Endocrine Disease Flashcards
When is the highest levels of cortisol produced?
in the morning
How does aldosterone regulate bp?
Fluid and sodium retention
Action of ______
Kidneys –distal tubules
Intravascular volume and RAA system
Regulates Na and H20 balance –affects BP
Aldosterone
Action of ______
• Increases contractility and vascular reactivity to vascoconstriction
(results in BP)
• Antagonizes insulin
• Activates lipolysis –increased FFA
• Stimulates gluconeogenesis - (results in sugar, insulin
intolerance and cholesterol)
• Muscle catabolism –increases glucose
• Decreases calcium absorption and activates osteoclasts
- (results in osteoporosis)
• *Inhibits PLA2 and mobilization, migration, function of leukocytes -
- (results in immune response)
• Increases appetite, suppresses sleep, regulates emotion and
memory
• Increases intraocular pressure
Cortisol
Action of _______
Fight or flight - stress response
Increases BP, peripheral resistance, cardiac output
Norepi and Epi
• ↑Aldosterone, cortisol, androgen, estrogen isolated or in combination
Hyperadrenalism
• Hypertension, hypokalemia, edema
Hyperaldosteronism
Glucocorticoid excess • MOST COMMON • High levels of cortisol ➢ Cushing disease (pituitary or adrenal tumor) ➢ Cushing syndrome (exogenous corticosteroids) ➢ Complications Jameson et al. Harrison’s Principles of Internal Medicine 20th ed. (2018) oDiabetes oHypertension oWeight gain oMoon facies oBuffalo hump oHirsutism oAcne oHeart failure Adrenal oOsteoporosis oDelayed wound healing oSusceptibility to infection oirregular menses Insomnia oPsychiatric disorders oPeptic ulcers oGlaucoma and cataracts oStunted growth
Glucocorticoid excess
Findings in ______:
Increased central adiposity (moon facies and buffalo hump) with thinning of extremities
- Diabetes
- Hypertension
- Osteoporosis
- Irregular menses
Management:
-Appropriate endocrine and surgical consultation
- Surgical removal of pituitary or adrenal tumor
- Adrenal enzyme inhibitors
- Radiation therapy
Cushing syndrome
The following drugs are used to treat\_\_\_\_\_\_\_\_: Prednisolone Triamcinolone Methylprednisolone Dexamethasone Betamethasone
Cushings
➢ Destruction of adrenal cortex o↓Cortisol and ↑ACTH (adrenocorticotropic hormone) ➢ Etiology oMost commonly autoimmune ❑ What does this mean? oChronic infectious disease and sepsis ❑ HIV, CMV, fungal infection oDrugs ➢ Cannot tolerate stress (emotional or physical) oAdrenal crisis ➢ Requires cortisol replacement oSurgery and stress may require supplemental corticosteroids oPain control is important
• Addison Disease
Related features of _____:
- Postural hypotension
- Anorexia and weight loss
- Fatigue
- Shock, coma, and death, if untreated
- Hyperpigmentation of skin and mucous membranes
Addison’s
Hyperpigmentation and adrenal crisis do not usually occur/less likely with
______ and ________ adrenal insufficiency
secondary and tertiary
Can hyperadrenalism pts be given NSAIDs or aspirin?
No
_________ may be a consequence of both hyperadrenalism and
adrenal insufficiency
Impaired wound healing
signs of ________
oHypotension - Monitor BP –vasopressors, patient position, fluid
replacement
oAbdominal pain
oMyalgia
oFever
oSupplement with 100 mg of hydrocortisone and send to ED
adrenal crisis
• Involved in developmental and metabolic processes • Depends on iodide • produces 3 hormones ➢ T3 and T4 oControlled by TSH (pituitary) ➢ Calcitonin oRegulates circulating calcium and phosphorus levels oAlso influenced by actions of PTH and Vit D
Thyroid function
oRegulates circulating calcium
and phosphorus levels
oAlso influenced by actions of
PTH and Vit D
Calcitonin
\_\_\_\_\_\_\_ functions: Heart -Increases number of B-adrenergic rcs - Enhanced responses to circulating catechloamines -Increased contraction Adipsoe tissue -Stimulates lipolysis Muscle -Increased protein breakdown Bone -Promote normal growth and skeletal development Lipoprotein Formation of LDL receptors Other -Stimulates oxygen consumption by metabolically active tissues
Thryoid
Hyperthryoidism goiter
–Graves disease
Hypothyroidism goiter –
Hashimoto thyroid
Symptoms of \_\_\_\_\_\_\_\_: Unintentional weight loss Heat intolerance/ sweating Multiple daily loose stools Weakness Oligomenorrhea C
Hyperthyroidism/ Graves
Clinical findings and complications of _______:
Goiter
tachycardia
Atrial fibrillation
Fine tremor
Ophthalmopathy
Thyroid storm with fever, confusion, dehydration, and possible death
Hyperthyroidism
What drug is used to inhibit thyroid hormone metabolism and conversion from t4 to t3
Propylthiouracil (B-blocker)
\_\_\_\_ symptoms: Unexplained weight gain Lethargic Cold intolerance Constipation Muscle weakness Decreased body temp
Hypothyroidism
Clinical findings and features: Goiter Bradycardia Coma and death without treatment Slowing down function
