Endocrinology

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Questions and Answers

Which of the following best describes endocrine glands?

  • Glands that produce and secrete sweat onto the skin surface.
  • Glands that secrete products via a ductal system to an epithelial surface.
  • Glands that secrete products directly into the bloodstream. (correct)
  • Glands that secrete digestive enzymes into the stomach.

Which of the following is NOT a primary function regulated by endocrine glands?

  • Metabolism
  • Growth and development
  • Reproduction
  • Regulation of body temperature (correct)

Which gland secretes melatonin?

  • Adrenal gland
  • Pituitary gland
  • Thyroid gland
  • Pineal gland (correct)

Which hormone is NOT secreted by the pituitary gland?

<p>Thyroid hormone (D)</p> Signup and view all the answers

What is the term for excessive hormone production by an endocrine gland?

<p>Hyper- (D)</p> Signup and view all the answers

Which of the following is NOT a potential cause of endocrine gland dysfunction?

<p>Sedentary lifestyle (C)</p> Signup and view all the answers

Acromegaly is typically caused by an excess of which hormone?

<p>Growth Hormone (GH) (A)</p> Signup and view all the answers

Hypopituitarism can result in which of the following conditions?

<p>Addison’s disease (C)</p> Signup and view all the answers

Diabetes insipidus is most directly related to a deficiency in which hormone?

<p>Antidiuretic Hormone (ADH) (B)</p> Signup and view all the answers

Which condition is associated with exophthalmos (protrusion of the eyeballs)?

<p>Hyperthyroidism (B)</p> Signup and view all the answers

What is the most common cause of hypothyroidism?

<p>Hashimoto's disease (B)</p> Signup and view all the answers

Which of the following is a symptom of hypothyroidism?

<p>Constipation (B)</p> Signup and view all the answers

In children, which oral manifestation is typically associated with hypothyroidism?

<p>Delayed tooth eruption (C)</p> Signup and view all the answers

Which of the following is a potential symptom of hyperparathyroidism?

<p>Kidney stones (B)</p> Signup and view all the answers

What oral manifestation is associated with hyperparathyroidism?

<p>Brown tumors of the jaw (B)</p> Signup and view all the answers

Which manifestation is NOT typically associated with hypoparathyroidism?

<p>Kidney stones (D)</p> Signup and view all the answers

Which of the following is a typical characteristic of endocrine glands?

<p>They secrete hormones into the bloodstream for systemic effects. (D)</p> Signup and view all the answers

Which of the following hormones is produced by the placenta during pregnancy?

<p>Human Chorionic Gonadotropin (hCG) (D)</p> Signup and view all the answers

If a patient presents with polyuria and polydipsia due to a deficiency in ADH, and their condition is not responsive to ADH administration, which type of diabetes insipidus is most likely present?

<p>Nephrogenic diabetes insipidus (C)</p> Signup and view all the answers

A patient experiencing muscle weakness, fatigue, constipation, and bone pain is suspected of having an endocrine disorder. Blood tests reveal elevated levels of calcium and parathyroid hormone (PTH). Which of the following is the MOST likely diagnosis?

<p>Hyperparathyroidism (B)</p> Signup and view all the answers

A 10-year-old child presents with accelerated tooth eruption, increased appetite but weight loss, and behavioral changes. Which endocrine disorder is MOST likely?

<p>Hyperthyroidism (A)</p> Signup and view all the answers

A patient presents with a constellation of symptoms including fatigue, weight gain, constipation, dry skin, and brittle nails. Further questioning reveals a history of autoimmune disease. Based on this presentation, which of the following is the most likely underlying endocrine disorder?

<p>Hashimoto's thyroiditis (A)</p> Signup and view all the answers

A patient is diagnosed with nephrogenic diabetes insipidus. Which of the following mechanisms is the most likely cause of their polyuria and polydipsia?

<p>Resistance of the kidneys to the action of antidiuretic hormone (ADH). (A)</p> Signup and view all the answers

An extremely rare presentation: A patient has both low parathyroid hormone AND low calcitonin. Assuming both values are appropriately low for the given calcium level, which single gland is most likely dysfunctional?

<p>Thyroid (B)</p> Signup and view all the answers

A patient presents with advanced acromegaly primarily affecting the mandible. After surgical removal of the causative pituitary adenoma, the surgeon contacts a prosthodontist. Why?

<p>To close the newly created anterior open bite (B)</p> Signup and view all the answers

Which of the following characteristics distinguishes endocrine glands from exocrine glands?

<p>Endocrine glands secrete hormones directly into the bloodstream. (C)</p> Signup and view all the answers

Which of the following is the primary focus when studying endocrine glands?

<p>Anatomy, physiology, and pathology (B)</p> Signup and view all the answers

Which gland is located in the brain and is responsible for the regulation of other endocrine glands?

<p>Pituitary gland (C)</p> Signup and view all the answers

Which of the following best describes the function of hormones released by endocrine glands?

<p>Chemical messengers that coordinate body functions (B)</p> Signup and view all the answers

Which of the following hormones is NOT produced by the hypothalamus?

<p>Adrenocorticotropic hormone (ACTH) (B)</p> Signup and view all the answers

Which of the following is an example of a genetic cause of endocrine dysfunction?

<p>Inherited defect leading to impaired hormone synthesis (B)</p> Signup and view all the answers

What is the term for a condition characterized by abnormally low hormone production?

<p>Hyposecretion (D)</p> Signup and view all the answers

Which of the following is a potential cause of hypopituitarism?

<p>Tumor or damage to the pituitary gland (D)</p> Signup and view all the answers

A patient presents with polyuria and polydipsia. The physician suspects diabetes insipidus. What laboratory test would be MOST useful in differentiating between cranial and nephrogenic causes?

<p>ADH levels (A)</p> Signup and view all the answers

Which of the following is a common symptom of hyperthyroidism?

<p>Heart palpitations (D)</p> Signup and view all the answers

During a dental examination of a child, the dentist notices delayed tooth eruption and micrognathia. Considering the information provided, which endocrine disorder might be suspected?

<p>Hypothyroidism (B)</p> Signup and view all the answers

Elevated parathyroid hormone (PTH) levels typically lead to increased:

<p>Serum calcium (D)</p> Signup and view all the answers

Which of the following is a typical symptom of hypoparathyroidism?

<p>Tingling in fingertips (C)</p> Signup and view all the answers

Which condition is related to hyperthyroidism and presents with protruding eyeballs?

<p>Graves disease (C)</p> Signup and view all the answers

Hashimoto’s disease primarily leads to which endocrine disorder?

<p>Hypothyroidism (D)</p> Signup and view all the answers

In a patient with diabetes insipidus, what clinical finding is MOST directly linked to the underlying hormonal imbalance?

