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Endocrine Disorders 2 Flashcards

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1
Q

What feedback mechanism controls hypothalamic and pituitary hormone secretion

A

Negative

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2
Q

What hormones work on the thyroid gland

A

TRH - Thyroid releasing hormone (from hypothalamus)

TSH - thyroid stimulating hormone (from pituitary)

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3
Q

What hormones work on the Adrenal Cortex

A

CRH - corticotrophin releasing hormone (from hypothalamus)

ACTH - Adrenocorticotrophic hormone (from pituitary)

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4
Q

What hormones does the adrenal cortex release

A

Glucocorticoids

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5
Q

What hormones work on the Gonads

A

GnRH - Gonadotrophin releasing hormone (from hypothalamus)

FSH - Follicle stimulating hormone and LH - luteinising hormone (From pituitary)

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6
Q

What are the mechanisms by which endocrine disorders manifest themselves

A

– Overproduction of hormones
– Underproduction of hormones
– Normal function but structural defect for e.g. compression due to enlargement

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7
Q

What are the causes/aetiology of endocrine disorders

A

– Primary dysfunction of gland
– Secondary dysfunction of gland ( over or understimulation by other gland or exogeneous hormones)
– Receptor dysfunction

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8
Q

Where is the thyroid gland located

A

Just below the cricoid cartilage of the pharynx come bop bop

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9
Q

What hormones does the thyroid hormone release

A

Thyroxine hormones T4, T3

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10
Q

What are the target organs of the thyroid gland

A 
Brain
Bone
Heart
Gut
Skin
Metabolism
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11
Q

Where are the adrenal glands found

A

Both are found on top of the kidneys

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12
Q

What part of the adrenal glands produce which hormones

A
  • Cortex - Androgens

- Medulla - Cortisol, Aldosterone, Adrenaline

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13
Q

What adrenal disorders cause overproduction

A
  • Cushing’s Syndrome

- Phaeochromocytoma

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14
Q

What adrenal disorders cause underproduction

A

Addison’s disease

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15
Q

What kind of disorder is addison’s disease and what can it be associated with

A

Autoimmune

Can be associated with TB and sarcoidosis

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16
Q

What can cause secondary addisons disease

A

Pituitary not producing enough ACTH

Exogenous Steroids

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17
Q

What are the physiological actions of cortisol

A

– Anti-inflammatory and immunosuppressive actions
– Stress response
– Metabolism
■ Gluconeogenesis

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18
Q

What can happen if we produce excess steroid hormones/cortisol

A

– Stimulates hepatic gluconeogenesis and glycogenlysis- elevated blood glucose
– Stimulates proteolysis- muscle wasting
– Sodium retention , potassium loss- limb/facial swelling
– Stimulates lipolysis-Dyslipidaemia
– hypertension

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19
Q

What are the clinical features of Addison’s disease

A
  • Hypotension
  • Hypoglycaemia
  • Weight loss
  • Lethargy
  • Anorexia
  • Abdominal pain
  • Skin and oral pigmentation (Increase MSH and ACTH)
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20
Q

How can exogenous steroids cause secondary adrenal insufficiency

A
  • Mainly for patients on long term systemic steroids
  • Can cause suppression of HPA axis upon discontinuation
  • Should taper down the dose
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21
Q

What is an Addisonian crisis

A

– New presentation
– Precipitated by infection
– Non-compliance with medication
– Poor absorption of steroids (diarrhoea)
– Life-threatening if untreated (medical emergency)

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22
Q

Why must oral infections be managed aggressively in patients with adrenal insufficiency

A

To prevent an acute adrenal insufficiency - addison ian crisis

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23
Q

What is the steroid cover for major procedures

A

– IM Hydrocortisone 100mg QDS, 1 hr prior to treatment on day of surgery and until oral intake satisfactory
– Once oral intake satisfactory, double oral dose for 3-5 days
– Consult endocrine specialist for individualised plan

