the patient with endocrine dysfunction
Med Clin N Am
(2003) Perioperative management of patients treated with glucocorticoids
Endocrinol Metab Clin N Am
(2003)