<p>Excessive thirst (C)</p> Signup and view all the answers

A 35-year-old female presents with irregular menstrual cycles, hirsutism, and acne. Which endocrine disorder is MOST likely?

<p>Polycystic ovary syndrome (PCOS) (A)</p> Signup and view all the answers

Which of the following best describes the mechanism of action of hormones secreted by endocrine glands?

<p>They bind to specific receptors on target cells, initiating a signaling cascade. (B)</p> Signup and view all the answers

Which of the following hormones is primarily responsible for the development of male secondary sexual characteristics?

<p>Testosterone (A)</p> Signup and view all the answers

A patient who has undergone a complete thyroidectomy is MOST at risk of developing which of the following complications if replacement hormone therapy is inadequate?

<p>Hypocalcemia (C)</p> Signup and view all the answers

What primary issue results from a diet deficient in iodine?

<p>Hypothyroidism (D)</p> Signup and view all the answers

A teenage patient is diagnosed with precocious puberty. From the list, what is the MOST likely additional sign or symptom the patient might exhibit?

<p>Advanced bone age (D)</p> Signup and view all the answers

A patient presents with muscle cramps, fatigue, and paresthesia. Blood tests reveal hypocalcemia. Further investigation reveals deficiency of only a single hormone, but the gland appears histologically normal. Which of the following is the BEST explanation for the hormonal deficiency?

<p>Genetic defect in the hormone itself (A)</p> Signup and view all the answers

A researcher is studying the impact of a novel drug on endocrine function. They administer the drug to lab animals and observe a significant decrease in the size of the thymus gland. Which of the following hormone levels would MOST likely be affected by this change?

<p>T-lymphocytes (C)</p> Signup and view all the answers

Insanely Difficult: A researcher discovers a novel hormone that appears to selectively inhibit the function of osteoclasts without affecting osteoblasts. If this hormone were administered chronically, what would be the MOST LIKELY long-term consequence, assuming ALL other homeostatic mechanisms remain normal?

<p>Hypercalcemia (C)</p> Signup and view all the answers

What is a key characteristic of endocrine glands that differentiates them from exocrine glands?

<p>Endocrine glands secrete hormones directly into the bloodstream, while exocrine glands secrete their products into a ductal system. (A)</p> Signup and view all the answers

Which of the following is a primary secretion of the pineal gland?

<p>Melatonin (B)</p> Signup and view all the answers

Which gland is responsible for producing releasing and inhibiting hormones that control the anterior pituitary gland?

<p>Hypothalamus (C)</p> Signup and view all the answers

Which of the following is a potential cause of endocrine dysfunction related to tissue destruction?

<p>Autoimmune disorders (B)</p> Signup and view all the answers

Which of the following hormones is NOT secreted by the anterior pituitary gland?

<p>Antidiuretic hormone (ADH) (D)</p> Signup and view all the answers

What is a common characteristic associated with hyperthyroidism?

<p>Exophthalmos (B)</p> Signup and view all the answers

Which of the following is a recognized potential outcome of hypopituitarism?

<p>Diabetes insipidus (B)</p> Signup and view all the answers

Which hormone directly affects water reabsorption in the kidneys?

<p>Antidiuretic Hormone (ADH) (C)</p> Signup and view all the answers

What is a common cause of hypothyroidism in developed countries?

<p>Hashimoto's disease (A)</p> Signup and view all the answers

Which of the following symptoms is MOST indicative of hypoparathyroidism?

<p>Numbness and tingling (B)</p> Signup and view all the answers

Which endocrine condition is characterized by an excess of cortisol?

<p>Cushing's syndrome (B)</p> Signup and view all the answers

Which of the following is a potential oral manifestation of hyperparathyroidism?

<p>Brown tumors of the jaw (A)</p> Signup and view all the answers

A patient exhibits symptoms of fatigue, weight gain, cold intolerance, and constipation. Which endocrine disorder is MOST likely?

<p>Hypothyroidism (A)</p> Signup and view all the answers

What is the primary physiological effect of parathyroid hormone (PTH)?

<p>Increase blood calcium levels (C)</p> Signup and view all the answers

A patient with acromegaly is likely to exhibit which of the following oral and maxillofacial features?

<p>Mandibular prognathism (D)</p> Signup and view all the answers

Which dietary factor is most commonly associated with goiter development?

<p>Iodine deficiency (B)</p> Signup and view all the answers

Which of the following is the primary function coordinated by hormones?

<p>Control and coordination of the metabolism (B)</p> Signup and view all the answers

What is the consequence of untreated acromegaly on the skeletal system?

<p>Coarsening of facial features (C)</p> Signup and view all the answers

Which of the following conditions is associated with decreased T-lymphocyte differentiation?

<p>Thymus dysfunction (B)</p> Signup and view all the answers

Following surgical removal of a pituitary adenoma causing acromegaly, what is a potential long-term effect on the dentition that a prosthodontist would address?

<p>Reversal of mandibular prognathism, requiring occlusal adjustments (C)</p> Signup and view all the answers

Which of the following best explains how tumors can cause endocrine disorders?

<p>By producing hormones autonomously, leading to hormone excess, or by destroying the gland, leading to hormone deficiency. (B)</p> Signup and view all the answers

Insanely Difficult: A previously healthy patient develops a pituitary adenoma secreting excessive Melanocyte-Stimulating Hormone (MSH). Which of the following signs would you expect to see?

<p>Marked hyperpigmentation, particularly in sun-exposed areas and mucous membranes. (C)</p> Signup and view all the answers

Insanely Difficult: A researcher is studying a newly discovered hormone that appears to specifically target and inhibit the production of thyroid-stimulating hormone (TSH) by the pituitary, without affecting other pituitary hormones. Prolonged exposure to this hormone would MOST likely result in:

<p>Decreased thyroid hormone synthesis and possible hypothyroidism. (B)</p> Signup and view all the answers

Which of the following scenarios would MOST likely result in iatrogenic endocrine dysfunction?

<p>A patient develops hypothyroidism following radiation therapy for head and neck cancer. (D)</p> Signup and view all the answers

What class of hormones is synthesized in the zona glomerulosa of the adrenal cortex?

<p>Mineralocorticoids (C)</p> Signup and view all the answers

Which of the following hormones primarily regulates glucose metabolism?

<p>Cortisol (C)</p> Signup and view all the answers

Which adrenal hormone contributes most significantly to masculinization?

<p>Dehydroepiandrosterone (DHEA) (D)</p> Signup and view all the answers

Which of the following hormones is produced by the adrenal medulla?

<p>Epinephrine (A)</p> Signup and view all the answers

What is the primary effect of mineralocorticoids released by the adrenal glands?

<p>Regulation of mineral balance (A)</p> Signup and view all the answers

Which of the following conditions is characterized by excessive cortisol production?

