DH220 Exam #3 Ch. 9 endocrine disorders

systemic diseases are reflected where?

oral mucosa, maxilla, and mandible

__________ can lead to opportunistic disease (infection and neoplasia)

immunodeficiency

local factors may be involved in the manifestation of systemic disease in oral mucosa T or F

true

hyperpituitarism

hyperthyroidism

hypothyroidism

hyperparathyroidism

diabetes mellitus

Addison disease

Cushing’s syndrome

are all examples of ____________

endocrine disorders

group of integrated glands and cells that secrete hormones

endocrine system

the amount of hormone circulating in blood triggers factors that control production T or F

true

diseases may result from conditions with too much/little hormone produced, ___________ dysfunction, a problem with hormone control and production

gland

excess hormone production by the anterior pituitary gland

hyperpituitarism

causes: benign tumor, a pituitary adenoma, that produces growth hormone

hyperpituitarism

occurs before the closure of epiphyseal plate of long bones

gigantism

hypersecretion occurs during adult life after epiphyseal plate closure

acromegaly

men/women in 40s

enlargement of max and mand = separation of teeth, malocclusion

hyperpituitarism

frontal bossing

enlargement of max sinus = voice deepening

enlargement of nasal bones

hyperpituitarism

diagnosis: measure growth hormone after glucose intake

normal: decrease in growth hormone

acromegaly: growth hormone will not decrease

hyperpituitarism

treatment: pituitary gland surgery, radiation therapy

untreated: diabetes, cardiovascular diseases, respiratory diseases, colon cancer

hyperpituitarism

excess production of thyroid hormone

thyrotoxicosis, Grave's disease

hyperthyroidism

women/men in 30s and 40s

most common cause is Grave's disease

other causes: thyroid hyperplasia, tumors, pituitary gland disease, metastatic tumors

hyperthyroidism

autoimmune disorder in which antibodies, thyroid-stimulating immunoglobulins (this), stimulate thyroid cells

grave’s disease

goiter - thyroid enlargement

increased metabolism

rosy complexion

exophthalmos - eye bulging

hyperthyroidism

Children: premature exfoliation of deciduous teeth and premature eruption of permanent teeth

burning tongue

hyperthyroidism

tx: surgery, meds to suppress thyroid, radioactive iodine

hyperthyroidism

hyperthyroidism may lead to hypothyroidism with clinical management T or F

true

a decreased output of thyroid hormone

hypothyroidism

infancy and childhood hypothyroidism

cretinism

hypothyroidism in older children and adults

myxedema

causes:

developmental disturbances

autoimmune destruction of thyroid: Hashimoto thyroiditis

iodine deficiency

Drugs

Tx for hyperthyroidism

hypothyroidism

infants: thickened lips, enlarged tongue, delayed eruption of teeth

adults: enlarged tongue

hypothyroidism

results from excessive secretion of parathyroid hormone (PTH) from the parathyroid glands

hyperparathyroidism

plays a role in calcium and phosphorus metabolism

PTH

elevated blood levels of calcium

hypercalcemia

low levels of blood phosphorus

hypophosphatemia

Cause: hyperplasia of parathyroid glands, benign tumor of 1 or more parathyroid glands, malignant parathyroid tumor

hyperparathyroidism

women/men, middle-aged

PTH increases uptake of calcium from GI and move calcium from bone to blood when necessary

hyperparathyroidism

Mild is asymptomatic, or cause joint pain or stiffness

Severe: lethargy and coma

kidney stones

affects skeletal and GI

hyperparathyroidism

bone changes: loosening of teeth

well-defined unilocular or multilocular radiolucencies

“ground glass”

loss of lamina dura

microscopically, lesions appear to be central giant cell granulomas (CGCG)

hyperparathyroidism

diagnosis: Measure PTH levels, calcium, phosphorus

Tx: correct the cause of increased hormone (tumors, renal disease, kidney failure, vitamin d deficiency)

hyperparathyroidism

high blood glucose levels

hyperglycemia

breakdown of tissues

catabolism

breakdown of fatty tissue leads to production of ketone acid, lowering the blood pH

ketoacidosis

chronic disorder of carb metabolism characterized by abnormally high blood glucose levels

diabetes mellitus

results from a lack of insulin, defective insulin, increased insulin resistance from obesity

diabetes mellitus

glucose signals beta cells of the pancreas to make insulin

insulin secreted to facilitate the uptake of glucose into fat and skeletal muscle

fat and skeletal muscle cells use glucose as energy

absence of glucose = cells starved of energy

diabetes mellitus

Acute = coma and death

Macrophages -> phagocytic activity is reduced

Neutrophils -> chemotaxis is delayed

lymphocyte function adversely affected

collagen production is abnormal

ketoacidosis

damage to blood vessels

eyes: blindness

kidney: end-stage kidney failure

nerves: paresthesia or numbness

diabetes mellitus

atherosclerosis of large and medium-size blood vessels: macrovascular disease

abdominal aortic aneurysm

thrombi, MI, stroke or cerebrovascular accident

diabetes mellitus

what is a normal fasting glucose

70-100 mg/dl

what is the random glucose diagnostic criteria for a symptomatic diabetic patient

