Chapter 7 -Endocrine Disorders
Endocrine disorders can result from these three things:
1. *Pituitary gland failing to secrete* the appropriate tropic or releasing hormone, or may not receive appropriate commands from hypothalamus 2. *Problem with the receptor or target cells* that could be blocked from receiving hormone 3. *Growths or tumors within the glands* can interfere with production or release of hormones (too little or too much)
List 4 *pituitary hormones*, their target cells, and their functions. *Hint: O GAP* there's more but know these 4.
1. Oxytocin-uterus/breasts-initiates labor /milk flow. 2. Growth hormone-bones, muscles, tissues- increases protein synthesis and growth 3. ADH-kidneys- increases BP and water retention. 4. Prolactin- mammary glands- stimulate milk production Others include: ACTH- adrenal cortex- production/release of hormones TSH- thyroid- production/release of thyroxine FSH- gonads- growth of egg/sperm LH-gonads- release of sex hormones
Name 4 dental hygiene considerations for hypothyroidism/iodine deficient diet (oral findings)
1. facial edema, puffy lips, enlarged gingival tissues aka myxedema 2. macroglossia 3. delayed exfoliation of primary teeth 4. delayed eruption of primary/permanent teeth
Name the 2 major hypothalmic hormones that target the posterior pituitary gland, and state their functions.
1. oxytocin: stimulates labor 2. antidiuretic hormone (ADH)/vasopressin: stimulates kidneys to absorb water.
Three general characteristics of hypopituitarism
1. premature aging (thin, pale, dry/wrinkled) 2. sexual characteristics become less apparent, sexual libido lost. 3. life threatening adrenal crisis
Hyperparathyroidism causes an increase in the following (3)
1. resorption of bone 2. reabsorption of calcium from kidney 3. increase production of vitamin D
________________ is the result of hypersecretion of growth hormone after puberty, which manifests with enlargement of the _____________ and _________ of the hands, feet, face, and skull. Excess soft tissue may cause ______________, _____________, and increased risk for ________________.
Acromegaly soft tissues bones sleep apnea respiratory obstructions respiratory infections
This adrenal cortex hormone regulates electrolyte balance by causing kidneys to resorb sodium and secrete potassium: ______________________, which is classified as a _____________________.
Aldosterone mineralcorticoid
Secreted by the thyroid, targets the bones to stimulate bone formation and regulate the amount of calcium in the blood
Calcitonin
_____________________ hypothyroidism is seen in infants (not common)
Congenital
Hyperadrenalism is also known as
Cushing syndrome
Secreted by the adrenal medulla, targets the heart and blood vessels to increase: heart rate, blood flow to muscles, glucose level in blood; and initiates fight or flight response (sympathetic nervous system)
Epinephrine
________________ is the result of hypersecretion of growth hormone prior to the end of puberty, which manifests as excessive growth of the _____________ system, producing very tall individuals.
Giantism skeletal
Secreted by the adrenal cortex, targets the immune system and many other systems with anti-inflammatory action; affects metabolism of nutrients; maintains blood glucose levels; modify the effects of stress; and involved in growth
Glucocorticoids
Name a hypothalamic hormone that targets the anterior pituitary gland, and state its function.
Growth hormone-releasing hormone: stimulates the release of growth hormone.
__________________ is a type of edema characteristic in individuals with hypothyroidism; caused by an accumulation of substances within the connective tissue cells that cause water retention, which leads to organ malfunction
Myxedema
Secreted by the adrenal medulla, targets the heart and blood vessels to regulate normal actions of the heart, blood vessels, etc (sympathetic nervous system)
Norepinephrine
Hyperparatheyroidism is characterized by an increased level of ______ and include 2 types: primary and secondary, which results in _________-calcemia
PTH hyper
Hypoparathyroidism is characterized by a decrease in level of ______ and usually caused by removal of glands during removal of thyroid which results in _____-calcemia. Very rare.
PTH hypo
Secreted by the parathyroid glands, targets the bones to resorb bone and regulate blood calcium levels
Parathormone
What does antidiuretic hormone (ADH) control?
