Endocrine: Pituitary and the thyroid Flashcards by Abby Lindsay

What are the two ways endocrine disease can present?

Primary - Gland failure

Secondary - Feedback failure

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What controls hormone production in the pituitary gland?

Signals from the hypothalamus

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What hormones are secreted from the anterior pituitary?

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

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What hormones are secreted from the posterior pituitary?

ADH: antidiuretic hormone

Oxytocin

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What are the two types of pituitary tumours?

Functional - hormones produced

Non-Functional - no hormone produced

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Describe a functional adenoma.

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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Describe a non-functions adenoma.

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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How are pituitary tumours removed?

Trans-sphenoidal surgery

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

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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Where is the growth hormone produced?

Anterior pituitary

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

The individual will be small and proportionate

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

Subtle changes

increased fat and reduced vitality/energy

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

Gigantism with everything proportionate

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

Acromegaly - membranous bone and soft tissue continue to grow

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

Measuring IGF - 1

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What are the features of acromegaly?

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.

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

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

What are the primary causes of hyperthyroidism?

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

Adenoma of the thyroid gland

How do you diagnose primary hyperthyroidism?

Low TSH

High thyroxine

What are the secondary causes of hyperthyroidism?

Pituitary adenoma

How do you diagnose secondary hyperthyroidism?

high TSH

High thyroxine

What are the symptoms of hyperthyroidism?

Hot and sweaty 
Anxious 
Irritable 
weight loss
heart palpitations

What are the signs of hyperthyroidism?

Tachycardia
A fib
warm and moist skin
lid lag

What is graves disease usually associated with?

A family history of autoimmune disease

i.e. type 1 diabetes, vitiligo

What is a visual indication of hyperthyroidism?

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

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

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

What is myxoedema?

Hypothyroidism

What are the primary causes of myxoedema/hypothyroidism?

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.

How do you diagnose primary hypothyroidism?

High TSH | Low thyroxine

What are the secondary causes of hypothyroidism?

Hypothalamus/pituitary diseases

How do you diagnose secondary hypothyroidism?

Low TSH | Low thyroxine

What are the symptoms of hypothyroidism?

puffy hair loss Cold intolerant

What are the signs of hypothyroidism?

Delayed reflexes bradycardia slow pulse and low BP confusion

How do you treat hyperthyroidism?

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 !!

How do you treat myxoedema/hypothyroidism?

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

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

Goitre - swelling in the neck Hyperthyroid = Anxiety Psychiatric problems

What must you avoid in patients with hypothyroidism/myxoedema?

Sedatives as they have a reduced metabolism.

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

As normal !!