 ≥ 200 mg/dl

how long does it take for blood glucose levels to return to fasting level after completion of a meal

2 hours

what is the fasting glucose criteria to diagnose for overt or outright diabetes according to WHO and ADA?

≥ 126 mg/dl

what is the 2-hour glucose criteria to diagnose for overt or outright diabetes according to WHO and ADA?

≥ 200 mg/dl after drinking 75g glucose after 2 hours

what is the glycosylated hemoglobin criteria to diagnose for overt or outright diabetes according to WHO and ADA?

≥ 6.5%

prediabetes fasting glucose level

100 - 125 mg/dl

prediabetes glycosylated hemoglobin level

5.7 - 6.4%

prediabetes 2 hour glucose level

140 - 199 mg/dl after the OGTT

what does OGTT stand for with diabetes mellitus testing and the 2 hour blood glucose test?

oral glucose tolerance test

insulin-producing cells of the pancreas are destroyed

type 1: insulin-dependent diabetes mellitus (IDDM)

thought to be an autoimmune disease

associated with Addison's disease, Grave's disease, pernicious anemia

type 1: IDDM

3% of all diabetic pts

any age; the peak is 20 years

pt requires lifelong insulin

type 1: IDDM

excessive thirst and intake of fluid

polydipsia

excessive urination

polyuria

excessive appetite

polyphagia

low blood sugar

hypoglycemia

insulin shock

severe hypoglycemia

uncontrolled blood glucose levels

brittle diabetes

Tx:

oral hypoglycemic meds

transplant of pancreatic beta cells into the liver

stem cell infusion

insulin pump

type 1: IDDM

characterized by insulin resistance

type 2: non–insulin-dependent diabetes mellitus (NIDDM)

97% of all diabetic pts

gradual onset

35 - 40 years or older

weight gain (OBESITY), social, cultural, ethnic

type 2: NIDDM

obesity decreases the # of receptors for insulin binding in fat and muscle

patient education by DH and dentist

type 2: NIDDM

hormones from fatty tissue

adipokines

occurs during pregnancy and disappears after pregnancy

gestational diabetes (GD)

increased birth weight of child

macrosomia

mother and child have higher risk of type 2 diabetes later in life

• vascular system adversely affected

• decreased resistance to infection

• skin infections: furuncles

• UTIs

• TB

gestational diabetes (GD)

a thickening of the blood vessel wall from fibrofatty plaques, can lead to impaired circulation, causing impaired O2 and nutrition in tissue

atherosclerosis

increases risk of ulceration and gangrene of the feet, HBP, kidney failure, stroke

diabetic retinopathy in the eye can lead to blindness

nervous system may be affected

gestational diabetes (GD)

a rare oral fungal infection that affects the palate and maxillary sinuses

mucormycosis

bilateral asymptomatic parotid gland enlargement

xerostomia

periodontal disease

accentuated response to plaque

slow wound healing

increased susceptibility to infection

diabetes mellitus

periodontal disease is:

significant complication

aggravates the control

significant prognostic or predictive clinical marker

uncontrolled________ = uncontrolled periodontal conditions

diabetes mellitus

insufficient production of adrenal steroids

Addison's disease

primary hypoadrenocorticism is another name for this disorder

Addison's disease

Causes:

malignant tumor

TB

deep fungal infections

HIV

autoimmune disease

unknown

Addison's disease

to compensate, pituitary gland increases production of adrenocorticotropic hormone (ACTH)

Addison's disease

stimulation of melanocytes - bronzing

melanotic macules on oral mucosa

Tx - steroid replacement therapy

Addison's disease

caused by sustained increase in glucocorticosteroid levels

hypercortisolism (Cushing's syndrome)

signs develop slowly

weight gain - most significant and obvious clinical feature

hypertension, hyperglycemia, mood alterations

decreased ability to respond to stress

hypercortisolism (Cushing's syndrome)