Endocrinology Flashcards
what are the 3 main problems that can occur in the endocrine system?
- excess hormone
- reduced hormone
- physical gland enlargement
which of these 3 problems that can occur in the endocrine system can give widespread effects?
- excess and reduced hormone level
what are the 3 thyroid diseases?
- hyperthyroidism (excess thyroxine)
- hypothyroidism (lack of thyroxine)
- thyroid mass (goitre)
what is the common age range to get diagnosed with hyperthyroidism?
20-40 years old
is hyperthyroidism more or less common in women that in men?
more common in women (2.3% compared to 0.2%)
what are the 3 possible causes for hyperthyroidism?
- auto-immune
- goitre or toxic adenoma (benign tumour)
- pituitary driven
if hyperthyroidism is auto-immune then what is it called?
graves disease
give some symptoms of hyperthyroidism?
- sweating -irritability
- heat intolerance -anxiety
- palpitations -poor sleep
- breathlessness -excess appetite
- diarrhoea -weight loss
what are some of the signs of hyperthyroidism?
- warm moist skin
- high blood pressure
- tachycardia
- heart failure
- fine tremor
- goitre
- pre-tibial myoedema
what is an addition symptoms of graves disease?
eye disease
which 2 ways can hyperthyroidism be diagnosed?
- clinical
- blood tests
which two sets of blood tests would you request for hyperthyroidism?
- thyroid function tests
2. auto-antibodies
what are the two main things to look for in a thyroid function test?
- low TSH (thyroid stimulating hormone)
- high T4 (thyroxine)
what are the 2 groups of drugs given to manage hyperthyroidism?
- anti-thyroid drugs
2. beta-blockers
why are beta blockers given to those with hyperthyroidism?
to help control symptoms
in which 2 patient categories should you be cautious about using radioactive iodine as treatment of hyperthyroidism?
- younger patients
2. pregnant/breast-feeding
what is the mean age of diagnosis of hypothyroidism?
60
is hypothyroidism more or less common in women than men?
more (2% compared to 0.2%)
what are the 4 possible causes of hypothyroidism?
- auto immune
- iatrogenic (surgery/radioiodine)
- iodine deficiency
- pituitary disease (rare)
what are the signs and symptoms of hypothyroidism?
- reduced metabolism (weight gain)
- cold intolerance
- mental slowness
- poor memory
- hoarse voice
- thin, dry hair (or hair loss)
- large tongue
- goitre
- constipation
- puffed face and extremities
what are the 2 acute signs of hypothyroidism?
- coma
- hypothermia
what are the 2 ways to test for hypothyroidism?
- clinical
2. blood tests
what are you looking for in the blood tests for hypothyroidism?
- high TSH
- low T3, T4
- auto-antibodies
name 2 anti-thyroid drugs?
- carbimazole
- propylthiouracil
what are the dentally relevant points about anti-thyroid drugs?
they can cause
- taste disturbances
- neutropenia and agranulocytosis ( both increasing infection risk)
what are the drugs given to patients who have hypothyroidism?
- thyroxine (T4)
- levothyroxine
what are the 3 subgroups from thyroid masses?
- no association with intrinsic thyroid disease
- associated with intrinsic thyroid disease
- malignancy
what are the 2 causes of thyroid masses not associated with intrinsic thyroid disease?
- simple cysts (adenoma)
2. iodine deficiency
what are the 2 causes of goitre that is associated with intrinsic thyroid disease?
- autoimmune (graves)
- toxic multi-nodular goitre (adenoma)
how common is goitre malignant?
rare
what are the dentally relevant points about goitres?
rarely have retro-sternal extension (compression) which will cause
- dyspahgia
- breathing difficulties
- can have lymphadenopathy (ominous sign)
what are the 3 ways to investigate goitre?
- blood tests
- fine needle aspiration
- radiology (ultrasound/ radioisotope scan)
what are the 2 treatment options for goitre?
- address underlying cause
- surgery to remove
the adrenal gland produces what?
corticosteroids
what is the disease that can occur due to a deficiency in the production of corticosteroids?
addisons disease
cushings syndome is…
when there is an excess in corticosteroid production
what are some of the causes of cushings syndrome?
- excess ACTH
- excess corticosteroids
where is ACTH produced? what affect does it have?
the anterior pituitary gland
brings about cortisol production in the adrenal gland during stressful situations
what may cause an excess in ACTH?
- pituitary adenoma (benign tumour)
2. ectopic production by cancers ie lung
what may cause an increase in corticosteroids?
adrenal carcinoma or adenoma
what are the normal uses of cortisol?
- maintain BP
- inhibit Bone formation
- anti-Inflammatory
- decreases Immune function
- increases gluceogenesis
in cushings syndrome where there is a prolonged period of high cortisol levels what are 3 negative consequences?
- diabetes
- hypertension
- prone to infection
what are some of the signs and symptoms of cushings syndome?
- moon face
- purple striae
- easy bruising
- impaired wound healing
- hair thinning
- acne
- weight gain
- increased body/facial hair
- red cheeks
- thin skin
- buffalo hump
- bronze skin
what are the 2 ways to manage cushings syndrome by addressing underlying cause?
- iatrogenic? - ie taking to many corticosteroids
tx = reduce dose - non-iatrogenic - surgery best option
what is the definition of addisons disease?
where steroid hormones are failed to be produced by the adrenal cortex
what are some of the causes of addisons disease?
- auto immune adrenal destruction
- iatrogenic (withdrawal from long term steroid use)
- hypopituitary due to
- cancer
- infection
- vascular issues
- trauma
name two groups of steroid hormones and example from each
glucocorticoids - cortisol
mineralocorticoids - aldosterone
what is the symptoms of chronic addisons disease?
general malaise
what are the symptoms of acute addisons disease?
shock
hypoglycaemia
vomiting
abdominal pain
what are some of the causes of ACUTE addisons disease
usually in response to stress
- infection
- trauma
- surgery
what are some of the signs of addisons disease?
hyperpigmentation
- scars
- buccal mucosa
- pressure points
- skin creases
how can addisons disease be managed?
replacement therapy
- hydrocortisone - glucocorticoid (20mg am & 10mg pm)
- fludrocortisone - mineralocorticoid
an acute addisonian crisis needs what?
- urgent medical attention!
- fluid replacement
- glucose
- hydrocortisone injection
- tx of infection
what 2 ways can the dental professional recognise undiagnosed adrenal diseases?
- hyperpigmentation of the buccal mucosa (addisons)
2. oral infections (cushings)
