Endocrinology Flashcards
what is the purpose of the endocrine system?
controls growth and development during childhood, regulation of bodily functions in adulthood, and the reproductive process.
what causes an endocrine disorder?
the improper function of the endocrine system, which includes the glands that secrete hormones, the receptors that respond to hormones and the organs that are directly impacted by hormones
what is multiple endocrine neoplasia (MEN)?
rare disorders of the endocrine system
what can MEN cause?
increase in likeliness to develop benign or malignant tumors in the endocrine glands
what are the 3 main types of MEN syndromes?
MEN 1
MEN 2a
MEN 2b
what diseases come under MEN 1?
Parathyroid tumors, pancreatic tumors, and pituitary tumors
What diseases come under MEN 2a?
Medullary thyroid cancers (MTC), pheochromocytoma, and parathyroid tumors
What diseases come under MEN 2b?
Medullary thyroid cancers, pheochromocytoma and neuromas
Which MEN is most interesting to the dental community and why?
MEN 2b
Part of the syndrome includes mucosal neuromas
where is the pituitary gland located?
behind the nose in the middle of the skull base
what is the sella turcica (“turkish seat”)
bony depression ion the sphenoid bone, where the pituitary gland sits
what are the 2 components of the pituitary gland?
anterior
posterior
what is the function of the pituitary gland?
acts as a controlling system
controls many hormones released within the body
what controls the pituitary gland?
the hypothalamus
what hormones are released by the anterior pituitary?
TSH - thyroid stimulating hormone
ACTH - adrenocorticotrophic hormone
GH - growth hormone
LH, FSH Prolactin
what hormones are released by the posterior pituitary?
ADH - anti diuretic hormone - this can lead to diabetes insipidus
oxytocin
what are the 2 main types of pituitary tumours?
functional
non - functional
what are pituitary adenomas
tumors of the pituitary gland
what is trans - sphenoidal surgery?
the most common procedure for removing a tumor of the pituitary gland.
what can an excess amount of growth hormone do to both adults and kids?
giantism in children
acromegaly in adults
how would you measure a person’s level of growth hormone?
Insulin-like growth factor 1 (IGF-1)
General presenting changes of acromegaly
coarse features
enlarged supra-orbital ridges
broad nose, thickened lips and soft tissues
enlarged hands - carpal tunnel syndrome
type 2 diabetes - due to insulin resistance from increased GH
cardiovascular disease
intra-oral changes caused by acromegaly
enlarged tongue
interdental spacing
‘shrunk’ dentures
reverse overbite
what is pituitary disease?
a rare disorder in which your pituitary gland fails to produce one or more hormones, or doesn’t produce enough hormones
what is thyroid disease?
a general term for a medical condition that keeps your thyroid from making the right amount of hormones
what is the name given to an excess production of hormone made my the thyroid gland?
hyperthyroidism
aka thyrotoxicosis
what is the name given to a deficiency in hormone production from the thyroid gland?
hypothyroidism
aka myxoedema
what are the 3 main causes of hyperthyroidism?
GRAVES disease
toxic multi-nodular goitre
toxic adenoma
what is GRAVES disease?
an autoimmune condition where your immune system mistakenly attacks your thyroid which causes it to become overactive. often seen in family history
signs of hyperthyroidism
warm and moist skin
tachycardia and atrial fibrillation
increased BP and heart failure
tremor and hyperreflexia
eyelid retraction and lid lag
symptoms of hyperthyroidism
hot and excess sweating, weight loss and diarrhoea
palpitations, muscle weakness
irritable, manic, anxious
what is a goitre?
a lump or swelling at the front of the neck caused by a swollen thyroid
causes of primary hypothyroidism
autoimmune (hashimoto’s) thyroiditis
idiopathic atrophy
iodine deficiency
radioiodine - used to treat hyper
drugs - carbimazole, amiodarone, lithium
causes of secondary hypothyroidism
hypothalamic/pituitary disease
signs of hypothyroidism
dry coarse skin
bradycardia, hyperlipidaemia
confusion
goitre
delayed reflexes
is hypothyroidism a reduced metabolism or increased metabolism?
reduced
is hyperthyroidism a reduced metabolism or increased metabolism?
increased
symptoms of hypothyroidism
tired
cold tolerance
weight gain
constipation
hoarse voice
puffed face
angina
poor memory
hair loss
how do you test for thyroid disease
blood tests
ultrasound to check for cysts
radioisotope to see gland uptake
biopsy
What hormones are looked at when taking bloods to investigate thyroid disease?
