Adrenal Diseases

Question 1

What are examples of adrenal diseases?

Answer 1

hyperfunction = Cushings syndrome (glucocorticoids - adrenal/pituitary tumour), Conn's syndrome (aldosterone - adrenal tumour)
hypofunction = Addison's disease (primary), pituitary failure (secondary)

Question 2

What is Addison’s disease?

Answer 2

hypofunction of adrenal gland, primary (gland failure)

Question 3

What is the aetiology of Addison’s disease?

Answer 3

previously TB was a major cause, autoimmune adrenalitis (90% of cases)

Question 4

What are the signs and symptoms of Addison’s disease?

Answer 4

postural hypotension, weight loss, lethargy, hyperpigmentation, vitiligo, weakness, anorexia, loss of body hair (females)

Question 5

What investigations results are diagnostic for Addison’s disease?

Answer 5

high ACTH, low cortisol, SYNACTHEN negative

Question 6

Describe the treatment options for Addison’s disease.

Answer 6

hormone replacement (cortisol, fludrocortisone)

Question 7

What is the dental relevance with patients who have Addison’s disease?

Answer 7

give steroid prophylaxis when patient has minor oral surgery/spreading dental infection, if patient is on 1-15mg prednisolone then cover with double dose, always ask about previous 6 months steroid use
Corticosteroids are immunosuppressants
ORAL PIGMENTATION

Question 8

What is Cushing’s syndrome/disease?

Answer 8

hyperfunction of adrenal gland
cushing’s syndrome = adrenal tumour, producing excess cortisol - primary
Cushing’s disease = pituitary tumour, producing excess ACTH (70% cases) - secondary

Question 9

What is the aetiology for Cushings syndrome/disease?

Answer 9

pituitary tumour, adrenal adenoma, hyperplasia, ectopic ACTH production

Question 10

What are the signs and symptoms for Cushings syndrome/disease?

Answer 10

moon face, buffalo hump, hypertension, thin skin, purpura, muscles weakness, osteoporotic changes i.e. fractures, diabetic features, poor resistance to infection, psychiatric disorders (depression, emotional lability, psychosis, hirsuitism (coarse, pigmented hair), skin and mucosal pigmentation (pituitary tumour only due to high ACTH levels), amenorrhea, impotence, infertility

Question 11

What are the investigations for Cushings syndrome/disease?

Answer 11

pituitary adenoma (high ACTH, high cortisol), gland adenoma (low ACTH, high cortisol)

Question 12

What are the different treatment options for Cushings syndrome/disease?

Answer 12

detect cause, surgery (partial/complete adrenalectomy)

Question 13

What is the dental relevance of Cushing’s syndrome/disease?

Answer 13

candidiasis

Question 14

What are the causes of oral pigmentation?

Answer 14

racial, smoking, drugs (oral contraceptive, antimalarials), pigmented naevi, melanoma, amalgam tattoo, chronic trauma, pregnancy, Addison’s disease, ACTH-secreting tumours

Question 15

What hormones are produced by the adrenal gland? Where are these produced?

Answer 15

cortex hormones (corticosteroids):
-mineralocorticoids (eg aldosterone)
-glucocorticoids (eg cortisol)
-sex hormones (eg androgens, oestrogens)
medulla (modified sympathetic ganglion):
-adrenaline (epinephrine)