ch 5 - endocrine disorders

Endocrine System consists of

a group of integrated glands and cells that secrete hormones

The amount of hormone circulating in blood triggers factors that control _____

production

endocrine glands: have ducts OR do not have ducts

do not have ducts

endocrine glands: secretory products

hormones

endocrine glands: route of secretion

released directly into bloodstream

endocrine glands: examples

• thyroid glands

• parathyroid glands

• adrenal glands

• sex glands

exocrine glands: have ducts OR do not have ducts

have ducts

exocrine glands: secretory products

• sweat

• enzymes

• mucus

• other substances

exocrine glands: route of secretion

released to outer surface of body or internal organ through duct

exocrine glands: examples

• salivary glands

• pancreas

• liver

• sweat glands

Endocrine Disorders result from

• Too much or too little hormone is produced

• Results from either gland dysfunction itself OR a problem in the mechanism that controls hormone production

the Endocrine Disorders

 Hyperpituitarism

 Hyperthyroidism

 Hypothyroidism

 Hyperparathyroidism

 Addison disease

 Diabetes mellitus

main regulator to stimulate other glands

pituitary glands

hormones pituitary gland secretes

TSH, GH or HGH, ACTH, FSH, LH

HGH =

Somatotrophic hormone “human growth hormone”

RELATIONSHIP OF HORMONES SECRETED FROM PITUITARY GLAND: overgrowth

• acromegaly

• gigantism

RELATIONSHIP OF HORMONES SECRETED FROM PITUITARY GLAND: undergrowth

dwarfism

HYPERPITUITARISM

• Excess hormone production by the anterior pituitary gland

• caused most often by a benign tumor (pituitary adenoma)

HYPERPITUITARISM overgrowth: gigantism

• overproduction of HGH

• childhood and young adulthood

• occurs before closure of bones

• usually class III prognathic

HYPERPITUITARISM overgrowth: acromegaly

• abnormal growth of hands, feet, face

• overproduction of HGH later in life, adulthood

• occurs after bones are fused

• small sessile and pedunculated fibromas (skin tags)

Hyperpituitarism Clinical Features: Affects men and women in their 40s

•Poor vision

•Light sensitivity

•Enlargement of

hands and feet

•Increase in rib size

Hyperpituitarism Clinical Features: Facial Changes

•Enlargement of maxilla and mandible may cause separation of teeth and malocclusion

•Frontal bossing and an enlargement of nasal bones

•Enlargement of maxillary sinus leads to voice deepening

Hyperpituitarism Clinical Features: Mucosal changes

May have thickened lips and macroglossia

HYPERPITUITARISM: OVERGROWTH – ORAL MANIFESTATIONS

• Macroglossia

• Mandibular enlargement with prognathism, Class III malocclusion

• Widened spaces between teeth

HYPOPITUITARISM UNDERGROWTH: Dwarfism

• Short stature

• Do not develop normally to normal parents

• Easier to control with hormone therapy

• Crowding of teeth

• Underdevelopment of teeth

Increased hormone from thyroid gland =

• hyperthyroidism

• thryrotoxicosis

Decreased hormone from thyroid gland =

hypothyroidism

An excess production of thyroid hormone is more common in

women (10x), ages 30s and 40s

most common cause of An excess production of thyroid hormone is

Graves disease

Graves disease

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

• thyroid gland enlarges

• exophthalmic

• increases pt metabolism

Clinical Features of Hyperthyroidism

• Thyroid enlargement (goiter)

• Rosy complexion

• Erythema of the palms

• Excessive sweating

• Fine hair

• Softened nails

• Exophthalmos

• Anxiety, weakness, restlessness, and cardiac problems

Oral Manifestations of Hyperthyroidism

• premature exfoliation of deciduous teeth in children andpremature eruption of permanent teeth

• Osteoporosis may affect alveolar bone

• Caries and periodontal disease may appear and develop more rapidly

• Burning tongue

Treatment of Hyperthyroidism

• Surgery

• Medications to suppress thyroid activity

• Administration of radioactive iodine

• Clinical mismanagement of hyperthyroidism may lead to hypothyroidism

Hypothyroidism

A decreased output of thyroid hormone

Myxedema

hypothyroidism in adults

Cretinism

hypothyroidism in infants/children

Hypothyroidism causes

• Developmental disturbances

• Autoimmune destruction of thyroid: Hashimoto thyroiditis

• Iodine deficiency

• Drugs

• Treatment for hyperthyroidism

PARATHYROID GLAND controls

controls calcium metabolism

Calcium and phosphorus are ______ proportional

inversely

Hyperparathyroidism

• Results from excessive secretion of parathyroid hormone (PTH) from the parathyroid glands

