Endocrine and Metabolic Diseases Flashcards
How does the pancreas regulate glucose levels?
It affects muscle, adipose tissue, liver, and brain.
Insulin stimulates glucose uptake into the muscle and adipose tissue and inhibits the liver releasing glucose into the bloodstream
What are the types of diabetes?
Type 1 (Juvenile diabetes insulin dependent) due to less insulin production
Type 2 (Non insulin dependent) caused by insulin resistance
Third type (Gestational diabetes (pregnant women))
How is glucose monitored?
Fasting blood glucose
Glucose tolerance test
Glycated/glycosylated haemoglobin
What are the oral manifestations of diabetes?
Compromised periodontal health
Candidiasis
Dry mouth
Increased caries
Glossitis
Burning mouth
Oral, facial dysaesthesia
Dental infections
Poor healing
What are thyroid hormones synthesized from?
Iodine and tyrosine
Which portion of the population is most prone to alterations in thyroid functions?
5% of the female population
What is hypothyroidism characterised by?
Increased TSH and decreased T3 and T4
What causes hypothyroidism?
Hashimoto’s thyroiditis
Radioactive iodine
Surgery
Severe iodine deficiency
Pituitary gland disorder
Pharmacological agents (lithium and amiodarone)
What does childhood hypothyroidism cause?
Cretinism
Usually caused by iodine deficiency or defective/absent thyroid gland
What are the clinical symptoms of hypothyroidism?
Slower metabolic rate,
Weight gain,
Lethargy,
Intolerance to cold, dry and cool skin,
Puffiness of the face and eyelids,
Hairloss,
Constipation,
Myxedema (mucopolysaccharide deposits in the skin).
What are the oral manifestations of hypothyroidism?
Delayed dental eruption
Macroglossia
Glossitis
Compromised periodontal health
Dysgeusia
Delayed healing
Enamel hypoplasia in both dentititions
Anterior open bite
Micrognathia
Thick lips
Mouth breathing
What is hyperthyroidism?
Decreased FSH and increased T3 and T4
Often caused by Graves disease which is caused by antibodies that stimulate the thyroid gland to secrete excessive quantities of thyroid hormones. Often characterised by a goitre.
What are the clniical symptoms of hyperthyroidism?
Tremor
Emotional instability
Intolerance to heat
Sinus tachycardia
Hypertension
Increased appetite
Weight loss
What are the oral manifestations of hyperthyroidism?
Increased susceptibility to periodontal disease
Enlargement of extraglandular thyroid tissue in the lateral posterior tongue.
Maxillary or mandibular osteoporosis
Accelerated dental eruption
Burning mouth
Sjogren’s syndrome
Increased susceptibility to caries
What is cushing’s syndrome?
Hypercortisolism:
Can be exogenous (due to glucocorticoid administration) or endogenous (due to excess ACTH from pituitary ademona)
What are the clinical features of cushing’s syndrome?
Osteoporosis
Cardiac hypertrophy (hypertension)
Obesity
Skin ulcers (poor wound healing)
Muscle weakness
Purpura
Moon face
Emotional disturbance
What is addison’s disease?
Insufficient cortisol caused by:
Autoimmune disease affecting adrenal glands.
Infections, neoplasia of adrenal glands
Pituitary disease
Abrupt stopping of corticosteroids
What are the potential complications of addison’s disease?
Low BP
Syncope
Hyperpigmentation of mucosa and skin (due to increase in ACTH)
What is an addisonian crisis? How is it treated?
Acute adrenal failure (life threatening)
Treated with IV glucocorticoids and saline with dextrose
Where is growth hormone produced?
Anterior pituitary
What causes hypopituitarism?
Can be Acquired (pituitary gland damage or disease) or inherited
What are the clinical features of hypopituitarism?
Short stature
Small face
Permanent teeth showing delayed pattern of eruption
Shedding pattern of deciduous teeth is delayed by several years
Small dental arches -> Dental malocclusion
Adults have thin eyebrows, loss of eyelashes, sharp features, thin lips, and immobile expression
What conditions arise as a result of hyperpituitarism? What causes hyperpituitarism?
