Endocrine Disorders Flashcards
Name 4 endocrine disorders?
Diabetes mellitus
Adrenocortical disorders
Adrenal medlla disorders
Thyroid disorders
What is diabetes mellitus?
Commonest endocrine disorder - 4% population
Impaired glucose utilisation (resistance or deficiency)
Consistently hyperglycaemic
Juvenille onset = IDDM, Adult onset = NIDDM
How do you diagnose diabetes mellitus?
random blood glucose (>11mmol/L) fasting blood glucose (>7mmol/L) glycosylated haemoglobin (HbA1c)
How can we treat diabetes mellitus?
diet, insulin, oral hypoglycaemics, sulphonylureas, biguanides
How does diabetes present oro-facially?
perio disease infections xerostaemia sialosis glossitis lichenoid drug reactions
What are the complication associated with diabetes mellitus?
GENERAL : retinopathy, cataracts, foot ulcers, gangrene ACUTE : hypoglycaemia, hyperglycaemia (diabetic ketoacidosis) CHRONIC : atheroma - ischaemic heart disease, CVA infections - S. aureus and C. albicans renal disease - UTI, neural - motor / sensory polyneuropathy
Describe hypoglycaemia and what are the symptoms and treatment?
Known diabetic Too much insulin Too little food Exercise Alcohol SYMPTOMS - fatigue, hunger, sweating, anxiety, aggression, confusion, rapid unconsciousness TREATMENT : conscious = 25g glucose unconscious = 50% dextrose IV or 1mg glucagon IM
Describe hyperglycaemia and what are the symptoms?
Undiagnosed diabetic Too little insulin SYMPTOMS - fatigue, thirst, polyuria, vomiting, hyperventilation, ketotic breath, slow unconsciousness TREATMENT: hospital fluids, electrolytes and insulin
What are adrenocortical disorders?
Adrenocortical hypofunction or adrenocortical hyperfunction
What is the normal process of adrenal gland?
pituitary gland - ACTH - kidneys - adrenal gland :
Cortex - cortisol, aldosterone, androgens
medulla - adrenaline
What is adrenocortical hypofunction?
A condition where there is an under expression of products of the adrenal cortex
Can be primary or secondary
PRIMARY - autoimmune (Addisons disease)
SECONDARY - hypopituitarism - ACTH deficiency
What causes primary adrenocortical hypofunction?
Infections - TB
Bilateral adrenalectomy
Suppression from long term steroid use
What are the clinical signs of adrenocortical hypofunction?
weight loss, weakness, hypotension, anorexia, nausea, vomiting, cutaneous and mucosal pigmentation
How do we diagnose adrenocortical hypofunction?
low BP diurnal rhythm of plasma control synacthen test (ACTH) autoimmine profile urea and electrolytes (low Na and high K)
How does adrenocortical hypofunction affect dentally?
oral pigmentation physiological stress as undiagnosed infections anaesthesia surgery systemis steroids in undiagnosed
What is adrenocortical hyperfunction?
A condition where there is an overexpression of products of the adrenal cortex:
High aldosterone - Conns syndrome
High cortisol - Cushings syndrome
Systemic steroids - Cushingoid features
What causes Cushings syndrome?
ACTH induced = pituitary tumour
autonomous = adrenal adenoma / carcinoma
High dose steroids = immunosuppression
How would adrenocortical hyperfunction be diagnosed?
high BP diurnal rhythm of plasma control urea and electrolytes (high Na and low K) lateral skull to see pituitary fossa abdominal imaging
What are disorders of the adrenal medulla?
Overexpression of products of the adrenal medulla
What causes adrenal medulla disorders?
benign tumour - overexpression of adrenaline / noradenaline, episodic hypertension
What are the clinical symptoms of adrenal medulla disorders?
anxiety palpitations sweating pyrexia headaches goitre - enlargment of the thyroid gland
what is the normal process for pituitary to make T4 and T5?
hypothalamus - pituitary - via TSH - thyroid - T4, T5
What are thyroid disorders?
The thyroid gland in the neck makes hormones to help regulate the body’s metabolism and a person’s growth. Problems with the thyroid include hyperthyroidism and hypothyroidism.
What causes hypothyroidism?
autoimmune - Hashimotos thyroiditis
Iodide deficiency
Hypopituitarism
Treatment for hyperthyroidism
How does hypothyroidism affect dental?
Avoid sedative and opiates, oral candidosis, presence of other autoimmune disorders
What causes hyperthyroidism?
Adenoma - toxic goitre
Graves disease - anitbodies against TSH receptor
Innapropriate thyroxine therapy
What is the treatment for hyperthyroidism?
Partial thyroidectomy
anti thyroid drugs (carbimazole)
radioactive iodine
post treatment hypothyroidism
How does hyperthyroid affect dental?
anxiety, irratibility, avoid GA, (LA contains adrenaline)
What are the parathyroids?
Produce PTH which regulates normal plasma calcium
What are the 2 disorders for the parathyroids?
Hypoparathyroidism and hyperparathyroidism
Describe hypoparathyroidism?
Generalised osteoporosis
Focal bone resorption - brown tumour
metastatic calcification - renal stones
Describe hyperparathyroidism?
Tetany
Facial twitch - Chvosters sign
Facial parasthesia
What is acromegaly?
hyperplasia or neoplasia of anterior pituiatry (prolonged and excessive secretion of growth hormone)
What are the signs of acromegaly?
reactivation of bone growth in adults
SKULL - enlarged, thickened, visual disturbances
JAWS - prognathic
HANDS / FEET - soft tissues thicken and enlarge
