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BDS2 BAMS > endocrine diseases > Flashcards

endocrine diseases Flashcards

1
Q

where is the pituitary gland located?

A

sella turcica

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2
Q

what does the hypothalamus secrete

A
  • corticotrophin rh
  • gonadotrophin rh
  • prolactin rh
  • growth hormone rh
  • thyrotrophin rh
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2
Q

what does the posterior and anterior pituitary gland secrete

A

posterior
- ADH (vasopressin)
- oxytocin

anterior
- adrenocorticotropic h
- follicle stimulating
-luteinizing
- thyroid stimulating
- growth
- prolactin
- melanocyte stimulating

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3
Q

significance of the optic chiasm

A

located next to the pituitary gland, where the visual field crosses

if there is swelling or tumour, might have vision problems

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4
Q

what hormones do the renal glands ie kidneys secrete

A

o renin
o erythropoietin
o activate vitamin D

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5
Q

is pancreas an endocrie gland

A

yes 2%
- insulin
- glucagon
- somatostatin

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6
Q

MEN2b

A
  • multiple endocrine neoplasia
  • 2b is relevant for dentistry
  • mucosal neuromas = swelling seen in mouth
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7
Q

how to remove pituitary tumours

A

trans sphenoidal surgery

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8
Q

functional vs non functional adenomas

A

functional = excess hormones created like cuhsings or acromegaly

non function = no production of pituitary hormones, hormone deficiencies

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9
Q

what causes acromegaly

A
  • excess growth hormone in adults
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10
Q

how to test for acromegaly cause

A
  • measure IGF-1 to assess GH
  • if IGF-1 is high after puberty, suggests acromegaly
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11
Q

what does IGF-1 do

A

IGF-1 promotes cell growth and division, especially in bones and muscles during growth phases. It stimulates the growth of muscle tissue, cartilage, and bone.

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12
Q

what dental problems do you see in patients with acromegaly

A

o reverse overbite
o increased interdenal spacing
o enlarged tongue

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13
Q

what are some physical changes you see in patients with acromegaly?

A

large hands and feet
enlarged supraorbital ridges
vision defects
thickened lips and soft tissues
diabetes type 2
CVS problems
acromegalic cardiomyopathy

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14
Q

why do people with acromegaly have type 2 diabetes?

A

insulin resistance from GH

GH promotes more gluconeogenesis and raises blood glucose

increases basal insulin levels

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15
Q

cause of primary hyperthyroidism

A

Graves dieases autoimmune
toxic adenoma
toxic multi-nodular goitre

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16
Q

causes of secondary hyperthyroidism

A

pituitary tumour

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17
Q

causes of primary hypothyroidism

A

hashimoto’s thyroiditis

iodine deficiency

radioiodine tx for hyper causes a change hyper-> hypo

drugs like
- carbimazole
- amiodarone
- lithium

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18
Q

is primary thyoid problems or secondary more rare

A

secondary rarer

primary causes like Graves and hashimotos’ more common

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19
Q

causes of secondary hypothyroidism

A

thyroid disease

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20
Q

signs and symptoms for hyperthyroidism

A

Warm moist skin
Tachycardia
Increased BP
Increased metabolism
Tremor
Eyelid retraction and lid lag
Bulging eyes
Goitre
weight loss
muscle weakness
manic
anxious

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21
Q

signs and symptoms for hyporthyroidism

A

Bradycardia
Confusion
Goitre (Hashimoto’s)
- inflammation of thyroid gland from antibody attack
Tired
Cold
Weight gain
Puffed face
Hair loss

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22
Q

Graves disease what it is and who tends to have it

A

autoimmune disease that causes excess production of thyroid hormone T3

people with family history of autoimmune diseases

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23
Q

common autoimmune disease

A

o vitiligo
o pernicious anaemia
o diabetes mellitus type 1
o coeliac
o myasthenia gravis
o Addison’s disease
o Graves disease
o Hashimoto’s thyroiditis

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24
Q

diffused goitre, proptosis and ophthalmopathy could represent what

A

graves disease

proptosis = eyelids pushed forward in socket due to fat tissue in the orbit

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25
Q

Investigation for thyroid disease

A

1 blood (tsh t3 t4)
2 imaging cysts
3 tissue biopsy

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26
Q

low TSH, high T3

A

pri hyper thyroid

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27
Q

high TSH. high T3

A

sec hyperthyroid

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28
Q

high TSH, low T4

A

primary hypothyroid

29
Q

low TSH, low T4

A

sec hypothyroid

30
Q

myxoedema

A

another name for hypothyroid

31
Q

acromegaly vs giantism

A

acromegaly in adults, giantism in children (too much GH and IGF-1)

32
Q

treatment for hyperthyroid

A
  • carbimazole
  • beta blockers
  • radioactive iodine therapy
  • surgery remove tumour or thyroid gland
33
Q

tx for hypothyroid

A

replacement therapy, give T4 tablets

34
Q

dental aspects of thyroid problems

A
  • detect goitre
  • hyperthyroid patient are more anxious and pain
  • hypothyroid patient should avoid sedatives
35
Q

can thyroid patients use LA?

