WK4 - Lecture 16 - Adrenal & Thyroid Emergencies PDF

Summary

This document provides a lecture covering adrenal insufficiency and crisis, as well as thyroid emergencies. The lecture, titled "WK4 - Lecture 16 - Adrenal Insufficiency & Crisis - Thyroid Emergencies," details various aspects of these conditions, including the functions of the adrenal glands, causes, symptoms, and treatment options. The document is focused on dental practice and medical considerations.

Full Transcript

DH 410 EMERGENCIES IN DENTAL PRACTICE LECTURE: ADRENAL INSUFFICIENCY & CRISIS & THYROID EMERGENCIES Objectives  Understand the adrenal gland function  Understand and describe etiologies of adrenal insufficiency  Recognize signs and symptoms associated with adrenal cri...

DH 410 EMERGENCIES IN DENTAL PRACTICE LECTURE: ADRENAL INSUFFICIENCY & CRISIS & THYROID EMERGENCIES Objectives  Understand the adrenal gland function  Understand and describe etiologies of adrenal insufficiency  Recognize signs and symptoms associated with adrenal crisis  Understand and prepare for treatment of patients experiencing adrenal crisis Adrenal Glands  Endocrine glands  At top of both kidneys  Consist of:  medulla (center)  cortex (surrounding area) The adrenal glands Adrenal Glands  Produce steroid hormones that control  Heart rate  Blood pressure  Metabolism  Response to stress  Blood sugar levels  More…. Adrenal Glands  Medulla  Epinephrine “adrenaline” fight-or-flight, heart rate, blood pressure  Norepinephrine Vasoconstrictor of blood vessels Adrenal Glands  Cortex  Aldosterone Control salt levels in the body  Cortisol Stresshormone Increase blood sugar, tissue repair  Androgens Male and female hormones Adrenal Insufficiency  Two categories  Primary(Addison’s disease)  Secondary  They are both CHRONIC conditions Primary Adrenal Insufficiency Primary (Addison’s Disease)  Adrenalcortex [outside portion] not producing enough hormones Respond to stress Regulate salt levels, blood pressure  Etiologies: autoimmune (approx. 70% of cases), TB, AIDS  40+ years of age, Women > Men  Clinical symptoms not usually present until 90% of both cortex have been destroyed Secondary Adrenal Insufficiency Secondary A problem with pituitary gland Pea size structure in brain Releases ACTH (Adrenocorticotropic Hormone) Stimulates adrenal gland to make cortisol  No ACTH = no cortisol Cortisol = regulates stress, blood sugar, tissue repair  More common than primary (Addison’s Disease)  60+ years of age, Women > Men Signs & Symptoms: Adrenal Insufficiency Primary & Secondary:  Flu-like symptoms  Nausea  Fatigue  Weight Loss  Hyperpigmentation (Addison’s only) Treatment: Adrenal Insufficiency Treatment  Hormone replacement  Stabilize hormone levels  Steroid: Hydrocortisone (most common) Adrenal Crisis!!!  Body severely lacking cortisol  Life-threatening  Occurs 2 possible reasons: 1. Individual not yet diagnosed Condition often mimics other illnesses 2. Patient with adrenal insufficiency in a stressful situation and requires additional cortisol Stresssets it off Often occurs in individuals on long time steroid therapy Signs and Symptoms: Adrenal Crisis A severe cortisol deficiency that leads to:  Hypotension  Dehydration – when coupled with stress can lead to -  Tachycardia  Shock  Cardiac arrest Treatment of Adrenal Crisis  Position: supine, feet elevated (hypotensive) comfortable (non hypotensive) Emergency Management: Adrenal Crisis  Position: supine, feet elevated (hypotensive) comfortable (non hypotensive)  Lightheaded  Fatigue, weak, drowsieness  Blurry vision, dizzy  Headache  Heart palpitations, tachycardia  Confusion  Nausea Emergency Management: Adrenal Crisis  Position: supine, feet elevated (hypotensive, low BP) comfortable (non hypotensive)  Definitive Care:  Contact EMS  Monitor vital signs  Administer O2 4-6 L/ minute if needed  Administer Glucocorticosteroid (if available) DDS or medical professional only & only if the patient has a history of adrenal insufficiency Prevention: Adrenal Crisis Adrenal crisis is rare is a dental setting Risk factors include:  Ending treatment with