Endocrine Disorders Overview

Endocrine Disorders

• Hormones are substances released by cells, circulated, and affecting distant organs
• Key functions of hormones include growth, homeostasis, and reproduction
• The hypothalamus controls the pituitary gland, which regulates other endocrine glands

Pituitary Gland

• The anterior lobe produces hormones such as ACTH, MSH, TSH, GH, FSH, LH, and Prolactin
• The posterior lobe produces ADH (antidiuretic hormone)

Hypothalamus and Pituitary Gland Cascade

• Hypothalamus controls the pituitary, which controls other endocrine glands
• Endocrine systems are closed loops, often regulated by negative feedback
• Intrinsic biological clocks, light/dark cycles, and menstrual cycles influence endocrine functions
• Cortisol secretion is stimulated by the hypothalamus and pituitary, but cortisol inhibits their secretion
• Example disorders: Hypopituitarism and Hyperpituitarism

Hypopituitarism

• Etiology: Congenital, infection, tumor, trauma, or irradiation, idiopathic
• General Manifestations: Impaired child growth (↓ GH), hypoadrenocorticism (↓ ACTH), hypothyroidism (↓ TSH), failure of ovulation/menstruation (↓ FSH), impotence (↓ LH), lactation failure (↓ prolactin).
• Growth Hormone (GH) Function: Acts on the liver, stimulating IGF-1 release, stimulating amino acid uptake, and protein synthesis, ultimately increasing cell growth, especially in muscle and bone, and stimulating fat breakdown.
• Growth Hormone Deficiency (Dwarfism): Short stature in children with a slower-than-normal growth rate, bone age often lagging behind chronological age.
• Oral Manifestations: Abnormal jaw growth, microdontia (small teeth), delayed teeth shedding/eruption, and crowding/malocclusion leading to higher plaque accumulation and potential oral hygiene problems.
• Hypo-pituitary Coma: Stress, surgery, general anesthesia, infections, or trauma can trigger the condition, managing the hypo-pituitary coma requires immediate medical attention with intravenous hydrocortisone, dextrose, and oxygen.

Hyperpituitarism

• Children (before epiphyseal closure, Gigantism): Well-proportioned individuals with excessive height and body size.
• Adults (after epiphyseal closure, Acromegaly): Enlarged hands, feet, and facial features, often with large tongues, difficulty chewing, and noticeable teeth spacing, and potentially problematic dental extractions.
• Oral Manifestations: Overgrowth of the mandible (macrognathia and prognathism), spacing between teeth often leading to food impaction and teeth fracture and possible extractions.

General features of acromegaly:

• Marked thickening of eyebrows, supraorbital ridges,

• Enlargement of soft tissues around the pharynx and larynx,

• Hypertrophy of sebaceous and sweat glands,

• Cardiomegaly (enlarged heart) and hypertension,

• Abnormal glucose tolerance,

• Large nose, sinuses, jaws, hands, and feet,

• Galactorrhea (excessive breast milk in non-pregnant/nursing women) and sexual dysfunction.

• Oral Manifestations: Enlargement of the Mandible (Macrognathia), prognathism (Class III malocclusion), tooth spacing, hypercementosis, lips enlargement, and macroglossia.

• Systemic issues: hypertension, diabetes, cardiomegaly, and heart failure, hypercalcemia, and osteoarthritis complicate dental treatment

• Hypersensitivity implications: difficulty breathing and swallowing complications, possible dangers of general anesthesia, and need for caution.

Thyroid Gland

• Located: the base of the neck
• Embryology: Originates from the base of the tongue, descends into the mid-line of the neck
• Physiology: Affects every cell in the body. Its hormones (T3 and T4) regulate metabolism, influence growth/development, and have permissive effects on other hormones (e.g., adrenaline).
• Thyroid Hormone Function: Increase the rate of metabolism in cells, accelerating carbohydrate utilization, enhancing lipolytic reactions, producing heat, promoting growth and development, including physical and mental development, protein synthesis, and bone growth. Crucial to cardiovascular, CNS function, and other important body processes.

Hyperthyroidism

• Etiology can be immunologic (like Graves' disease) or other causes (like tumors of the thyroid)
• Types include Grave's disease (diffused enlargement and exophthalmos/bulging eyes) and nodular goiter (less severe enlargement)
• Diagnosis: Low TSH (thyroid stimulating hormone) levels, an overproduction of T4 and/or T3 is indicative.
• Additional Diagnostic Methods: Ultrasonography, computed tomography, MRI, fine-needle biopsy, and auto-antibody profile test to assess thyroid function and related issues.

Hypothyroidism

• Types: Cretinism (infants with congenital gland absence/low iodine intake in maternal diet) and Myxedema (adults).
• Cretinism: Developmental retardation, mental retardation, delayed teeth eruptions, micrognathia, macroglossia, and malocclusion.
• Myxedema: Cold intolerance, decreased sweating, hair loss, dry and cold skin, decreased appetite, weight gain, slowed reflexes, bradycardia, voice hoarseness, poor memory, chronic fatigue.
• Oral Manifestations: Facial edema, macroglossia, compromised periodontal and oral health are significant oral manifestations.

Thyroid Crisis (Storm)

• Definition: Exaggerated manifestation of hyperthyroidism
• Precipitating Factors: Stress, infection, surgery, pain, and trauma
• Clinical Manifestations: Nausea, vomiting, excessive sweating, tremors, tachycardia, fever, and hypotension or low blood pressure
• Management: Medical interventions (e.g., hydrocortisone, glucose, ice packs, anti-thyroid drugs, and adrenergic antagonists).

General Dental Implications

• Precipitating factors: Trauma, surgery, infection, and general anesthesia are factors often associated with complications.

• Manifestations: Hypothermia, hypotension, bradycardia, and epileptic seizures, potential complications in patients with thyroid disorders.

• Management: Prompt medical intervention with considerations like artificial respiration and hydrocortisone to ensure patient safety and stabilization.

• Important Note: Avoid procedures with patients with thyroid disorders and incomplete treatments until they are fully stabilized by medical professionals to avoid potential complications. Local anesthetics should be free from adrenaline (epinephrine).