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BDS2; CHHD > Endocrine Disorders > Flashcards

Endocrine Disorders Flashcards

1. Overview of the endocrine system 2. Classification of endocrine disorders and their manifestations 3. Epidemiology and pathophysiology of the main types of diabetes mellitus 4. Diagnostic criteria of diabetes mellitus 5. Treatment goals for diabetes 6. Strategies and mediations used to manage the main types of diabetes mellitus 7. Impact of diabetes mellitus and its management on oral health and dental care

1
Q

What is the endocrine system made up of

A
  1. Hypothalamus
  2. Pituitary gland
  3. Pineal gland
  4. Thyroid and parathyroid gland
  5. Thymus
  6. Pancreas
  7. Adrenal glands
  8. Ovary/Testes
  9. Placenta
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2
Q

What is the role of the endocrine system

A

It coordinates the function of organs through chemical messengers (hormones) in the blood stream

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3
Q

What are hormones

A
  • peptides, steroids or amino acids
  • produced by endocrine glands and released in the bloodstream
  • they bond selectively to receptors on target cells
  • they influence the function of target tissues
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4
Q

When do endocrine disorders manifest

A

When there is overproduction or underproduction of hormones; there could be primary gland dysfunction, secondary dysfunction or receptor dysfunction

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5
Q

How is diabetes insipidus different to diabetes mellitus

A

This is not related to glucose homeostasis - there is abnormality in antidiuretic hormone

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6
Q

What are the different forms of diabetes mellitus

A
  1. Type 1 = lack of insulin
  2. Type 2 = insulin resistance
  3. MODY = maturity onset diabetes of the young (autosomal dominent)
  4. Drug induced = steroids and immunotherapy (causes hyperglaecimia)
  5. Cystic fibrosis
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7
Q

Briefly outline how glucose homeostasis is achieved in a healthy person

A

Rise in blood glucose after food causes the pancreas to release insulin. This stimulates glycogen formation in the liver and glucose uptake by tissue cells. Blood glucose is now normalised

Fall in blood glucose causes the pancreas to release glucagon. This stimulates glycogen breakdown into glucose. Blood glucose is normalised

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8
Q

What are the clinical features at presentation of diabetes

A
  • osmotic symptoms; polyuria, polydipsia, nocturia, weight loss
  • recurrent infections e.g. candidiasis because the high blood sugar makes you more prone to bacterial and viral infections
  • lethargy
  • visual blurring due to increased lens viscosity
  • diabetic emergencies;
    1. Type I Diabetic ketoacidosis
    2. Type II Hyperosmolar hyperglycaemic syndrome
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9
Q

What are the clinical features of diabetic ketoacidosis

A

Type I

  • osmotic symptoms
  • weight loss
  • abdominal pain
  • confusion
  • sweet smelling breath due to high ketones
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10
Q

What are the clinical features of hyperosmolar hyperglycaemic syndrome

A
  • osmotic symptoms
  • dry mouth
  • confusion
  • hallucinations
  • reduced consciousness
  • coma
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11
Q

What complications can occur with long-term poorly controlled diabetes mellitus

A
  1. Vascular complications
  2. Problems affecting nerves
  3. Increased risk of infections and poor healing
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12
Q

What vascular complications can occur with poorly controlled diabetes mellitus

A
  1. Microvascular
    - retinopathy: causing blindness
    - nephropathy: leading cause of CKD
    - neuropathy: impaired sensations to lower limbs
  2. Macrovascular atherosclerosis leading to
    - angina pectoris and myocardial infarction
    - TIAs and cerebrovascular accidents
    - peripheral vascular disease leading to acute limb ischaemia, gangrene, amputation
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13
Q

What neural complications can occur with poorly controlled diabetes mellitus

A
  1. Symmetric polyneuropathy
  2. Autonomic neuropathy
  3. Mononeuropathy
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14
Q

What is symmetric polyneuropathy

A

Affects the distal feet and hands

  • causes paraesthesia, dysesthesia or painless loss of sense of touch, vibration, proprioception or temperature
  • lower extremities; foot ulceration and infection
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15
Q

What is involved with autonomic neuropathy

A
  • Gastroparesis
  • Erectile dysfunction
  • Orthostatic hypotension
  • Neuropathic bladder
  • Impaired salivary production causing dry mouth
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16
Q

