Endocrine Glands and Disorders PDF

**[ENDOCRINE AND OTHER DISORDERS]** **[ENDOCRINE GLANDS ]** **DUCTLESS** **GLANDS** that *[secrete]* their **products** **Straight** *into the* **BLOODSTREAM** not into ductal system *[Difference]* to **EXOCRINE GLANDS** that secrete their products into a **DUCTAL SYSTEM** that leads to an **EPIT...

**[ENDOCRINE AND OTHER DISORDERS]** **[ENDOCRINE GLANDS ]** **DUCTLESS** **GLANDS** that *[secrete]* their **products** **Straight** *into the* **BLOODSTREAM** not into ductal system *[Difference]* to **EXOCRINE GLANDS** that secrete their products into a **DUCTAL SYSTEM** that leads to an **EPITHELIAL SURFACE.** - **ANATOMY** -- Where? - **PHYSIOLOGY** -- What product/action? - **Disease** -- Why? **[Endocrine Glands -- Where?]** **Scattered throughout the body** **Thymus is bigger in childhood but gets smaller as you age.** *https://www.tutor2u.net/psychology/reference/biopsychology-the-endocrine-system-glands* **[Endocrine Glands -- WHAT PRODUCT/ACTION?]** **Products** = Hormones **Hormones** = Chemical Messengers **Chemical** **Messengers** = Control and Coordinate - Metabolism, - Energy levels, - Reproduction, - Growth, - Development, - Mood, - Sleep, - Response to injury and stress **[Endocrine Glands -- What Product?]** - **Hypothalamus:** - **[Pituitary gland:]** - **Pineal gland:** - **[Thyroid gland:]** - **[Parathyroid glands:]** - **Thymus:** - **[Pancreas:]** - **[Adrenal glands:]** - **[Ovaries:]** **[PRODUCTION]:** - **Increased Production** \-\-\-\-\-- **Hyper-** - **Decreased Production** \-\-\-\-- **Hypo**- **[Endocrine Glands -- Why?]** 1. **Genetic** -- cause hyperproduction 2. **Tumour --** random tumours can sometimes also release hormones 3. **Tissue Destruction/Loss/Suppression -- Keep 1/3 of the thyroid gland** i. Autoimmune ii. Infection iii. Trauma iv. Iatrogenic (surgery, radiation, drugs) v. Diet **ENDOCRINE GLANDS -- DISORDERS/OTHER** - **Acromegaly** -- related to growth hormone - **Hypopituitarism** -- underacting piutary - **Diabetes Insipidus** - - **Hyperthyroidism** - **Hypothyroidism** - **Hyperparathyroidism** - **Hypoparathyroidism** - **Cushing's disease** - **Addison's disease** - **Amenorrhea -** - **Polycystic Ovarian Syndrome** - **Precocious Puberty** - **Premature** **Ovarian** **Failure** - **Hypogonadism** - **Pregnancy** -- Not Disorders - **Menopause** -- Not Disorders - **Polyglandular** **Deficiency** **Syndromes** (PDS) - **Multiple Endocrine Neoplasia** (MEN) - Osteoporosis **PITUITARY GLAND** **Increased GH = Acromegaly** [*more information*](https://www.wapo.org/pituitary-disorders/acromegaly/) **Decreased = HYPOPITUITARISM (2+) (you must have 2 of these to be considered)** & **PANHYPOPITUITARISM** **Look at the front and back lobe** - *[Slow]* **growth** - **Addison's** - **Hypothyroidism** - **Diabetes** **Insipidus** - *[Underdevelopment]* of Male/Female Characteristics **Low ADH production or action = Diabetes Insipidus** *(not the same as normal diabetes)* - **[Cranial]** - **[Nephrogenic]** **HYPER (THYROTOXICOSIS)** **GRAVES DISEASE** **[GOITRE]- Is when your thyroid gland has become enlarged** - **Exophthalmos** -- **Eyes** **Popping** **Out** - **Neck Swelling** - **Fatigue** - **Mood Swings** - **Heart Palpitations** - **Trembling** - **Irritability** - **Difficulty** **Sleeping** **HYPO (MYXOEDEMA)** **[HASHIMOTO'S DISEASE]** - **Tiredness** - Being Sensitive to **Cold** - **Weight** **Gain** - **Constipation** - **Depression** - **Slow Movements** and **Thoughts** - Muscle **Aches** and **Weakness** - **Muscle** **Cramps** - **Dry** and **Scaly Skin** - **Brittle** **Hair** and **Nails** - Loss of **Libido** (sex drive) - **Pain, Numbness**, and a **Tingling Sensation** in