Endocrine Flashcards
endocrine disease
dysfunction of hormone secreting glands. negative feedback
control failure - secondary
gland failure - primary
multiple endocrine neoplasia
rare disorders, tumour develop, affect collection of glands not just one
MEN1
parathyroud, pituitary, pancreatic islets
MEN2a
parathyroid, medullary thyroid, phaeochromocytoma
MEN2b
dental concern
medullary thyroud, phaeochromocytoma
mucosal nueromas [swelling on nerves in tissue]
where it pituitary gland located
small depression in middle of skull, sella turcica
pituitary gland functions
gland controlling, releases hormones
directly act on tissues to cause effect
what hormnes does the anterior pituitary release
TSH - thyroid stimulating hormone
ACTH - adrenocorticotropic hormone
GH - growth hormone
LH, FSH, prolactin
what hormones does the posterior pituitary secrete
ADH - antidiuretic hormone
oxytocin
functional adenoma pituitary tumour
active homone, unrestricted
, still secrete hormones
non functional adenoma pituitary tumour
space occupying, no secreting ability, lack of other hormones, visual field defects
consequences of pituitary tumour
expands upwards causing mass effect on optic chiasma
optic nerve fibres cross each other, compression from tumour, narrowed visual field
pituitary tumour surgery
trans-sphenoidal
through sphenoid bone, up nose
growth hormone
from pituitary, necessary for growth in chlildren
GH releasing H occurs at night
excess GH
continued growth of tissues
child - giantism
adult - acromegaly
insufficient GH
growth failure
acromegaly
excess GH as adult
MEN1, onset 30-50
coarse features, broad nose, enlarged hands, CV disease as heart less efficient, thicken lips
acromegaly dental aspects
enlarged tongue, interdental spacing, shrunk dentures, reverse overbite
investigations for GH
IGF-1
thyroid disease 2 types
hyperthyroidsim, hypothyroidism
what hormone is released by thyroid
TSH - thyroid stimulating hormone
tells thyroid how much thyroid hormone is needed
hyperthyroidism
excess TSH
hyperthyroidism aetiology
Graves disease - common, autoimmune, thinks TSH already bonded, excess TSH, organ specific
toxic multi-nodular goitre - toxic adenoma tumour, thyroid hormones unregulated, too much
pituitary tumour - rare, excess TSH
signs + symptoms of hyperthyroidism
sign = warm moist skin, tachycardia, increased BP, tachycardia, heart failure, increased metabolic rate
sympt - hot, excess sweating, weight loss, diarrhoea, palpitations
graves disease
hyperthyroidism
organ specific, familyh of autoimmune
thinks already bonded, unregulated excess release
symptoms - swelling of thyroid gland, propotosis [eyeballs pushed farward], swelling around eyes
hypothyroidism
deficiency in TSH
hypothyroidism aetiology
primary - gland problem, autoimmune Hashimotos, idiopathic atrophy, drugs, iodine deficiency, congenital
secondary - hypothalamic/pituitary disease
hashimotos thyroiditis
autoimmune issue, 90% of hypothyroidism
women, goitre, familyH of AI disease, Down’s syndrome, addisons
idiopathic atrophy
10x in females, primary hypothyroidism
normal thyroid tissue replaced with fat tissue
autoimmune cause, lymphocyte
investigations for thyroid disease
blood - TSH, T4, T4
imaging - ultrasound, changes in gland, radioisotope
tissue - biopsy
hyperthyroid graves or adenoma findings
low TSH, raised T3
common
hyperthyroid pituitary cause findings
raised TSH + T3
rare
hypothyroid gland failure hashimotos findings
high TSH, low T4
hypothyroid pituitary cause findings
low TSH + T4
treatment for hyperthyroidism
carbizamole [block T4], beta blockers [reduce side effects], partial thyroidectomy
optich chiamsa - not much to be done
treatment for hypothyroidism
thyroid/hormone replacement therapy
give T4 tablets, use TSH as a guide
thyroid cancer
thyroid swelling, TSH senstitive, good prognosis in young
dental aspects of thyroid disease
goitre detectible = feel neck
hyperthyroid - pain, anxiety, psychiatric problems, caution until controlled
hypothyroid avoid sedatives if severe, new drugs not metabolised well
treated px are normal - no extra considerations
adrenal gland
sits on the kidneys, divided into outer cortex and inner medulla
secrete hormones
adrenal gland areas
zona glomerulosa - aldosterone [renin, angiotensin]
cona fasicularis - cortisol [hypothalamus, pituitary]
zona reticularis - adrenal androngens
adrenal regulation
controlled by hypothalamus and pituitary
hormones to regulate metabolism, immue system, BP, stress
adrenla hormones
aldosterone, cortisol, progesterone, corticosterone
aldosterone
MOA - salt and water regulation, retains fluid
inhibited by ACE inhibtors [cough, angiooedema], AT2 blockers
ABSENCE will cause px to have change in salt/water balance
cortisol
MOA - psychological steroid, stress hormone, promotes gluconeogenesis
lowers immune reactivty, raised BP, inhibits bone synthesis
therapeutic steroids
hydrocortisone, prednisolone, betamethasone [oral disease, mucosa inflammation]
effects of therapeutic steroids
immunosuppression, reduced inflammatory response, enahnces salt/walter retention, hypertension, type2DM, osteoporosis, increased infection risk, thinning of skin, easy bruising, peptic ulceration, cataracts, increased cancer risk
adrenal hyperfunction
excess glucocorticoids + aldosterone
causes - cushings, adrenal tumour [p], pituitary tumour [s]
aldosterone - conns syndrome, adrenal tumour
adrenal hypofunction
addisons - primary
pituitary failure [s], compression from another adenoma, Sheehans syndrome
gland failure - autoimmune gland destructions
cushings disease
adrenal hyperfunction, too much cortisol
aetiology - long term glucocorticoids use, pituitary/adrenal tumours
cushing disease symptoms
weight gain, round face, purple stretch marks of abdomen, diabetes features
dental - oral fungal infection, reduced immune response, can’t resist infection
high ACTH effects
adrenocorticotropic hormone, regulates cortisol
causes pigmenatation of cells - joints, mucosa, brown patchy
investigations - cortisol excretion test
diagnosis - pituitary adenoma [high ACTH, high cortisol], gland adenoma [low ACTH, high cortisol]
addisons disease
adrenal hypofunction, too little cortisol
excess ACTH, pigmentation
aetiology - autoimmune attack response, DM, thyroid, TB
addisons disease symptoms
weakness, anorexia, loss of body hair
hypotension, salt/water depletion, weight loss, lethargy, hyperpigmentation
addisons investigations + diagnosis
investigations - high ACTH level, synaCTH test
diagnosis - pituitary failure [low ACTH, lowcort, positivr synacten
gland destruction [high ACTH, lowcort, negative synacthen
adrenal hyperfunction treatment
detect cause - adenoma
surgery - pituitary, adrenal
addisonian crisis
autoimmune destruction of adrenal gland
hypotension, vomiting, coma
basence of mineralcorticoid and glucocorticoid effects
takes time to develop
addisons management
hormone replacement - cortisol, flurdrocortisone
steroid prophylaxis
px aware of situations where needed
increased when - infection [abscess], surgery, psychological stress
if not enough, addisonian crisis, steroids needed to stop this
dental aspects of steroids
precautions may be needed, liase for infections/illness with physician
candidiasis in cushings, can cause thrush
oral pigmentation in addisons, cushings