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24
Q

What is the steroid cover for minor procedures

A

Take double oral steroid dose at same time (24 hour should be sufficient)

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25
What are some steroid precautions that you should be aware of
– Steroid card, bracelet – Emergency intramuscular Hydrocortisone pack – Sick day rules
26
Where are the parathyroid glands
They're like 4 nodules on the back side of the thyroid
27
What do the parathyroid hormones release and what effect does this hormone have
Parathyroid hormone - regulates the calcium levels in the blood
28
What can Primary hyperparathyroidism be caused by
– Parathyroid adenoma – Parathyroid hyperplasia including genetic familial HP, MEN – Parathyroid carcinoma
29
What can secondary hyperparathyroidism be caused by
– Vitamin D deficiency | – Chronic renal failure
30
What are the clinical features of hyperparathyroidism except the osmotic symptoms
Moans, stones, bones, groans and psychiatric overtones” – Abdominal pain, constipation – Renal stones – Bone pain, osteopaenia and osteoporosis – Lethargy, fatigue – Confusion, memory impairment, depression, hallucinations
31
What are the osmotic symptoms of hyperparathyroidism
Polyuria Polydipsia Urinary Frequency
32
LEARN THE INVESTIGATION RESULTS FOR PRIMARY AND SECONDARY HYPERPARATHYROIDISM ON LECTURE
DO IT
33
What is the treatment for primary hyperparathyroidism due to parathyroid adenoma
parathyroidectomy
34
What is the treatment for primary hyperparathyroidism due to hyperplasia
Drug Cinacalcet
35
What is the treatment for secondary hyperparathyroidism
Treat underlying cause
36
Name some oral manifestations of patients with hyperparathyroidism
- Loosening and drifting of teeth - Alterations in dental eruption - Partial loss of lamina dura - Malocclusions - periodontal ligament widening - Obliteration of pulp chamber by pulp stone
37
Name some oral manifestations of patients with hypoparathyroidism
- Enamel hypoplasia - Delayed eruption - poorly calcified dentin - widened pulp chambers - malformed roots - chronic candidiasis - Hypodontia + microdontia
38
What are the dental aspects of brown tumours
``` – Benign – Radiolucent – Abnormal bone metabolism – Extensive bone resorption replaced by fibrovascular tissue and giant cells ```
39
What parts of the pituitary gland secrete what hormones
``` Anterior = ACTH, TSH, GH, Prolactin, Gonadotrophins (LH and FSH) Posterior = ADH and Oxytocin ```
40
Where does the negative feedback come from for the pituitary gland
the hypothalamus
41
What is Acromegaly
Excess growth hormone
42
What is cushing's syndrome caused by
excess cortisol
43
What are the causes/aetiology of cushing's syndrome
– Adrenal Cushing’s syndrome – Pituitary Cushing’s disease – Ectopic ACTH production
44
What investigations can be done for cushing's syndrome
– Midnight Cortisol, Cortisol Day Curve – Low Dose Dexamethasone Suppression test, Overnight Dexamethasone suppression test – MRI adrenal/pituitary – Pituitary catheter
45
What are the treatments for cushing's syndrome
- Surgery - TSS/adrenalectomy - Drugs - Metyrapone, Ketoconazole - Radiotherapy
46
What is there an increased risk of if you have excess cortisol
- Hypertension - Peptic ulcers - Diabetes mellitus - Osteoporosis and myopathy - Immunosuppression - Poor wound healing
47
Where are phaeochromocytomas and paragangliomas found
Phaeochromocytoma - Adrenal | Paraganglioma - Extra Adrenal
48
What do phaeochromocytomas and paragangliomas cause
Excess production of catecholamine
49
What are the clinical features of pheochromocytomas
``` – High blood pressure – Heavy sweating – Headache – Rapid heartbeat (tachycardia) – Tremors – Paleness in the face (pallor) – Shortness of breath (dyspnoea) – Pre-syncope or syncope – Feeling of impending doom ```