a corticosteroid too early  Stressful situations  i.e. dental appointment  Need to consult MD Prevention: Adrenal Crisis  Regimen – most patients taking steroids do not need additional steroids for dental treatment unless severe phobic or major surgical procedure (additional 5-10 mg hydrocortisone if stressful) Reference: Low Risk of Adrenal Crisis in Dental Setting https://jada.ada.org/article/S0002-8177(14)60616-4/pdf https://dimensionsofdentalhygiene.com/article/corticosteroid-supplementation/ THYROID EMERGENCIES Objectives  State anatomical location of the thyroid  Define goiter  Differentiate between hyper- and hypothyroidism  Compare and contrast symptoms of hyper- and hypothyroidism  Determine the dental relevance for patients with hyper- and hypothyroidism  Determine suggested medical emergency management of patients experiencing an unconscious state of myxedema and thyroid strom WHERE IS IT? Thyroid Gland  Butterfly shaped organ  Anterior to trachea  Endocrine gland  Produces thyroid hormones that determine:  Metabolic rate  Growth rate  Other body mechanisms The thyroid gland Effects of thyroxine Goiter  Nodular goiter enlarged thyroid gland with multiple nodules Inflammation of thyroid gland - NOT present in all cases “A goiter can occur in a gland that is producing too much hormone (hyperthyroidism), too little hormone (hypothyroidism), or the correct amount of hormone (euthyroidism). A goiter indicates there is a condition present which is causing the thyroid to grow abnormally” https://www.mayoclinic.org/diseases-conditions/goiter/symptoms-causes/syc-20351829 Hypothyroidism  Not enough thyroid hormone produced  SIGNS & SYMPTOMS:  Cold intolerance (wearing sweats in summer heat)  Unexplained weight gain  Mental slowing  Physical slowing  Dry skin Hypothyroidism Etiologies:  Pituitary Tumors Pituitary gland tells thyroid what to do Not enough thyroid hormone being produced  Hoshimoto’s Thyroiditis Autoimmune disease  Surgery or Irradiation Altering gland Treatment of Hypothyroidism  Synthetic thyroid hormone  Needto take for life  Common Drug: Levothyroxine Hyperthyroidism  Too much thyroid hormone produced  SIGNS & SYMPTOMS:  Heat intolerance (Shorts in dead of winter)  Unexplained weight loss  Increased appetite  Nervousness, tremors  Insomnia  Rapid heart rate  Sweating  Bulging eyes/Exophalmos Hyperthyroidism Etiologies:  Graves’ Disease Originunknown Hereditary Autoimmune suspected  Not all Hyperthyroidism is due to Graves’ disease Graves Disease  Unknown Etiology  Marty Feldman (actor) Treatment of Hyperthyroidism  3 methods –  Anti-thyroid medications Several available – methimazole or propylthiouracil Temporary treatment – common relapse  Ablation therapy (decrease thyroid function) Radioactive iodine to disable thyroid gland  Surgery Removal of thyroid gland Last resort; complications Dental Considerations: Hypothyroidism  Most are asymptomatic and managed by physician  Medical consult consideration  Caution with CNS depressants (anti-anxiety drugs)  Dental appointment can be managed normally Dental Considerations: Hyperthyroidism  Most managed by physician  Dental appointment can be managed normally  Review cardiac findings  Higher prevalence for cardiovascular disease risk  May appear nervous or anxious (hard to differentiate)  Anxious: cold, clammy palms  Hyperthryroidism: warm, sweaty palms Thyroid Emergencies  Myxedema coma (hypo) Loss of brain function as a result of severe, longstanding low level of thyroid hormone in the blood  Thyroid storm (hyper) Results from untreated hyperthyroidism. Usually brought on by a stress, such as trauma or infection. Myxedema Coma  Usually patient NOT comatose – misnomer  Myxedema – hard, nonpitting edema  Occurs when body unable to compensate for severe thyroid hormone deficiency  End point of chronic hypothyroidism  Etiologies: undiagnosed hypothyroidism, incorrect treatment, trauma, infection, surgery, medications  More common 70+ years, >women Signs and Symptoms: Myxedema Coma  Hallucinations  Hypothermia (

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