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CHHD > Endocrine Disorders 2 > Flashcards

Endocrine Disorders 2 Flashcards

1
Q

What feedback mechanism controls hypothalamic and pituitary hormone secretion

A

Negative

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2
Q

What hormones work on the thyroid gland

A

TRH - Thyroid releasing hormone (from hypothalamus)

TSH - thyroid stimulating hormone (from pituitary)

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3
Q

What hormones work on the Adrenal Cortex

A

CRH - corticotrophin releasing hormone (from hypothalamus)

ACTH - Adrenocorticotrophic hormone (from pituitary)

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4
Q

What hormones does the adrenal cortex release

A

Glucocorticoids

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5
Q

What hormones work on the Gonads

A

GnRH - Gonadotrophin releasing hormone (from hypothalamus)

FSH - Follicle stimulating hormone and LH - luteinising hormone (From pituitary)

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6
Q

What are the mechanisms by which endocrine disorders manifest themselves

A

– Overproduction of hormones
– Underproduction of hormones
– Normal function but structural defect for e.g. compression due to enlargement

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7
Q

What are the causes/aetiology of endocrine disorders

A

– Primary dysfunction of gland
– Secondary dysfunction of gland ( over or understimulation by other gland or exogeneous hormones)
– Receptor dysfunction

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8
Q

Where is the thyroid gland located

A

Just below the cricoid cartilage of the pharynx come bop bop

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9
Q

What hormones does the thyroid hormone release

A

Thyroxine hormones T4, T3

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10
Q

What are the target organs of the thyroid gland

A 
Brain
Bone
Heart
Gut
Skin
Metabolism
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11
Q

Where are the adrenal glands found

A

Both are found on top of the kidneys

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12
Q

What part of the adrenal glands produce which hormones

A
  • Cortex - Androgens

- Medulla - Cortisol, Aldosterone, Adrenaline

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13
Q

What adrenal disorders cause overproduction

A
  • Cushing’s Syndrome

- Phaeochromocytoma

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14
Q

What adrenal disorders cause underproduction

A

Addison’s disease

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15
Q

What kind of disorder is addison’s disease and what can it be associated with

A

Autoimmune

Can be associated with TB and sarcoidosis

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16
Q

What can cause secondary addisons disease

A

Pituitary not producing enough ACTH

Exogenous Steroids

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17
Q

What are the physiological actions of cortisol

A

– Anti-inflammatory and immunosuppressive actions
– Stress response
– Metabolism
■ Gluconeogenesis

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18
Q

What can happen if we produce excess steroid hormones/cortisol

A

– Stimulates hepatic gluconeogenesis and glycogenlysis- elevated blood glucose
– Stimulates proteolysis- muscle wasting
– Sodium retention , potassium loss- limb/facial swelling
– Stimulates lipolysis-Dyslipidaemia
– hypertension

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19
Q

What are the clinical features of Addison’s disease

A
  • Hypotension
  • Hypoglycaemia
  • Weight loss
  • Lethargy
  • Anorexia
  • Abdominal pain
  • Skin and oral pigmentation (Increase MSH and ACTH)
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20
Q

How can exogenous steroids cause secondary adrenal insufficiency

A
  • Mainly for patients on long term systemic steroids
  • Can cause suppression of HPA axis upon discontinuation
  • Should taper down the dose
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21
Q

What is an Addisonian crisis

A

– New presentation
– Precipitated by infection
– Non-compliance with medication
– Poor absorption of steroids (diarrhoea)
– Life-threatening if untreated (medical emergency)

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22
Q

Why must oral infections be managed aggressively in patients with adrenal insufficiency

A

To prevent an acute adrenal insufficiency - addison ian crisis

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23
Q

What is the steroid cover for major procedures

A

– IM Hydrocortisone 100mg QDS, 1 hr prior to treatment on day of surgery and until oral intake satisfactory
– Once oral intake satisfactory, double oral dose for 3-5 days
– Consult endocrine specialist for individualised plan

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24
Q

What is the steroid cover for minor procedures

A

Take double oral steroid dose at same time (24 hour should be sufficient)

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25
Q

What are some steroid precautions that you should be aware of

A

– Steroid card, bracelet
– Emergency intramuscular Hydrocortisone pack
– Sick day rules

