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
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
26
How can acromegaly affect the oral cavity
enlarged tongue​ ​ interdental spacing​ ​ ‘shrunk’ dentures​ ​ Reverse overbite
27
What is myxoedema another name for
Hypothyroidism
28
What are some signs and symptoms of hyperthyroidism (increased metabolism)
Increased BP Warm moist skin (sweat) Weight loss Diarrhoea Muscle weakness Tachycardia/atrial fibrillation
29
What can cause hyperthyroidism
Graves’ Disease- autoimmune condition (70-80% of cases) Thyroiditis Toxic adenomas
30
What are the signs and symptoms of hypothyroidism
Dry coarse skin Bradycardia Confusion Weight gain Constipation Tiredness Hair loss
31
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
32
What is a secondary cause of hypothyroidism
Hypothalamic/Pituitary disease
33
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
34
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.
35
How is thyroid disease tested
Blod (TSH, T3,T4) Imaging (ultrasound, radiosotope) Biopsies
36
What are the most common causes of hyperthyroidism
Graves and adenoma -low TSH -raised T3,T4
37
What are the most common causes of hypothyroidism
Gland failure -High TSH -Low T4 pituitary cause is rare low TSH and low T4
38
How is Hyperthyroidism treated
Medication- Carbimazole, beta-blockers e.g. propanolol​ ​ Radioiodine 131i- risk of hypothyroidism with time, need to review​ ​ Surgery- partial thyroidectomy
39
How is hypothyroidism treated
T4 tablets- Thyroxine​ ​ Slow response- weeks​ ​ Increase dose slowly- IHD​ ​ Recheck using TSH as a guide if gland failure
40
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
41
What glandular disease can be detected at the dentist during examination
Goitre
42
How does thyroid cancer present
Usually presents with thyroid swelling​ Young or elderly Cold nodules on radioisotope scan
43
What are the two types of thyroid cancer
Papillary Follicular
44
Where are the adrenal glands
Triangle-shaped glands that are located on top of each kidney
45
What are the parts to the adrenal glands
Adrenal medulla Adrenal cortex
46
What bodily functions do the adrenal gland hormones regulate
Metabolism​ Immune system​ Blood pressure​ Stress response​ Development of sexual characteristics
47
What does the adrenal medulla secrete/control
Releases adrenaline and noradrenaline - These hormones control blood pressure, heart rate, sweating etc
48
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)
49
Where would you find the zona glomerulosa and zona fasciculata
Adrenal gland cortex
50
Where are mineralocorticoids produces
Zona glomerulosa of the adrenal cortex
51
Where are glucocoticoids produced
Zona fasciculata in the adrenal cortex
52
Where are adrenal androgens produced
Zona reticularis in the adrenal cortex
53
What drugs cause aldosterone action inhibition
ACE inhibitors Angiotensin 2 blockers (block angiotensin receptor)
54
Where is aldosterone secreted
Zona glomerulosa
55
Where is cortisol secreted
Zona fasciculata
56
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
57
What does circadian release indicate
Levels rise through the night and reach a peak within first hour of awakening then decrease
58
What are the effects of cortisol
Antagonist to insulin (Gluocneogenesis, fat & protein breakdown)​ Lowers the immune reactivity​ Raises blood pressure​ Inhibits bone synthesis
59
What are adrenal androgens used for
Taken up by ovaries and testes to produce testosterone and oestrogen
60
What are therapuetic steriods
Man-made version of the adrenal hormones Anti-Inflammatory- reduce inflammation and supress the activity of the immune system
61
What are therapuetic steroids used to treat
Asthma, COPD​ Eczema, severe hives​ Arthritis​ IBS​ Lupus​ Multiple Sclerosis
62
What are possible adverse effects of therapuetic steroids
Hypertension​ Type 2 diabetes​ Osteoporosis​ Increased infection risk​ Peptic ulceration​ Thinning of the skin​ Easy bruising
63
What are examples of therapuetic steroids and their cortisol equivalent
Hydrocortisone (cortisol equivalent = 1)​ Prednisolone (4) (most common)​ Triamcinolone (5)​ Dexamethasone (25)​ Betamethasone (30)
64
What causes addison's disease
Destruction of adrenal tissue
65
What is cushing's syndrome
Excess adrenal action
66
What causes adrenal gland hyperfunction
Glucocorticoids – Cushing’s Syndrome​ adrenal tumour - primary​ pituitary tumour - secondary​ Aldosterone - Conn’s Syndrome​ adrenal tumour
67
What causes adrenal gland hypofunction
Addison’s disease - primary​ Pituitary failure - secondary
68
What causes 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
69
How much more frequent is cushing's syndrome in females compared to males
F 4:1 M
70
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
71
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
72
What is Addison's disease
Primary adrenal insufficiency, adrenal glands do not produce enough cortisol or aldosterone
73
What is autoimmune adrenalitis
Organ-specific Autoimmune disease​ Associated with other autoimmune endocrine diseases e.g. autoimmune thyroid disease, diabetes mellitus, Pernicious anaemia
74
What are symptoms of addison's disease
weakness​ anorexia​ loss of body hair (females)
75
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
76
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
77
How can addisons be detected
high ACTH level​ negative synACTHen tests​ -No plasma cortisol rise in response to ACTH injection
78
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
79
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
80
How is adrenal hyperfunction treated
Detect cause (adenoma)​ -pituitary​ -adrenal​ -ectopic (lung)​ ​ Surgery​ -pituitary ​ -adrenal - partial/complete adrenalectomy
81
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
82
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
83
How is adrenal crisis prevented when infection/surgery or physiological stress is anticipated
Increase steroid dose
84
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
85
What may be present with patients who have Cushings
Candidiasis
86
What diseases may explain oral pigmentation
Addison's or Cushing's
87
When is it called cushing's disease
When there is a tumour of pituitary gland resulting in too much cortisol
88
What is the difference between addisons and cushings
Addisons - not enough cortisol Cushing's - Too much cortisol