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HUD > Endocrine Pathology > Flashcards

Endocrine Pathology Flashcards

1
Q

Where does the thyroid gland lie?

A

Anterior midline of neck
Below thyroid cartilage

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2
Q

What does the thyroid gland produce?

A

Thyroxine T4
Triiodothyronine T3 - regulates metabolic rate
Calcitonin - calcium homeostasis

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3
Q

What is hypothyroidism?

A

Under activity of thyroid gland
Due to primary thyroid disease
Secondary pituitary disease, reduced TSH

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4
Q

What is the hypothalamic pituitary thyroid feedback system?

A

T3 and T4 feed back on pituitary to reduce TRH and TSH

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5
Q

What are the primary causes of thyroid damage?

A

Congenital
Hormone synthesis defects - iodine
Autoimmune - hashimotos
Tumour
Infective

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6
Q

What is secondary causes of thyroid damage?

A

Hypopituitarism
Reduced TSH

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7
Q

What are the clinical features of hypothyroidism?

A

Slows everything down except menstruation
Mental
Weight gain
Cold intolerance
Bradycardia
Depression

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8
Q

What is the dental relevance of hypothyroidism?

A

Children have delayed dental development
Increased risk of decay, perio
Adults have enlarged tongue
Delayed tooth eruption, wound healing
Changed taste
Avoid sedation
Lower pain threshold

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9
Q

What is hyperthyroidism?

A

Overactivity of the thyroid

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10
Q

What are the causes of hyperthyroidism?

A

Graves
Plumbers
Toxic goitre
Acute thyroiditis

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11
Q

What are the clinical features of hyperthyroidism?

A

Everything increases
Goitre
Graves - more T3 and T4
Weight loss
Heat intolerance
Tachycardia

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12
Q

What are the 3 treatments or hyperthyroidism?

A

Anti thyroid drugs - carbimazole and beta blockers
Radioactive iodine
Surgery

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13
Q

What is the dental relevance of hyperthyroidism?

A

Accelerates perio
Sensitive to adrenaline
Drugs cause infections and poor wound healing

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14
Q

What is a goitre?

A

A visible thyroid swelling

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15
Q

What is the key feature of a thyroglossal cyst?

A

Elevates when protrude tongue

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16
Q

What is the key feature of a thyroid lump?

A

Elevate on swallowing
Anterior midline below thyroid cartilage

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17
Q

How can we tell if a goitre is benign or malignant?

A

Multinodular is benign
Single nodes higher malignant risk

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18
Q

What is the treatment for thyroid lumps?

A

Toxic remove surgically or radioiodine
Cysts aspirated

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19
Q

What is the dental relevance of thyroid nodules?

A

Swelling at base of tongue could be due to thyroid

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20
Q

What is hypoparathyroidism?

A

Hypocalcaemia causing neuromuscular instability

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21
Q

What is hypoparathyroidism caused by?

A

Post-thyroid surgery
Autoimmune cases
Genetic Di Georges
Low magnesium
Chrons, renal tubular

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22
Q

What are the signs of hypocalcaemia?

A

Increased excitability of nerves
Seizures
Spasms

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23
Q

What is the dental relevance of hypoparathyroidism?

A

Addisons disease
Oral candidiasis

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24
Q

What is hyperparathyroidism caused by?

A

Parathyroid adenoma
Parathyroid hyperplasia

25
Q

What does hyperparathyroidism cause?

A

Hypercalcaemia
Carcinoma
Immobilisation
Renal disease

26
Q

What are the clinical features of hyperparathyroidism?

A

Bones - cysts
Stones - renal
Groans - weakness
Abdominal moans - peptic ulceration

27
Q

What is the dental relevance of hyperparathyroidism?

A

Brown tumours of mandible maxilla
Loss of lamina dura around teeth
Autoimmune diseases

28
Q

What are the 3 types of pituitary tumours?

A

Excess hormone secretion
Large - non-secreting prolactinomas
Medium - acromegaly
Small - Cushings, TSH secreting

29
Q

What is cranial diabetes insipidus?

A

Lack of vasopressin
Polyuria, nocturia, thirst
Lots of urine leads to dehydration
Diabetes as result of renal disease

30
Q

What is acromegaly?

A

Due to pituitary tumour secreting growth hormone

31
Q

What are the clinical features of acromegaly?

A

Hand and feet enlargement
Coarse facial hair
Hypertension
Diabetes
Overbite lower jaw
Splaying teeth

32
Q

what is the dental relevance of acromegaly?

