Endocrine and Metabolic Diseases Flashcards by Rodwan Halimi

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

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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))

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How is glucose monitored?

Fasting blood glucose

Glucose tolerance test

Glycated/glycosylated haemoglobin

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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

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What are thyroid hormones synthesized from?

Iodine and tyrosine

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Which portion of the population is most prone to alterations in thyroid functions?

5% of the female population

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What is hypothyroidism characterised by?

Increased TSH and decreased T3 and T4

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What causes hypothyroidism?

Hashimoto’s thyroiditis

Radioactive iodine

Surgery

Severe iodine deficiency

Pituitary gland disorder

Pharmacological agents (lithium and amiodarone)

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What does childhood hypothyroidism cause?

Cretinism

Usually caused by iodine deficiency or defective/absent thyroid gland

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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).

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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

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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.

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What are the clniical symptoms of hyperthyroidism?

Tremor

Emotional instability

Intolerance to heat

Sinus tachycardia

Hypertension

Increased appetite

Weight loss

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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

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What is cushing’s syndrome?

Hypercortisolism:

Can be exogenous (due to glucocorticoid administration) or endogenous (due to excess ACTH from pituitary ademona)

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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