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endocrine Flashcards

1
Q

what is hyperthyroidism?

A

too much thyroid hormone is made

causes increased metabolism

e.g. grave’s disease = autoimmune disorder = oedema can be seen in eye

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2
Q

hyperthyroidism TSH & T3

A

LOW TSH
HIGH T3 (T3 build up)

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3
Q

hyperthyroidism symptoms

A

hyperactive
heat intolerance
palpitations
weight loss
diarrhoea
tachycardia

can feel manic, anxious, increased BP

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4
Q

hyperthyroidism signs

A

goitre (neck swelling), atrial fibrillation (tachycardia),
warm moist skin

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5
Q

hyperthyroidism test

A

Test for free T3 & TSH

Gland - low TSH, high T3
pituitary - Raised TSH, raised T3

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6
Q

hyperthyroidism treatment

A

Beta blockers reduce symptoms
Antithyroid drugs: Carbimazole
Surgery (partial thyroidectomy with drug therapy)
Radio iodine

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7
Q

what is hypothyroidism?

A

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

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8
Q

hypothyroidism TSH and T3?

A

HIGH TSH
LOW T3 (TSH build up)

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9
Q

hypothyroidism symptoms?

A

tiredness
cold intolerance
slow heart rate
weight gain

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10
Q

hypothyroidism signs?

A

goitre
bradycardia
depression
poor libido
constipation

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11
Q

hypothyroidism tests?

A

Test free T4 & TSH

Gland - LOW TSH, Low T4
pituitary - Raised TSH , Low T4

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12
Q

hypothyroidism treatment?

A

thyroxine (shrinks goitre)

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13
Q

cause of hyperthyroidism?

A

gland failure
pituitary failure (rare)

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14
Q

cause of hypothyroidism?

A

autoimmune
drugs (lithium-mood stabilisers)
treatment of hyper

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15
Q

blood tests for thyroid problems

A

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

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16
Q

hormones secreted in anterior pituitary

A

TSH - Thyroid Stimulating Hormone
ACTH - Adrenocorticotrophic Hormone
GH - Growth Hormone
LH
FSH
Prolactin

17
Q

hormones secreted in posterior pituitary

A

ADH - Anti Diuretic Hormone or Vasopressin
Oxytocin

18
Q

hormones secreted in adrenal gland

A

aldosterone and cortisol

19
Q

tell me about growth hormone disorder

A

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

20
Q

aldosterone ?

A

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

21
Q

cortisol?

A

Produced in zona fasicularis
Insulin antagonist
Anti-inflammatory
Immunosuppression

22
Q

Cushing’s syndrome symptoms?

A

diabetes symptoms
hiturism (facial hair in women)
psychiatric disorder

23
Q

Cushing’s syndrome signs?

A

moon face
increased infection risk
buffalo hump
“lollipop on sticks”
thin skin, easily bruised
melanocytes in oral mucosa

24
Q

Cushing’s syndrome investigations?

A

■ High 24hr urinary cortisol excretion
■ Dexamethasone suppression tests to see is ACTH is suppressed
■ CRH tests - cushing’s shows rise in ACTH with CRH

25
Q

Cushing’s syndrome treatment?

A

surgery, radiation, chemotherapy, or cortisol-reducing medicines.

26
Q

Cushing’s syndrome cause?

A

hyper - increased cortisol levels

most common cause is non cancerous tumour or medications such as steroids

27
Q

Addison’s syndrome cause

A

hypo - decreased cortisol levels

the adrenal gland is damaged, and not enough cortisol and aldosterone are produced.

28
Q

Addison’s syndrome symptoms

A

weakness
loss of body hair
anorexia

29
Q

Addison’s syndrome signs

A

postural hypotension
hyperpigmentation
unintentional weight loss

30
Q

Addison’s syndrome investigations

A

High ACTH level
Negative synACTHen tests

31
Q

Addison’s syndrome treatment

A

■ Addisonian Crisis - hospitalisation
■ Hormone replacement
● Cortisol/hydrocortisone
● Fludrocortisone

32
Q

Dental aspects with adrenal problems

A
  • STEROID precautions may be needed
  • liase with physician for infections/illness
  • candidiasis in Cushings
  • oral pigmentation in Addison’s/Cushings
33
Q

What is a mineral-corticoid?

A

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.

34
Q

What is an example of a glucocorticoid?

A

CORTISOL

e.g. prednisone, dexamethasone, and hydrocortisone, which are commonly used to treat inflammation, allergies, and autoimmune disorders.

35
Q

In what clinical situation might you recommend your patient altering their hormone therapy treatment?

A

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.

36
Q

Hydrocortisone and fludrocortisone. Which one would you recommend a patient take before dental treatment and why?

A

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

37
Q

Addisons crisis, what is pulse rate? What is blood pressure?

A

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

bds 2 (38 decks)

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