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Diseases of human systems > Endocrine diseases > Flashcards

Endocrine diseases Flashcards

1
Q

What is the endocrine system

A

Complex network of glands that produce and release hormones

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2
Q

What glands are within the endocrine system

A

Adrenal, Hypothalamus, Islet cells of pancreas, Ovaries, Parathyroid, Pineal, Pituitary gland, Testes, Thymus, Thyroid

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3
Q

What do adrenal glands release

A

releases multiple hormones such as cortisol, aldosterone etc​

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4
Q

What controls the pituitary gland

A

Hypothalamus

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5
Q

What do islet cells secrete

A

Insulin and glucagon

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6
Q

What part of the endocrine system controls blood calcium levels

A

Parathyroid

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7
Q

What gland secretes melatonin

A

Pineal

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8
Q

What is the function of the thymus in the endocrine system

A

Helps develop immune system

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9
Q

What gland controls metabolism

A

Thyroid gland in neck

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10
Q

Why do disorders of the endocrine system occur

A

Hormone Levels are too high​

Hormone Levels are too low ​

Your body does not respond to hormones in the expected way

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11
Q

How does the endocrine feedback system work

A

If you have too much or too little of a particular hormone the feedback system signals to the appropriate gland/ glands to correct this

Problems with the feedback system leads to hormone imbalance

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12
Q

What is the difference between primary and secondary endocrine disease

A

Gland Failure (Primary)​

Control Failure (Secondary)

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13
Q

Where is the pituitary gland

A

Located at base of brain, below the hypothalamus

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14
Q

What hormones does the pituitary gland release

A

ANTERIOR pituitary ​
TSH - Thyroid Stimulating Hormone​
ACTH - Adrenocorticotrophic Hormone ​
GH - Growth Hormone​
LH, FSH, Prolactin​
​

POSTERIOR pituitary​
ADH - Anti Diuretic Hormone (vasopressin) - diabetes insipidus ​
Oxytocin

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15
Q

What hormones are released from the posterior pituitary gland

A

ADH
Oxytocin

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16
Q

Where are both growth hormone and ACTH (Adrenocorticotrophic Hormone) released from

A

Anterior pituitary

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17
Q

What hormones does the hypothalamus control

A

TRH, GnRH, CRH

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18
Q

What does a non-functional adenoma mean

A

Space occupying

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19
Q

How are tumours infringing on the optic nerve treated

A

Trans-sphynoidal surgery

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20
Q

What impacts does insufficient growth hormone production have

A

Growth failure in Children​

Metabolic Changes in Adults​
increased fat​
reduced vitality

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21
Q

What effect does growth hormone have on blood glucose levels

A

Can raise them

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22
Q

How is GH levels assessed

A

Measure Insulin-like growth factor 1 as growth hormone can raise blood glucose levels

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23
Q

When is acromegaly most commonly developed

A

30-50yrs

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24
Q

What is acromegaly caused by

A

Benign pituitary tumour

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25
Q

What are some features of acromegaly

A

coarse features​

enlarged supra-orbital ridges​

Broad nose, thickened lips & soft tissues​

enlarged hands ​
(carpal tunnel syndrome - finger numbness)​

Type 2 diabetes mellitus​
-insulin resistance from increased GH​

Cardiovascular disease​
-Ischaemic heart disease​
-acromegalic cardiomyopathy

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26
Q

How can acromegaly affect the oral cavity

A

enlarged tongue​

​

interdental spacing​

​

‘shrunk’ dentures​

​

Reverse overbite

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27
Q

What is myxoedema another name for

A

Hypothyroidism

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28
Q

What are some signs and symptoms of hyperthyroidism (increased metabolism)

A

Increased BP
Warm moist skin (sweat)
Weight loss
Diarrhoea
Muscle weakness
Tachycardia/atrial fibrillation

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29
Q

What can cause hyperthyroidism

A

Graves’ Disease- autoimmune condition (70-80% of cases)

Thyroiditis

Toxic adenomas

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30
Q

What are the signs and symptoms of hypothyroidism

A

Dry coarse skin
Bradycardia
Confusion
Weight gain
Constipation
Tiredness
Hair loss

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31
Q

What are the primary causes of hypothyroidsim

A

Autoimmune (Hashimoto’s) Thyroiditis 90% of cases​

Idiopathic Atrophy​

Radioiodine Treatment/ Thyroidectomy surgery​

Iodine Deficiency ​

Drugs e.g. Carbimazole, amiodarone, lithium​

Congenital

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32
Q

What is a secondary cause of hypothyroidism

A

Hypothalamic/Pituitary disease

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33
Q

Who is affected by Hashimoto’s Thyroiditis

A

Common in middle aged elderly women
Often family history of another autoimmune disease
Associated with down’s syndrome

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34
Q

How can pituitary tumours cause hypothyroidism

A

Limited space for expansion of pituitary gland in Sella Turcica​

If the pituitary tumour increases in size, it can compress ‘normal’ pituitary tissue​

If the compressed cells secrete TSH then abnormally low TSH will be secreted. This can lead to hypothyroidism.

