Endocrine Pathology Flashcards
Where does the thyroid gland lie?
Anterior midline of neck
Below thyroid cartilage
What does the thyroid gland produce?
Thyroxine T4
Triiodothyronine T3 - regulates metabolic rate
Calcitonin - calcium homeostasis
What is hypothyroidism?
Under activity of thyroid gland
Due to primary thyroid disease
Secondary pituitary disease, reduced TSH
What is the hypothalamic pituitary thyroid feedback system?
T3 and T4 feed back on pituitary to reduce TRH and TSH
What are the primary causes of thyroid damage?
Congenital
Hormone synthesis defects - iodine
Autoimmune - hashimotos
Tumour
Infective
What is secondary causes of thyroid damage?
Hypopituitarism
Reduced TSH
What are the clinical features of hypothyroidism?
Slows everything down except menstruation
Mental
Weight gain
Cold intolerance
Bradycardia
Depression
What is the dental relevance of hypothyroidism?
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
What is hyperthyroidism?
Overactivity of the thyroid
What are the causes of hyperthyroidism?
Graves
Plumbers
Toxic goitre
Acute thyroiditis
What are the clinical features of hyperthyroidism?
Everything increases
Goitre
Graves - more T3 and T4
Weight loss
Heat intolerance
Tachycardia
What are the 3 treatments or hyperthyroidism?
Anti thyroid drugs - carbimazole and beta blockers
Radioactive iodine
Surgery
What is the dental relevance of hyperthyroidism?
Accelerates perio
Sensitive to adrenaline
Drugs cause infections and poor wound healing
What is a goitre?
A visible thyroid swelling
What is the key feature of a thyroglossal cyst?
Elevates when protrude tongue
What is the key feature of a thyroid lump?
Elevate on swallowing
Anterior midline below thyroid cartilage
How can we tell if a goitre is benign or malignant?
Multinodular is benign
Single nodes higher malignant risk
What is the treatment for thyroid lumps?
Toxic remove surgically or radioiodine
Cysts aspirated
What is the dental relevance of thyroid nodules?
Swelling at base of tongue could be due to thyroid
What is hypoparathyroidism?
Hypocalcaemia causing neuromuscular instability
What is hypoparathyroidism caused by?
Post-thyroid surgery
Autoimmune cases
Genetic Di Georges
Low magnesium
Chrons, renal tubular
What are the signs of hypocalcaemia?
Increased excitability of nerves
Seizures
Spasms
What is the dental relevance of hypoparathyroidism?
Addisons disease
Oral candidiasis
What is hyperparathyroidism caused by?
Parathyroid adenoma
Parathyroid hyperplasia
What does hyperparathyroidism cause?
Hypercalcaemia
Carcinoma
Immobilisation
Renal disease
What are the clinical features of hyperparathyroidism?
Bones - cysts
Stones - renal
Groans - weakness
Abdominal moans - peptic ulceration
What is the dental relevance of hyperparathyroidism?
Brown tumours of mandible maxilla
Loss of lamina dura around teeth
Autoimmune diseases
What are the 3 types of pituitary tumours?
Excess hormone secretion
Large - non-secreting prolactinomas
Medium - acromegaly
Small - Cushings, TSH secreting
What is cranial diabetes insipidus?
Lack of vasopressin
Polyuria, nocturia, thirst
Lots of urine leads to dehydration
Diabetes as result of renal disease
What is acromegaly?
Due to pituitary tumour secreting growth hormone
What are the clinical features of acromegaly?
Hand and feet enlargement
Coarse facial hair
Hypertension
Diabetes
Overbite lower jaw
Splaying teeth
what is the dental relevance of acromegaly?
Growth in facial structures
Affecting dentures, bridges, orthodontics
Difficult extractions
What is hypopituitarism?
Deficiency of:
Hypothalamic releasing hormones - GH, FSH
Pituitary tropic hormones - LH, TSH, ACTH
What is panhypopituitarism?
Deficiency of all anterior pituitary hormones
Caused by pituitary tumours
Which 5 main hormones are affected in panhypopituitarism?
Gonadotropin - LH, FSH
Prolactin - high
Growth hormone
TSH - hypothyroidsim
ACTH - adrenal failure
What is the dental relevance of pituitary disease?
Extractions difficult - bony ankyloses
Multiple endocrine problems
Hypertension, cardiac, arthritis usually affected
What is the importance of the adrenal gland?
Produces catecholamines from medulla
Steroid hormones from cortex - cortisol, aldersterone, androgens
What are the 3 classes of steroid hormone produced?
Glucocorticoids - affects metabolism, fluid balance, immune response - increase blood glucose
Mineralocorticoids - affect sodium and potassium balance, salt and water - increase BP prevent addison
Androgens
What is the dental relevance of adrenal disease?
Liable to infections, candidiasis
Avoid NSAIDs - increase risk of peptic ulceration
What are the side effects of adrenal disease?
Osteoporosis increased risk of fractures
Diabetes
Cushings
Hypertension
What is another name for Addisons disease?
Hypoadrenalism
What is Addison’s disease caused by?
Lack of corticosteroids
Autoimmune disease
Primary - destruction of adrenal cortex by antibodies
TB, HIV
What are the clinical features of Addison’s disease?
Scar hyperpigmentation - excess ACTH
Postural hypotension
Addisonian crisis
Dehydration
What is the treatment for Addison’s disease?
Long term glucocorticoid and mineralocorticoid replacement
What is another name for Cushing’s syndrome?
Hyperadrenalism
What is Cushings caused by?
Over-production of cortisol - glucocorticoid
After taking exogenous steroids, adrenal tumour, pituitary tumour - lung cancer
What are the clinical features of cushings?
Moon face
Frontal balding
Acne
Hump on back shoulders
Thin skin, bruising
Hypertension
Osteoporosis
What are phaeochromocytomas?
Rare tumours of adrenal medulla
Hypersecretion of catecholamines
What is the dental relevance of Addison’s disease?
Pigmentation of oral mucosa
What is diabetes mellitus?
High blood glucose levels - hyperglycaemia
Deranged metabolism, lack of insulin
What are the 3 things that cause hyperglycaemia?
Glucagon
Cortisol - promotes gluconeogenesis
Catercholamines, GH - stress response
What are the 2 types of diabetes?
Type 1 - autoimmune, destruction of pacreatic beta cells, childhood
Type 2 - impaired insulin function, older age, obesity, exercise, genetic
What are some other causes of diabetes?
Pregnancy
Endocrinopathies
Steroids, thiazides
Pancreatic disease
Genetic defects of beta cells or insulin
What is the aetiology of diabetes?
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
What are the clinical features of diabetes?
Excess glucose in blood excreted kidneys
Osmotic diuresis - polyuria
Dehydration, thirst, weight loss
What are complications of diabetes?
Hypoglycaemia
Autonomic
Neurological
Type 1 - ketoacidosis
Type 2 - non-ketotic coma
Atheroma formation
What is the dental relevance of diabetes?
Increased perio
Increased infection risk - candidiasis
Xerostomia
Burning mouth
Lichen planus
Caries
Ulcers
What is the treatment for diabetes?
Type 1 - insulin injections
Type 2 - oral hypoglycaemic drugs stimulate insulin
Metformin
What to do for a diabetes emergency?
Rapid ingestion of sugar, dextros
IV glucose
Schedule AM appointments
Avoid sedation
