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2 - Diseases Of The Human System > Endocrine Medicine 1 > Flashcards

Endocrine Medicine 1 Flashcards

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1
Q

What is the extent of endocrine diseases effects?

A

widespread, multisystem effects

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2
Q

What are the two methods of failure?

A

control failure (secondary)
gland failure (primary)

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3
Q

What is an example of a dentally relevant multiple endocrine neoplasia?

what are the characteristics

A

MEN 2b

Medullary Thyroid, Phaeochromocytoma
Mucosal neuromas (small swelling on nerves present in tissue)
Marfanoid appearance

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4
Q

Where is the PG?

A

gland is in a small depression in the middle of the skull base called the sella turcica (turkish saddle)

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5
Q

What are the two types of hormones released from the hypothalamus?

A

primary hormones - hormones from the pituitary act directly on tissues to cause effect e.g, Thyroid, growth hormone,

trophic hormones - releasing hormones e.g. TRH, GnRH, CRH

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6
Q

How are the anterior pituitary and hypothalamus connected?

A

hypothalamic pituitary portal vessels

(vascular plexus into vascular tissue)

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7
Q

How are the posterior pituitary and hypothalamus connected?

A

via nerve axons mainly

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8
Q

What hormones do the anterior pituitary release?

A
  • TSH - Thyroid Stimulating Hormone
  • ACTH -Adrenocorticotrophic Hormone
  • GH - Growth Hormone
  • LH, FSH, Prolactin
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9
Q

What hormones do the posterior pituitary release?

A
  • ADH - Anti Diuretic Hormone
  • Oxytocin
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10
Q

What type of tumour are most pituitary tumours?

A

adenoma
- arise from glandular tissue

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11
Q

What are the two types of adenoma?

A

functional - produces active hormone and obstructs/impinges on other tissue

non functional - may cause pressure/obstruction

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12
Q

What can pituitary tumours cause in the eyes?

A

growth in PG can head upwards and cause pressure to optic chiasm compressing optic nerves and narrowing visual fields

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13
Q

What surgery is used for PG tumour removal?

A

trans-sphenoidal
no need to open the skull and compromise the brain

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14
Q

What is the pathway for GH?

A

hypothalamus > GHRH > anterior pituitary > GH > tissues > IGF-1 > anabolic reactions

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15
Q

What does insufficient growth hormone cause in children?

A

growth failure

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16
Q

What does insufficient growth hormone cause in adults?

A

metabolic changes in adults
- increased fat
- reduced vitality

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17
Q

What does excess growth hormone cause in children?

A

giantism

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18
Q

What does excess growth hormone cause in adults?

A

acromegaly

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19
Q

What is measured to assess GH?

Study These Flashcards
A

IGF-1 - insulin growth factor 1

20
Q

What are the features seen in acromegaly?

Study These Flashcards
A
  • coarse features
  • enlarged hands
  • carpal tunnel syndrome - finger numbness,
  • type 2 diabetes mellitus - insulin resistance from increased GH
  • cardiovascular disease - due to increased load from larger body
21
Q

What are the dental features of acromegaly?

Study These Flashcards
A
  • enlarged tongue
  • interdental spacing (diastema)
  • ‘shrunk’ dentures
  • Reverse overbite
22
Q

What is thyrotoxicosis without hyperthyroidism usually caused by?

Study These Flashcards
A

excess thyroid hormone drugs to promote weight loss

23
Q

What is most hyperthyroidism caused by?

Study These Flashcards
A

graves disease
auto antibodies stimulating the TSH receptor

24
Q

What is toxic adenoma?

Study These Flashcards
A

tumour within thyroid gland producing active hormone

25
What are the features of hyperthyroidism?
moist, sweaty skin weight loss tachycardia increased blood pressure tremors and hyperreflexia eyelid retraction and lid lag
26
What is grave's disease usually caused by?
often a family history of Autoimmune disease
27
What autoimmune diseases are see in family history of patient's with graves disease?
vitiligo pernicious anemia type 1 DM coeliac myaesthenia gravis (autoantibodies against ACh receptors in muscle)
28
What eye conditions occur with grave's disease?
ophthalmopthy * scleral injection * proptosis * periorbital oedema * conjuntival oedema
29
What neck condition occurs with graves disease?
diffuse goitre
30
What is hypothyroidism mostly caused by?
Autoimmune (Hashimoto’s) thyroiditis
31
What other reasons might hypothyroidism occur?
* Idiopathic atrophy (likely autoimmune, more in females) * Radioiodine treatment/ thyroidectomy surgery * Iodine deficiency * Drugs * Congenital * Hypothalamic/pituitary disease
32
What drugs caused hypothyroidism?
carbimazole (used for hyper treatment) amiodarone lithium
33
What are the features of hypothyroidism?
dry, coarse skin bradycardia hyperlipidemia psychiatric or cognitive changes goiter (in Hashimoto's), delayed reflexes.
34
What are the associations of hashimoto's thyroiditis?
* Middle aged & elderly women * often a family history of Autoimmune disease * vitiligo, PA, Type 1 DM, Addisons disease * Down’s syndrome
35
How can thyroid disease be investigated?
* Blood * TSH, T3 & T4 * Imaging * ultrasound scan (cysts) * radioisotope scans - gland uptake (areas producing/not producing hormones) * Tissue * fine needle aspirate/biopsy (FNA & FNB)
36
FNA VS FNB
FNA = needle stuck into gland, some cells sucked out FNB = wide borne needle where core of tissue is trapped within needle itelf and taken away for histological examination
37
If the cause of hyperthyroidism is pituitary, what are the blood indications?
* RAISED TSH * RAISED T3
38
If the cause of hyperthyroidism is graves or adenoma, what are the blood indications?
* LOW TSH (PG stops TSH to reverse high T3 from gland) * RAISED T3
39
If the cause of hypothyroidism is pituitary, what are the blood indications?
* Low TSH * Low T4
40
If the cause of hypothyroidism is hashimoto's, what are the blood indications?
* HIGH TSH (PG tries to compensate but the gland is irresponsive) * Low T4
41
What are treatments of hyperthyroidism?
* Carbimazole * B-blockers (reduce symptoms - tremor, high BP etc) * Radioiodine - 131I * Surgery - partial thryoidectomy
42
How is grave's ophthalmophathy treated?
no treatment as the conditions is not due to the thyroid gland activity but due to thyroid autoantibodies controlled with immunosuppressives/ steriods
43
What is the treatment for hypothyroidism?
* Give T4 tablets (thyroxine) * slow response - weeks * increase dose slowly
44
What mineral deficiency can cause goitre?
iodine
45
What does cancer appear on a radioisotope scan?
cold nodules
46
What are the 3 types of thyroid cancer?
* papillary (80%) or folicular in younger * undifferentiated in elderly
47
What are the dental aspects of thyroid diseases?
* Goitre detectable to the dentist Hyperthyroid * pain anxiety and psychiatric problems * caution for treatment until controlled * Hypothyroid * avoid the use of sedatives if severe

2 - Diseases Of The Human System (19 decks)

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