EX 2; Growth and Diabetes Flashcards
This is the principle factor that regulates growth
genetics
This is a critical factors in regulating growth
nutrition; begins in utero
This is an often forgetting factor of growth
freedom from disease
What are four important growth regulating endocrine factors
hormones of the growth axis
thyroid hormones
glucose-regulating hormones
gonadal steroids
What are some hormones of the growth axis
IgF1 and IgF2; insulin-like growth factor
GHRH
GH
chronic elevation of this rill inhibit growth (GHRH/GH)
cortisol
What are the two basic requirements of growth
cell division/replication
protein synthesis
The final height is determined by what
growth of the long bones
Long bones grow as this is replaced by bone
epiphyseal plate cartilage
Cartilage replacement adds bone to where
the ends of both diaphysis
GH increases what on the chondrocytes, stimulating replication
IgF1 receptors
Epiphyseal plates ossify when?
at puberty
which is why males are generally taller because puberty is later/longer
What are two hypothalamic hormones that regular GH secretion
GHRH
somatostatin
Pituitary GH has these three effects
mitogenic peptide hormone
has some direct effects on somatic tissues
stimulates secretion of IGF1 from liver and other tissues
What are two direct effects on somatic tissues of pituitary GH
stimulates protein synthesis
anti-insulin effects
Feedback regulation of GH secretion by long and short loop negative feedbacks have what three effects
inhibition of GHRH and GH secretion
stimulation of SS secretion
both GHRH and SS exhibit contrasting diurnal patters of secretion (GHRH increases during early sleep)
GH induces precursor cells in bone and other tissues to differentiate and do what
secrete IGF-1 which stimulates cell division
The anti-insulin effects by GH have what three consequences
renders adipocytes more responsive to stimuli that induce the breakdown of triglycerides, releasing FA into blood
stimulates gluconeogenesis
reduces ability of insulin to stimulate glucose uptake
Somatic growth is the result of the interactions between what
GH and IGF-1
Example; GH stimulates maturation of chondroblasts and IGF-1 stimulates cell division
Deficits in either GH or IGF-1 cause what
reduced growth
What can be two defects in GH of IGF-1
genetic mutations
defects caused by malnutrition
Why are there no genetic mutations for IGF-1/receptor
The fetus needs it to grow, if there is a mutation, the fetus will die
GH production is affected by what
age
When is GH production the highest/lowest
highest = adolescence
lowest = adult
effects of GH decrease on somatic tissues
GH synthesis and activity is regulated by what
other hormones like sex steroids, thyroid hormones
What four effects do the sex steroids have on GH synthesis and activity
stimulate GH synthesis
stimulate IGF-1 synthesis
skeletal growth; stimulates prepubertal bone growth
causes fusion of epiphyseal plates inhibiting growth
What two effects do thyroid hormones have on GH synthesis and activity
regulates GH synthesis
required for GH effects
These have anti-growth effects
cortisol/glucocorticoids
Excess production of GH results in what
acromegaly and gigantism
What typical causes excess GH
pituitary tumor
Gigantism results from what
pre-pubertal onset of excess GH
Acromegaly results from what
post-pubertal onset of excess GH
What are two considerations from patients with excess GH
remove tumor or give SS
Which is more common, GH excess or GH deficiency
deficiency; relatively common
What causes dwarfism
lack of GH receptor which leads to no IGF synthesis
This is when fibroblast growth factor receptor constitutively active which results in abnormal cartilage development
achondroplasia
What are some considerations for patients with GH deficiency
macroglossia, enlarged salivary glands, excess cementum, delayed shedding and replacement, etc.
What becomes of athletes that take GH
they don’t get taller, the build muscle (including heart muscle)
What are some symptoms of GH abuse
they resemble acromegaly
also consider the anti-insulin actions of GH; bones thicken, cardiovascular problems, diabetic symptoms, etc.
This involves a disruption in the normal function of insulin
diabetes
This is a peptide hormone produced in the pancreas
insulin
What does insulin normally regulate
glucose transport into the cells
What kind of hormone does insulin act as
an anabolic hormone, stimulating mitosis, cell growth, etc.
Loss of insulin function can lead to what
ketoacidosis and can be fatal
This type of diabetes is an autoimmune disorder with onset early in life, destroys pancreatic β cells. (5-8% diabetics)
Type 1
This type of diabetes is a combination of insulin resistance and insulin deficiency, onset later in life
type II
How can you manage diabetes type I and II
type I; insulin supplementation
type II; dietary and lifestyle controls
What is the treatment for type II
can also include insulin sensitizers and insulin supplemental enhance the insulin receptor and cells
What are four symptoms of diabetes, linked to the increase of circulating glucose
elevated fasting glucose levels
polyuria
fatigue
blurred vision
What are five common complications of diabetes, linked to the chronic hyperglycemia
kidney failure vascular disease blindless skin/mucosal infections periodontal diseases
what are three considerations to keep in mind with a dental patient with diabetes
vascular diseases affect teeth
dehydration can reduce salivary flow
increased risk of periodontal disease
What should the dental provider be aware of with type I
be familiar with history
increased risk of periodontal disease
What should the dental provider be aware of with type II
emphasize the importance of maintaining glycemic control
frequently have cardiovascular and renal disease
