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Flashcards in Endocrine Disorders Deck (34):
1

Name 4 endocrine disorders?

Diabetes mellitus
Adrenocortical disorders
Adrenal medlla disorders
Thyroid disorders

2

What is diabetes mellitus?

Commonest endocrine disorder - 4% population
Impaired glucose utilisation (resistance or deficiency)
Consistently hyperglycaemic
Juvenille onset = IDDM, Adult onset = NIDDM

3

How do you diagnose diabetes mellitus?

random blood glucose (>11mmol/L)
fasting blood glucose (>7mmol/L)
glycosylated haemoglobin (HbA1c)

4

How can we treat diabetes mellitus?

diet, insulin, oral hypoglycaemics, sulphonylureas, biguanides

5

How does diabetes present oro-facially?

perio disease
infections
xerostaemia
sialosis
glossitis
lichenoid drug reactions

6

What are the complication associated with diabetes mellitus?

GENERAL :
retinopathy, cataracts, foot ulcers, gangrene
ACUTE :
hypoglycaemia, hyperglycaemia (diabetic ketoacidosis)
CHRONIC :
atheroma - ischaemic heart disease, CVA
infections - S. aureus and C. albicans
renal disease - UTI,
neural - motor / sensory polyneuropathy

7

Describe hypoglycaemia and what are the symptoms and treatment?

Known diabetic
Too much insulin
Too little food
Exercise
Alcohol
SYMPTOMS - fatigue, hunger, sweating, anxiety, aggression, confusion, rapid unconsciousness
TREATMENT :
conscious = 25g glucose
unconscious = 50% dextrose IV or 1mg glucagon IM

8

Describe hyperglycaemia and what are the symptoms?

Undiagnosed diabetic
Too little insulin
SYMPTOMS - fatigue, thirst, polyuria, vomiting, hyperventilation, ketotic breath, slow unconsciousness
TREATMENT:
hospital
fluids, electrolytes and insulin

9

What are adrenocortical disorders?

Adrenocortical hypofunction or adrenocortical hyperfunction

10

What is the normal process of adrenal gland?

pituitary gland - ACTH - kidneys - adrenal gland :
Cortex - cortisol, aldosterone, androgens
medulla - adrenaline

11

What is adrenocortical hypofunction?

A condition where there is an under expression of products of the adrenal cortex
Can be primary or secondary
PRIMARY - autoimmune (Addisons disease)
SECONDARY - hypopituitarism - ACTH deficiency

12

What causes primary adrenocortical hypofunction?

Infections - TB
Bilateral adrenalectomy
Suppression from long term steroid use

13

What are the clinical signs of adrenocortical hypofunction?

weight loss, weakness, hypotension, anorexia, nausea, vomiting, cutaneous and mucosal pigmentation

14

How do we diagnose adrenocortical hypofunction?

low BP
diurnal rhythm of plasma control
synacthen test (ACTH)
autoimmine profile
urea and electrolytes (low Na and high K)

15

How does adrenocortical hypofunction affect dentally?

oral pigmentation
physiological stress as undiagnosed
infections
anaesthesia
surgery
systemis steroids in undiagnosed

16

What is adrenocortical hyperfunction?

A condition where there is an overexpression of products of the adrenal cortex:
High aldosterone - Conns syndrome
High cortisol - Cushings syndrome
Systemic steroids - Cushingoid features

17

What causes Cushings syndrome?

ACTH induced = pituitary tumour
autonomous = adrenal adenoma / carcinoma
High dose steroids = immunosuppression

18

How would adrenocortical hyperfunction be diagnosed?

high BP
diurnal rhythm of plasma control
urea and electrolytes (high Na and low K)
lateral skull to see pituitary fossa
abdominal imaging

19

What are disorders of the adrenal medulla?

Overexpression of products of the adrenal medulla

20

What causes adrenal medulla disorders?

benign tumour - overexpression of adrenaline / noradenaline, episodic hypertension

21

What are the clinical symptoms of adrenal medulla disorders?

anxiety
palpitations
sweating
pyrexia
headaches
goitre - enlargment of the thyroid gland

22

what is the normal process for pituitary to make T4 and T5?

hypothalamus - pituitary - via TSH - thyroid - T4, T5

23

What are thyroid disorders?

The thyroid gland in the neck makes hormones to help regulate the body's metabolism and a person's growth. Problems with the thyroid include hyperthyroidism and hypothyroidism.

24

What causes hypothyroidism?

autoimmune - Hashimotos thyroiditis
Iodide deficiency
Hypopituitarism
Treatment for hyperthyroidism

25

How does hypothyroidism affect dental?

Avoid sedative and opiates, oral candidosis, presence of other autoimmune disorders

26

What causes hyperthyroidism?

Adenoma - toxic goitre
Graves disease - anitbodies against TSH receptor
Innapropriate thyroxine therapy

27

What is the treatment for hyperthyroidism?

Partial thyroidectomy
anti thyroid drugs (carbimazole)
radioactive iodine
post treatment hypothyroidism

28

How does hyperthyroid affect dental?

anxiety, irratibility, avoid GA, (LA contains adrenaline)

29

What are the parathyroids?

Produce PTH which regulates normal plasma calcium

30

What are the 2 disorders for the parathyroids?

Hypoparathyroidism and hyperparathyroidism

31

Describe hypoparathyroidism?

Generalised osteoporosis
Focal bone resorption - brown tumour
metastatic calcification - renal stones

32

Describe hyperparathyroidism?

Tetany
Facial twitch - Chvosters sign
Facial parasthesia

33

What is acromegaly?

hyperplasia or neoplasia of anterior pituiatry (prolonged and excessive secretion of growth hormone)

34

What are the signs of acromegaly?

reactivation of bone growth in adults
SKULL - enlarged, thickened, visual disturbances
JAWS - prognathic
HANDS / FEET - soft tissues thicken and enlarge