<p>Cushing's Syndrome (C)</p> Signup and view all the answers

Hyperpigmentation, low blood pressure, and weight loss are characteristic signs of which adrenal gland disorder?

<p>Addison's Disease (C)</p> Signup and view all the answers

Which oral manifestation is associated with hypercortisolism?

<p>Alveolar bone loss (A)</p> Signup and view all the answers

What is the primary focus of dental management for patients with Addison's disease?

<p>Preventing adrenal crisis (A)</p> Signup and view all the answers

A patient with Cushing's syndrome is at an increased risk for which oral infection?

<p>Candidiasis (C)</p> Signup and view all the answers

Which of the following is a typical dental consideration for patients with adrenal insufficiency undergoing a major dental procedure?

<p>Steroid supplementation (D)</p> Signup and view all the answers

A patient taking oral prednisone for several weeks is likely to experience what change in adrenal function?

<p>Adrenal atrophy (B)</p> Signup and view all the answers

Which of the following signs and symptom combinations is MOST indicative of Addisonian crisis?

<p>Hypotension, hypoglycemia, and fever (C)</p> Signup and view all the answers

What is the recommended dental management adjustment for a patient with Addison's disease undergoing a routine scaling and polishing?

<p>Administer an extra oral dose of steroid medication 60 minutes before the procedure (D)</p> Signup and view all the answers

Which of the following pre-operative needs is unique to major dental surgery on an Addison's patient?

<p>100mg hydrocortisone IM just before anaesthesia. (D)</p> Signup and view all the answers

Why might a dentist adjust the position of a patient with endocrine dysfunction?

<p>To accommodate the patient's tolerance of the supine position (C)</p> Signup and view all the answers

What systemic change would result in stimulation of the HPA axis?

<p>Hypotension (D)</p> Signup and view all the answers

A patient presents with a 'moon face,' fat deposits on the face and back of the shoulders, and purple striae. Which condition is MOST likely?

<p>Cushing's syndrome (C)</p> Signup and view all the answers

A patient undergoing long-term glucocorticoid therapy is scheduled for a tooth extraction. What is the primary concern regarding their adrenal function?

<p>Risk of adrenal crisis (D)</p> Signup and view all the answers

Chronically suppressed ACTH will result in:

<p>Adrenal atrophy (B)</p> Signup and view all the answers

Insanely Difficult: A patient with a known pituitary tumor undergoes surgical removal of the mass. Post-operatively, the patient develops severe hyponatremia, hypotension, and altered mental status. Urinalysis reveals elevated urine sodium levels despite the hyponatremia. What is the MOST likely hormonal deficiency causing this presentation?

<p>Aldosterone (B)</p> Signup and view all the answers

Insanely Difficult: A patient presents with clinical signs including hypertension, hypokalemia, and metabolic alkalosis, but has normal aldosterone and renin levels. Further investigation reveals the patient is surreptitiously ingesting a substance that mimics the effects of mineralocorticoids. Discontinuing use of THIS substance would MOST likely result in rebound:

<p>Hyperkalemia (C)</p> Signup and view all the answers

What long-term sequalae or treatment can result in dry mouth? (Select all that apply)

<p>Secondary Adrenal Insufficiency (A), Menopause (D)</p> Signup and view all the answers

Under normal conditions, what direct effect would increased cortisol have on the anterior pituitary?

<p>Decreased ACTH release (D)</p> Signup and view all the answers

What is the mechanism by which chronic glucocorticoid therapy can lead to osteoporosis?

<p>Increased osteoclast activity and decreased osteoblast activity (B)</p> Signup and view all the answers

Which zone of the adrenal cortex is primarily responsible for the production of mineralocorticoids like aldosterone?

<p>Zona glomerulosa (C)</p> Signup and view all the answers

What is the primary hormone produced by the zona fasciculata of the adrenal cortex?

<p>Cortisol (A)</p> Signup and view all the answers

Which category of hormones is synthesized in the zona reticularis of the adrenal cortex?

<p>Androgens (B)</p> Signup and view all the answers

What is the primary function of the hormones produced by the adrenal medulla?

<p>Stimulating the sympathetic nervous system (B)</p> Signup and view all the answers

Which of the following signs or symptoms is NOT typically associated with Cushing's syndrome?

<p>Weight loss (C)</p> Signup and view all the answers

Hyperaldosteronism (Conn's syndrome) is characterized by an excess of which hormone?

<p>Aldosterone (A)</p> Signup and view all the answers

What is the underlying cause of adrenogenital or virilizing syndromes?

<p>Excess of androgens (B)</p> Signup and view all the answers

A phaeochromocytoma is a tumor that causes an overproduction of which hormones?

<p>Epinephrine and norepinephrine (D)</p> Signup and view all the answers

What oral manifestation is MOST associated with hypercortisolism?

<p>Alveolar bone loss (C)</p> Signup and view all the answers

Increased rates of what oral condition are associated with hypercortisolism?

<p>Oral candidiasis (D)</p> Signup and view all the answers

What is a significant dental consideration for patients with adrenal insufficiency (Addison's disease)?

<p>The need for stress management protocols (D)</p> Signup and view all the answers

What is the MOST likely oral sequalae of long-term steroid treatment?

<p>Dry mouth (A)</p> Signup and view all the answers

What is the primary treatment strategy for Addison's disease?

<p>Administration of corticosteroids (C)</p> Signup and view all the answers

What physiological event directly activates the Hypothalamus-Pituitary-Adrenal (HPA) axis?

<p>Exposure to a stressor (C)</p> Signup and view all the answers

Which laboratory finding is MOST consistent with Addison's disease?

<p>Hyponatremia (B)</p> Signup and view all the answers

A patient with Cushing's syndrome would MOST likely exhibit which facial characteristic?

<p>Round 'moon' face (A)</p> Signup and view all the answers

What is a key pre-operative consideration for a major dental surgery on a patient with Addison's disease?

<p>Increasing the dose of corticosteroids (A)</p> Signup and view all the answers

What is the primary concern when managing a pregnant dental patient?

<p>Patient positioning (D)</p> Signup and view all the answers

Which of the following is the MOST appropriate dental management for a patient with Addison's disease undergoing a routine scaling and polishing?

<p>Administer an extra oral dose of corticosteroids 60 minutes before the procedure. (D)</p> Signup and view all the answers

A patient on long-term oral prednisone is scheduled for a tooth extraction. What is the GREATEST risk related to their adrenal function?

<p>Adrenal crisis due to HPA axis suppression. (B)</p> Signup and view all the answers

Insanely Difficult: A previously healthy individual undergoes treatment with high-dose glucocorticoids for several weeks due to a severe allergic reaction. After discontinuing the medication, the patient experiences profound fatigue, muscle weakness, and dizziness. Their blood pressure is notably low. Which of the following best explains the patient's symptoms?