Acromegaly (Excess growth hormone production after epiphyseal plate closure)
Gigantism (Excess growth hormone prior to epiphyseal plate closure)
Often caused by a pituitary adenoma
What are the complications associated with hyperpituitarism?
Cardiovascular: Concentric biventricular hypertrophy, heart failures
Respiratory complications: sleep apnea
Metabolic: Impaired glucose tolerance due to growth hormone induced insulin resistance, lipid abnormalities like hypertriglyceridemia
What are the clinical features of gigantism?
Prognathic mandible
Frontal bossing
Dental malocclusion
Interdental spacing
Hypercementosis
What are the clinical features of acromegaly?
Soft tissue swelling and bony enlargement leading to:
Coarse facial features (skin thickening and thick lips)
Large spade shaped hands
Enlarged feet
Occlusal changes
Malocclusion
Hypercementosis
Macroglossia
Hypertrophy of palatal tissues
Protruded glabella
Increased anterior face height
Mandibular prognathism
Deep voice
How does hypo and hyper pituitarism affect dentition?
Hypopituitarism results in delayed eruption rate as well as shedding of deciduous teeth, smaller clinical crown of teeth, smaller roots with retarded growth of supporting apparatus, smaller dental arches, crowding and malocclusion, and retarded growth of mandible.
Gigantism results in teeth that are large but correctly proportioned with the rest of the body, dental malocclusion, and hypercementosis.
Acromegaly leads to thick and negroid lips, enlarged tongue with indentations on lateral borders, enlarged prognathic mandible, class 3 occlusion, teeth tipped to outside labial or buccal surface (pressure applied by tongue), increased periosteal bone formation, major salivary gland enlargement, thickening and coarsening of facial skin, spacing in the teeth, enlarged nasal sinuses, anterior open bite
What is the function of the parathyroid glands?
Produce parathyroid hormone (PTH) in response to drop in blood calcium
PTH increases the blood calcium in 3 ways:
Stimulating osteoclasts
Increasing GI absorption of Ca by activating vitD
Increasing renal absorption of Ca
What causes primary hyperparathyroidism?
Primary:
Problem with one or more of the 4 parathyroid glands
Adenoma (most common)
Hyperplasia
Malignant tumour
What causes secondary hyperparathyroidism?
Result of another condition which lowers Ca
Parathyroid galnds overwork to return Ca to normal
Severe Ca and vitD deficiency can cause this as well as chronic renal failure
What are the complications of hyperparathyroidism?
Fragile bones
Kidney stones
Excessive urination
Abdominal pain
Tiring easily or weakness
Depression and forgetfulness
Bone and joint pain
Nausea, vomiting or loss of appetite
What are the oral manifestations of hyperparathyroidism?
Widened pulp chambers
Development defects
Alterations in dental eruption
Weak teeth
Malocclusions
Loss of lamina dura on
radiographs
Giant cell lesions
Brown tumour
Loss of bone density (bone resorption)
Soft tissue calcifications
What are brown tumours?
Radiolucency caused by excessive osteoclast break down of bone. It is not a neoplasm, but rather simply a mass that most commonly affects the mandible and maxilla.
What causes hypoparathyroidism?
Can be inherited or caused by thyroid or parathyroid surgery.
This leads to decreased function of the parathyroid gland, underproduction of PTH and in turn a low blood Ca.
What are the complications of hypoparathyroidism?
Paraesthesia of finertips, toes, and lips
Muscle aches, cramps
Twitching or spasms of muscles
Fatigue or weakness
Memory problems
Anxiety
Brittle nails
Headaches
Depression, mood swings
What are the dental manifestations of hypoparathyroidism?
Enamel hypoplasia
Poorly calcified dentine
Widened pulp chambers
Dental pulp calcifications
Shortened roots
Hypodontia
Delay or cessation of dental development
Chronic candidiasis
Paraesthesia of tongue and lips
Altered facial muscles
How does pregnancy affect hormones?
Human chorionic gonadotropin rises rapidly and peaks after 8 weeks
Progesterone and oestrogens increase throughout pregnancy until the baby is born
What are the complications of pregnancy?
Morning sickness (vomiting)
Esophageal reflux
Increased acid exposure damages the teeth
Pregnancy gingivitis
Hormonal epulis (inflammation of the interdental papilla) Risk is higher with poor plaque control