• PTH plays a role in calcium and phosphorus metabolism

  • too much PTH - decalcification of bone, osteoporosis

• Hypercalcemia: Elevated blood levels of calcium

• Hypophosphatemia: Low levels of blood phosphorus

• Found in middle-aged adults

• more common in women

• PTH increases the uptake of dietary calcium from the GI tract and moves it to blood

Oral Manifestations of Hyperparathyroidism

• Bone changes: Loosening of teeth

• Well-defined unilocular or multilocular radiolucencies

• “Ground glass” appearance, loss of lamina dura

• Microscopically, lesions appear to be central giant cell granulomas

Clinical Features of Hyperparathyroidism

• Mild cases may be asymptomatic, or may cause joint pain or stiffness

• Lethargy and coma may occur with severe disease

• Kidney stones

• Affects skeletal system and gastrointestinal system

Diagnosis and Treatment of Hyperparathyroidism

• Measurement of PTH blood levels

  • include serum calcium and phosphorus measurements

• Treatment: Correcting the cause of increased hormone production (tumors, renal disease, kidney failure, vitamin D deficiency)

Hypoparathyroidism

• Low levels of parathyroid hormone

• Muscles are missing calcium

• Low Ca level → cannot function properly

Adrenal Glands are located

superior medial borders of kidney

Adrenal Glands secretes

directly into the blood - endo

Adrenal Gland parts and their functions

• medulla - epinephrine and norepinephine

• cortex - 3 hormones produced

  • Glucocorticoids

  • mineralocorticoids

  • androgens

Glucocorticoids

• Cushing’s syndrome = inability to process the sugars

• steroids – affects carbohydrate metabolism → Cushing’s syndrome

Mineralocorticoids

• Conn’s disease

• electrolyte imbalance → messes around with kidneys

• overproduction of this causes a loss of minerals in body

Androgens

• virulism

• group of sex hormones

• male hormones

• some naturally produced in women

Hypercortisolism (Cushing Syndrome)

• Caused by sustained increase in glucocorticosteroid levels

• Signs develop slowly

• Weight gain is the most significant and obvious clinical feature

• Other signs include:

  • Hypertension

  • Hyperglycemia

  • Mood alterations

  • Decreased ability to respond to stress

Primary Aldosteronism (Conn’s Syndrome)

• Caused by excess production of aldosterone

• aldosterone controls: sodium (Na) and potassium in the blood (K)

• Most often caused by an adrenal tumor

• Benign, but in rare cases, can be malignant

Addison’s Disease (Primary Hypoadrenocorticism)

• DECREASE IN ALL

• Adrenal insufficiency - Insufficient production of adrenal steroids

• Causes of adrenal gland destruction include:

  • Malignant tumor

  • Tuberculosis

  • Deep fungal infections

  • HIV infection

  • Autoimmune disease

  • Unknown

• To compensate, the pituitary gland increases production of adrenocorticotropic hormone (ACTH)

Clinical Features of Addison’s Disease

• Stimulation of melanocytes

  • Bronzing of the skin to white individual

  • Melanotic macules on oral mucosa

• Treatment

  • Steroid replacement therapy

PANCREAS has BOTH

• endocrine and exocrine gland

• Alpha and Beta cells in islets of Langerhans secrete hormones:

  • α-GLUCAGON – what glucose is stored as

  • β-INSULIN – hormone that effects transport of glucose into cells

• Both hormones crucial for glucose homeostasis

SEX HORMONES

• Secretes both endocrine and exocrine

• Released from anterior pituitary gland

• in response to stimulation from the hypothalamus:

  • FOLLICLE STIMULATING HORMONE (FSH)

    • Male – spermatogenesis (makes sperm)

    • Female – Estrogen - follicle (egg) production

  • LEUTINIZING HORMONE (LH)

    • Male – testosterone (interstitial cells of Leydig)

    • Female – Progesterone – triggers ovulation

      • Development of corpus luteum

      • Luteinizing corpus luteum

gland known as principle regulator in stimulation of other glands? 

pituitary gland 

thyrotoxicosis is associated with

graves disease 

3 hormones produced by cortex of adrenal glands are

glucocorticoids, mineralocorticoids, and androgens 

Addison's disease occurs with this change to the adrenal gland function happens

decrease in all hormones released 

sex hormones involve

FSH and LH