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26
Q

Where are the parathyroid glands

A

They’re like 4 nodules on the back side of the thyroid

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27
Q

What do the parathyroid hormones release and what effect does this hormone have

A

Parathyroid hormone - regulates the calcium levels in the blood

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28
Q

What can Primary hyperparathyroidism be caused by

A

– Parathyroid adenoma
– Parathyroid hyperplasia including genetic familial HP, MEN
– Parathyroid carcinoma

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29
Q

What can secondary hyperparathyroidism be caused by

A

– Vitamin D deficiency

– Chronic renal failure

30
Q

What are the clinical features of hyperparathyroidism except the osmotic symptoms

A

Moans, stones, bones, groans and psychiatric overtones”
– Abdominal pain, constipation
– Renal stones
– Bone pain, osteopaenia and osteoporosis
– Lethargy, fatigue
– Confusion, memory impairment, depression, hallucinations

31
Q

What are the osmotic symptoms of hyperparathyroidism

A

Polyuria
Polydipsia
Urinary Frequency

32
Q

LEARN THE INVESTIGATION RESULTS FOR PRIMARY AND SECONDARY HYPERPARATHYROIDISM ON LECTURE

33
Q

What is the treatment for primary hyperparathyroidism due to parathyroid adenoma

A

parathyroidectomy

34
Q

What is the treatment for primary hyperparathyroidism due to hyperplasia

A

Drug Cinacalcet

35
Q

What is the treatment for secondary hyperparathyroidism

A

Treat underlying cause

36
Q

Name some oral manifestations of patients with hyperparathyroidism

A
  • Loosening and drifting of teeth
  • Alterations in dental eruption
  • Partial loss of lamina dura
  • Malocclusions
  • periodontal ligament widening
  • Obliteration of pulp chamber by pulp stone
37
Q

Name some oral manifestations of patients with hypoparathyroidism

A
  • Enamel hypoplasia
  • Delayed eruption
  • poorly calcified dentin
  • widened pulp chambers
  • malformed roots
  • chronic candidiasis
  • Hypodontia + microdontia
38
Q

What are the dental aspects of brown tumours

A 
– Benign
– Radiolucent
– Abnormal bone metabolism
– Extensive bone resorption
replaced by fibrovascular tissue and giant cells
39
Q

What parts of the pituitary gland secrete what hormones

A 
Anterior = ACTH, TSH, GH, Prolactin, Gonadotrophins (LH and FSH)
Posterior = ADH and Oxytocin
40
Q

Where does the negative feedback come from for the pituitary gland

A

the hypothalamus

41
Q

What is Acromegaly

A

Excess growth hormone

42
Q

What is cushing’s syndrome caused by

A

excess cortisol

43
Q

What are the causes/aetiology of cushing’s syndrome

A

– Adrenal Cushing’s syndrome
– Pituitary Cushing’s disease
– Ectopic ACTH production

44
Q

What investigations can be done for cushing’s syndrome

A

– Midnight Cortisol, Cortisol Day Curve
– Low Dose Dexamethasone Suppression test, Overnight Dexamethasone suppression test
– MRI adrenal/pituitary
– Pituitary catheter

45
Q

What are the treatments for cushing’s syndrome

A
  • Surgery - TSS/adrenalectomy
  • Drugs - Metyrapone, Ketoconazole
  • Radiotherapy
46
Q

What is there an increased risk of if you have excess cortisol

A
  • Hypertension
  • Peptic ulcers
  • Diabetes mellitus
  • Osteoporosis and myopathy
  • Immunosuppression
  • Poor wound healing
47
Q

Where are phaeochromocytomas and paragangliomas found

A

Phaeochromocytoma - Adrenal

Paraganglioma - Extra Adrenal

48
Q

What do phaeochromocytomas and paragangliomas cause

A

Excess production of catecholamine

49
Q

What are the clinical features of pheochromocytomas

A 
– High blood pressure
– Heavy sweating
– Headache
– Rapid heartbeat (tachycardia)
– Tremors
– Paleness in the face (pallor)
– Shortness of breath (dyspnoea)
– Pre-syncope or syncope
– Feeling of impending doom
50
Q

What dental aspects are there for patients with overactive pituitary glands and phaenochromocytoma etc

