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My BDS2 > Endocrine: Pituitary and the thyroid > Flashcards

Endocrine: Pituitary and the thyroid Flashcards

1
Q

What are the two ways endocrine disease can present?

A

Primary - Gland failure

Secondary - Feedback failure

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2
Q

What controls hormone production in the pituitary gland?

A

Signals from the hypothalamus

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3
Q

What hormones are secreted from the anterior pituitary?

A

The growth hormone
TSH: Thyroid stimulating hormone
ACTH: Adrenocorticotrophic hormone (stimulates cortisol)

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4
Q

What hormones are secreted from the posterior pituitary?

A

ADH: antidiuretic hormone

Oxytocin

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5
Q

What are the two types of pituitary tumours?

A

Functional - hormones produced

Non-Functional - no hormone produced

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6
Q

Describe a functional adenoma.

A

Tumour arises from a cell secreting a hormone - excess of the hormone is produced and there is a deficiency of others as tumour grows to occupy the space of the pituitary gland (squishes the other cells)

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7
Q

Describe a non-functions adenoma.

A

Tumour does not produce any hormone and grows to occupy the space of the pituitary gland therefore prevents other pituitary cells from secreting hormones.

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8
Q

How are pituitary tumours removed?

A

Trans-sphenoidal surgery

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9
Q

What is the consequence of a growing tumour in the pituitary gland?

A

Pituitary gland is encased in bone, therefore the tumour will grow up and out of the bone and put pressure on the optic chiasma.
= visual field defects and loss of peripheral vision.

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10
Q

Where is the growth hormone produced?

A

Anterior pituitary

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11
Q

What happens when there is a deficiency of growth hormone as a child?

A

The individual will be small and proportionate

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12
Q

What happens when there is a deficiency of growth hormone as an adult?

A

Subtle changes

increased fat and reduced vitality/energy

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13
Q

What happens when there is an excess of growth hormone as a child?

A

Gigantism with everything proportionate

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14
Q

What happens when there is an excess of growth hormone as an adult?

A

Acromegaly - membranous bone and soft tissue continue to grow

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15
Q

How do you measure the levels of growth hormone within the body?

A

Measuring IGF - 1

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16
Q

What are the features of acromegaly?

A

Enlarged hands and feet.

Broad nose

Large mandible

Type 2 diabetic - GH is antagonistic to insulin

Cardiovascular problems - heart is bigger and less efficient = heart failure.

Loss of peripheral vision - if adenoma is growing up and out of the boney case surrounding pituitary.

17
Q

What will be observed within the mouth of an individual with acromegaly?

A

Enlarged tongue
Interdental spacing
Reversed overbite
Complaining of denture ‘shrunk’

18
Q

What are the primary causes of hyperthyroidism?

A

Graves disease - autoimmune disease, autoantibodies produced mimic the effect of the TSH hormone.

Adenoma of the thyroid gland

19
Q

How do you diagnose primary hyperthyroidism?

A

Low TSH

High thyroxine

20
Q

What are the secondary causes of hyperthyroidism?

A

Pituitary adenoma

21
Q

How do you diagnose secondary hyperthyroidism?

A

high TSH

High thyroxine

22
Q

What are the symptoms of hyperthyroidism?

A 
Hot and sweaty 
Anxious 
Irritable 
weight loss
heart palpitations
23
Q

What are the signs of hyperthyroidism?

A

Tachycardia
A fib
warm and moist skin
lid lag

24
Q

What is graves disease usually associated with?

A

A family history of autoimmune disease

i.e. type 1 diabetes, vitiligo

25
Q

What is a visual indication of hyperthyroidism?

A

Opthalmopthy - autoantibodies also bind to the fat cells in the orbit and cause irritation and swelling which projects the eyeballs out of the socket

26
Q

Once the hyperthyroidism has be treated, what will happen to the opthalmopthy?

A

Will remain - treating the high levels of thyroxine will have no impact on the orbit as it is the autoantibodies that affect it.

27
Q

What is myxoedema?

A

Hypothyroidism

28
Q

What are the primary causes of myxoedema/hypothyroidism?

A

Thyroiditis - autoimmune disease
Commonly Hashimoto’s thyroiditis - gland becomes inflamed initially and swells (goitre), then it shrinks and stops producing thyroxine.

Drugs i.e. carbimazole (used to treat hyperthyroidism)

Idiopathic - no reason

Hyperthyroid treatment:
i.e. radioiodine - radiation released destroys gland tissue and reduces the amount of thyroxine produced. Once in the body this cannot be stopped therefore will eventually lead to the patient developing hypothyroidism.

29
Q

How do you diagnose primary hypothyroidism?

A

High TSH

Low thyroxine

30
Q

What are the secondary causes of hypothyroidism?

A

Hypothalamus/pituitary diseases

31
Q

How do you diagnose secondary hypothyroidism?

A

Low TSH

Low thyroxine

32
Q

What are the symptoms of hypothyroidism?

A

puffy
hair loss
Cold intolerant

33
Q

What are the signs of hypothyroidism?

A

Delayed reflexes
bradycardia
slow pulse and low BP
confusion

34
Q

How do you treat hyperthyroidism?

A

Surgery - partial thyroidectomy

Drugs i.e. carbimazole

Radioiodine - radiation released destroys gland tissue and reduced/stops production of thyroxine.

Beta blockers address the symptoms only !!

35
Q

How do you treat myxoedema/hypothyroidism?

A

Thyroxine tablets

Dosage of thyroxine starts off low and is gradually increased until the body reaches normal TSH levels.

36
Q

In the dental setting ; what must the dentist be looking out for?

A

Goitre - swelling in the neck

Hyperthyroid =
Anxiety
Psychiatric problems

37
Q

What must you avoid in patients with hypothyroidism/myxoedema?

A

Sedatives as they have a reduced metabolism.

38
Q

In terms of dental treatment; how must a patient with controlled hyper/hypothyroidism be treated?

A

As normal !!

My BDS2 (72 decks)

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