<p>Prolonged glucocorticoid use suppressed the HPA axis, leading to adrenal insufficiency. (D)</p> Signup and view all the answers

What would be the expected outcome of a surgery to remove the adrenal gland?

<p>Requires life-long hormone replacement (A)</p> Signup and view all the answers

What is the primary role of the adrenal cortex?

<p>Produce hormones that regulate metabolism, immune function, and sexual development (C)</p> Signup and view all the answers

Why is it important for a dentist to consider the length and time of day for appointments when treating patients with endocrine disorders?

<p>To accommodate fluctuations in hormone levels. (B)</p> Signup and view all the answers

Insanely Difficult: A patient with a history of Addison's disease requires a full-mouth extraction under general anesthesia. Preoperatively, they receive stress-dose hydrocortisone. Postoperatively, the patient develops severe hypertension, tachycardia, and agitation despite adequate pain control. What is the MOST likely underlying cause of this patient’s acute decompensation?

<p>Latent pheochromocytoma triggered by the surgical stress. (B)</p> Signup and view all the answers

Endocrine glands are characterized by which of the following?

<p>Releasing their products directly into the bloodstream. (A)</p> Signup and view all the answers

Which of the following is a key focus when studying endocrine glands?

<p>All of the above. (D)</p> Signup and view all the answers

Which of the following does NOT directly coordinate and control the function of the endocrine glands?

<p>Immune response. (B)</p> Signup and view all the answers

What is the primary role of hormones as secreted by endocrine glands?

<p>Acting as chemical messengers to control and coordinate bodily functions. (C)</p> Signup and view all the answers

Which of the following pairs is correctly matched?

<p>Thyroid gland: Thyroid hormone. (B)</p> Signup and view all the answers

What term describes abnormally high hormone production?

<p>Hypersecretion (C)</p> Signup and view all the answers

Which of the following conditions is NOT identified as causing endocrine dysfunction?

<p>Sedentary lifestyle. (D)</p> Signup and view all the answers

Accelerated tooth eruption may indicate issues with the hormone produced by which of the following glands?

<p>Thyroid Gland. (D)</p> Signup and view all the answers

A patient presents with depression, fatigue, constipation, and bone fractures. These symptoms could be due to a problem with which of the following?

<p>High levels of parathyroid hormone. (A)</p> Signup and view all the answers

What is often the result of insufficient iodine in the diet?

<p>Goiter. (D)</p> Signup and view all the answers

A patient with diabetes insipidus is likely to present with which of the following?

<p>Excessive thirst. (C)</p> Signup and view all the answers

What is a common oral manifestation of hypothyroidism in children?

<p>Delayed tooth eruption. (A)</p> Signup and view all the answers

Which of the following symptoms is MOST indicative of of hyperthyroidism?

<p>Trembling. (C)</p> Signup and view all the answers

Which hormone is produced by the parathyroid glands?

<p>Parathyroid hormone (A)</p> Signup and view all the answers

Which oral manifestation is typically associated with hyperparathyroidism?

<p>Brown tumors of the jaw (B)</p> Signup and view all the answers

A patient presents with muscle cramps and tingling sensations in their fingertips. Which condition might be suspected?

<p>Hypoparathyroidism (D)</p> Signup and view all the answers

Which of the following conditions is associated with exophthalmos (protrusion of the eyeballs)?

<p>Graves' disease (D)</p> Signup and view all the answers

What is the most common cause of hypothyroidism in developed countries?

<p>Hashimoto's disease (D)</p> Signup and view all the answers

What is the primary concern regarding adrenal function for a patient undergoing long-term glucocorticoid therapy and scheduled for a tooth extraction?

<p>Suppressed adrenal function. (C)</p> Signup and view all the answers

What are the dental management considerations for a pregnant dental patient?

<p>All of the above. (D)</p> Signup and view all the answers

Given a patient with advanced bone loss, what treatment would a dentist be LEAST likely to recommend?

<p>Surgical removal of associated teeth. (B)</p> Signup and view all the answers

Which gland is responsible for T-lymphocyte differentiation?

<p>Thymus. (D)</p> Signup and view all the answers

What is the MOST appropriate dental management for a patient with Addison's disease undergoing a routine scaling and polishing?

<p>Consider administering an extra dose of steroid medication before the procedure. (B)</p> Signup and view all the answers

According to the graphic, from what area are mineralocorticoids released?

<p>Zona glomerulosa. (D)</p> Signup and view all the answers

According to the graphic, what is the main hormone regulating sugar metabolism?

<p>Cortisol. (B)</p> Signup and view all the answers

According to the graphic, what class of adrenal hormones has the primary role of stimulating masculinization?

<p>Andgrogens. (C)</p> Signup and view all the answers

According to the graphic, what is the primary role of the adrenal medulla?

<p>Stress response. (D)</p> Signup and view all the answers

Hyperpigmentation is MOST likely to be associated with which of the following?

<p>Addison's disease. (C)</p> Signup and view all the answers

The graphic demonstrates that increased rates of what oral condition are associated with hypercortisolism?

<p>Oral Candidiasis. (B)</p> Signup and view all the answers

When planning a dental surgery on a patient using bisphosphonates, which is MOST important to consider?

<p>All of the above. (D)</p> Signup and view all the answers

A patient on long-term oral prednisone is scheduled for a tooth extraction. If the patient is suffering from adrenal suppression, what should the dentist be aware of?

<p>Higher risk of medical emergency. (B)</p> Signup and view all the answers

Which of the following would MOST likely be associated with the sequaele of menopause?

<p>Burning Mouth Syndrome. (A)</p> Signup and view all the answers

Insanely Difficult: A patient has a tumor resulting in high levels of Mineralcorticoids, normal aldosterone, and low renin levels. Where is the MOST likely origin of the tumor?

<p>Adrenal Gland. (A)</p> Signup and view all the answers

Insanely Difficult: A patient has known Addison's. It is discovered that they additionally have tuberculosis, a common granulomatous infection that often affects the lungs. At what other site would the symptoms of TB most exacerbate the Addison's?

<p>Adrenal Glands. (A)</p> Signup and view all the answers

Which of the following best describes the mechanism of action of ductless endocrine glands?

<p>Secreting products directly into the bloodstream (C)</p> Signup and view all the answers

A patient exhibits symptoms of fatigue, muscle weakness, salt craving, and hyperpigmentation of the skin. Which endocrine disorder is MOST likely indicated by these signs?

<p>Addison's Disease (A)</p> Signup and view all the answers

A patient is diagnosed with diabetes insipidus. What symptom is MOST directly associated with diabetes insipidus?

