Endocrine Disorders Quiz

Endocrine Disorders

• The endocrine system comprises integrated glands and cells secreting hormones.
• Hormone secretion is regulated by feedback mechanisms.
• Hormone levels in the blood trigger mechanisms that control hormone production.
• Diseases arise from either too much or too little hormone production.

Hyperpituitarism

• Excessive hormone production originates from the anterior pituitary gland, frequently due to a benign pituitary tumor (adenoma).
• Growth hormone overproduction before bone closure leads to gigantism.
• Overproduction during adulthood results in acromegaly.
• Symptoms include poor vision, light sensitivity, enlarged hands/feet, and increased rib size.
• Facial changes: maxilla and mandible enlargement causing tooth separation and malocclusion; frontal bossing and enlarged nasal bones leading to voice deepening.
• Mucosal changes: thickened lips and macroglossia.

Diagnosis and Treatment of Hyperpituitarism

• Diagnosis entails measuring growth hormone levels.
• Treatment typically involves pituitary gland surgery.

Hyperthyroidism (Thyrotoxicosis)

• Excess thyroid hormone production is more prevalent in women.
• Graves' disease, an autoimmune condition, is a frequent cause.
• Another cause is the over-stimulation of the thyroid gland due to hyperplasia (overgrowth) or the presence of benign/malignant tumors.

Clinical Features of Hyperthyroidism

• Rosy complexion, hand erythema, excessive sweating, fine hair, and softened nails.
• Possible exophthalmos (bulging eyes).
• Patients may also experience anxiety, weakness, restlessness, and cardiac issues.

Oral Manifestations of Hyperthyroidism

• Premature exfoliation of deciduous teeth in children.
• Premature eruption of permanent teeth.
• Accelerated caries and periodontal disease.
• Potential burning tongue sensations.
• Increased risk for connective tissue diseases such as Sjogren's syndrome or SLE.

Treatment of Hyperthyroidism

• Treatments may include surgery, medications to suppress thyroid activity, or radioactive iodine administration.

Hypothyroidism

• Lowered thyroid hormone output.
• Causes span from developmental abnormalities, autoimmune issues, and iodine deficiency to drug-related or pituitary gland problems.
• Cretinism: hypothyroidism onset in infancy/childhood.
• Myxedema: hypothyroidism onset in older children/adults.
• Oral manifestations: thickened lips, enlarged tongue, and delayed tooth eruption in infants; enlarged tongue in adults.
• Other oral manifestations: enamel hypoplasia in both dentitions, anterior open bite, macroglossia, micrognathia, thick lips, dysgeusia, and mouth breathing in patients.

Dental Management in Hypothyroidism

• Requires medical consultation due to potential complications.

Hyperparathyroidism

• Excessive parathyroid hormone secretion from the parathyroid glands, situated close to the thyroid.
• Parathyroid hormone controls calcium and phosphorus metabolism.
• Hyperparathyroidism is characterized by elevated blood calcium (hypercalcemia) and lowered blood phosphorus (hypophosphatemia).
• Can result from hyperplasia, benign/malignant tumor of parathyroid gland(s).
• More prevalent in middle-aged women.

Clinical Features of Hyperparathyroidism

• Mild cases may be asymptomatic or present with joint pain/stiffness.
• Severe cases may cause lethargy and coma.

Oral Manifestations of Hyperparathyroidism

• Well-defined unilocular or multilocular radiolucencies (microscopically, central giant cell granulomas).
• Bone may exhibit a mottled appearance.
• Potential dental abnormalities include widened pulp chambers, developmental defects during dental eruption, weak teeth and malocclusions.
• Loss of bone density.
• Soft tissue calcifications.

Diagnosis and Treatment of Hyperparathyroidism

• Diagnosis involves measuring parathyroid hormone and related blood measurements (like calcium and phosphorus).
• Treatment involves addressing the cause, which may consist of tumors, kidney diseases, or vitamin D deficiency.

Diabetes Mellitus

• Chronic disorder of carbohydrate metabolism resulting in abnormally high blood glucose levels.
• Caused by insufficient insulin, ineffective insulin action, or increased insulin resistance (possibly due to obesity).
• Glucose normally stimulates insulin release from pancreatic beta cells.
• Insulin facilitates glucose uptake by fat and muscle tissues for energy.

Diabetes Mellitus (Type 1)

• Autoimmune disease destroying insulin-producing beta cells.
• Impacts 3-5% of diabetics.
• Can manifest at any age, peaking in the 20s.
• Rapid-onset symptoms: Polydipsia (excessive thirst), polyuria (excessive urination), polyphagia (excessive eating), and possible weight loss, despite increased appetite.
• Requires lifelong insulin therapy.

