Flashcards in Endocrine Disorders Deck (34):
Name 4 endocrine disorders?
Adrenal medlla disorders
What is diabetes mellitus?
Commonest endocrine disorder - 4% population
Impaired glucose utilisation (resistance or deficiency)
Juvenille onset = IDDM, Adult onset = NIDDM
How do you diagnose diabetes mellitus?
random blood glucose (>11mmol/L)
fasting blood glucose (>7mmol/L)
glycosylated haemoglobin (HbA1c)
How can we treat diabetes mellitus?
diet, insulin, oral hypoglycaemics, sulphonylureas, biguanides
How does diabetes present oro-facially?
lichenoid drug reactions
What are the complication associated with diabetes mellitus?
retinopathy, cataracts, foot ulcers, gangrene
hypoglycaemia, hyperglycaemia (diabetic ketoacidosis)
atheroma - ischaemic heart disease, CVA
infections - S. aureus and C. albicans
renal disease - UTI,
neural - motor / sensory polyneuropathy
Describe hypoglycaemia and what are the symptoms and treatment?
Too much insulin
Too little food
SYMPTOMS - fatigue, hunger, sweating, anxiety, aggression, confusion, rapid unconsciousness
conscious = 25g glucose
unconscious = 50% dextrose IV or 1mg glucagon IM
Describe hyperglycaemia and what are the symptoms?
Too little insulin
SYMPTOMS - fatigue, thirst, polyuria, vomiting, hyperventilation, ketotic breath, slow unconsciousness
fluids, electrolytes and insulin
What are adrenocortical disorders?
Adrenocortical hypofunction or adrenocortical hyperfunction
What is the normal process of adrenal gland?
pituitary gland - ACTH - kidneys - adrenal gland :
Cortex - cortisol, aldosterone, androgens
medulla - adrenaline
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
What causes primary adrenocortical hypofunction?
Infections - TB
Suppression from long term steroid use
What are the clinical signs of adrenocortical hypofunction?
weight loss, weakness, hypotension, anorexia, nausea, vomiting, cutaneous and mucosal pigmentation
How do we diagnose adrenocortical hypofunction?
diurnal rhythm of plasma control
synacthen test (ACTH)
urea and electrolytes (low Na and high K)
How does adrenocortical hypofunction affect dentally?
physiological stress as undiagnosed
systemis steroids in undiagnosed
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
What causes Cushings syndrome?
ACTH induced = pituitary tumour
autonomous = adrenal adenoma / carcinoma
High dose steroids = immunosuppression
How would adrenocortical hyperfunction be diagnosed?
diurnal rhythm of plasma control
urea and electrolytes (high Na and low K)
lateral skull to see pituitary fossa
What are disorders of the adrenal medulla?
Overexpression of products of the adrenal medulla
What causes adrenal medulla disorders?
benign tumour - overexpression of adrenaline / noradenaline, episodic hypertension
What are the clinical symptoms of adrenal medulla disorders?
goitre - enlargment of the thyroid gland
what is the normal process for pituitary to make T4 and T5?
hypothalamus - pituitary - via TSH - thyroid - T4, T5
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.
What causes hypothyroidism?
autoimmune - Hashimotos thyroiditis
Treatment for hyperthyroidism
How does hypothyroidism affect dental?
Avoid sedative and opiates, oral candidosis, presence of other autoimmune disorders
What causes hyperthyroidism?
Adenoma - toxic goitre
Graves disease - anitbodies against TSH receptor
Innapropriate thyroxine therapy
What is the treatment for hyperthyroidism?
anti thyroid drugs (carbimazole)
post treatment hypothyroidism
How does hyperthyroid affect dental?
anxiety, irratibility, avoid GA, (LA contains adrenaline)
What are the parathyroids?
Produce PTH which regulates normal plasma calcium
What are the 2 disorders for the parathyroids?
Hypoparathyroidism and hyperparathyroidism
Focal bone resorption - brown tumour
metastatic calcification - renal stones
Facial twitch - Chvosters sign
What is acromegaly?
hyperplasia or neoplasia of anterior pituiatry (prolonged and excessive secretion of growth hormone)