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2 - Diseases Of The Human System > Endocrine Medicine 1 > Flashcards

Endocrine Medicine 1 Flashcards

1
Q

What is the extent of endocrine diseases effects?

A

widespread, multisystem effects

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2
Q

What are the two methods of failure?

A

control failure (secondary)
gland failure (primary)

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3
Q

What is an example of a dentally relevant multiple endocrine neoplasia?

what are the characteristics

A

MEN 2b

Medullary Thyroid, Phaeochromocytoma
Mucosal neuromas (small swelling on nerves present in tissue)
Marfanoid appearance

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4
Q

Where is the PG?

A

gland is in a small depression in the middle of the skull base called the sella turcica (turkish saddle)

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5
Q

What are the two types of hormones released from the hypothalamus?

A

primary hormones - hormones from the pituitary act directly on tissues to cause effect e.g, Thyroid, growth hormone,

trophic hormones - releasing hormones e.g. TRH, GnRH, CRH

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6
Q

How are the anterior pituitary and hypothalamus connected?

A

hypothalamic pituitary portal vessels

(vascular plexus into vascular tissue)

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7
Q

How are the posterior pituitary and hypothalamus connected?

A

via nerve axons mainly

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8
Q

What hormones do the anterior pituitary release?

A
  • TSH - Thyroid Stimulating Hormone
  • ACTH -Adrenocorticotrophic Hormone
  • GH - Growth Hormone
  • LH, FSH, Prolactin
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9
Q

What hormones do the posterior pituitary release?

A
  • ADH - Anti Diuretic Hormone
  • Oxytocin
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10
Q

What type of tumour are most pituitary tumours?

A

adenoma
- arise from glandular tissue

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11
Q

What are the two types of adenoma?

A

functional - produces active hormone and obstructs/impinges on other tissue

non functional - may cause pressure/obstruction

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12
Q

What can pituitary tumours cause in the eyes?

A

growth in PG can head upwards and cause pressure to optic chiasm compressing optic nerves and narrowing visual fields

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13
Q

What surgery is used for PG tumour removal?

A

trans-sphenoidal
no need to open the skull and compromise the brain

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14
Q

What is the pathway for GH?

A

hypothalamus > GHRH > anterior pituitary > GH > tissues > IGF-1 > anabolic reactions

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15
Q

What does insufficient growth hormone cause in children?

A

growth failure

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16
Q

What does insufficient growth hormone cause in adults?

A

metabolic changes in adults
- increased fat
- reduced vitality

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17
Q

What does excess growth hormone cause in children?

A

giantism

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18
Q

What does excess growth hormone cause in adults?

A

acromegaly

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19
Q

What is measured to assess GH?

A

IGF-1 - insulin growth factor 1

20
Q

What are the features seen in acromegaly?

A
  • coarse features
  • enlarged hands
  • carpal tunnel syndrome - finger numbness,
  • type 2 diabetes mellitus - insulin resistance from increased GH
  • cardiovascular disease - due to increased load from larger body
21
Q

What are the dental features of acromegaly?

A
  • enlarged tongue
  • interdental spacing (diastema)
  • ‘shrunk’ dentures
  • Reverse overbite
22
Q

What is thyrotoxicosis without hyperthyroidism usually caused by?

A

excess thyroid hormone drugs to promote weight loss

23
Q

What is most hyperthyroidism caused by?

A

graves disease
auto antibodies stimulating the TSH receptor

24
Q

What is toxic adenoma?

A

tumour within thyroid gland producing active hormone

25
Q

What are the features of hyperthyroidism?

A

moist, sweaty skin
weight loss
tachycardia
increased blood pressure
tremors and hyperreflexia
eyelid retraction and lid lag

26
Q

What is grave’s disease usually caused by?

A

often a family history of Autoimmune disease

27
Q

What autoimmune diseases are see in family history of patient’s with graves disease?

A

vitiligo
pernicious anemia
type 1 DM
coeliac
myaesthenia gravis (autoantibodies against ACh receptors in muscle)

28
Q

What eye conditions occur with grave’s disease?

A

ophthalmopthy
* scleral injection
* proptosis
* periorbital oedema
* conjuntival oedema

29
Q

What neck condition occurs with graves disease?

A

diffuse goitre

30
Q

What is hypothyroidism mostly caused by?

A

Autoimmune (Hashimoto’s) thyroiditis

31
Q

What other reasons might hypothyroidism occur?

A
  • Idiopathic atrophy (likely autoimmune, more in females)
  • Radioiodine treatment/ thyroidectomy surgery
  • Iodine deficiency
  • Drugs
  • Congenital
  • Hypothalamic/pituitary disease
32
Q

What drugs caused hypothyroidism?

A

carbimazole (used for hyper treatment)
amiodarone
lithium

33
Q

What are the features of hypothyroidism?

A

dry, coarse skin
bradycardia
hyperlipidemia
psychiatric or cognitive changes
goiter (in Hashimoto’s),
delayed reflexes.

34
Q

What are the associations of hashimoto’s thyroiditis?

A
  • Middle aged & elderly women
  • often a family history of Autoimmune disease
  • vitiligo, PA, Type 1 DM, Addisons disease
  • Down’s syndrome
35
Q

How can thyroid disease be investigated?

A
  • Blood
  • TSH, T3 & T4
  • Imaging
  • ultrasound scan (cysts)
  • radioisotope scans - gland uptake (areas producing/not producing hormones)
  • Tissue
  • fine needle aspirate/biopsy (FNA & FNB)
36
Q

FNA VS FNB

A

FNA = needle stuck into gland, some cells sucked out

FNB = wide borne needle where core of tissue is trapped within needle itelf and taken away for histological examination

37
Q

If the cause of hyperthyroidism is pituitary, what are the blood indications?

A
  • RAISED TSH
  • RAISED T3
38
Q

If the cause of hyperthyroidism is graves or adenoma, what are the blood indications?

A
  • LOW TSH (PG stops TSH to reverse high T3 from gland)
  • RAISED T3
39
Q

If the cause of hypothyroidism is pituitary, what are the blood indications?

A
  • Low TSH
  • Low T4
40
Q

If the cause of hypothyroidism is hashimoto’s, what are the blood indications?

A
  • HIGH TSH (PG tries to compensate but the gland is irresponsive)
  • Low T4
41
Q

What are treatments of hyperthyroidism?

A
  • Carbimazole
  • B-blockers (reduce symptoms - tremor, high BP etc)
  • Radioiodine - 131I
  • Surgery - partial thryoidectomy
42
Q

How is grave’s ophthalmophathy treated?

A

no treatment as the conditions is not due to the thyroid gland activity but due to thyroid autoantibodies

controlled with immunosuppressives/ steriods

43
Q

What is the treatment for hypothyroidism?

A
  • Give T4 tablets (thyroxine)
  • slow response - weeks
  • increase dose slowly
44
Q

What mineral deficiency can cause goitre?

A

iodine

45
Q

What does cancer appear on a radioisotope scan?

A

cold nodules

46
Q

What are the 3 types of thyroid cancer?

A
  • papillary (80%) or folicular in younger
  • undifferentiated in elderly
47
Q

What are the dental aspects of thyroid diseases?

A
  • Goitre detectable to the dentist

Hyperthyroid
* pain anxiety and psychiatric problems
* caution for treatment until controlled

  • Hypothyroid
  • avoid the use of sedatives if severe

2 - Diseases Of The Human System (19 decks)

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