the **Hand** and **Fingers** (carpal tunnel syndrome) - **Irregular Periods** or **Heavy Periods** - **Fertility** and **Embryo-Development** issues **[THYROID GLAND - CHILDREN]** - **Delayed Tooth Eruption** - **Enamel hypoplasia** - **Micrognathia** - **Anterior Open Bite** - **Accelerated** **Tooth** **Eruption** - **Maxillary**, and **Mandibular** **Osteoporosis** **PARATHYROID GLANDS** **Hyper** 1. **Primary** -- rare 2. **Secondary** -- Most often caused by tumours 3. **Tertiary** -- rare - **Depression** **&** **Fatigue** - Being **Sick** **&** Losing your **Appetite** - **Muscle** **Weakness** - **Tummy** **Pain** **&** **Constipation** - **Drowsiness** **&** **Confusion** - **HBP** **&** **Irregular** **Heartbeat** - **Osteoporosis** **&** **Bone** **Fractures** - **Kidney** **Stones** **&** **Sequalae** - **Stomach Ulcers** **&** **Pancreatitis** - **Brown Tumours** of the **Bone** - **CENTRAL GIANT CELL LESIONS** -- **Posterior Lower Jaw**. *[behind]* **First Lower Molar** **HYPO** - A **Tingling Sensation** (paraesthesia) in **Fingertips**, **Toes**, and **Lips** - **Twitching** **Facial Muscles** and of **Tongue** - **Muscle** **Pains** or **Cramps**, *[particularly]* in **Legs**, **Feet**, or **Tummy** - **Tiredness** - **Mood Changes**, such as feeling **Irritable, Anxious,** or **Depressed** - **Dry, Rough Skin** - **Coarse Hair** that **breaks easily** and can **fall out** - **Fingernails** that **break easily** -- **Low Calcium** **ADRENAL GLANDS** *[Sit on top]* of **Kidneys** -- **Produce** and **Circulate** *[Responsible]* for **Natural Steroid Production** and **Regulation** **HYPER** - **Cushing Syndrome** (excess of cortisol) **Exogenous** (corticosteroids) -- Taking too many steroids from outside source **Endogenous** - **Hyperaldosteronism** (excess of aldosterone = Conn's syndrome) - **Adrenogenital** or **Virilizing Syndromes** (excess of androgens) - **Phaeochromocytoma** (tumour overproducing epinephrine and norepinephrine) - **Fat pad** on **Back** **[Hyper - Cushing]** - **Alveolar Bone Loss** (i.e., osteoporosis of the jaw) *[can result from]* **Hypercortisolism**. - *[This in turn can contribute to]* **TOOTH LOSS**, as can **Periodontal Disease** *[resulting]* from - **Oral Candidiasis** *[occurs]* at **Elevated** **Rates**. *[more susceptible to]* **Fungal** - **Risk** of **Infection** may be *[increased]* with **Complex Dental Procedures**. [Implications of diabetes](https://www.cdho.org/Advisories/CDHO_Factsheet_Cushing_Syndrome.pdf) **[Hypo -- Addison's disease]** - **[PRIMARY]** - **[SECONDARY]** (corticosteroids) *[You can see the]* **HYPERPIGMENTATION** that it causes **[Medical Emergency -- ADDISONIAN CRISIS]** - *[Caused]* by **Stress** which is **Bad** *[because]* *[most]* **People** are **Stressed** *[seeing]* *[the]* **Dentist** - **Fever** - **Syncope** - **Convulsions** - **Hypoglycemia** - **Hyponatremia** - Severe **Vomiting** and **Diarrhea** *[Most people]* who have this **Issue** carry their own **Emergency Medications.** *[Ideally]* **DOUBLE THE DOSE** of their **Normal Meds** on the day of the **Appointment** You have to be **Careful** -- speak to **GP** about this **Dosage**. See what kind of **Patient** you have. [***Addison's** -- Dental Guidelines*](https://www.addisonsdisease.org.uk/addisons-disease-advice-for-dentists) **FEEDBACK LOOPS -- STRESS RESPONSE** **Hypothalamus-Pituitary Gland-Adrenal Glands (Hpa) Axis** (*[increased]* **Cortisol**) **Adrenal Gland** -- Blood Stream -**Hypothalamus** -- **Pituitary** to **ACTH**- **Adrenal** **Gland** to *[create]* or *[reduce]* **CORTISOL** **Stress** *[come]* into the **Loop** and causes **Issues** which *[increases]* **Cortical** which results in: - **[Results