A

yes no problem

36
Q

carbimazole drug function

A

blocks effect of thyroid hormone, completely block then replace with normal levels of T4

37
Q

addison’s disease what is it

A

too little cortisol due to destruction of adrenal gland

38
Q

cushing’s syndrome vs diseases

A

sydrome = excess cortisol
disease = excess acth

39
Q

is aldosterone a mineralcorticoid or a glucocorticoid

A

aldosterone = mineralcorticoid

glucocorticoid = cortisol

40
Q

Adrenal hormones all synthesized from

A

CHOLESTEROL

41
Q

what drugs block the production of aldosterone

A

ace inhibitors and angiotensin II blockers

42
Q

where is angiotensinogen secreted

A

liver

43
Q

where is renin secreted

A

kidneys

44
Q

what is the function of aldosterone

A

increase bp and water reabsorption

45
Q

is angiotensin a vasoconstrictor or vasodilator

A

vasoconstrictor

RAAS is for aldosterone which increases BP so angiotensin also increases bp by vasoconstriction

46
Q

cortisol function

A
  • at high levels, inhibits growth
  • stimulates protein catabolism
  • suppresses bone growth
  • promotes bone resorption
  • osteoporosis
  • suppresses inflammation
  • raises blood pressure
47
Q

cortisol vs GH

A

raise blood glucose => type 2 diabetes

cortisol causes osteoporosis while GH causes growth of bone

cortisol protein catabolism while GH protein synthesis

48
Q

what are some Corticosteroid drugs

A
  • prednisolone typical and most common (4x more potent than cortisol)
  • triamcinolone
  • dexamethasone
  • betamethasone
49
Q

what do therapeutic steroids do

A

more potent

anti inflammatory

enhanced glucocorticoid and mineralocorticoid effects
o immunosuppression
o salt and water retention
o hypertension

50
Q

adverse effects of corticosteroids drugs

A

o hypertension
o high blood sugar -> type 2 diabetes
o osteoporosis
o infection risk
o hyperlipidaemia (atherosclerosis)

51
Q

what causes cushing’s syndrome

A

adrenal adenoma
adrenal hyperplasia

52
Q

what causes cushings diseases

A

pituitary tumour
spontaneous
ectopic acth from lung tumours

53
Q

signs and symptoms of cushings syndrome

A

Hypertension
Purple striae and thin skin
Osteoporosis
Diabetes type 2
Swollen face and neck (moon face and bufalo bump)

54
Q

signs and symptoms of cushings disease

A

Skin and mucosa pigmentation!!!

from excess acth rather than excess cortisol

55
Q

Low acth
High cortisol

A

cushings syndrome

56
Q

High acth
High cortisol

A

cushings disease

57
Q

addisons disease

A

autoimmune disease that GRADUALLY destroys the adrenal gland, lack of cortisol and aldosterone

58
Q

What is addison’s disease caused by

A

autoimmune adrenalitis 90%

infection

infarction

59
Q

signs and symptoms of addisons disease

A
  • postural hypotension
  • salt and water depletion due to low aldosterone
  • weight loss
  • lethargy
  • hyperpigmentation (only in PRIMARY NOT SECONDARY gland dysfunction)
60
Q

when you see hyperpigmentation on the mucosa, what disease could it be?

A

high acth

  1. could be cushings disease
  2. could be addisons disease PRIMARY (low cortisol despite high acth)
61
Q

investigating cushings

A

o high 24hr urinary cortisol excretion

o abnormal dexamethasone suppression tests

o corticotrophin rh tests

62
Q

investigating addisons

A

o high acth levels with low cortisol levels
o NEGATIVE synACTHen tests

63
Q

synACTHen positive and negative results indicate what

A

Adrenal disease primary high acth low cortisol (negative synACTHen)

Adrenal disease secondary low acth low cortisol (positive synACTHen)

64
Q

how to treat adrenal hyperfunction

A

remove adenomas either from pituitary or adrenal gland surgery

65
Q

how to treat adrenal hypofunction

A
  • cortisol
  • fludrocortisone which is the replacement of aldosterone
66
Q

adrenal crisis when does it occur

A

occurs when replacement therapy is not given to addisons disease patient

lack aldosterone and cortisol

67
Q

what are the symptoms of adrenal crisis

A

o hypotension
o vomiting
o coma
o hypovolaemic shock

68
Q

when do you give steroid prophylaxis? (prophylaxis means to tx to prevent disease)

A
  • infections like dental abscess
  • surgery like wisdom tooth
  • physiological stress not psychological
69
Q

what are some oral manifestations of cushings

A

thrush and candidiasis

70
Q
A

BDS2 BAMS (27 decks)

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