Endocrine Disorders

Question 1

what are the types of endocrine disorders ?

Answer 1

diabetes mellitus,
adrenocortical disorders - hypo function, hyper function,
adrenal medulla,
thyroid disorders - hypothyroidism, hyperthyroidism,
parathyroid disorders,
acromegaly

Question 2

what is diabetes mellitus ?

Answer 2

impaired glucose utilisation caused by insulin resistance or or deficiency

Question 3

what are the clinical features of diabetes mellitus ?

Answer 3

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

Question 4

how is diabetes mellitus diagnosed ?

Answer 4

BM stix,
random blood glucose >11 mol/l 
fasting blood glucose > 7 mol/l
serum fructosamine,
glycosylated haemoglobin

Question 5

what are the acute complications of diabetes mellitus ?

Answer 5

hyperglycaemia

hypoglycaemia

Question 6

what are the chronic complications of diabetes mellitus ?

Answer 6

atheroma - ischemic heart disease, CVA
infection s aureus and c albicans 
retinopathy and cataracts
renal disease - glomerulosclerosis and UTI 
neural - motor or sensory polyneuropathy

Question 7

what causes hypoglycaemia ?

Answer 7

known diabetic, too much insulin, too little food, exercise, alcohol

Question 8

what are the symptoms of hypoglycaemia ?

Answer 8

fatigue, hunger, sweating, anxiety/aggression, confusion, rapid unconsciousness

Question 9

what is the treatment for hypoglycaemia ?

Answer 9

conscious - 25g glucose

unconscious - 50 ml 50% dextrose IV, 1mg glucagon IM

Question 10

what causes hyperglycaemia ?

Answer 10

undiagnosed diabetes, too little insulin

Question 11

what are the symptoms of hyperglycaemia ?

Answer 11

fatigue, thirst, polyuria, vomiting, hyperventilation, ketotic breath, slow loss of consciousness

Question 12

what are the orofacial manifestations of diabetes mellitus ?

Answer 12

periodontal disease,
infections - bacterial sialadenitis, candidosis
dry mouth,
sialosis,
glossitis/burning mouth,
lichenoid drug reactions - metformin, chlorpropramide

Question 13

what is the treatment for diabetes mellitus ?

Answer 13

diet,
orla hypoglycaemia,
sulphonylureas (glibenclamide, chlorpropramide)
biguanides - metformin 
insulin

Question 14

describe primary adrenocortical hypo function

Answer 14

autoimmune addison’s disease
infections - tuberculosis, histoplasmosis
bilateral adrenalectomy
suppression form long term steroids

Question 15

describe secondary adrenocortical hypo function

Answer 15

hypoptuitarism - ACTH deficiency

Question 16

what are the clinical features of adrenal hypo function ?

Answer 16

weight loss, weakness, hypotension, anorexia, nausea, vomiting, cutaneous and mucosal pigmentation

Question 17

how is adrenal hypo function diagnosed ?

Answer 17

low BP, diurnal rhythm of plasma cortisol, synachthen test, autoimmune profile, urea and electrolytes - reduced Na and increased K, abdominal film +/- MRI

Question 18

what are the dental manifestations of adrenal hypo function ?

Answer 18

oral pigmentation

Question 19

what does excess aldosterone cause ?

Answer 19

Conn’s syndrome

Question 20

what does excess cortisol cause ?

Answer 20

Cushing’s syndrome

Question 21

what can systemic steroids cause ?

Answer 21

Cushingoid features

Question 22

what causes ACTH induced cushing’s disease ?

Answer 22

pituitary tumour, ACTH therapy, ectopic secretion from tumours

Question 23

what causes autonomous cushing’s disease

Answer 23

adrenal carcinoma or adenoma

Question 24

what are the clinical features of Cushing’s disease ?

Answer 24

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

Question 25

how is Cushing's disease investigated ?

Answer 25

increaed BP, diurnal variations on plasma cortisol, urea and electrolytes - increased Na decreased K, lateral skull x ray to see pituitary fossa, abdominal imaging

Question 26

what is phaechromocytoma ?

Answer 26

benign tumour of the adrenal medulla, overproduction of adrenaline/noradrenaline, episodic hypertension

Question 27

what are the clinical symptoms of phaechromocytoma ?

Answer 27

anxiety, palpitations, sweating, pyrexia, headaches

Question 28

what is goitre ?

Answer 28

enlargement of the thyroid gland

Question 29

what causes hypothyroidism ?

Answer 29

autoimmune - Hashimoto's thyroiditis, iodide deficiency, hypopituitarism, treatment for hyperthyroidism

Question 30

what are the clinical features of hypothyroidism ?

Answer 30

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

Question 31

what are the late clinical manifestations of hypothyroidism ?

Answer 31

subnormal temperature, bradycaridia, weight gain, thickened skin, cardiac complications

Question 32

what is the relevance of hypothyroidism to dentistry ?

Answer 32

avoid sedatives and opiates, GA---> coma, oral candidacies, presence of other autoimmune diseases

Question 33

what are the causes of hyperthyroidism ?

Answer 33

adenoma - toxic goitre, grave's disease, inappropriate thyroxine therapy

Question 34

what are the clinical features of hyperthyroidism ?

Answer 34

fine hair, bulging eyes, flushing, enlarged thyroid, tachycardia, increased systolic BP, breast enlargement, weight loss, muscle wasting, menstrual changes, diarrhoea, tremors, finger clubbing

Question 35

what is the treatment for hyperthyroidism ?

Answer 35

partial thyroidectomty, antithyroid drugs e.g. carbimazole, radioactive iodine

Question 36

what is the relevance of hyperthyroidism to dentistry ?

Answer 36

anxiety, irritability, avoid general anaesthesia, LA with adrenaline, hyperpyrexia, tachycardia - heart failure

Question 37

what is the function of PTH?

Answer 37

regulate normal plasma calcium

Question 38

what are the symptoms of hypoparathyroidism ?

Answer 38

tetany, facial twitch, facial paraesthesia

Question 39

what are the symptoms of hyperparathyroidism ?

Answer 39

osteoporosis, focal bone resorption - brown tumour, metastatic calcification - renal stones

Question 40

what is acromegaly ?

Answer 40

hyperplasia/neoplasia of anterior pituitary, prolonged and excessive secretion of growth hormone, reactivation of bone growth in adults

Question 41

what are the clinical signs of acromegaly ?

Answer 41

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

Question 42

what are the effects of acromegaly on the skull ?

Answer 42

enlarged and thickened pituitary fossa (visual disturbances), prominent supraorbital ridges

Question 43

what is the effect of acromegaly on the jaws ?

Answer 43

prognathic (condylar growth centre)

Question 44

what is the effect of acromegaly of the soft tissues ?

Answer 44

thick and enlarged nose/lips