50
What dental aspects are there for patients with overactive pituitary glands and phaenochromocytoma etc
- Hypertension and risks of uncontrolled hypertension - Alpha Blocker increases bleeding risks - Drugs to avoid as may precipitate a crisis: Opiates, MAOi, cocaine, metochlopramide
51
What treatments are there for phaemochromocytoma
Drugs - Alpha blocker, followed by beta blockers Surgery - Adrenalectomy or removal of paraganglioma
52
What modifications for dentistry are there for Hypertension and Peptic Ulcers
Hypertension - Blood pressure should be routinely monitored Peptic ulcers - avoid aspirin and NSAIDs
53
What modifications for dentistry are there for Diabetes Mellitus and Poor Wound Healing
Diabetes Mellitus - Regular assessment of periodontal health Poor Wound Healing -Adequate antibiotic cover following major surgical procedure
54
What modifications for dentistry are there for Osteoporosis + Myopathy
* Dentures may need frequent readjustments | * Accommodate for limited mobility
55
What modifications for dentistry are there for Immunosuppression
• Assess and treat for opportunistic infections e.g oral candidiasis, hairy leukoplakia , herpes virus infection
56
What are the cardiovascular effects of thyroid hormones
- Increases heart rate - Increases the force of cardiac contractions - Increases cardiac output as a result of the previous two effects - Promotes peripheral vasodilation
57
What are the GI effects of thyroid hormones
- Increases appetite - Increases secretion of digestive juices - Increases gastric motility
58
What are the haematopoietic effects of thyroid hormones
Influences erythropoiesis
59
What are the cardiovascular clinical features for hyperthyroidism vs hypothyroidism
Hyper - tachycardia, atrial fibrillation | Hypo - Bradycardia
60
What are the Metabolism clinical features for hyperthyroidism vs hypothyroidism
Hyper - weight loss, increased hunger | Hypo - Weight gain
61
What are the GI clinical features for hyperthyroidism vs hypothyroidism
Hyper - Diarrhoea | Hypo - Constipation
62
What are the Skin clinical features for hyperthyroidism vs hypothyroidism
Hyper - Palmar sweating, hair loss | Hypo - Dry skin, hair loss
63
What are the neurological/psychiatry clinical features for hyperthyroidism vs hypothyroidism
Hyper - anxiety, insomnia, restless | Hypo - Poor concentration/memory, Reduced fetal brain development
64
What are the skeletal/muscle clinical features for hyperthyroidism vs hypothyroidism
Hyper - Proximal muscle weakness | Hypo - Proximal muscle weakness
65
What are the reproductive clinical features for hyperthyroidism vs hypothyroidism
Hyper - Infertility, oligo/amenorrhoea | Hypo - Infertility, oligo/amenorrhoea
66
What are the Temperature clinical features for hyperthyroidism vs hypothyroidism
Hyper - Intolerant of heat | Hypo - Intolerant of cold weather
67
What are the investigations and results for hyper and hypothyroidism
``` T4, T3 - - Hyper - elevated - Hypo - low TSH - - Hyper - Suppressed - Hypo - elevated ```
68
What drugs can be used for hyperthyroidism
- Beta blockers to slow heart rate | - Antithyroid medication such as carbimazole and propylthiouracil
69
What drugs can be used for hypothyroidism
Thyroxine replacement
70
What are the dental aspects of Hyperthyroidism
- Increased susceptibility to caries - Increased susceptibility to periodontal disease - Enlargement of extra glandular thyroid tissue (lat posterior tongue) - Burning mouth syndrome - Accelerated dental eruption - Maxillary and mandibular osteoporosis - Mouth ulcers due to antithyroid medication
71
What are the dental aspects of hypothyroidism
Congenital Hypothyroidism - - delayed dental eruption - Macroglossia - Microganthia - Malocclusion - Glossitis - Dysgeusia - poor wound healing

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