Adrenal Diseases Past Paper PDF - King Faisal University

College of Dentistry, King Faisal University, Al Ahsa Department of Oral and Maxillofacial Surgery and Diagnostic Sciences Clinical Medicine for Dentists 3401302 Year 4 Semester 1 : Batch 5 (2020) Dr. Ah...

College of Dentistry, King Faisal University, Al Ahsa Department of Oral and Maxillofacial Surgery and Diagnostic Sciences Clinical Medicine for Dentists 3401302 Year 4 Semester 1 : Batch 5 (2020) Dr. Ahmed Hashim Clinical Medicine for Dentists Adrenal diseases  Clinical Medicine for Dentists Learning Outcome  Types of Adrenal gland disorders associated with Dentistry  Causes of Adrenal gland disorders  Symptoms of Adrenal gland disorders  Diagnosis of Adrenal gland disorders  Treatment of Adrenal gland disorders  Clinical Medicine for Dentists  Adrenal gland disorders (or diseases) are conditions that interfere with the normal functioning of the adrenal glands.  The adrenal gland produces hormones that affects growth, development and stress, and also helps to regulate kidney function. There are two parts of the adrenal glands: Nacl magnesum 1. The adrenal cortex produces mineralocorticoids, which regulate salt and water balance within the body, glucocorticoids (including cortisol) 2. The adrenal medulla produces epinephrine (adrenaline) and norepinephrine (noradrenaline).  Clinical Medicine for Dentists Gland: an organ in the human or animal body which secretes particular chemical substances for use in the body or for discharge into the surroundings. Adrenal glands: secrete directly in the blood Small endocrine glands (weight 6-8 grams) Located on superior pole of each kidney Composed of cortex and medulla Medulla secretes catecholamines (epinephrine, norepinephrine and dopamine) neurotransmitters. Cortex (more than 90% of adrenal gland) secretes glucocorticoids (cortisol, which helps the body adapt to stress thus important for Nacl magnesium survival), mineralocorticoids and androgens sex hormones  Clinical Medicine for Dentists Pathophysiology: Normal adrenal function Adrenocortical steroids affect all body tissue and organs Helps to keep body’s internal environment constant (homeostasis) via actions on metabolism of carbohydrates, fats, proteins, water and electrolytes The body provides a minimum amount of cortisol (20 mg in non-stressed adults) Adrenocorticotropic hormone ACTH is released by anterior pituitary gland in  Clinical Medicine for Dentists In stressful situations, the pituitary gland rapidly increases the release of ACTH, and adrenal cortex responds within minutes synthesizing and secreting increased amounts of various corticosteroids that prepares the body to successfully manage the stressful situation C more than 20mg Metabolic rate increases, sodium and water are retained, small blood vessels become increasingly responsive to the actions of norepinephrine (Constricts blood vessels, which helps maintain blood pressure in times of stress. Affects sleep-wake cycle, mood and memory)  Clinical Medicine for Dentists Stress stimulates the hypothalamus to secrete corticotrophin-releasing hormone (CRH) CRH then stimulates anterior pituitary to release ACTH into circulation ACTH promotes the rapid secretion of cortisol (within minutes) by adrenal cortex This is known as hypothalamic-pituitary- adrenal axis  Clinical Medicine for Dentists I ACTH levels in blood controls the secretion of corticosteroids by adrenal cortex also sleep e In non-stressful situations, the level of cortisol in the blood controls the secretion of ACTH High plasma cortisol level suppresses ACTH release Low plasma cortisol level enhances the release of ACTH The individual sleep cycle (circadian rhythm) controls ACTH secretion sleep awake cycle Plasma ACTH begin to rise at 2 AM, reaching peak levels at the time of awakening The ACTH less stress  Clinical Medicine for Dentists Mechanisms of glucocorticosteroid availability in normal adrenal function Interrupt Functions ators Is to interrupt inflammation by moving into cells and I suppressing the proteins that go on to promote inflammation. Ins  Clinical Medicine for Dentists Cushing’s syndrome: mostly cancer A clinical condition resulting from cortisol hypersecretion Associated with adrenal adenoma (tumor of adrenal cortex) Does not usually result in acute life-threatening situation to inflamation Hypercortisolism contributes to early development of systemic diseases  Clinical Medicine for Dentists Complications include obesity, hypertension, diabetes mellitus, hypercoagulability, dyslipidemia (elevation of plasma cholesterol levels or Misinflamatient low levels of high-density lipoprotein), atherosclerosis, depression, muscle weakness, impaired quality of life Vertebral fractures due to impairment of skeletal system Treatment is by surgical removal (all or part) of adrenal glands me Renal and adrenal surgery can cause primary adrenocortical insufficiency  Clinical Medicine for Dentists 1. Primary adrenocortical insufficiency Addison’s disease: Life-threatening condition caused by cortisol deficiency In Autoimmune adrenalitis is a common cause (80% of cases) e Clinical presentation in acute