endocrine diseases Flashcards
where is the pituitary gland located?
sella turcica
what does the hypothalamus secrete
- corticotrophin rh
- gonadotrophin rh
- prolactin rh
- growth hormone rh
- thyrotrophin rh
what does the posterior and anterior pituitary gland secrete
posterior
- ADH (vasopressin)
- oxytocin
anterior
- adrenocorticotropic h
- follicle stimulating
-luteinizing
- thyroid stimulating
- growth
- prolactin
- melanocyte stimulating
significance of the optic chiasm
located next to the pituitary gland, where the visual field crosses
if there is swelling or tumour, might have vision problems
what hormones do the renal glands ie kidneys secrete
o renin
o erythropoietin
o activate vitamin D
is pancreas an endocrie gland
yes 2%
- insulin
- glucagon
- somatostatin
MEN2b
- multiple endocrine neoplasia
- 2b is relevant for dentistry
- mucosal neuromas = swelling seen in mouth
how to remove pituitary tumours
trans sphenoidal surgery
functional vs non functional adenomas
functional = excess hormones created like cuhsings or acromegaly
non function = no production of pituitary hormones, hormone deficiencies
what causes acromegaly
- excess growth hormone in adults
how to test for acromegaly cause
- measure IGF-1 to assess GH
- if IGF-1 is high after puberty, suggests acromegaly
what does IGF-1 do
IGF-1 promotes cell growth and division, especially in bones and muscles during growth phases. It stimulates the growth of muscle tissue, cartilage, and bone.
what dental problems do you see in patients with acromegaly
o reverse overbite
o increased interdenal spacing
o enlarged tongue
what are some physical changes you see in patients with acromegaly?
large hands and feet
enlarged supraorbital ridges
vision defects
thickened lips and soft tissues
diabetes type 2
CVS problems
acromegalic cardiomyopathy
why do people with acromegaly have type 2 diabetes?
insulin resistance from GH
GH promotes more gluconeogenesis and raises blood glucose
increases basal insulin levels
cause of primary hyperthyroidism
Graves dieases autoimmune
toxic adenoma
toxic multi-nodular goitre
causes of secondary hyperthyroidism
pituitary tumour
causes of primary hypothyroidism
hashimoto’s thyroiditis
iodine deficiency
radioiodine tx for hyper causes a change hyper-> hypo
drugs like
- carbimazole
- amiodarone
- lithium
is primary thyoid problems or secondary more rare
secondary rarer
primary causes like Graves and hashimotos’ more common
causes of secondary hypothyroidism
thyroid disease
signs and symptoms for hyperthyroidism
Warm moist skin
Tachycardia
Increased BP
Increased metabolism
Tremor
Eyelid retraction and lid lag
Bulging eyes
Goitre
weight loss
muscle weakness
manic
anxious
signs and symptoms for hyporthyroidism
Bradycardia
Confusion
Goitre (Hashimoto’s)
- inflammation of thyroid gland from antibody attack
Tired
Cold
Weight gain
Puffed face
Hair loss
Graves disease what it is and who tends to have it
autoimmune disease that causes excess production of thyroid hormone T3
people with family history of autoimmune diseases
common autoimmune disease
o vitiligo
o pernicious anaemia
o diabetes mellitus type 1
o coeliac
o myasthenia gravis
o Addison’s disease
o Graves disease
o Hashimoto’s thyroiditis
diffused goitre, proptosis and ophthalmopathy could represent what
graves disease
proptosis = eyelids pushed forward in socket due to fat tissue in the orbit
Investigation for thyroid disease
1 blood (tsh t3 t4)
2 imaging cysts
3 tissue biopsy
low TSH, high T3
pri hyper thyroid
high TSH. high T3
sec hyperthyroid
high TSH, low T4
primary hypothyroid
low TSH, low T4
sec hypothyroid
myxoedema
another name for hypothyroid
acromegaly vs giantism
acromegaly in adults, giantism in children (too much GH and IGF-1)
treatment for hyperthyroid
- carbimazole
- beta blockers
- radioactive iodine therapy
- surgery remove tumour or thyroid gland
tx for hypothyroid
replacement therapy, give T4 tablets
dental aspects of thyroid problems
- detect goitre
- hyperthyroid patient are more anxious and pain
- hypothyroid patient should avoid sedatives
can thyroid patients use LA?
