17 Oral manifestations of endocrine disease

Question 1

Define and characterize the endocrine system.

Answer 1

A specialized system of glands and gland-like structures with the following characteristics: produce hormones, secretes directly into the bloodstream (no duct system), influence metabolism and/or control specific body functions, usually effects entire body, blood levels of hormone provide homeostasis via positive and/or negative feedback controls.

Question 2

What are the key components of the endocrine system?

Answer 2

Pituitary gland, Thyroid gland, Parathyroid glands, Adrenal glands (cortex & medulla), Pancreas (Islands of Langerhans), Gonads

Question 3

Contrast hyperfunction and hypofunction.

Answer 3

Hyperfunction - overproduction of the active hormone. Hypofunction - underproduction of the hormone.

Question 4

Describe the potential causes of hyperfunction of an endocrine “organ.”

Answer 4

Typically produced by proliferation of the endocrine tissue (hyperplasia, neoplasia - functional), or loss of the NEGATIVE feedback signal.

Question 5

Describe the potential causes of hypofunction of an endocrine “organ.”

Answer 5

Typically produced by destruction of the endocrine tissue: inflammatory/infections (ex.Tuberculosis), infarction (most common), surgical, and loss of the POSITIVE feedback (stimulating) signal

Question 6

Describe the characteristics and location of the pituitary gland.

Answer 6

The Hypophysis, The Master Gland
Located in sella turcica at the base of the brain beneath hypothalamus; typically a landmark in cephalometric radiographs
3 divisions: anterior lobe, intermediate area, posterior lobe

Question 7

Hormones associated with anterior lobe of the pituitary (adenohypophysis) derived from oral mucosa (Rathkey’s pouch)-“LGFLAT”

Answer 7

LTH: LuteoTropic Hormone
GH: Growth Hormone
FSH: Follicle Stimulating Hormone
LH: Luteinizing Hormone
ACTH: AdrenoCorticoTropic Hormone (corticotropin)
TSH: Thyroid Stimulating Hormone (thyrotropin)

Question 8

Hormones associated with intermediate area (pars intermedia) of the pituitary

Answer 8

Intermediate area (pars intermedia):  actually part of the anterior lobe
Secretes MSH:  Melanocyte Stimulating Hormone

Question 9

Hormones associated with posterior lobe of the pituitary (nuerohypophysis)

Answer 9

Posterior lobe of the pituitary (neurohypophysis): extension of CNS tissue
Secretes two hormones:
ADH: Anti-Diuretic Hormone (vasopressin)
Oxytocin

Question 10

(Pituitary malfunction) Gigantism: describe condition and associated hormones

Answer 10

HYPERfunction: (growth hormone)
Giantism: Pre-pubertal onset
One-fifth of patients have McCune-Albright syndrome
Oral manifestations:Macrodontia!, ,mandibular enlargement with prognathism

Question 11

(Pituitary malfunction) Acromegaly: describe condition and associated hormones

Answer 11

HYPERfunction: (growth hormone)
Acromegaly: Post pubertal onset
Oral manifestations:
Enlargement of the skull and jaws, mandibular prognathism, often with anterior open bite, development of diastemas, macroglossia

Question 12

(Pituitary malfunction) Dwarfism: describe condition and associated hormones

Answer 12

HYPOfunction: (growth hormone)
Dwarfism: (Normal proportions maintained)
Oral manifestations: Delayed eruption; prolonged retention of deciduous teeth, microdontia, failure of development of third molars±, crowding of teeth, malocclusion±

Question 13

(Pituitary malfunction) SIADH: describe condition and associated hormones

Answer 13

HYPERfunction: (anti-diuretic hormone)
SIADH (Syndrome of Inappropriate ADH Secretion)
No oral manifestations

Question 14

(Pituitary malfunction) Diabetes Insipidus: describe condition and associated hormones

Answer 14

HYPOfunction: (anti-diuretic hormone)
Diabetes Insipidus
No oral manifestations

Question 15

Describe the characteristics and location of the thyroid gland.

Answer 15

Located in the anterior midline of the neck, just below the laryngeal prominence
Primary role in regulation of cellular metabolism
Hormones produced:
Thyroid hormones (primarily thyroxine)
Calcitonin (weak antagonist to parathormone from the parathyroid glands)

Question 16

(Thyroid malfunction) Grave’s disease: describe condition and associated hormones

Answer 16

HYPERfunction: (thyroid hormone)
Grave’s Disease, Toxic Multinodular Goiter
Major potential complication of dental treatment is Thyroid Storm
Oral manifestations: Mass in the anterior midline of the neck, often U-shaped, glossopyrosis (burning tongue), tremor of the tongue

Question 17

(Thyroid malfunction) Cretinism: describe condition and associated hormones

Answer 17

HYPOfunction: (thyroid hormone)
Cretinism: (Congenital hypothyroidism)
Oral manifestations: Large, often protruding tongue, sometimes crenated, delayed development and eruption of teeth, caries and periodontal disease (2o to severe mental retardation)

Question 18

(Thyroid malfunction) Myxedema: describe condition and associated hormones

Answer 18

HYPOfunction: (thyroid hormone)
Myxedema (Acquired hypothyroidism)
Oral manifestations: enlarged tongue, lingual thyroid nodule

Question 19

Describe the characteristics, location and hormones secreted by the parathyroid glands.