Hypothyroidism
Oral findings in _____:
• Increased periodontal bone loss
• Increased susceptibility to caries
Hyperthyroidism
Oral findings in \_\_\_\_\_\_; • Delayed tooth eruption and altered bone formation • Macroglossia • Dysgeusia and burning mouth • Salivary gland enlargement • Oral lichen planus
• Hypothyroidism
Thyroid issue: ➢ CPR and vital signs ➢ Ice packs or wet packs ➢ Administer hydrocortisone 100-300 mg ➢ IV glucose ➢ Administer propylthiouracil ➢ Send to ED
Thyrotoxic crisis/storm - hyperthyroidism
Thyroid issue: ➢ CPR and vital signs ➢ Conserve body heat –blanket ➢ Administer hydrocortisone 100-300 mg ➢ IV saline and glucose ➢ Administer thyroxine ➢ Send to ED
Myxedema coma - hypothyroidism
In _________
• Caution with aspirin and NSAIDS- can increase T4
• Ciprofloxacin contraindicated –decreases absorption of thyroid hormone
• Avoid local anesthestics containing epinephrine and ginigval retraction cord
with epinephrine in poorly controlled patients (since already tachycardic)
Hyperthyroidism
In _________
• Avoid CNS depressants (narcotics, barbituates, sedatives) if patient is poorly
controlled
• Cytochrome p450 inducers (phenytoin, carbamazepine, and rifampin) should
be avoided –increases metabolism of levothyroxine
hypothyroidism
According to the graph in lecture, about ___% of b cells need to be destroyed before T1DM is symptomatic
80%
What is the best metric for diabetes since most stable?
HbA1C (>5.7%)
Higher prevalence of ________ in poorly
controlled diabetics - HbA1c>9%
severe periodontal disease
If there is severe periodontal issues in a pt, how does this typically correlate to the other systemic efects of DM like nephropathy, retinopathy, CV complications
Usually means they are present and bad
What do sulfonylureas do?
Increase insulin secretion
What does metformin do?
Decreases gluconeogenesis
The following ar oral manifestations of __________:
• Xerostomia/dry mouth
• Oral burning (different from burning mouth, secondary)
• Infections (bacterial, fungal, viral)
• Poor wound healing
• Increased caries
• Increased severity risk of periodontal disease
DM
If a DM pt has an A1C of over 8%, how do you treat them?
Defer treatment until under control
Do you prophylactically treat with ABX for DM?
Case dependent
are the following meds indicated or contraindicated in DM pts?
• Tetracyclines (including doxycycline) with insulin
• fluoroquinolones ciprofloxacin (Cipro), levofloxacin (Levaquin), etc. with
insulin
• Aspirin with sulfonylureas
Contraindicated
Should DM pts fast before dental treatment?
NO; could cause major hypoglycemia
- occurs in 2-10% of pregnancies
- Fetus can have excess weight gain
- Affects lung development
- Delivery may require cesarean section
- Treated similar to Type 2 diabetes
Gestational diabetes
Which trimester is the longest?
2nd
Which trimesters are routine dental treatment indicated in?
2nd
1st half of 3rd
Common \_\_\_\_\_\_ Discomforts ➢Nausea and vomiting - hormonal imbalances, stress (physical and emotional) and hyperacidity ➢Indigestion - difficulties digesting foods rich in fats, sugars, acids can lead to nausea and vomiting ➢Headaches ➢Polyuria ➢Lumbar pain ➢Perspiration ➢Breast tenderness
Pregnancy
Radiographs are _____ in all pregnancies unless emergent care is needed; must have lead shield
Contraindicated
\_\_\_\_\_\_\_\_\_\_ occurs in late (3rd trimester) pregnancy • Due to compression of the inferior vena cava that results in impaired venous return to the heart. • Manifests as: • Fall in blood pressure • Bradycardia • Sweating • Nausea Patient can rotate to their side to allow venous return to recover. Studies indicated that the LEFT side is the best.
Supine hypotension syndrome
Can pregnant pts take NSAIDs and aspirin?
No; can take acetaminophen
Can opioids be used in pregnant pts?
No
T/ F: Amoxicillin, clindamycin, azithromycin, metronidazole and
erythromycin are common antibiotics that may be used in pregnant
patients
True
Can tetracyclines and doxycycline used in pregnant pts?
No
Can benzodiazepenes be given to pregnant pts?
No
Are most drugs ok to be taken while lactating?
Yes; take just after breast feeding
________ is the most common oral condition in pregnancy, 60-75% of
pregnant women.
- Lack of attention to Oral Hygiene
- Increased systemic fluid levels from increased progesterone and
estrogen exacerbate any existing gingival/periodontal condition
Gingivitis
• not an actual granuloma as there is proliferation of vascular tissues as well proliferation
of fibrous tissue
• forms submucosally and takes the shape a nodular growth
• in pregnancy, it is an exacerbated response to plaque and bacteria precipitated by the
changes in progesterone and estrogen hormonal levels –
Epulis gravidarum
