ch 19 - endocrine disorders

Hormones are secreted by ______ ______

endocrine glands

horomones are transported by _______ to target organs

blood

hormones help maintain ________ by regulating body functions

homeostasis

pineal gland function

biological clock

pituitary gland function

• menstrual cycle

• osmoregulation

• growth and division

• birth contractions

• milk production

thyroid gland function

metabolic rate

adrenal glands function

fight or flight, anti stress

pancreas function

blood sugar levels

ovaries function

menstrual cycle

testes function

male characteristics

pituitary gland is the _______ gland

master

pituitary gland is located at

base of brain

trophic effect

stimulating the activity of another endocrine gland

Pituitary Hormone Deficiency

• Loss of secondary sex characteristics

• Decreased metabolism

• Dwarfism

• Diabetes insipidus

• Hypothyroidism

• Addison disease

• Loss of pigmentation

• Thinning and softening of the skin

• Decreased libido

• Retarded dental development

2 parts of pituitary gland

• Adenohypophysis - anterior lobe

• Neurohypophysis - posterior lobe

Adenohypophysis - anterior lobe

regulates several physiological processes (including stress, growth, reproduction, lactation)

Neurohypophysis (posterior lobe)

coordinating fluid balance and reproductive function

Hypersecretion of pituitary hormones

• sexual precocity: sex characteristics at an earlier age

• Goiter: thyroid gland growth

• Cushing disease: benign tumor of pituitary gland produces excess ACTH which makes more cortisol

• Acromegaly: overproduction of GH (hands, feet, face)

• gigantism: CHILD or adolescent has high levels of GH

Anterior Pituitary

• Growth hormone (somatotropin)

• Luteinizing hormone (LH)

• Follicle-stimulating hormone (FSH)

• Thyroid-stimulating hormone (TSH) or thyrotropin

• Adrenocorticotropic hormone (ACTH) or corticotropin

• Prolactin

• β-Lipotropin is a precursor to β-endorphin

Posterior Pituitary

• Vasopressin (antidiuretic hormone [ADH])

  • Vasopressor and antidiuretic hormone activity

  • Used to treat diabetes insipidus

  • Synthetic analogs of vasopressin

  • Desmopressin (DDAVP, Stimate)

  • Lypressin (Diapid)

• Oxytocin (Pitocin, Syntocinon)

  • Induces labor

  • Controls postpartum hemorrhage

  • Induces postpartum lactation

Thyroid Hormones

• Triiodothyronine (T3)

• Tetraiodothyronine (T4, thyroxine)

• Calcitonin- regulates calcium metabolism

Thyroid hormones act on virtually every ____ and ____ system of the body

tissue and organ

thyroid hormones are important for

• energy metabolism

• growth

• development

Cretinism

hypothyroidism in small children

Myxedema or simple hypothyroidism

hypothyroidism in adults

Hypothyroidism treatment

Levothyroxine sodium (Synthroid)

Hypothyroidism oral finding

 Delayed tooth eruption

 Malocclusion

 Increased gingivitis/periodontal disease

 Poorly shaped teeth; large teeth

 Dental caries

Hypothyroidism - Hashimoto disease

• chronic inflammation of the thyroid associated with an autoimmune response

• middle aged women

• often occur alongside other autoimmune disease

Hyperthyroidism - Diffuse toxic goiter (Graves disease)

• diffusely enlarged, highly vascular thyroid gland

• young adults

• immune response

Hyperthyroidism - Toxic nodular goiter (Plummer disease)

• nodules that secrete excessive hormone while the remainder of the glandular tissue is atrophied

• older patients

Hyperthyroidism - Thyrotoxicosis

• Excessive levels of circulating thyroid hormone

• adverse effects :

  • excessive production of heat

  • increased sympathetic activity,

  • increased neuromuscular activity

  • increased sensitivity to pain

  • ophthalmopathy

  • exophthalmos (protruding eyes),

  • anxiety

• oral manifestations:

  • accelerated tooth eruption

  • marked loss of the alveolar process

  • diffuse demineralization of the jawbone

  • rapidly progressing periodontal destruction

________ is relatively contraindicated in pts with hyperthyroidism

epinephrine

people with hyperthyroidism have an increased _____ ___ ______ and increased _______ _______ to CNS depressants, requiring higher doses of sedatives, analgesics, and local anesthetics

sensitivity to pain, tolerance

Female Sex Hormones

• Estrogens

• Progestins

  • Medroxyprogesterone (Provera)

  • Parenteral medroxyprogesterone (Depo-Provera)

  • Progestin-only “minipills”

  • Intrauterine device (IUD)

• primarily secreted by ovaries

• contraceptives have effects on oral tissues

• Hormonal contraceptives are associated with a significant increase in the frequency of dry sockets after extractions

hormonal contraceptives side effect

 Thrombophlebitis

 Thromboembolism

 Carcinogenicity

 Nausea

 Dizziness

 Headache

 Weight gain

 Breast discomfort

 Elevated BP

 Liver damage

 Increased gingival fluid

 GINGIVITIS***

 DRY SOCKETS AFTER EXTRACTIONS**

Dental Drug Interactions with Oral Contraceptives

• Certain antibiotics reduce the effectiveness of hormonal contraceptives

• Recommendations

  • Use additional contraceptive method

  • Substitute topical antibiotics for systemic

  • Use contraceptive with higher estrogen component

  • Document in patient record

• Penicillin - Decrease effectiveness of OC

• Tetracyclines - Decrease effectiveness of OC

Male Sex Hormones

• Androgens: testosterone is the main androgen

• Increase in tissue protein and nitrogen retention