<p>Polyuria and Polydipsia (A)</p> Signup and view all the answers

During a routine dental visit, you observe noticeable macroglossia, prognathism and frontal spacing in a 45-year-old patient. Which of the following conditions is MOST likely associated with these oral manifestations?

<p>Acromegaly (B)</p> Signup and view all the answers

Insanely Difficult: A researcher is investigating a novel compound that selectively inhibits the enzyme 11β-Hydroxysteroid dehydrogenase type 2 (11β-HSD2) in vivo. This enzyme normally converts cortisol to cortisone (an inactive metabolite). What is the MOST likely consequence of administering this compound chronically?

<p>Hypertension, hypokalemia, and metabolic alkalosis (B)</p> Signup and view all the answers

What physiological process is directly regulated by hormones released from endocrine glands?

<p>Metabolism (D)</p> Signup and view all the answers

If a patient is diagnosed with diabetes insipidus of nephrogenic origin, what is a possible symptom?

<p>Dry mouth (B)</p> Signup and view all the answers

Which of the following diagnostic methods is LEAST likely to be used as an initial step in the evaluation of an endocrine disorder?

<p>Biopsy (A)</p> Signup and view all the answers

In a patient with known hyperparathyroidism, dental radiographs are MOST likely to reveal:

<p>Brown tumors of the jaw (C)</p> Signup and view all the answers

Hashimoto's disease often results in which of the following conditions?

<p>Hypothyroidism (C)</p> Signup and view all the answers

The pituitary gland directly affects:

<p>Other endocrine glands (D)</p> Signup and view all the answers

What is a key characteristic of endocrine glands compared to exocrine glands?

<p>They release hormones directly into the bloodstream (A)</p> Signup and view all the answers

Which of the following is LEAST likely to directly cause endocrine dysfunction?

<p>Physical exercise (C)</p> Signup and view all the answers

What class of medication is used to treat the sequalae of osteoporosis?

<p>Bisphosphonates (A)</p> Signup and view all the answers

Which hormone is targeted in management of acromegaly?

<p>GH (A)</p> Signup and view all the answers

For a dental patient with Addison's disease undergoing a major dental procedure, what pre-operative need is MOST critical to consider?

<p>Steroid stress-dose administration (A)</p> Signup and view all the answers

Which hormone is often relevant to pregnancy?

<p>hCG (C)</p> Signup and view all the answers

A patient with suspected Cushing's syndrome would MOST likely exhibit which sign?

<p>&quot;Moon face&quot; (C)</p> Signup and view all the answers

What is the primary goal of management or treatment for endocrine glands?

<p>Replacement/Suppression (D)</p> Signup and view all the answers

What is a possible oral complication of the sequalae related to disease/treatment?

<p>Dry mouth (D)</p> Signup and view all the answers

Which of the following hormones is produced by the parathyroid glands?

<p>Parathyroid hormone (A)</p> Signup and view all the answers

In managing thyroid disorders in children, what oral manifestation is associated with hyperthyroidism?

<p>Accelerated tooth eruption (C)</p> Signup and view all the answers

Which of the following symptoms is caused by hyperthyroidism?

<p>Difficulty sleeping (C)</p> Signup and view all the answers

Which of the following choices is NOT a symptom of hypothyroidism?

<p>Irritability (B)</p> Signup and view all the answers

What is of primary consideration when planning dental appointments for patients with endocrine disorders?

<p>Time of day and length of appointment (B)</p> Signup and view all the answers

A patient presents with fatigue, muscle weakness, and salt cravings. Which adrenal gland disorder might be suspected?

<p>Addison's disease (A)</p> Signup and view all the answers

Why is an extra dose of steroid medication required for minor dental procedures performed on a patient whom is steroid-dependent?

<p>To counteract potential hypoadrenal symptoms (D)</p> Signup and view all the answers

What is the primary function of mineralocorticoids released by the adrenal glands?

<p>Regulating mineral balance (A)</p> Signup and view all the answers

Which of the following choices is NOT a dental consideration for Endocrine Glands Management/Treatment?

<p>Hair Color (C)</p> Signup and view all the answers

Which of the following is a dental consideration for extraction procedures?

<p>Bisphosphonates (D)</p> Signup and view all the answers

A dentist diagnoses a pregnant woman with pyogenic granuloma. What is most likely indicated by this diagnosis?

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What is of key consideration when prescribing for a pregnant patient?

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What post-operative needs are required after a major dental surgery for a patient suffering from Addison's disease?

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In Addison's disease Management/Treatment, what hormonal class is administered therapeutically?

<p>Steroids (C)</p> Signup and view all the answers

What directly stimulates the sympathetic ANS (Autonomic Nervous System)?

<p>Stress hormones (B)</p> Signup and view all the answers

What is a common dental related sequalae of menopause?

<p>Dry mouth (D)</p> Signup and view all the answers

Phaeochromocytoma (tumor) causes the overproduction of epinephrine and norepinephrine. Where is this most likely found?

<p>Adrenal Glands (C)</p> Signup and view all the answers

What is a common oral manifestation of hypercortisolism?

<p>Rapidly progressing periodontitis (C)</p> Signup and view all the answers

A patient undergoing long-term glucocorticoid therapy is scheduled for a tooth extraction without alterations to their existing steroid replacement regimen. Following the procedure, the patient is MOST at risk for:

<p>Addisonian crisis (C)</p> Signup and view all the answers

Insanely Difficult: A patient with known primary adrenal insufficiency (Addison's disease) presents to the emergency room with severe abdominal pain, nausea, vomiting, and profound weakness and altered mental status. The medical history is significant for tuberculous (TB). What is the MOST likely underlying cause?

<p>Disseminated TB infection of the adrenal glands (B)</p> Signup and view all the answers

Insanely Difficult: A researcher is studying the impact of endocrine disorders on bone remodeling. They discover that a mutation causing constitutive activation of the mineralocorticoid receptor (MR) in osteoblasts, but not in the kidneys, independently causes increased bone density. This increased bone density is primarily due to:

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Which of the following is a characteristic unique to endocrine glands?

<p>Release products into the bloodstream (C)</p> Signup and view all the answers

To assess the function of a target organ, which diagnostic tools are most helpful?

<p>Blood or imaging of the target organ (C)</p> Signup and view all the answers

Which sequence of events accurately describes the stress response system?

<p>Hypothalamus releases CRH -&gt; Pituitary gland releases ACTH -&gt; Adrenal gland releases Cortisol -&gt; Hypothalamus. (B)</p> Signup and view all the answers

A patient exhibits fatigue, weight gain, constipation, and dry skin. The dentist suspects hypothyroidism. If this is because of Hashimoto's, what blood component would MOST likely be elevated?

