endocrine Flashcards
what is hyperthyroidism?
too much thyroid hormone is made
causes increased metabolism
e.g. grave’s disease = autoimmune disorder = oedema can be seen in eye
hyperthyroidism TSH & T3
LOW TSH
HIGH T3 (T3 build up)
hyperthyroidism symptoms
hyperactive
heat intolerance
palpitations
weight loss
diarrhoea
tachycardia
can feel manic, anxious, increased BP
hyperthyroidism signs
goitre (neck swelling), atrial fibrillation (tachycardia),
warm moist skin
hyperthyroidism test
Test for free T3 & TSH
Gland - low TSH, high T3
pituitary - Raised TSH, raised T3
hyperthyroidism treatment
Beta blockers reduce symptoms
Antithyroid drugs: Carbimazole
Surgery (partial thyroidectomy with drug therapy)
Radio iodine
what is hypothyroidism?
not enough thyroid hormones made
causes decreased metabolism
e.g. hashimotos thyroiditis
autoimmune destruction of thyroid gland
pituitary tumour so not enough TSH (thyroid stimulating hormone) made
hypothalamus doesn’t make enough thyroid-tropin releasing hormone
hypothyroidism TSH and T3?
HIGH TSH
LOW T3 (TSH build up)
hypothyroidism symptoms?
tiredness
cold intolerance
slow heart rate
weight gain
hypothyroidism signs?
goitre
bradycardia
depression
poor libido
constipation
hypothyroidism tests?
Test free T4 & TSH
Gland - LOW TSH, Low T4
pituitary - Raised TSH , Low T4
hypothyroidism treatment?
thyroxine (shrinks goitre)
cause of hyperthyroidism?
gland failure
pituitary failure (rare)
cause of hypothyroidism?
autoimmune
drugs (lithium-mood stabilisers)
treatment of hyper
blood tests for thyroid problems
Primary Hyperthyroidism = LOW TSH but HIGH T3
Secondary Hyperthyroidism = HIGH TSH and HIGH T3
Primary Hypothyroidism = HIGH TSH but LOW T4
Secondary Hypothyroidism = LOW TSH and LOW T4
hormones secreted in anterior pituitary
TSH - Thyroid Stimulating Hormone
ACTH - Adrenocorticotrophic Hormone
GH - Growth Hormone
LH
FSH
Prolactin
hormones secreted in posterior pituitary
ADH - Anti Diuretic Hormone or Vasopressin
Oxytocin
hormones secreted in adrenal gland
aldosterone and cortisol
tell me about growth hormone disorder
Measure by insulin-like growth factor (IGF-1), it more stable in blood than growth hormone
Under secretion
Children - growth failure
Adults
■ Increase fat storage
■ Decrease tissue repair
Over secretion
Children - Giantism
○ Adults
■ Acromegaly
● Enlarged mandible
Dental:
○ Denture ‘shrunk’
○ Interdental spacing
○ Malocclusion or reversed bite
aldosterone ?
Produced in zona glomerulosa
Responsible for salt and water regulation
Inhibitors
■ Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors)
● Can cause oral lichenoid reactions, fat tongue, cough and increased BP
cortisol?
Produced in zona fasicularis
Insulin antagonist
Anti-inflammatory
Immunosuppression
Cushing’s syndrome symptoms?
diabetes symptoms
hiturism (facial hair in women)
psychiatric disorder
Cushing’s syndrome signs?
moon face
increased infection risk
buffalo hump
“lollipop on sticks”
thin skin, easily bruised
melanocytes in oral mucosa
Cushing’s syndrome investigations?
■ High 24hr urinary cortisol excretion
■ Dexamethasone suppression tests to see is ACTH is suppressed
■ CRH tests - cushing’s shows rise in ACTH with CRH
Cushing’s syndrome treatment?
surgery, radiation, chemotherapy, or cortisol-reducing medicines.
Cushing’s syndrome cause?
hyper - increased cortisol levels
most common cause is non cancerous tumour or medications such as steroids
Addison’s syndrome cause
hypo - decreased cortisol levels
the adrenal gland is damaged, and not enough cortisol and aldosterone are produced.
Addison’s syndrome symptoms
weakness
loss of body hair
anorexia
Addison’s syndrome signs
postural hypotension
hyperpigmentation
unintentional weight loss
Addison’s syndrome investigations
High ACTH level
Negative synACTHen tests
Addison’s syndrome treatment
■ Addisonian Crisis - hospitalisation
■ Hormone replacement
● Cortisol/hydrocortisone
● Fludrocortisone
Dental aspects with adrenal problems
- STEROID precautions may be needed
- liase with physician for infections/illness
- candidiasis in Cushings
- oral pigmentation in Addison’s/Cushings
What is a mineral-corticoid?
steroid hormone that is produced by the adrenal cortex and regulates the balance of ELECTROLYTES AND H20 in the body.
e.g. ALDOSTERONE
acts on the kidney to promote the reabsorption of sodium ions and the excretion of potassium ions
regulates blood pressure, blood volume, and electrolyte balance.
What is an example of a glucocorticoid?
CORTISOL
e.g. prednisone, dexamethasone, and hydrocortisone, which are commonly used to treat inflammation, allergies, and autoimmune disorders.
In what clinical situation might you recommend your patient altering their hormone therapy treatment?
patients on glucorticoids can have a different response to anaesthesia and INCREASE THE RISK OF ADRENAL CRISIS during dental procedures.
adrenal hormone therapy for conditions such as autoimmune disorders - may increase their risk of oral infections and complications following dental procedures.
hypercortisolism or hypoparathyroidism, can cause oral manifestations that may require dental intervention.
Hydrocortisone and fludrocortisone. Which one would you recommend a patient take before dental treatment and why?
both given in addisons
unable to adapt to stress so require both before to prevent adrenal crisis
hydrocortisone = can manage pain or swelling after oral surgery = cortisol equivalent
bring a dose forward and take ahead of LA
adrenaline LA is suitable
fludrocortisone = controls sodium and fluids
helps treat adrenal sufficiency and and can help during hypotension or electrolyte imbalances
XLAs should be referred to primary care
Addisons crisis, what is pulse rate? What is blood pressure?
hypotension < 90/60 mmHg
Pulse < 60 beats per minute
dehydration
serum cortisol < 100 mol/L
it is managed with IV hydrocortisone (100mg) and IV fluid rehydration
