Endocrine diseases Flashcards
What is the endocrine system
Complex network of glands that produce and release hormones
What glands are within the endocrine system
Adrenal, Hypothalamus, Islet cells of pancreas, Ovaries, Parathyroid, Pineal, Pituitary gland, Testes, Thymus, Thyroid
What do adrenal glands release
releases multiple hormones such as cortisol, aldosterone etc
What controls the pituitary gland
Hypothalamus
What do islet cells secrete
Insulin and glucagon
What part of the endocrine system controls blood calcium levels
Parathyroid
What gland secretes melatonin
Pineal
What is the function of the thymus in the endocrine system
Helps develop immune system
What gland controls metabolism
Thyroid gland in neck
Why do disorders of the endocrine system occur
Hormone Levels are too high
Hormone Levels are too low
Your body does not respond to hormones in the expected way
How does the endocrine feedback system work
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
What is the difference between primary and secondary endocrine disease
Gland Failure (Primary)
Control Failure (Secondary)
Where is the pituitary gland
Located at base of brain, below the hypothalamus
What hormones does the pituitary gland release
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
What hormones are released from the posterior pituitary gland
ADH
Oxytocin
Where are both growth hormone and ACTH (Adrenocorticotrophic Hormone) released from
Anterior pituitary
What hormones does the hypothalamus control
TRH, GnRH, CRH
What does a non-functional adenoma mean
Space occupying
How are tumours infringing on the optic nerve treated
Trans-sphynoidal surgery
What impacts does insufficient growth hormone production have
Growth failure in Children
Metabolic Changes in Adults
increased fat
reduced vitality
What effect does growth hormone have on blood glucose levels
Can raise them
How is GH levels assessed
Measure Insulin-like growth factor 1 as growth hormone can raise blood glucose levels
When is acromegaly most commonly developed
30-50yrs
What is acromegaly caused by
Benign pituitary tumour
What are some features of acromegaly
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
How can acromegaly affect the oral cavity
enlarged tongue
interdental spacing
‘shrunk’ dentures
Reverse overbite
What is myxoedema another name for
Hypothyroidism
What are some signs and symptoms of hyperthyroidism (increased metabolism)
Increased BP
Warm moist skin (sweat)
Weight loss
Diarrhoea
Muscle weakness
Tachycardia/atrial fibrillation
What can cause hyperthyroidism
Graves’ Disease- autoimmune condition (70-80% of cases)
Thyroiditis
Toxic adenomas
What are the signs and symptoms of hypothyroidism
Dry coarse skin
Bradycardia
Confusion
Weight gain
Constipation
Tiredness
Hair loss
What are the primary causes of hypothyroidsim
Autoimmune (Hashimoto’s) Thyroiditis 90% of cases
Idiopathic Atrophy
Radioiodine Treatment/ Thyroidectomy surgery
Iodine Deficiency
Drugs e.g. Carbimazole, amiodarone, lithium
Congenital
What is a secondary cause of hypothyroidism
Hypothalamic/Pituitary disease
Who is affected by Hashimoto’s Thyroiditis
Common in middle aged elderly women
Often family history of another autoimmune disease
Associated with down’s syndrome
How can pituitary tumours cause hypothyroidism
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.
How is thyroid disease tested
Blod (TSH, T3,T4)
Imaging (ultrasound, radiosotope)
Biopsies
What are the most common causes of hyperthyroidism
Graves and adenoma
-low TSH
-raised T3,T4
What are the most common causes of hypothyroidism
Gland failure
-High TSH
-Low T4
pituitary cause is rare low TSH and low T4
How is Hyperthyroidism treated
Medication- Carbimazole, beta-blockers e.g. propanolol
Radioiodine 131i- risk of hypothyroidism with time, need to review
Surgery- partial thyroidectomy
How is hypothyroidism treated
T4 tablets- Thyroxine
Slow response- weeks
Increase dose slowly- IHD
Recheck using TSH as a guide if gland failure
How can hypo/hyperthyroidism be treated/presented at dentist
Hyperthyroidism
Pain anxiety and psychiatric problems
Caution for treatment until controlled
Hypothyroidism
Avoid use of sedative if severe
Can present as burning mouth
What glandular disease can be detected at the dentist during examination
Goitre
How does thyroid cancer present
Usually presents with thyroid swelling
Young or elderly
Cold nodules on radioisotope scan
What are the two types of thyroid cancer
Papillary
Follicular
Where are the adrenal glands
Triangle-shaped glands that are located on top of each kidney
What are the parts to the adrenal glands
Adrenal medulla
Adrenal cortex
What bodily functions do the adrenal gland hormones regulate
Metabolism
Immune system
Blood pressure
Stress response
Development of sexual characteristics
What does the adrenal medulla secrete/control
Releases adrenaline and noradrenaline - These hormones control blood pressure, heart rate, sweating etc
What does the adrenal cortex secrete/control
Releases glucocorticoid and mineralocorticoid steroid hormones - The adrenal cortex also stimulates the production of small amounts of sex steroid hormones (androgenic steroids)