<p>Anti-thyroglobulin antibodies (D)</p> Signup and view all the answers

Insanely Difficult: A researcher is investigating the effects of chronic stress on adrenal function in rats. They subject the rats to prolonged periods of unpredictable stressors. After several weeks, they observe significant atrophy (shrinkage) of the adrenal cortex, specifically affecting the zona fasciculata. They also take blood samples. Which of the following hormonal profiles would they most likely observe?

<p>Elevated CRH, elevated ACTH, decreased cortisol (D)</p> Signup and view all the answers

Flashcards

Endocrine Glands

Ductless glands that secrete products directly into bloodstream, affecting various bodily functions.

Endocrine Glands

The study of the anatomy, physiology, and diseases related to endocrine glands.

Hormones

Chemical messengers produced by endocrine glands that coordinate body functions.

Hyper-Production

An increase in the production of hormones by a gland.

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Hypo-Production

A decrease in the production of hormones by a gland.

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Acromegaly

A condition caused by excessive growth hormone (GH), leading to enlarged features.

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Hypopituitarism

A condition resulting from deficiency of pituitary hormones, causing various symptoms.

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Diabetes Insipidus

A condition caused by insufficient ADH, leading to excessive urination and thirst.

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Hyperthyroidism

Excessive thyroid hormone production, leading to symptoms like exophthalmos and goiter.

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Hashimoto's disease

An autoimmune condition where the body attacks the thyroid gland leading to reduced thyroid hormone production.

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Hypoparathyroidism

Condition with low parathyroid hormone leading to tingling, muscle twitching and mood changes

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Hyperparathyroidism

An excess of parathyroid hormone, leading to bone and kidney problems.

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What are Endocrine Glands?

Glands that secrete hormones directly into the bloodstream, affecting distant target cells.

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Major Endocrine Glands Locations

Hypothalamus, Pituitary, Pineal, Thyroid, Parathyroid, Thymus, Adrenals, Pancreas, Ovaries, and Testes.

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Hormones regulate what?

Metabolism, energy levels, reproduction, growth, mood, sleep, and response to injury/stress.

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What hormones does the hypothalamus produce?

TRH, GnRH, GHRH, CRH, somatostatin, and dopamine.

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What hormones does the pituitary gland produce?

GH, prolactin, ACTH, TSH, LH, FSH, ADH, and oxytocin.

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What hormone does the pineal gland produce?

Melatonin

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Hormone produced by the thyroid gland?

Thyroid hormone

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Hormone produced by the parathyroid glands?

Parathyroid hormone

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What is the role of the thymus?

T-lymphocytes differentiation

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What hormone does the pancreas produce?

Insulin

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What hormones do the adrenal glands produce?

Epinephrine and Corticosteroids

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What hormones do the ovaries produce?

Estrogen and Progesterone

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What hormone do the testes produce?

Testosterone

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What hormones does the placenta produce?

Estrogen, progesterone, hCG, hPL, PGH, relaxin, and kisspeptin

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Endocrine Diseases - Why?

Genetic factors, tumors, tissue destruction/loss/suppression, iatrogenic causes (surgery, radiation, drugs), and diet.

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What are the causes of Tissue Destruction/Loss/Suppression?

Autoimmune conditions, infection, trauma

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What is the primary cause of hyperthyroidism?

Graves disease

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Eye Bulging in Hyperthyroidism

Exophthalmos

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Absent menstrual period

Amenorrhea

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Cessation of menstruation

Menopause

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Polyglandular Deficiency Syndrome (PDS)

Deficiency in multiple gland activity.

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MEN

Multiple Endocrine Neoplasia (MEN)

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Brittle bones

Osteoporosis

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What is an Endocrine Gland?

Glands that secrete hormones into the bloodstream.

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What causes Hashimoto's Disease?

Autoimmune attack on the thyroid, causing hypothyroidism.

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What is a Goitre?

Enlargement of the thyroid gland

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What is Hyperthyroidism?

Excessive thyroid hormones, causes nervousness and irritability.

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What are Brown Tumors?

Bone tissue affected by increased localized bone remodelling

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What is Hypothyroidism?

Lack of thyroid hormone, causes fatigue and weight gain.

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What is Cushing's Disease?

Caused by excess cortisol, leading to weight gain and skin changes.

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What is Addison's Disease?

Adrenal insufficiency, causing fatigue and skin darkening.

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What are the adrenal glands?

Located on top of the kidneys, responsible for producing hormones that regulate stress response, metabolism, and blood pressure.

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Adrenal Cortex

Outer layer of the adrenal gland; produces mineralocorticoids, glucocorticoids, and androgens.

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Adrenal Medulla

Inner part of the adrenal gland; produces epinephrine and norepinephrine.

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Mineralocorticoids

Regulates mineral balance (sodium and potassium levels) in the body.

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Glucocorticoids

Regulate glucose metabolism, inflammation, and immune function.

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Androgens

Stimulate masculinization; includes hormones like dehydroepiandrosterone.

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Stress Hormones

Stimulate the sympathetic nervous system (fight or flight).

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Aldosterone

Mineralocorticoid that helps regulate blood pressure and electrolyte balance.

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Cortisol

Glucocorticoid that regulates glucose metabolism and reduces inflammation.

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Epinephrine and Norepinephrine

Stress hormones related to 'fight or flight' response.

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Cushing Syndrome

Caused by excessive cortisol. Can be exogenous (corticosteroids) or endogenous.

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Hyperaldosteronism

Excess of aldosterone, leading to hypertension and potassium depletion.

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Adrenogenital Syndrome

Excess of androgens, leading to virilization in females.

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Phaeochromocytoma

Tumor overproducing epinephrine and norepinephrine.

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Osteoporosis of the Jaw

Alveolar bone loss due to increased cortisol levels.

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Oral Candidiasis

Fungal infection in the mouth, more common with elevated cortisol.

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Addison's Disease

Insufficiency of adrenal hormones leading to fatigue, weight loss, and skin changes.

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Addisonian Crisis

Medical emergency due to acute adrenal insufficiency.

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Post-operative needs Major Dental Surgery

In patients with Adrenal Insufficiency, double oral dose for 24 hours.

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HPA Axis

Regulates the body's response to stressors by releasing cortisol.

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Steroid treatment

Can suppress the HPA axis

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Adrenal atrophy

Can occur as a result of decreased ACTH stimulation.

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Cosyntropin

Can be used to assess adrenal function.

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Hydrocortisone Replacement Therapy

Can be used to treat Secondary Adrenal Insufficiency.

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Planning of appointment

Timing of day and how long the appointment will be.

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What are Adrenal Glands?

Glands located on top of the kidneys that produce hormones for various bodily functions.

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What is the Adrenal Cortex?

The outer region of the adrenal gland, responsible for producing mineralocorticoids, glucocorticoids, and androgens.

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What is the Adrenal Medulla?