TSH
T3
T4
treatment used for hyperthryroidism
carbimazole
beta blockers
radioiodine
surgery - thyroidectomy
treatment used for hypothyroidism
thyroxine (T4 tablets)
dental aspects of hyperthyroid
pain anxiety and psychiatric problems
caution for treatment until controlled
dental aspects of hypothyroid
avoid the use of sedatives if severe
symptoms of thyroid cancer
A lump in the neck, sometimes growing quickly.
Swelling in the neck.
Pain in the front of the neck, sometimes going up to the ears.
Hoarseness or other voice changes that do not go away.
Trouble swallowing.
Trouble breathing.
A constant cough that is not due to a cold.
treatment for thyroid cancer
radiotherapy
chemotherapy
what are the two pain types of thyroid cancer?
papillary (80%)
folicular (more common in younger)
where does the adrenal gland sit?
on the renal gland (kidney)
the adrenal gland is divided into 2 parts, what are they?
outer cortex
inner medulla
what is addison’s disease?
when the adrenal tissue is destroyed and no hormones can be produced
what is the term given to an excess adrenal action?
cushings disease/syndrome
treatment for adrenal issues
therapeutic corticosteroids
what hormones are produced by the adrenal gland?
aldosterone
cortisol
adrenal androgens (adrenaline)
what zone of the adrenal gland secretes aldosterone?
glomerulosa
what zone of the adrenal gland secretes cortisol?
fasicularis
what zone of the adrenal gland secretes adrenal androgens (adrenaline)?
reticularis
purpose of aldosterone
It helps control the balance of water and salts in the kidney by keeping sodium in and releasing potassium from the body
purpose of cortisol
the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain’s use of glucose and increases the availability of substances that repair tissues. Cortisol also curbs functions that would be nonessential or harmful in a fight-or-flight situation
types of therapeutic steroids
hydrocortisone
prednisolone
triamcinolone
dexamethasone
betamethasone
adrenal hyperfunction
aka cushings syndrome
causes excess cortisol secretion by the adrenal gland
adrenal hypofunction
aka Addison’s disease
is an uncommon illness that occurs when the body doesn’t make enough of certain hormones.
what is cushing’s syndrome?
a disorder that occurs when your body makes too much of the hormone cortisol over a long period of time
Dental aspects of cushings disease
candidiasis
oral pigmentation
steroid precautions may be needed
dental aspects of addisons disease
oral pigmentation
what is diabetes mellitus?
abnormality of glucose regulation
your body doesn’t make enough insulin or can’t use it as well as it should
what is diabetes insipidus?
abnormality of renal function (water)
what is tests are carried out to diagnose diabetes?
random sugar test
fasting sugar test
glucose tolerance test (GTT)
HbA1C
what result from an RPG indicates diabetes?
> 11.1mmol/L on 2 occassions
before the GTT what results state normal, impaired fasting glucose and diabetes
normal - < 6.1 mmol/L
impaired fasting glucose - 6.1-7.0 mmol/L
diabetes - >7.0 mmol/L
what are the 2 hour plasma glucose results that state normal, impaired glucose tolerance and diabetes
normal - < 7.8 mmol/L
IGT - 7.8-11.1 mmol/L
diabetes - > 11.1
What is Type 1 diabetes
an insulin deficiency
autoimmune destruction of pancreatic B cells
What is Type 2 diabetes
an impairment in the way the body regulates and uses sugar (glucose) as a fuel