A

Growth in facial structures
Affecting dentures, bridges, orthodontics
Difficult extractions

33
Q

What is hypopituitarism?

A

Deficiency of:
Hypothalamic releasing hormones - GH, FSH
Pituitary tropic hormones - LH, TSH, ACTH

34
Q

What is panhypopituitarism?

A

Deficiency of all anterior pituitary hormones
Caused by pituitary tumours

35
Q

Which 5 main hormones are affected in panhypopituitarism?

A

Gonadotropin - LH, FSH
Prolactin - high
Growth hormone
TSH - hypothyroidsim
ACTH - adrenal failure

36
Q

What is the dental relevance of pituitary disease?

A

Extractions difficult - bony ankyloses
Multiple endocrine problems
Hypertension, cardiac, arthritis usually affected

37
Q

What is the importance of the adrenal gland?

A

Produces catecholamines from medulla
Steroid hormones from cortex - cortisol, aldersterone, androgens

38
Q

What are the 3 classes of steroid hormone produced?

A

Glucocorticoids - affects metabolism, fluid balance, immune response - increase blood glucose
Mineralocorticoids - affect sodium and potassium balance, salt and water - increase BP prevent addison
Androgens

39
Q

What is the dental relevance of adrenal disease?

A

Liable to infections, candidiasis
Avoid NSAIDs - increase risk of peptic ulceration

40
Q

What are the side effects of adrenal disease?

A

Osteoporosis increased risk of fractures
Diabetes
Cushings
Hypertension

41
Q

What is another name for Addisons disease?

A

Hypoadrenalism

42
Q

What is Addison’s disease caused by?

A

Lack of corticosteroids
Autoimmune disease
Primary - destruction of adrenal cortex by antibodies
TB, HIV

43
Q

What are the clinical features of Addison’s disease?

A

Scar hyperpigmentation - excess ACTH
Postural hypotension
Addisonian crisis
Dehydration

44
Q

What is the treatment for Addison’s disease?

A

Long term glucocorticoid and mineralocorticoid replacement

45
Q

What is another name for Cushing’s syndrome?

A

Hyperadrenalism

46
Q

What is Cushings caused by?

A

Over-production of cortisol - glucocorticoid
After taking exogenous steroids, adrenal tumour, pituitary tumour - lung cancer

47
Q

What are the clinical features of cushings?

A

Moon face
Frontal balding
Acne
Hump on back shoulders
Thin skin, bruising
Hypertension
Osteoporosis

48
Q

What are phaeochromocytomas?

A

Rare tumours of adrenal medulla
Hypersecretion of catecholamines

49
Q

What is the dental relevance of Addison’s disease?

A

Pigmentation of oral mucosa

50
Q

What is diabetes mellitus?

A

High blood glucose levels - hyperglycaemia
Deranged metabolism, lack of insulin

51
Q

What are the 3 things that cause hyperglycaemia?

A

Glucagon
Cortisol - promotes gluconeogenesis
Catercholamines, GH - stress response

52
Q

What are the 2 types of diabetes?

A

Type 1 - autoimmune, destruction of pacreatic beta cells, childhood
Type 2 - impaired insulin function, older age, obesity, exercise, genetic

53
Q

What are some other causes of diabetes?

A

Pregnancy
Endocrinopathies
Steroids, thiazides
Pancreatic disease
Genetic defects of beta cells or insulin

54
Q

What is the aetiology of diabetes?

A

Insulin secreted by islets of langerhans in response to raised blood sugar
Promotes glucose uptake, fatty acids, amino acids
Stored in liver as glucagon
Lack of insulin - triglycerides to fatty acids - ketones

55
Q

What are the clinical features of diabetes?

A

Excess glucose in blood excreted kidneys
Osmotic diuresis - polyuria
Dehydration, thirst, weight loss

56
Q

What are complications of diabetes?

A

Hypoglycaemia
Autonomic
Neurological
Type 1 - ketoacidosis
Type 2 - non-ketotic coma
Atheroma formation

57
Q

What is the dental relevance of diabetes?

A

Increased perio
Increased infection risk - candidiasis
Xerostomia
Burning mouth
Lichen planus
Caries
Ulcers

58
Q

What is the treatment for diabetes?

A

Type 1 - insulin injections
Type 2 - oral hypoglycaemic drugs stimulate insulin
Metformin

59
Q

What to do for a diabetes emergency?

A

Rapid ingestion of sugar, dextros
IV glucose
Schedule AM appointments
Avoid sedation

HUD (16 decks)

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