The inner region of the adrenal gland that produces stress hormones, such as epinephrine and norepinephrine.

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What is Primary Addison's?

Primary adrenal insufficiency due to adrenal gland damage.

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What is Secondary Addison's?

Adrenal insufficiency due to pituitary or hypothalamus issues.

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What are Mineralocorticoids?

Hormones that regulate mineral balance specifically sodium and potassium balance.

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What are Glucocorticoids?

Hormones that affect glucose metabolism and inflammation.

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What is Addisonian Crisis?

Medical emergency due to severe lack of cortisol.

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What are Androgens?

Hormones that stimulate masculinization (e.g., DHEA).

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Zone Glomerulosa produces?

The zone of the adrenal cortex that is responsible Mineralocorticoid production.

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Zona Fasciculata produces?

The zone of the adrenal cortex that is responsible for Glucocorticoid production.

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Zona Reticularis produces?

The zone of the adrenal cortex that is responsible for Androgen production.

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What is Exogenous Cushing's?

Cushing's Syndrome caused by taking corticosteroids.

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What is Endogenous Cushing's?

Cushing's Syndrome caused by an overproduction of cortisol inside the body.

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Moon Face

Swollen face associated with Cushing's syndrome.

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What is Cosyntropin?

A diagnostic use of ACTH analog to test adrenal function.

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Endocrine Glands - What?

Ductless glands that secrete their products directly into the bloodstream.

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Endocrine Glands Approach

Involves anatomy (where), physiology (action), and diseases (why).

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What does the hypothalamus produce?

TRH, GnRH, GHRH, CRH, somatostatin and dopamine.

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Pituitary gland products

GH, prolactin, ACTH, TSH, LH, FSH, ADH, oxytocin

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Symptoms of acromegaly

Increase soft tissue, ring and shoe size due to increase in growth hormone.

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Symptoms of Hypopituitarism

Slow Growth and diabetes insipidus

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Cranial Diabetes insipidus

Polyuria and polydipsia

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Hyperthyroidism common conditions

Graves disease and Goitre

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Hyperthyroidism Management

Carbimazole and Propylthiouracil

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Symptoms of hypothyroidism

Tiredness, weight gain

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How to treat Hypothyroidism?

Throxine

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Hypothyroidism in Children

Delayed tooth eruption, enamel hypoplasia

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What happens to teeth in children in hyperthyroidism?

Accelerated tooth eruption

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Symptoms of Hyperparathyroidism

Fatigue, kidney stones and bone fracture

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Symptoms of Hypoparathyroidism

a tingling sensation (paraesthesia)

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What is the overall role of adrenal glands?

Regulates hormones

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Addison's symptoms include?

Gastrointestinal and skin depigmentation

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Addisonian crisis - Time Frame?

emergency cortisol injection needed

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Dental Treatment on Addison's Patients

Double Oral Dose (24 hours)

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Contraception can cause?

Medical condition

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Pregnancy can cause?

Medical condition

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Menopause can cause?

Medical condition

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Endocrine Glands - How investigated?

Various types of imagery

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Endocrine Gland - What treatments are used?

Hormone levels adjustment

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What should planning of appointment be

Time of day

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Position of Dental patient considerations

What will the patient tolerate and dexterity

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What are oral complications?

Dry mouth, caries, glossitis

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What kind of anaesthesia, extraction

LA with or without adrenaline

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Pregnancy and breastfeeding

Patient position radiology

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What are Ductless Glands?

Glands secreting products into the bloodstream without ducts.

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What is Thyrotoxicosis?

Excessive production of thyroid hormones.

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What is Hashimoto's thyroiditis

Autoimmune disease causing hypothyroidism

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What are pregnancy oral considerations?

Oral health impacts and symptoms in pregnancy.

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What are common symptoms of Menopause?

Mouth dryness, Periodontal health, Osteoporosis

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What are Endocrine Glands - Investigations?

Tests that are useful for the endocrine glands

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Endocrine treatment

Repairing imbalances to re-establish healthy function.

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Hypothyroidism in newborn babies?

What causes congenital hypothyroidism?

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Addison's - Dental guidelines

Medications for the dental health implications of Addison's disease.

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Medical emergency - Addisonian crisis

The time when the symptoms of Addison's get worse

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Endocrine Glands - Management/Treatment

Can be achieved from different approach

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Nephrogenic Diabetes insipidus

Low amount of ADH produced by the body

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Study Notes

  • Endocrine glands are ductless glands that secrete products directly into the bloodstream
  • Exocrine glands secrete products into a ductal system leading to an epithelial surface

Endocrine Gland Focus Areas

  • Anatomy: Where are they located?
  • Physiology: What product/action do they perform?
  • Disease: Why do endocrine disorders occur?

Endocrine Gland Locations

  • Hypothalamus
  • Pituitary gland
  • Pineal gland
  • Thyroid and parathyroid glands
  • Thymus
  • Pancreas
  • Adrenal glands
  • Ovaries (in females)
  • Testicles (in males)
  • Placenta (during pregnancy)

Hormone Actions

  • Hormones are chemical messengers to control and coordinate:
  • Metabolism
  • Energy levels
  • Reproduction
  • Growth and development
  • Mood
  • Sleep
  • Response to injury and stress

Gland Products

  • Hypothalamus produces TRH, GnRH, GHRH, CRH, somatostatin, and dopamine
  • Pituitary gland produces GH, prolactin, ACTH, TSH, LH, FSH, ADH, and oxytocin
  • Pineal gland produces melatonin
  • Thyroid gland produces thyroid hormone
  • Parathyroid glands produce parathyroid hormone
  • Thymus produces T-lymphocytes for differentiation
  • Pancreas produces insulin
  • Adrenal glands produce epinephrine and corticosteroids
  • Ovaries produce estrogen and progesterone
  • Testes produce testosterone
  • Placenta produces estrogen, progesterone, hCG, hPL, PGH, relaxin, and kisspeptin

Endocrine Gland Dysfunction

  • Hyper: Overproduction
  • Hypo: Underproduction

Etiology of Endocrine Gland Disorders

  • Genetic factors
  • Tumors
  • Tissue destruction, loss, or suppression:
  • Autoimmune disorders
  • Infections
  • Trauma
  • Iatrogenic causes (surgery, radiation, drugs)
  • Diet
  • Acromegaly
  • Hypopituitarism
  • Diabetes insipidus
  • Hyperthyroidism
  • Hypothyroidism
  • Hyperparathyroidism
  • Hypoparathyroidism
  • Cushing's disease
  • Addison's disease
  • Amenorrhea
  • Polycystic ovarian syndrome
  • Precocious puberty
  • Premature ovarian failure
  • Hypogonadism
  • Pregnancy
  • Menopause
  • Polyglandular deficiency syndromes (PDS)
  • Multiple endocrine neoplasia (MEN)
  • Osteoporosis