adrenal insufficiency includes hypotension, hypoglycemia, hyperpigmentation and loss of consciousness, circulatory shock, hyponatremia, hyperkalemia, muscle cramps, nausea, vomiting, diarrhea, unexplained fever we can take sample to see 914 glucocorticoids makes  Clinical Medicine for Dentists 8H before Taking sample Impaired fasting glucose Treatment I Administration of physiologic doses of exogenous corticosteroid (cortisol) can correct pathophysiological effects associated with Addison’s disease When 90% of adrenal cortex is destroyed, clinical manifestations starts to develop in This case should remove we  Clinical Medicine for Dentists 2. Secondary adrenocortical insufficiency most dangerous Can develop in stressful situations after abrupt cessation or gradual withdrawal (uncommon) of exogenous corticosteroid therapy Adrenal cortex returns to normal after i 2-4 weeks of cessation Secondary adrenocortical insufficiency is 2 to 3 times more common than primary adrenal insufficiency  Clinical Medicine for Dentists It is a greater potential threat than primary adrenal insufficiency e (Addison’s disease) in the development of acute adrenal crisis ch of cortisol Patients developing acute adrenal insufficiency are in immediate danger due to cortisol deficiency, i.e. lack of glucocorticosteroid hormones is the major predisposing factor in all cases of acute adrenal insufficiency Vascular collapse (shock) and cardiac arrest are the usual cause of death  Clinical Medicine for Dentists situationsome Mechanisms for development of glucocorticosteroid deficiency: Mechanism 1: sudden withdrawal of steroid hormone in a patient who suffers primary adrenal insufficiency (Addison’s disease) Mechanism 2: sudden withdrawal of steroid in a patient with normal f adrenal cortex who is receiving prolonged exogenous steroid treatment (secondary insufficiency), therefore withdrawal of steroid should always be gradual  Clinical Medicine for Dentists Mechanism 3: after stress (physiological or psychological), which is the most common factor in the dental setting predisposing for acute adrenal insufficiency FEED Mechanism 4: after bilateral adrenalectomy, or removal of a functional adrenal tumor that was suppressing the other adrenal gland Mechanism 5: after sudden destruction of the pituitary gland trauma t Mechanism 6: after both adrenal glands are injured through trauma, hemorrhage, infection, thrombosis or tumor  Clinical Medicine for Dentists Management of adrenal insufficiency: (not enough cortisol hormone) Replacement therapy with exogenous glucocorticoids Can be given as oral or parenteral  Clinical Medicine for Dentists Management of adrenal insufficiency in Dentistry: Conscious patients: at Termination of dental treatment (when signs of adrenal insufficiency appear, mental confusion, nausea, vomiting, abdominal pain, in patients L who are on steroid or have recently ceased long term steroid therapy) Positioning of the patient: supine position with legs elevated slightly (signs of hypotension- mental confusion, profuse sweating) C-A-B (circulation-airway-breathing), basic life support as needed11  Clinical Medicine for Dentists manageadmistration Monitoring of vital signs every 5 minutes so first Then 02 Vitals Summoning of emergency medical assistance acute or Emergency kit and administration of O2 at a flow rate of 5 to 10 L per min c Administration of glucocorticosteroids from the emergency kit In patients with chronic adrenal insufficiency, then 50 to 100 mg e hydrocortisone is administered every 6 to 8 hours Tanagment Diagnosis of adrenal insufficiency is confirmed by the laboratory test ITTest (ACTH stimulation test) before diagnosing any adrenal diseases  Clinical Medicine for Dentists action for fast 4 mg of dexamethasone should be administered by I/V route every 6 to 8 hour while waiting the result of ACTH stimulation test Dexamethasone is approx. 100 more potent than cortisol Fianna Assistant staff administer I/V fluid (normal saline) to counteract depletion of body fluid (hypovolemia) 5 % dextrose solution is administered to combat hypoglycemia  Clinical Medicine for Dentists Unconscious patients in Dentistry: Recognition of unconsciousness (lack of response) In Positioning of the patient: supine position with legs elevated slightly C-A-B (circulation-airway-breathing), basic life support immediately (cardiopulmonary resuscitation, CPR)  Clinical Medicine for Dentists Obtain the emergency drug kit containing aromatic ammonia, and administer O2 THE Patients with adrenal insufficiency do not respond to inhalation of aromatic ammonia unlike other unconscious patients  Clinical Medicine for Dentists Summoning of emergency medical assistance Evaluation of medical history of the patient for clue of possible cause Administration of glucocorticosteroids (100 mg hydrocortisone administered I/V or I/M) over 30 seconds, and I/V infusion together with 100 mg hydrocortisone over 2 hours y n I/V infusion of 1 L normal saline to combat hypotension, or 5% dextrose t solution over 1 hour while waiting emergency assistance Transfer to hospital YouTube Video: https://youtu.be/pSeU9Ei-3u4?feature=shared