What is mononeuropathy

A

Causes diplopia (when one of the cranial nerves is affected) ptosis when they affect the 3rd cranial nerve or motor palsies when they affect the 4th or 6th cranial nerves

  • causes finger weakness and numbness (median nerve)
  • causes foot drop (peroneal nerve) prone to nerve compression disorders such as carpel tunnel
17
Q

Why does poorly controlled diabetes mellitus cause an increased risk of infection and poorer healing

A

Because hyperglycaemia has an adverse effect on granulocytes and T-cell function

  • making patients prone to fungal and bacterial infection
  • candidiasis and bacterial foot infections
18
Q

What is the diagnostic criteria for diabetes

A

Diabetic symptoms + one of the criterion below

  • random blood glucose >= 11.1 mmol/L
  • fasting blood glucose >7.0 mmol/L
  • oral glucose tolerance test; 2hr glucose >= 11.1 mmol/L after taking a 75g glucose load
  • HbA1c >= 48 mmol/mol

If asymptomatic then another positive test result is needed on a separate day within the diabetic range

19
Q

What does glycosylated Hb (HbA1c) show

A

This is a surrogate marker of the average glucose levels over the past 3 months

  • if greater than 48mmol/mol = DM
  • if between 42-47 = pre-diabetic range
20
Q

When can the HbA1c value not be used to assess whether patients are diabetic and what can be used instead

A

If there is a haemoglopinopathy present (sikle cell disease or thalasemia; fructosamine can be used instead

21
Q

What are the treatments for diabetes

A
  • control hyperglycaemia to alleviate symptoms
  • prevention of complications
  • avoid hypoglycaemic episodes
  • if on metformin/diet then HbA1c <48mmol/mol
  • otherwise HbA1c <53mmol/mol
  • address other cardiovascular risk factors
22
Q

Why is continuous monitoring not as good as using a finger prick test

A

Because this measures interstitial glucose (not capillary) and so it is not as accurate

23
Q

Describe what a diebetic patient should aim to eat

A
  • less saturated fat and cholesterol
  • reduced amounts of carbohydrates: should eat whole grain sources with higher fiber content
  • caloric intake should be balanced with physical activity
  • should eat at regular intervals
24
Q

What oral drugs can be given for diabetic patients to control their blood glucose levels

A
  1. Metformin
  2. Gliclazide
  3. Pioglitazone
  4. Acarbose
  5. Repaglinide
  6. Sitagliptin
  7. Dapagliflozin
25
Q

How does metformin work

A

It is a biguanide which reduces target tissue resistance

26
Q

How does gliclazide work

A

It is a sulphonylurea which stimulates insulin release from the pancreas

27
Q

How does pioglitazone work

A

This is a thiozolinedione which alleviates insulin resistance and stimulates the pancreas to release insulin; this is not commonly used because it causes fluid retention and heart failure

28
Q

How does acarbose work

A

It is an alpha-glucosidae inhibitor which delays intestinal breakdown of oligosaccharises to glucose

29
Q

How does repalinide work

A

It is a meglitinide which stimulates insulin release but is quicker acting than sulphonylyreas

30
Q

How does sitagliptin work

A

It is a DDP-4 inhibitor which stimulates insulin production through GLP-1 pathway

31
Q

How does dapagliflozin work

A

It is an SGLT-2 inhibitor which excretes glucose through urine

32
Q

What are non-insulin injectables

A

These are GLP-1 analogues which promote weight loss and improve glycaemic control
- these can be daily or weekly injections and are derived from gilla monster saliva

33
Q

Where can insulin be injected

A
  • upper outer arm
  • abdomen
  • buttocks
  • upper outer thighs
34
Q

What are the dental aspects of diabetes mellitus

A
  1. Chronic/aggressive periodontitis
  2. Severe dentoalveolar abcesses with facial space involvement
  3. Dry mouth; secondary to dehydration and decreased salivary flow
  4. Oral lichenoid reaction
  5. Oral candidiasis, angular chelitis
35
Q

What precautions must be taken when treating a diabetic patient

A
  • Dental treatment may impact normal food intake pattern so could interfere with diabetic control
  • The patient should be told to eat a normal breakfast and to take their medications
  • There is a risk of orthostatic hypotension as a result of autonomic neuropathy so patients should be raised slowly to the upright position in the dental chair
  • Steroids should be avoided as they worsen glycaemic control (make liver less responsive to insulin)
  • Routine antibiotics should be taken for emergency surgery

BDS2; CHHD (32 decks)

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