A
  • Hypertension and risks of uncontrolled hypertension
  • Alpha Blocker increases bleeding risks
  • Drugs to avoid as may precipitate a crisis:
    Opiates,
    MAOi,
    cocaine,
    metochlopramide
51
Q

What treatments are there for phaemochromocytoma

A

Drugs - Alpha blocker, followed by beta blockers

Surgery - Adrenalectomy or removal of paraganglioma

52
Q

What modifications for dentistry are there for Hypertension and Peptic Ulcers

A

Hypertension - Blood pressure should be routinely monitored

Peptic ulcers - avoid aspirin and NSAIDs

53
Q

What modifications for dentistry are there for Diabetes Mellitus and Poor Wound Healing

A

Diabetes Mellitus - Regular assessment of periodontal health

Poor Wound Healing -Adequate antibiotic cover following major surgical procedure

54
Q

What modifications for dentistry are there for Osteoporosis + Myopathy

A
  • Dentures may need frequent readjustments

* Accommodate for limited mobility

55
Q

What modifications for dentistry are there for Immunosuppression

A

• Assess and treat for opportunistic infections e.g oral candidiasis, hairy leukoplakia , herpes virus infection

56
Q

What are the cardiovascular effects of thyroid hormones

A
  • Increases heart rate
  • Increases the force of cardiac contractions
  • Increases cardiac output as a result of the previous two effects
  • Promotes peripheral vasodilation
57
Q

What are the GI effects of thyroid hormones

A
  • Increases appetite
  • Increases secretion of digestive juices
  • Increases gastric motility
58
Q

What are the haematopoietic effects of thyroid hormones

A

Influences erythropoiesis

59
Q

What are the cardiovascular clinical features for hyperthyroidism vs hypothyroidism

A

Hyper - tachycardia, atrial fibrillation

Hypo - Bradycardia

60
Q

What are the Metabolism clinical features for hyperthyroidism vs hypothyroidism

A

Hyper - weight loss, increased hunger

Hypo - Weight gain

61
Q

What are the GI clinical features for hyperthyroidism vs hypothyroidism

A

Hyper - Diarrhoea

Hypo - Constipation

62
Q

What are the Skin clinical features for hyperthyroidism vs hypothyroidism

A

Hyper - Palmar sweating, hair loss

Hypo - Dry skin, hair loss

63
Q

What are the neurological/psychiatry clinical features for hyperthyroidism vs hypothyroidism

A

Hyper - anxiety, insomnia, restless

Hypo - Poor concentration/memory, Reduced fetal brain development

64
Q

What are the skeletal/muscle clinical features for hyperthyroidism vs hypothyroidism

A

Hyper - Proximal muscle weakness

Hypo - Proximal muscle weakness

65
Q

What are the reproductive clinical features for hyperthyroidism vs hypothyroidism

A

Hyper - Infertility, oligo/amenorrhoea

Hypo - Infertility, oligo/amenorrhoea

66
Q

What are the Temperature clinical features for hyperthyroidism vs hypothyroidism

A

Hyper - Intolerant of heat

Hypo - Intolerant of cold weather

67
Q

What are the investigations and results for hyper and hypothyroidism

A 
T4, T3 - 
- Hyper - elevated
- Hypo - low
TSH -
- Hyper - Suppressed
- Hypo - elevated
68
Q

What drugs can be used for hyperthyroidism

A
  • Beta blockers to slow heart rate

- Antithyroid medication such as carbimazole and propylthiouracil

69
Q

What drugs can be used for hypothyroidism

A

Thyroxine replacement

70
Q

What are the dental aspects of Hyperthyroidism

A
  • Increased susceptibility to caries
  • Increased susceptibility to periodontal disease
  • Enlargement of extra glandular thyroid tissue (lat posterior tongue)
  • Burning mouth syndrome
  • Accelerated dental eruption
  • Maxillary and mandibular osteoporosis
  • Mouth ulcers due to antithyroid medication
71
Q

What are the dental aspects of hypothyroidism

A

Congenital Hypothyroidism -

  • delayed dental eruption
  • Macroglossia
  • Microganthia
  • Malocclusion
  • Glossitis
  • Dysgeusia
  • poor wound healing

CHHD (27 decks)

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