Answer 19

4-6 small glands located bilaterally in the anterior neck, beneath and often incorporated into the thyroid gland
Responsible primarily for regulation of serum and extracellular fluid calcium levels
Hormone produced is parathormone
Control of serum calcium via phosphate diuresis and intestinal reabsorption of calcium

Question 20

(Parathyroid malfunction) HYPERparathyroidism: describe condition and associated hormones

Answer 20

HYPERfunction: (PTH)
Hyperparathyroidism
Oral manifestations: Radiolucent lesions in the jaws, often multiple, loss of normal bone trabecular pattern: Ground glass, loss of lamina dura

Question 21

(Parathyroid malfunction) HYPOthyroidism: describe condition and associated hormones

Answer 21

HYPOfunction: (PTH)
Hypoparathyroidism
Oral manifestations: Partial anodontia, malformed or hypoplastic teeth, increased susceptibility to candidiasis

Question 22

Describe the characteristics, and location of the adrenal glands

Answer 22

2 paired glands found at the superior pole of the kidneys-2 divisions: cortex and medulla

Question 23

Describe function and hormones associated with the cortex of the adrenal glands

Answer 23

Cortex:
Responsible for electrolyte balance, fluid balance, stress management, control of inflammatory responses
Hormones produced:
Mineralocorticoids (Aldosterone): Electrolyte (sodium, chloride, potassium, and bicarbonate) and fluid balance
Glucocorticoids (Cortisol primarily): Glucose utilization (stress management) and control of inflammatory responses

Question 24

Describe function and hormones associated with the medulla of the adrenal glands

Answer 24

Medulla:
Responsible for regulation of cardiac output and blood pressure
Hormones produced are epinephrine and norepinepherine

Question 25

(Adrenal gland malfunction-cortex) Cushing's syndrome: describe condition and associated hormones

Answer 25

HYPERfunction (adrenal cortical hormones) Cushing’s Syndrome: Oral manifestations:“Moon” face, decreased mobility of tongue and muscles of mastication

Question 26

(Adrenal gland malfunction-cortex) Waterhouse-Friderichsen's disease: describe condition and associated hormones

Answer 26

HPYOfunction (adrenal cortical hormones) Waterhouse-Friderichsen’s Disease (Acute Adrenocortical Insufficiency): Sudden onset usually followed by death within 3 days No oral manifestations

Question 27

(Adrenal gland malfunction-cortex) Addison's disease: describe condition and associated hormones

Answer 27

HPYOfunction (adrenal cortical hormones) Addison’s Disease (Chronic Adrenocortical Insufficiency: Major potential complication of dental treatment is Addisonian crisis Oral manifestations:Bronzing of the skin of the face, multiple macular pigmented lesions of the oral mucosa

Question 28

(Adrenal gland malfunction-medulla) Pheochromocytoma: describe condition and associated hormones

Answer 28

HYPERfunction (adrenal medulla hormones) Almost 100% of cases are caused by pheochromocytoma No oral manifestations

Question 29

Describe the characteristics, location, and hormones secreted by the pancreas.

Answer 29

The Endocrine Pancreas Small islands of cells (the Islets of Langerhans) scattered within the parenchyma of the exocrine pancreas.

Question 30

Classify the four major cell types of the pancreas by function: alpha, beta, delta and PP cells.

Answer 30

α (alpha) cells: produce glucagon (mobilizes glucose) β (beta) cells: produce insulin (stores glucose) δ (delta) cells: produce somatostatin (counteracts growth hormone, among other functions)—see Growth Hormone under Pituitary Gland PP cells: produce pancreatic polypeptide (modulates intestinal function)

Question 31

(Pancreas malfunction) hypoglycemia: describe condition and associated hormones

Answer 31

HYPERfunction (excess insulin/inadequate glucagon) Hypoglycemia No oral manifestations

Question 32

(Pancreas malfunction) Diabetes mellitus: describe condition and associated hormones

Answer 32

HYPOfunction (inadequate insulin/excess glucagon) Diabetes mellitus Diabetic coma is potential life threatening complication that can be exacerbated by dental treatment Diabetic coma is potential life threatening complication that can be exacerbated by dental treatment Oral manifestations: Delayed healing, predisposition to development of infections, predisposition to development of periodontal disease

Question 33

What are some oral manifestations associated with HYPERfunction of the gonads?

Answer 33

Predisposition to gingival hyperplasia

Question 34

What are some oral manifestations associated with HYPOfunction of the gonads?

Answer 34

Predisposition to development of oral pigmentations due to concomitant secretion of MSH from the pituitary gland

Question 35

Melasma (AKA Chloasma gravidarum, Pregnancy pigmentation)

Answer 35

Diffuse, often irregular pigmentation Face commonly involved: Midface, malar eminences, forehead Any exposed skin surface may be affected Etiology related to excessive MSH secretion in concert with LH Intraoral manifestations are rare but can occur in areas of chronic trauma

Question 36

Drug-induced pigmentation associated with birth control pills

Answer 36

Estrogen content causes increased LH secretion from pituitary gland Concomitant secretion of MSH predisposes to increased pigmentation Pattern of pigmentation mirrors that seen in melasma: Irregular, sometimes spotty pigmentation, sun exposed surfaces of skin, face is most common site, forehead, malar eminences Periorally Intraoral pigmentations may also be seen in areas of chronic trauma

Question 37

Post-menopausal pigmentation

Answer 37

Lesions very similar to melasma Tendency to occur on sun-exposed skin Face, arms, hands Decreased hormone production by the ovaries stimulates increased FSH secretion from pituitary with concomitant MSH secretion