in: ]** - **Increased** **Blood Glucose** availability - **Increased** **Sodium Retention** - **Increased** **Potassium Excretion** - **Increased** suppression of **Immune System** **Feedback loops -- Steroid treatment** Suppression of **Adrenal Glands** *[If you]* **Withdraw** **Corticosteroids** too **suddenly**, the **Adrenal Glands**, *[need some]* **Time** to *[prepare]* which it don't have. *[So you have]* **Very Low Steroids** in the **Body** and it can cause **Adrenal Crisis** This is why you **Shuffle** the **Lowering** of the **Dose** *[Some people will]* **Never Be Able** to **Recover** and *[will]* need **steds for life.** **CONTRACEPTION (DRUG) -** [More Info](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198473/) - **Periodontal Disease** - **Pigmentation** (facial melasma and/or intraoral) **PREGNANCY** \-\-\-\-- [Links](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3681080/) \-\-- [More Info](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883753/) - **Hormones** affect your **Immune Response** - - **Periodontal Disease** - **Pyogenic Granuloma/Pregnancy Epulis** -- don't remove till after pregnancy - **Dental Cavities**??? - **Dental Erosion** **MENOPAUSE \-\-\-\-\--** [more info](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793432/) - **BMS** (**Burning Mouth** is related to stress sand mood swings that can be as a result of hormonal imbalance) - **Dry Mouth** - **Periodontal Health** - **Osteoporosis** **[ENDOCRINE GLANDS - INVESTIGATIONS]** - **Blood Tests** - **Hormones** - **Target Receptors/Organs** - Function of **Target Organs** - **[Imaging]** - **Radiographs** - **USS** - **CT/CBCT** - **MRI** - **Scintigraphy** - **Biopsy** if needed/possible **[ENDOCRINE GLANDS -- MANAGEMENT/TREATMENT]** - **Replacement**/**Suppression** - **Surgery** - **Target** **Organs** -- *[rather than]* **Affecting** the **Production** of the **Hormone** we try tackle at the *[source]* of the **organ** - Sequalae - Prevention **[ENDOCRINE GLANDS \-\-\-- MANAGEMENT/TREATMENT]** - **PITUITARY GLAND** - **Acromegaly** -- **GH** - **Hypo** -- **Replace** - **Diabetes** **Insipidus** -- **Vasopressin** - **THYROID** - **Hyper** -- **Carbimazole, Propylthiouracil** - **Hypo** -- **Thyroxine** - **PARATHYROID** - **Hyper**: - **PRIMARY** -- **Rehydration, Bisphosphonates** (short-term), **Surgery** - **SECONDARY** -- **vit D** - **TERTIARY** -- **surgery** - **Hypo** -- **Calcium, Vit D** - **ADRENAL** - **Cushing's** -- **Surgery**, **Lower Steroids** - **Addison's** -- **Steroids** (hydrocortisone, fludrocortisone) - **MENOPAUSE** - **HRT** - **Osteoporosis** - **Bisphosphonates** -- cosderations need to be made in regards yo XLA **[Dental Considerations]** - *[Planning]* of **Appointments** -- Morning Middle Afternoon - *[Position]* of **Patient** - *[Adjusted]* **OH** - **Oral Complications** - **Diagnosis** - **Extractions** - *[Choice]* of **Anaesthesia** - **Pregnancy** and **Breastfeeding** - **Prescribing** and **Drug Interactions** - **Medical** **Emergency** *[Planning]* of **Appointments** - *[Consider]* **Time Of Day** and **Length Of Appointment** - *[Consider]* whether the **Patient** can **Tolerate Supine Position** - *[Consider]* **Dexterity**, **Need** and **Anatomy** **[Oral Complications - Diagnosis]** 1. **[Manifestations]** 2. **[Sequalae of disease/treatment]** i. **Dry mouth** ii. **Oral thrush** iii. **Caries** iv. **Glossitis** - **EXTRACTIONS** - ***[Choice]* of Anesthesia** 1. *[Consider]* **Primary/Secondary Care** 2. **Bisphosphonates** 3. **Dry** **Socket** 4. **LA** with/without **Adrenaline** 5. **Sedation** **GA** **[Pregnancy and Breastfeeding]** - **Position** - **OHI** - **Radiology** - **Prescribing**