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35
Q

How is thyroid disease tested

A

Blod (TSH, T3,T4)
Imaging (ultrasound, radiosotope)
Biopsies

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36
Q

What are the most common causes of hyperthyroidism

A

Graves and adenoma
-low TSH
-raised T3,T4

37
Q

What are the most common causes of hypothyroidism

A

Gland failure
-High TSH
-Low T4

pituitary cause is rare low TSH and low T4

38
Q

How is Hyperthyroidism treated

A

Medication- Carbimazole, beta-blockers e.g. propanolol​

​

Radioiodine 131i- risk of hypothyroidism with time, need to review​

​

Surgery- partial thyroidectomy

39
Q

How is hypothyroidism treated

A

T4 tablets- Thyroxine​

​

Slow response- weeks​

​

Increase dose slowly- IHD​

​

Recheck using TSH as a guide if gland failure

40
Q

How can hypo/hyperthyroidism be treated/presented at dentist

A

Hyperthyroidism​

Pain anxiety and psychiatric problems​
Caution for treatment until controlled​

​

Hypothyroidism ​

Avoid use of sedative if severe​
Can present as burning mouth

41
Q

What glandular disease can be detected at the dentist during examination

A

Goitre

42
Q

How does thyroid cancer present

A

Usually presents with thyroid swelling​

Young or elderly

Cold nodules on radioisotope scan

43
Q

What are the two types of thyroid cancer

A

Papillary
Follicular

44
Q

Where are the adrenal glands

A

Triangle-shaped glands that are located on top of each kidney

45
Q

What are the parts to the adrenal glands

A

Adrenal medulla
Adrenal cortex

46
Q

What bodily functions do the adrenal gland hormones regulate

A

Metabolism​

Immune system​

Blood pressure​

Stress response​

Development of sexual characteristics

47
Q

What does the adrenal medulla secrete/control

A

Releases adrenaline and noradrenaline - These hormones control blood pressure, heart rate, sweating etc

48
Q

What does the adrenal cortex secrete/control

A

Releases glucocorticoid and mineralocorticoid steroid hormones - The adrenal cortex also stimulates the production of small amounts of sex steroid hormones (androgenic steroids)

49
Q

Where would you find the zona glomerulosa and zona fasciculata

A

Adrenal gland cortex

50
Q

Where are mineralocorticoids produces

A

Zona glomerulosa of the adrenal cortex

51
Q

Where are glucocoticoids produced

A

Zona fasciculata in the adrenal cortex

52
Q

Where are adrenal androgens produced

A

Zona reticularis in the adrenal cortex

53
Q

What drugs cause aldosterone action inhibition

A

ACE inhibitors
Angiotensin 2 blockers (block angiotensin receptor)

54
Q

Where is aldosterone secreted

A

Zona glomerulosa

55
Q

Where is cortisol secreted

A

Zona fasciculata

56
Q

What systems does cortisol affect and why

A

Nervous system​

Immune system​

Cardiovascular system​

Respiratory system​

Reproductive system

Glucocorticoid receptors are present in almost every tissue in body

57
Q

What does circadian release indicate

A

Levels rise through the night and reach a peak within first hour of awakening then decrease

58
Q

What are the effects of cortisol

A

Antagonist to insulin (Gluocneogenesis, fat & protein breakdown)​

Lowers the immune reactivity​

Raises blood pressure​

Inhibits bone synthesis

59
Q

What are adrenal androgens used for

A

Taken up by ovaries and testes to produce testosterone and oestrogen

60
Q

What are therapuetic steriods

A

Man-made version of the adrenal hormones

Anti-Inflammatory- reduce inflammation and supress the activity of the immune system

61
Q

What are therapuetic steroids used to treat

A

Asthma, COPD​

Eczema, severe hives​

Arthritis​

IBS​

Lupus​

Multiple Sclerosis

62
Q

What are possible adverse effects of therapuetic steroids

A

Hypertension​

Type 2 diabetes​

Osteoporosis​

Increased infection risk​

Peptic ulceration​

Thinning of the skin​

Easy bruising

63
Q

What are examples of therapuetic steroids and their cortisol equivalent

A

Hydrocortisone (cortisol equivalent = 1)​

Prednisolone (4) (most common)​

Triamcinolone (5)​

Dexamethasone (25)​

Betamethasone (30)