Diabetes Mellitus (Type 2)

• Characterized by insulin resistance.
• Represents 95% of diabetic cases.
• Commonly develops in adults (35-40 years and older).
• Often associated with obesity, which reduces receptor sensitivity to insulin.
• Diet and weight management can often control symptoms; some require oral hypoglycemic agents.
• Gradual symptom onset.

Risk Factors for Type 2 Diabetes

• Age (over 45)
• Family history (parent, sibling with diabetes)
• Gestational diabetes/large babies at birth.
• Heart disease
• High cholesterol
• Obesity
• Lack of exercise
• Polycystic ovary syndrome (women)
• Previous impaired glucose tolerance

Clinical Features of Non-Insulin-Dependent Diabetes Mellitus

• Atherosclerosis can affect blood vessel walls leading to impaired circulation and oxygenation to tissues.
• Potential for gangrene, high blood pressure, kidney failure, and stroke.
• Diabetic retinopathy potentially causing blindness.
• Potential nervous system damage and increased infection susceptibility.

Oral Complications of Non-Insulin-Dependent Diabetes Mellitus

• Increased prevalence of oral candidiasis (yeast infection).
• Rare risk of mucormycosis (rare fungal infection).
• Bilateral asymptomatic parotid gland enlargement.
• Xerostomia (dry mouth).
• Accentuated response to plaque.
• Slow-healing injuries.

Symptoms of Diabetes

• Type 1: rapid symptom onset (fatigue, increased thirst, etc.)
• Type 2: gradual symptom onset (blurred vision, fatigue, etc.)

Main Oral Health Problems associated with Diabetes

• Increased risk for gingivitis and periodontitis.
• Susceptibility to infections and slow wound healing.

Other Oral Problems associated with Diabetes

• Thrush (oral yeast infection)
• Dry mouth and potential lesions (ulcers)
• Cavities.
• Enlarged/inflamed gums.

Oral Complications of Diabetes (cont.)

• Altered oral flora (changes in bacteria).
• Increased caries rate.
• Salivary dysfunction.

Periodontal Disease (Diabetes)

• Increased prevalence of periodontal disease in uncontrolled diabetes.
• Reduced healing in poorly managed diabetes.
• Periodontal management can contribute to better glycemic control.

Salivary Dysfunction & Xerostomia (Diabetes)

• Dry mouth (xerostomia) from decreased salivary gland function.
• Role of saliva: digestion, oral health maintenance, avoiding decay), and potential damage to salivary glands from neuropathy.

Dental Caries (Diabetes)

• Increased prevalence of dental caries due to salivary hyperglycemia.

Oral Candidiasis (Diabetes)

• Opportunistic fungal infection is increased with hyperglycemia.
• Salivary dysfunction compromises immune function.
• Increased salivary glucose is a growth substrate for fungi.

Burning Mouth Syndrome (Diabetes)

• Chronic burning pain in the mouth of undetermined origin.
• Potentially impacts tongue, gums, lips, and other oral areas.

Patient Management: Diabetes Mellitus

• Regular appointments, including early morning dental visits, are crucial.
• Post-operative care should include antimicrobial/antibiotic therapy after dental procedures.
• Avoiding smoking is crucial for wound healing.

Addison's Disease

• Chronic insufficiency of the adrenal cortex.
• Initial symptoms include increasing pigmentation of exposed skin areas (face, hands), sometimes appearing as light brown or bronze discoloration.

Addison's Disease (cont.)

• Common symptoms include fatigue, lightheadedness, especially when standing, muscular weakness, fever, and weight loss; difficulty standing; anxiety, nausea, vomiting and/or diarrhea/headache/sweating.
• Spot or stripes on the mucous membrane areas (inside of mouth; palate; gums).

Addison's Disease (cont.)

• Differentiated from the following similar ailments: multiple melanotic macules, smoker's melanosis, Peutz-Jeghers syndrome, heavy metal poisoning, post-inflammatory hyperpigmentation, and congenital oral pigmentation.

Addison's Disease (cont.)

• Treatment: Replacing insufficient cortisol (hydrocortisone) and aldosterone.
• Prognosis: Excellent with appropriate treatment.
• Untreated, or poorly managed, cases may result in an Addisonian crisis.

Pre- and Post-operative Considerations for Steroid-Dependent Patients

• Specific dose adjustments for steroids (hydrocortisone) are needed before, and for a period after, dental procedures.