Where would you find the zona glomerulosa and zona fasciculata
Adrenal gland cortex
Where are mineralocorticoids produces
Zona glomerulosa of the adrenal cortex
Where are glucocoticoids produced
Zona fasciculata in the adrenal cortex
Where are adrenal androgens produced
Zona reticularis in the adrenal cortex
What drugs cause aldosterone action inhibition
ACE inhibitors
Angiotensin 2 blockers (block angiotensin receptor)
Where is aldosterone secreted
Zona glomerulosa
Where is cortisol secreted
Zona fasciculata
What systems does cortisol affect and why
Nervous system
Immune system
Cardiovascular system
Respiratory system
Reproductive system
Glucocorticoid receptors are present in almost every tissue in body
What does circadian release indicate
Levels rise through the night and reach a peak within first hour of awakening then decrease
What are the effects of cortisol
Antagonist to insulin (Gluocneogenesis, fat & protein breakdown)
Lowers the immune reactivity
Raises blood pressure
Inhibits bone synthesis
What are adrenal androgens used for
Taken up by ovaries and testes to produce testosterone and oestrogen
What are therapuetic steriods
Man-made version of the adrenal hormones
Anti-Inflammatory- reduce inflammation and supress the activity of the immune system
What are therapuetic steroids used to treat
Asthma, COPD
Eczema, severe hives
Arthritis
IBS
Lupus
Multiple Sclerosis
What are possible adverse effects of therapuetic steroids
Hypertension
Type 2 diabetes
Osteoporosis
Increased infection risk
Peptic ulceration
Thinning of the skin
Easy bruising
What are examples of therapuetic steroids and their cortisol equivalent
Hydrocortisone (cortisol equivalent = 1)
Prednisolone (4) (most common)
Triamcinolone (5)
Dexamethasone (25)
Betamethasone (30)
What causes addison’s disease
Destruction of adrenal tissue
What is cushing’s syndrome
Excess adrenal action
What causes adrenal gland hyperfunction
Glucocorticoids – Cushing’s Syndrome
adrenal tumour - primary
pituitary tumour - secondary
Aldosterone - Conn’s Syndrome
adrenal tumour
What causes adrenal gland hypofunction
Addison’s disease - primary
Pituitary failure - secondary
What is cushing’s syndrome
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
How much more frequent is cushing’s syndrome in females compared to males
F 4:1 M
What are the possible symptoms of Cushing’s syndrome
‘diabetes mellitus’ features
poor resistance to infections
osteoporotic changes
back pain & bone fractures
psychiatric disorders
-depression
-emotional lability
-psychosis
As health care workers what are some signs of Cushing’s syndrome
centripetal obesity
-moon face
-buffalo hump
hypertension
thin skin & purpura
muscle weakness
Osteoporotic changes & fractures
What is Addison’s disease
Primary adrenal insufficiency, adrenal glands do not produce enough cortisol or aldosterone
What is autoimmune adrenalitis
Organ-specific Autoimmune disease
Associated with other autoimmune endocrine diseases e.g. autoimmune thyroid disease, diabetes mellitus, Pernicious anaemia
What are symptoms of addison’s disease
weakness
anorexia
loss of body hair (females)
What signs may indicate addisons disease
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
How can cushings syndrome be tested
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
How can addisons be detected
high ACTH level
negative synACTHen tests
-No plasma cortisol rise in response to ACTH injection
What does hyperfunction of the adrenal glands do to ACTH and cortisol levels
Hyperfunction (Primary)
Gland adenoma
-Low ACTH
-High Cortisol
Hyperfunction (Secondary)
Pituitary adenoma
Ectopic ACTH production
-High ACTH
-High Cortisol
What does hypofunction of the adrenal glands do to ACTH and cortisol levels
Hypofunction (primary) Synacthen -ve
Gland destruction
-High ACTH
-Low Cortisol
Hypofunction (secondary) Synacthen +ve
Pituitary failure
-Low ACTH
-Low Cortisol
How is adrenal hyperfunction treated
Detect cause (adenoma)
-pituitary
-adrenal
-ectopic (lung)
Surgery
-pituitary
-adrenal - partial/complete adrenalectomy
What is addisonian crisis
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
How can addisons disease be managed
Hormone Replacement
-Hydrocortisone, prednisolone- Glucocorticoid (cortisol) replacement
-Fludrocortisone - mineralocorticoid (aldosterone) replacement
Cortisol dose varies with environment
-increased by physical/psychological stress
-Increased by infection
How is adrenal crisis prevented when infection/surgery or physiological stress is anticipated
Increase steroid dose
When might steroid cover be needed in dentists
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
What may be present with patients who have Cushings
Candidiasis
What diseases may explain oral pigmentation
Addison’s or Cushing’s
When is it called cushing’s disease
When there is a tumour of pituitary gland resulting in too much cortisol
What is the difference between addisons and cushings
Addisons - not enough cortisol
Cushing’s - Too much cortisol
