Endocrine Disorders Flashcards
what are the types of endocrine disorders ?
diabetes mellitus,
adrenocortical disorders - hypo function, hyper function,
adrenal medulla,
thyroid disorders - hypothyroidism, hyperthyroidism,
parathyroid disorders,
acromegaly
what is diabetes mellitus ?
impaired glucose utilisation caused by insulin resistance or or deficiency
what are the clinical features of diabetes mellitus ?
central - polydypsia, polyphagia, lethargy, stupor
blurred vision,
weight loss,
smell of acetone on breath,
kassmual breathing (hyperventilation)
gastric - nausea, vomiting, abdominal pain
urinary - polyuria, glycosuria
how is diabetes mellitus diagnosed ?
BM stix, random blood glucose >11 mol/l fasting blood glucose > 7 mol/l serum fructosamine, glycosylated haemoglobin
what are the acute complications of diabetes mellitus ?
hyperglycaemia
hypoglycaemia
what are the chronic complications of diabetes mellitus ?
atheroma - ischemic heart disease, CVA infection s aureus and c albicans retinopathy and cataracts renal disease - glomerulosclerosis and UTI neural - motor or sensory polyneuropathy
what causes hypoglycaemia ?
known diabetic, too much insulin, too little food, exercise, alcohol
what are the symptoms of hypoglycaemia ?
fatigue, hunger, sweating, anxiety/aggression, confusion, rapid unconsciousness
what is the treatment for hypoglycaemia ?
conscious - 25g glucose
unconscious - 50 ml 50% dextrose IV, 1mg glucagon IM
what causes hyperglycaemia ?
undiagnosed diabetes, too little insulin
what are the symptoms of hyperglycaemia ?
fatigue, thirst, polyuria, vomiting, hyperventilation, ketotic breath, slow loss of consciousness
what are the orofacial manifestations of diabetes mellitus ?
periodontal disease,
infections - bacterial sialadenitis, candidosis
dry mouth,
sialosis,
glossitis/burning mouth,
lichenoid drug reactions - metformin, chlorpropramide
what is the treatment for diabetes mellitus ?
diet, orla hypoglycaemia, sulphonylureas (glibenclamide, chlorpropramide) biguanides - metformin insulin
describe primary adrenocortical hypo function
autoimmune addison’s disease
infections - tuberculosis, histoplasmosis
bilateral adrenalectomy
suppression form long term steroids
describe secondary adrenocortical hypo function
hypoptuitarism - ACTH deficiency
what are the clinical features of adrenal hypo function ?
weight loss, weakness, hypotension, anorexia, nausea, vomiting, cutaneous and mucosal pigmentation
how is adrenal hypo function diagnosed ?
low BP, diurnal rhythm of plasma cortisol, synachthen test, autoimmune profile, urea and electrolytes - reduced Na and increased K, abdominal film +/- MRI
what are the dental manifestations of adrenal hypo function ?
oral pigmentation
what does excess aldosterone cause ?
Conn’s syndrome
what does excess cortisol cause ?
Cushing’s syndrome
what can systemic steroids cause ?
Cushingoid features
what causes ACTH induced cushing’s disease ?
pituitary tumour, ACTH therapy, ectopic secretion from tumours
what causes autonomous cushing’s disease
adrenal carcinoma or adenoma
what are the clinical features of Cushing’s disease ?
emotional disturbance, enlarged selia turcica, moon face, osteoporosis, cardiac hypertrophy, obesity, buffalo hump, adrenal tumor or hyperplasia, think wrinkled skin, abdominal striae, amenorrhoea, muscle weakness, purpura, skin ulcers
how is Cushing’s disease investigated ?
increaed BP,
diurnal variations on plasma cortisol,
urea and electrolytes - increased Na decreased K,
lateral skull x ray to see pituitary fossa,
abdominal imaging
what is phaechromocytoma ?
benign tumour of the adrenal medulla,
overproduction of adrenaline/noradrenaline,
episodic hypertension
what are the clinical symptoms of phaechromocytoma ?
anxiety, palpitations, sweating, pyrexia, headaches
what is goitre ?
enlargement of the thyroid gland
what causes hypothyroidism ?
autoimmune - Hashimoto’s thyroiditis,
iodide deficiency,
hypopituitarism,
treatment for hyperthyroidism
what are the clinical features of hypothyroidism ?
intolerance to cold, receding hairline, facial and eyelid oedema, blank expression, thick tongue, anorexia, brittle nails and hair, menstrual disturbances, constipation, muscle aches and weakness, dry skin, lethargy, apathy
what are the late clinical manifestations of hypothyroidism ?
subnormal temperature, bradycaridia, weight gain, thickened skin, cardiac complications
what is the relevance of hypothyroidism to dentistry ?
avoid sedatives and opiates, GA—> coma, oral candidacies, presence of other autoimmune diseases
what are the causes of hyperthyroidism ?
adenoma - toxic goitre, grave’s disease, inappropriate thyroxine therapy
what are the clinical features of hyperthyroidism ?
fine hair, bulging eyes, flushing, enlarged thyroid, tachycardia, increased systolic BP, breast enlargement, weight loss, muscle wasting, menstrual changes, diarrhoea, tremors, finger clubbing
what is the treatment for hyperthyroidism ?
partial thyroidectomty, antithyroid drugs e.g. carbimazole, radioactive iodine
what is the relevance of hyperthyroidism to dentistry ?
anxiety, irritability, avoid general anaesthesia, LA with adrenaline, hyperpyrexia, tachycardia - heart failure
what is the function of PTH?
regulate normal plasma calcium
what are the symptoms of hypoparathyroidism ?
tetany, facial twitch, facial paraesthesia
what are the symptoms of hyperparathyroidism ?
osteoporosis, focal bone resorption - brown tumour, metastatic calcification - renal stones
what is acromegaly ?
hyperplasia/neoplasia of anterior pituitary, prolonged and excessive secretion of growth hormone, reactivation of bone growth in adults
what are the clinical signs of acromegaly ?
visual field defects, prominent supraorbital ridge, large nose and jaw, teeth separated of lacking, spade shaped hands and feet, arthrosis, abnormal glucose tolerance test glycosuria/polyuria, peripheral neuropathy, sexual dysfunction, cardiomegaly hypertension, galacterhoea, hypertrophy of sweat and sebaceous glands, pituitary adenoma
what are the effects of acromegaly on the skull ?
enlarged and thickened pituitary fossa (visual disturbances), prominent supraorbital ridges
what is the effect of acromegaly on the jaws ?
prognathic (condylar growth centre)
what is the effect of acromegaly of the soft tissues ?
thick and enlarged nose/lips
