Part III Adrenal Insufficiency- Endocrine and Metabolic conditions

Question 1

What is adrenal insufficiency ?

Answer 1

Adrenal glands don’t produce enough hormones.

Question 2

What is cortisol?

Answer 2

• Primary glucocorticoid
• Aids in digestion, metabolism, cardiovascular function, the immune system and managing physical and emotional stress
• Acts against insulin → high levels could result in hyperglycemia
• Increases blood pressure and has anti- inflammatory properties
• Secreted upon waking; lowest levels middle of the night during sleep
• Increases when body detects a need: Very stressed, anxious

Question 3

what is Aldosterone?

Answer 3

Hormone responding to hormones produced bu the kidney which help regulates blood pressure

Question 4

What the two types of adrenal gland disorders?

Answer 4

Hyperadrenalism and Adrenal insufficiency

Question 5

What are the types of hyperadrenalism?

Answer 5

• Crushing Syndrome: excessive cortisol production from any cause
• Crushing disease: Excessive crotisol production caused by pathology

Question 6

What are the types of adrenal insufficiency?

Answer 6

• Primary- addison disease is caused by adrenal gland removal or addrenal cortex destruction
• Secondary- caused by problems with the pituitary gland
• Tertiary- caused by issues with the hypothalamus

Question 7

What are the signs and symptoms of crushing disease?

Answer 7

• Weight gain
• Broad/round face
• Buffalo hump on upper back
• Abdominal striae (stretch marks)
• Hypertension
• Hirsutism
• Acne
• Glucose intolerance and impaired healing
• Osteoporosis
• Psychiatric disorders

Question 8

What are the signs and symptoms of Addison disease?

Answer 8

• Impaired glucose metabolism
• Hypotension
• Impaired fluid excretion
• Hypovolemia
• Hyperkalemia
• Acidosis
• lethargy
• weightloss
• hyperpigmentation
• vitiligo
• Dehydration
• Gastro intestinal disorders

Question 9

What are the medical management of Addison Disease?

Answer 9

• Glucocorticoid therapy replacement- Hormone replacement is required for the rest of the patient’s life
• Dosage corresponds with amount body normally would produce
• Given in two doses so the levels are like they would be a certain times of the day
• Diet should include enough sodium and patients monitor BP

Question 10

What are the medical management of Cushing disease?

Answer 10

• Medications to reduce cortisol hormone production
• Removal of pituitary or adrenalglands- Severe cases; rare
• Chemotherapy or radiation for tumor causing disease

Question 11

What is Adrenal crisis?

Answer 11

LIFE THREATENING EMERGENcy
- May occur when someone who has adrenal
insufficiency (Addison Disease) is in a stressful
situation, has had surgery, or has an infection.
- The lack of glucocorticoid prevents the body
from dealing with the situation.
- Must immediately stop whatever is causing it and
administer glucocorticoid.

Question 12

What is the Dental management and oral manifestations of Adrenal insuf?

Answer 12

• Patients can receive treatment, but highest risk is those with primary insufficiency (Addison)
• Recommendation for supplemental glucocorticoid comes from physician(Not usually indicated for DH care)
• Monitor BP during invasive procedures
• If patient is hypotensive adjust chair, give fluids, and activate medical emergency procedures
• Addison: Mucous membranes may have brown
  macules