yes no problem
carbimazole drug function
blocks effect of thyroid hormone, completely block then replace with normal levels of T4
addison’s disease what is it
too little cortisol due to destruction of adrenal gland
cushing’s syndrome vs diseases
sydrome = excess cortisol
disease = excess acth
is aldosterone a mineralcorticoid or a glucocorticoid
aldosterone = mineralcorticoid
glucocorticoid = cortisol
Adrenal hormones all synthesized from
CHOLESTEROL
what drugs block the production of aldosterone
ace inhibitors and angiotensin II blockers
where is angiotensinogen secreted
liver
where is renin secreted
kidneys
what is the function of aldosterone
increase bp and water reabsorption
is angiotensin a vasoconstrictor or vasodilator
vasoconstrictor
RAAS is for aldosterone which increases BP so angiotensin also increases bp by vasoconstriction
cortisol function
- at high levels, inhibits growth
- stimulates protein catabolism
- suppresses bone growth
- promotes bone resorption
- osteoporosis
- suppresses inflammation
- raises blood pressure
cortisol vs GH
raise blood glucose => type 2 diabetes
cortisol causes osteoporosis while GH causes growth of bone
cortisol protein catabolism while GH protein synthesis
what are some Corticosteroid drugs
- prednisolone typical and most common (4x more potent than cortisol)
- triamcinolone
- dexamethasone
- betamethasone
what do therapeutic steroids do
more potent
anti inflammatory
enhanced glucocorticoid and mineralocorticoid effects
o immunosuppression
o salt and water retention
o hypertension
adverse effects of corticosteroids drugs
o hypertension
o high blood sugar -> type 2 diabetes
o osteoporosis
o infection risk
o hyperlipidaemia (atherosclerosis)
what causes cushing’s syndrome
adrenal adenoma
adrenal hyperplasia
what causes cushings diseases
pituitary tumour
spontaneous
ectopic acth from lung tumours
signs and symptoms of cushings syndrome
Hypertension
Purple striae and thin skin
Osteoporosis
Diabetes type 2
Swollen face and neck (moon face and bufalo bump)
signs and symptoms of cushings disease
Skin and mucosa pigmentation!!!
from excess acth rather than excess cortisol
Low acth
High cortisol
cushings syndrome
High acth
High cortisol
cushings disease
addisons disease
autoimmune disease that GRADUALLY destroys the adrenal gland, lack of cortisol and aldosterone
What is addison’s disease caused by
autoimmune adrenalitis 90%
infection
infarction
signs and symptoms of addisons disease
- postural hypotension
- salt and water depletion due to low aldosterone
- weight loss
- lethargy
- hyperpigmentation (only in PRIMARY NOT SECONDARY gland dysfunction)
when you see hyperpigmentation on the mucosa, what disease could it be?
high acth
- could be cushings disease
- could be addisons disease PRIMARY (low cortisol despite high acth)
investigating cushings
o high 24hr urinary cortisol excretion
o abnormal dexamethasone suppression tests
o corticotrophin rh tests
investigating addisons
o high acth levels with low cortisol levels
o NEGATIVE synACTHen tests
synACTHen positive and negative results indicate what
Adrenal disease primary high acth low cortisol (negative synACTHen)
Adrenal disease secondary low acth low cortisol (positive synACTHen)
how to treat adrenal hyperfunction
remove adenomas either from pituitary or adrenal gland surgery
how to treat adrenal hypofunction
- cortisol
- fludrocortisone which is the replacement of aldosterone
adrenal crisis when does it occur
occurs when replacement therapy is not given to addisons disease patient
lack aldosterone and cortisol
what are the symptoms of adrenal crisis
o hypotension
o vomiting
o coma
o hypovolaemic shock
when do you give steroid prophylaxis? (prophylaxis means to tx to prevent disease)
- infections like dental abscess
- surgery like wisdom tooth
- physiological stress not psychological
what are some oral manifestations of cushings
thrush and candidiasis
