- multiple endocrine neoplasia - 2b is relevant for dentistry - mucosal neuromas = swelling seen in mouth

endocrine diseases Flashcards by Laura Ang

where is the pituitary gland located?

sella turcica

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what does the hypothalamus secrete

corticotrophin rh
gonadotrophin rh
prolactin rh
growth hormone rh
thyrotrophin rh

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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

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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

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what hormones do the renal glands ie kidneys secrete

o renin
o erythropoietin
o activate vitamin D

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is pancreas an endocrie gland

yes 2%
- insulin
- glucagon
- somatostatin

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MEN2b

multiple endocrine neoplasia
2b is relevant for dentistry
mucosal neuromas = swelling seen in mouth

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how to remove pituitary tumours

trans sphenoidal surgery

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functional vs non functional adenomas

functional = excess hormones created like cuhsings or acromegaly

non function = no production of pituitary hormones, hormone deficiencies

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what causes acromegaly

excess growth hormone in adults

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how to test for acromegaly cause

measure IGF-1 to assess GH
if IGF-1 is high after puberty, suggests acromegaly

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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.

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what dental problems do you see in patients with acromegaly

o reverse overbite
o increased interdenal spacing
o enlarged tongue

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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

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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

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cause of primary hyperthyroidism

Graves dieases autoimmune
toxic adenoma
toxic multi-nodular goitre

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causes of secondary hyperthyroidism

pituitary tumour

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causes of primary hypothyroidism

hashimoto’s thyroiditis

iodine deficiency

radioiodine tx for hyper causes a change hyper-> hypo

drugs like
- carbimazole
- amiodarone
- lithium

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is primary thyoid problems or secondary more rare

secondary rarer

primary causes like Graves and hashimotos’ more common

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causes of secondary hypothyroidism

thyroid disease

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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

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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

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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

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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

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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 1. could be cushings disease 2. 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