Pituitary Gland: Acromegaly

  • Caused by increased growth hormone (GH)
  • Signs and symptoms include:
  • Thickening of skull and protruding supraorbital ridges
  • Coarsening of facial features and prognathism
  • Headaches, diplopia, lethargy, blindness
  • Goiter, enlargement of visceral organs, cardiomyopathy, diabetes mellitus
  • Broadening of hands and feet and thickened heel pads
  • More information on Acromegaly may be found at https://www.wapo.org/pituitary-disorders/acromegaly/

Pituitary Gland: Hypopituitarism

  • Can cause the following symptoms:
  • Slow growth
  • Addison's disease
  • Hypothyroidism
  • Diabetes insipidus
  • Underdevelopment of male/female characteristics

Pituitary Gland: Diabetes Insipidus

  • Caused by decreased antidiuretic hormone (ADH)
  • Cranial diabetes insipidus leads to polyuria and polydipsia
  • Nephrogenic diabetes insipidus can cause dry mouth

Thyroid Gland: Hyperthyroidism (Thyrotoxicosis)

  • Can cause the following symptoms:
  • Exophthalmos
  • Neck swelling
  • Fatigue and mood swings
  • Heart palpitations and trembling
  • Irritability and difficulty sleeping
  • Graves disease
  • Goitre

Thyroid Gland: Hypothyroidism (Myxoedema)

  • Symptoms include:
  • Tiredness and sensitivity to cold
  • Weight gain and constipation
  • Depression and slow movements/thoughts
  • Muscle aches/weakness and muscle cramps
  • Dry/scaly skin and brittle hair/nails
  • Loss of libido
  • Pain, numbness, or tingling in hands and fingers (carpal tunnel syndrome)
  • Irregular or heavy periods
  • Fertility and embryo-development issues
  • Hashimoto’s disease

Thyroid Gland: Disorders in Children

  • Hypothyroidism symptoms include:
  • Delayed tooth eruption
  • Enamel hypoplasia
  • Micrognathia
  • Anterior open bite
  • Stunted bone and tooth growth
  • Hyperthyroidism symptoms include:
  • Accelerated tooth eruption
  • Maxillary and mandibular osteoporosis
  • Changes in behavior and school performance

Parathyroid Glands: Hyperparathyroidism

  • Can cause the following symptoms:
  • Depression and fatigue
  • Loss of appetite
  • Muscle weakness
  • Tummy pain and constipation
  • Drowsiness and confusion
  • High blood pressure and irregular heartbeat
  • Osteoporosis and bone fractures
  • Kidney stones
  • Stomach ulcers and pancreatitis
  • Brown tumors of the bone

Parathyroid Glands: Hypoparathyroidism

  • Can cause the following symptoms:
  • Tingling sensation in fingertips, toes, and lips (paresthesia)
  • Twitching facial muscles
  • Muscle pains or cramps, particularly in legs, feet, or tummy
  • Tiredness
  • Mood changes (irritability, anxiety, or depression)
  • Dry, rough skin
  • Coarse hair that breaks easily and hair loss
  • Fingernails that break easily

Adrenal Glands: Hyperfunction

  • Cushing syndrome is caused by excess cortisol, and can be exogenous (corticosteroids) or endogenous
  • Hyperaldosteronism is caused by excess aldosterone and known as Conn’s syndrome
  • Adrenogenital or virilizing syndromes are caused by excess androgens
  • Phaeochromocytoma is a tumor that overproduces epinephrine and norepinephrine

Adrenal Glands: Hyper - Cushing

  • Alveolar bone loss can result from hypercortisolism, contributing to tooth loss and periodontal disease via decreased white cell migration
  • Oral candidiasis occurs at elevated rates
  • Risk of infection may be increased with complex dental procedures
  • Implications of diabetes
  • Refer to https://www.cdho.org/Advisories/CDHO_Factsheet_Cushing_Syndrome.pdf for more info

Adrenal Glands: Hypofunction - Addison’s disease

  • Can be primary or secondary (corticosteroids)

Medical Emergency - Addisonian Crisis

  • Symptoms include fever, syncope, convulsions, hypoglycemia, hyponatremia, severe vomiting, and diarrhoea

Addison's Disease - Dental Guidelines

Feedback Loops - Stress Response

  • The Hypothalamus-Pituitary Gland-Adrenal Gland(HPA) axis
  • An increase in Cortisol result in:
  • Increased blood glucose availability
  • Increased sodium retention
  • Increased potassium excretion
  • Increased suppression of the immune system

Feedback Loops - Steroid treatment

Contraception (drug)

  • Can cause periodontal disease
  • Can cause Pigmentation (facial melasma and/or intraoral)
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198473/

Pregnancy

Menopause

  • Can cause Burning Mouth Syndrome (BMS)
  • Can cause Dry mouth
  • Can affect Periodontal Health
  • Can cause Osteoporosis
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793432/

Endocrine Gland - Investigations

  • Blood tests to check hormone levels
  • Target analysis of receptors/organs
  • Function testing of target organs
  • Imaging (radiographs, USS, CT/CBCT, MRI, scintigraphy)
  • Biopsy if needed

Endocrine Gland - Management/Treatment

  • Replacement/suppression
  • Surgery on Glands
  • Consideration of target organs
  • Consideration of Sequalae
  • Prevention

Endocrine Gland - Management/Treatment - Specific Examples

  • Pituitary gland:
  • Acromegaly treated with surgery
  • Hypopituitarism treated with hormone replacement
  • Diabetes insipidus with vassopresin
  • Thyroid
  • Hyper treated with carbimazole, propythiouracil
  • Hypo treated with Thyroxine
  • Parathyroid
  • Hyper is given Primary with rehydration bisphosphonates (short term), surgery
  • Adrenal
  • Cushing's given surgery to lower steroids
  • Addison's given steroids of hydrocortisone and fludocortisone
  • Menopause is given HRT
  • Osteoporosis is given Bisphosphonates

Endocrine Gland Management/Treatment - Dental Considerations

  • Planning of appointments, considering time of day and length
  • Position of patient, considering if they can tolerate supine position
  • Adjusted Oral Hygiene (OH)
  • Management of oral complications
  • Manifestations
  • Sequalae of disease/treatment
  • Dry mouth
  • Oral thrush
  • Caries
  • Glossitis
  • Diagnosis
  • Extractions considering primary/secondary care, bisphosphonates, and risk of dry socket
  • Choice of anesthesia, LA with/without adrenaline, Sedation, or General Anesthesia (GA)
  • Pregnancy and breastfeeding considerations:
  • Position
  • Oral Health Instruction
  • Radiology
  • Prescribing
  • Medical Emergency

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