64
Q

What causes addison’s disease

A

Destruction of adrenal tissue

65
Q

What is cushing’s syndrome

A

Excess adrenal action

66
Q

What causes adrenal gland hyperfunction

A

Glucocorticoids – Cushing’s Syndrome​

adrenal tumour - primary​
pituitary tumour - secondary​

Aldosterone - Conn’s Syndrome​

adrenal tumour

67
Q

What causes adrenal gland hypofunction

A

Addison’s disease - primary​

Pituitary failure - secondary

68
Q

What is cushing’s syndrome

A

Occurs when there is too much cortisol in the body for long period of time due to:​

Adrenal adenoma or hyperplasia producing cortisol- primary cause​

Pituitary adenoma producing too much ACTH (Cushing’s disease) – secondary cause​

Lung tumour producing ACTH (ectopic ACTH production)​

Taking too many steroid medications

69
Q

How much more frequent is cushing’s syndrome in females compared to males

A

F 4:1 M

70
Q

What are the possible symptoms of Cushing’s syndrome

A

‘diabetes mellitus’ features​

poor resistance to infections​

osteoporotic changes​

back pain & bone fractures ​

psychiatric disorders ​
-depression​
-emotional lability​
-psychosis

71
Q

As health care workers what are some signs of Cushing’s syndrome

A

centripetal obesity​
-moon face​
-buffalo hump​

hypertension​

thin skin & purpura​

muscle weakness​

Osteoporotic changes & fractures

72
Q

What is Addison’s disease

A

Primary adrenal insufficiency, adrenal glands do not produce enough cortisol or aldosterone

73
Q

What is autoimmune adrenalitis

A

Organ-specific Autoimmune disease​

Associated with other autoimmune endocrine diseases e.g. autoimmune thyroid disease, diabetes mellitus, Pernicious anaemia

74
Q

What are symptoms of addison’s disease

A

weakness​

anorexia​

loss of body hair (females)

75
Q

What signs may indicate addisons disease

A

postural hypotension​
-salt and water depletion​
absence of ALDOSTERONE and aldosterone effects of GLUCOCORTICOIDS​

weight loss & lethargy

hyperpigmentation (not in secondary hypofunction)​
-scars, mouth, skin creases​
pigmentation effect of increased ACTH secretion​

vitiligo

76
Q

How can cushings syndrome be tested

A

high 24hr urinary cortisol excretion​

abnormal dexamethasone suppression tests​
-feedback suppression of cortisol via ACTH​

CRH tests ​
-Cushing’s disease show rise in ACTH with CRH

77
Q

How can addisons be detected

A

high ACTH level​

negative synACTHen tests​
-No plasma cortisol rise in response to ACTH injection

78
Q

What does hyperfunction of the adrenal glands do to ACTH and cortisol levels

A

Hyperfunction (Primary)​
Gland adenoma​
​
-Low ACTH​
-High Cortisol

Hyperfunction (Secondary)​
Pituitary adenoma​
Ectopic ACTH production​
​
-High ACTH​
-High Cortisol

79
Q

What does hypofunction of the adrenal glands do to ACTH and cortisol levels

A

Hypofunction (primary)​ Synacthen -ve
Gland destruction​
​
-High ACTH​
-Low Cortisol

Hypofunction (secondary)​ Synacthen +ve
Pituitary failure​
​
-Low ACTH​
-Low Cortisol

80
Q

How is adrenal hyperfunction treated

A

Detect cause (adenoma)​
-pituitary​
-adrenal​
-ectopic (lung)​

​

Surgery​
-pituitary ​
-adrenal - partial/complete adrenalectomy

81
Q

What is addisonian crisis

A

Adrenal crisis:
Life threatening condition when adrenal hormone levels fall significantly​
-hypotension​
-vomiting​
-eventual coma

​

Absence of MINERALOCORTICOID and mineralocorticoid effects of GLUCOCORTICOIDS ​

CRISIS takes time to develop​
hypovolaemic shock​
Hyponatraemia

82
Q

How can addisons disease be managed

A

Hormone Replacement ​
-Hydrocortisone, prednisolone- Glucocorticoid (cortisol) replacement​
-Fludrocortisone - mineralocorticoid (aldosterone) replacement ​

Cortisol dose varies with environment​
-increased by physical/psychological stress​
-Increased by infection

83
Q

How is adrenal crisis prevented when infection/surgery or physiological stress is anticipated

A

Increase steroid dose

84
Q

When might steroid cover be needed in dentists

A

Patients with Addison’s Disease​

Patients with secondary adrenal insufficiency ​

Patients taking ≥5mg prednisolone (or equivalent dose of other therapeutic steroid) for 4 weeks or longer

85
Q

What may be present with patients who have Cushings

A

Candidiasis

86
Q

What diseases may explain oral pigmentation

A

Addison’s or Cushing’s

87
Q

When is it called cushing’s disease

A

When there is a tumour of pituitary gland resulting in too much cortisol

88
Q

What is the difference between addisons and cushings

A

Addisons - not enough cortisol
Cushing’s - Too much cortisol

Diseases of human systems (7 decks)

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