endocrine

Question 1

what is hyperthyroidism?

Answer 1

too much thyroid hormone is made

causes increased metabolism

e.g. grave’s disease = autoimmune disorder = oedema can be seen in eye

Question 2

hyperthyroidism TSH & T3

Answer 2

LOW TSH
HIGH T3 (T3 build up)

Question 3

hyperthyroidism symptoms

Answer 3

hyperactive
heat intolerance
palpitations
weight loss
diarrhoea
tachycardia

can feel manic, anxious, increased BP

Question 4

hyperthyroidism signs

Answer 4

goitre (neck swelling), atrial fibrillation (tachycardia),
warm moist skin

Question 5

hyperthyroidism test

Answer 5

Test for free T3 & TSH

Gland - low TSH, high T3
pituitary - Raised TSH, raised T3

Question 6

hyperthyroidism treatment

Answer 6

Beta blockers reduce symptoms
Antithyroid drugs: Carbimazole
Surgery (partial thyroidectomy with drug therapy)
Radio iodine

Question 7

what is hypothyroidism?

Answer 7

not enough thyroid hormones made

causes decreased metabolism

e.g. hashimotos thyroiditis
autoimmune destruction of thyroid gland
pituitary tumour so not enough TSH (thyroid stimulating hormone) made
hypothalamus doesn’t make enough thyroid-tropin releasing hormone

Question 8

hypothyroidism TSH and T3?

Answer 8

HIGH TSH
LOW T3 (TSH build up)

Question 9

hypothyroidism symptoms?

Answer 9

tiredness
cold intolerance
slow heart rate
weight gain

Question 10

hypothyroidism signs?

Answer 10

goitre
bradycardia
depression
poor libido
constipation

Question 11

hypothyroidism tests?

Answer 11

Test free T4 & TSH

Gland - LOW TSH, Low T4
pituitary - Raised TSH , Low T4

Question 12

hypothyroidism treatment?

Answer 12

thyroxine (shrinks goitre)

Question 13

cause of hyperthyroidism?

Answer 13

gland failure
pituitary failure (rare)

Question 14

cause of hypothyroidism?

Answer 14

autoimmune
drugs (lithium-mood stabilisers)
treatment of hyper

Question 15

blood tests for thyroid problems

Answer 15

Primary Hyperthyroidism = LOW TSH but HIGH T3
Secondary Hyperthyroidism = HIGH TSH and HIGH T3

Primary Hypothyroidism = HIGH TSH but LOW T4
Secondary Hypothyroidism = LOW TSH and LOW T4

Question 16

hormones secreted in anterior pituitary

Answer 16

TSH - Thyroid Stimulating Hormone
ACTH - Adrenocorticotrophic Hormone
GH - Growth Hormone
LH
FSH
Prolactin

Question 17

hormones secreted in posterior pituitary

Answer 17

ADH - Anti Diuretic Hormone or Vasopressin
Oxytocin

Question 18

hormones secreted in adrenal gland

Answer 18

aldosterone and cortisol

Question 19

tell me about growth hormone disorder

Answer 19

Measure by insulin-like growth factor (IGF-1), it more stable in blood than growth hormone

Under secretion
Children - growth failure
Adults
■ Increase fat storage
■ Decrease tissue repair

Over secretion
Children - Giantism
○ Adults
■ Acromegaly
● Enlarged mandible

Dental:
○ Denture ‘shrunk’
○ Interdental spacing
○ Malocclusion or reversed bite

Question 20

aldosterone ?

Answer 20

Produced in zona glomerulosa
Responsible for salt and water regulation

Inhibitors
■ Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors)
● Can cause oral lichenoid reactions, fat tongue, cough and increased BP

Question 21

cortisol?

Answer 21

Produced in zona fasicularis
Insulin antagonist
Anti-inflammatory
Immunosuppression

Question 22

Cushing’s syndrome symptoms?

Answer 22

diabetes symptoms
hiturism (facial hair in women)
psychiatric disorder

Question 23

Cushing’s syndrome signs?

Answer 23

moon face
increased infection risk
buffalo hump
“lollipop on sticks”
thin skin, easily bruised
melanocytes in oral mucosa

Question 24

Cushing’s syndrome investigations?

Answer 24

■ High 24hr urinary cortisol excretion
■ Dexamethasone suppression tests to see is ACTH is suppressed
■ CRH tests - cushing’s shows rise in ACTH with CRH

Question 25

Cushing's syndrome treatment?

Answer 25

surgery, radiation, chemotherapy, or cortisol-reducing medicines.

Question 26

Cushing's syndrome cause?

Answer 26

hyper - increased cortisol levels most common cause is non cancerous tumour or medications such as steroids

Question 27

Addison's syndrome cause

Answer 27

hypo - decreased cortisol levels the adrenal gland is damaged, and not enough cortisol and aldosterone are produced.

Question 28

Addison's syndrome symptoms

Answer 28

weakness loss of body hair anorexia

Question 29

Addison's syndrome signs

Answer 29

postural hypotension hyperpigmentation unintentional weight loss

Question 30

Addison's syndrome investigations

Answer 30

High ACTH level Negative synACTHen tests

Question 31

Addison's syndrome treatment

Answer 31

■ Addisonian Crisis - hospitalisation ■ Hormone replacement ● Cortisol/hydrocortisone ● Fludrocortisone

Question 32

Dental aspects with adrenal problems

Answer 32

* STEROID precautions may be needed * liase with physician for infections/illness * candidiasis in Cushings * oral pigmentation in Addison’s/Cushings

Question 33

What is a mineral-corticoid?

Answer 33

steroid hormone that is produced by the adrenal cortex and regulates the balance of ELECTROLYTES AND H20 in the body. e.g. ALDOSTERONE acts on the kidney to promote the reabsorption of sodium ions and the excretion of potassium ions regulates blood pressure, blood volume, and electrolyte balance.

Question 34

What is an example of a glucocorticoid?

Answer 34

CORTISOL e.g. prednisone, dexamethasone, and hydrocortisone, which are commonly used to treat inflammation, allergies, and autoimmune disorders.

Question 35

In what clinical situation might you recommend your patient altering their hormone therapy treatment?

Answer 35

patients on glucorticoids can have a different response to anaesthesia and INCREASE THE RISK OF ADRENAL CRISIS during dental procedures. adrenal hormone therapy for conditions such as autoimmune disorders - may increase their risk of oral infections and complications following dental procedures. hypercortisolism or hypoparathyroidism, can cause oral manifestations that may require dental intervention.

Question 36

Hydrocortisone and fludrocortisone. Which one would you recommend a patient take before dental treatment and why?

Answer 36

both given in addisons unable to adapt to stress so require both before to prevent adrenal crisis hydrocortisone = can manage pain or swelling after oral surgery = cortisol equivalent bring a dose forward and take ahead of LA adrenaline LA is suitable fludrocortisone = controls sodium and fluids helps treat adrenal sufficiency and and can help during hypotension or electrolyte imbalances XLAs should be referred to primary care

Question 37

Addisons crisis, what is pulse rate? What is blood pressure?

Answer 37

hypotension < 90/60 mmHg Pulse < 60 beats per minute dehydration serum cortisol < 100 mol/L it is managed with IV hydrocortisone (100mg) and IV fluid rehydration