The reabsorption of water into the body by the kidneys
____________________________ or adrenal crisis is a life threatening condition caused by sudden physiologically stressful event (surgery/trauma) in an individual with chronic adrenal insufficiency. Symptoms of this are associated with ______________ and include ____________ and ____________. If this condition is not identified and treated vascular collapse, loss of consciousness, and coma/death will result
acute adrenal insufficiency altered electrolyte balances low BP tachycardia
The pituitary aka hypophysis is composed of an anterior region called the ____________ and a posterior portion called the _____________________________.
adenohypophysis neurohypophysis
Targets the adrenal cortex to stimulate its production and release of hormones
adrenocorticotrophic hormone (ACTH)
Hypersecretion of growth hormone by the ________________ (anterior/posterior) pituitary affects patients differently depending on their age.
anterior
Targets the kidneys to increase water retention and raise blood pressure
antidiuretic hormone (ADH)
All symptoms of hyperthyroidism are caused by elevated amount of ________________________ that trigger an increase in the ____________________________.
circulating thyroid hormones basal metabolic rate (BMR)
Endocrine system is composed of glands that secrete products/chemical messengers directly into the ______________ or ________________ systems, and without use of ducts into ______________. Products that are secreted are called ______________________.
circulatory lymphatic local tissues hormones
This adrenal cortex hormone acts as a cardiac stimulant, induces release of vasoconstrictive substances, regulates carb/lipids/protein metabolism, and inhibits effects of insulin: ______________, which is classified as a _______________.
cortisol glucocorticoid
Tx of diabetes insipidus requires the administration of ______________, a synthetic analogue, maintenance of adequate water intake, and a low sodium diet.
desmopressin
A physical manifestation of thyroid disease is a _______________, caused by _______________ (increase in cell sizes) or _____________________ (increase in cell numbers) growth
goiter hypertrophic hyperplastic
Targets the bones, muscles, and other tissues to increase protein synthesis and growth
growth hormone (GH)
Endocrine system is responsible for slower processes, such as
growth, metabolism, electrolyte balance, and immune response
_________________ that are secreted by endocrine glands are used to regulate the functions of organs and systems in the body
hormones
________-calcemia is characteristic of hyperparathyroidism, and result in development of kidney _____________.
hyper stones
Name the dental hygiene implication (1) of primary adrenal insufficiency
hyperpigmentation or "bronzing" of the skin and gingival/mucosal tissues of the face
Whatever the cause of endocrine disorders, the symptoms are usually a result from either _____________ (too little hormone) or ______________ (too much hormone)
hypofunction hyperfunction
The pituitary gland is also known as the _______________. The anterior portion is known as the _____________________________, and the posterior portion is known as the _______________________________________.
hypophysis adenohypophysis neurohypophysis
With _________________, there is a deficiency in any of the pituitary hormones. The characteristics of this disorder are determined by the hormones affected. For example, if ____ is affected, you would expect symptoms of hypothyroidism; if _______ is affected, this would cause hypoadrenalism
hypopituitarism TSH ACTH
Women with hyperadrenalism will see an __________ and ______________ of facial hair, and possible increase in hair growth on the ___________, ______________, and _________________
increase coarsening neck chest abdomen
Most common cause of hypothyroidism internationally is an ________________________
iodine-deficient diet
Inadequate ADH causes production of ___________ (large/small) amounts of urine, which quickly leads to _________________ and _____________ imbalances
large dehydration electrolyte
Medical treatment for hyperparathyroid patients with minor or no symptoms include ________________ and drastically _________________________.
limiting calcium intake increasing fluid intake
Failure of the thyroid to descend to its proper place in the neck may result in a ________________________.
lingual thyoid
The ________________ gland is known as the "master gland."
pituitary aka hypophysis - located directly beneath the hypothalamus in the sella turcica and is connected to the hypothalamus via pituitary stalk
Medical treatment of growth hormone hypersecretion focuses on removing the cause, of which the cause is usually a ____________________.
pituitary tumor
Patients who suffer from diabetes insipidus experience ______________ and ______________. If water intake is inadequate, dehydration can be life threatening.
polydipsia polyuria
__________________________ is the temporary absence of teeth due to delayed eruption
pseudoandontia
Treatment of primary adrenal insufficiency includes _______________.
replacement of deficient glucocorticoids
Medical treatment for hyperparathyroidism focuses on ______________________________.
surgical removal of adenomas
Treatment of hyperthyroidism focuses on decreasing the amount of thyroid hormones available to cells. Certain drugs can interfere with production of hormones or with their use by cells, or gland/portions of gland can be removed ___________ or destroyed by _________________ injected into the blood stream.
surgically radioactive iodine
cells that have receptors for specific hormones on their membranes are called ____________________.
target cells
____________ is a rare life-threatening emergency associated with hyperactive thyroid.
thyroid storm
List 3 dental hygiene implications of hyperparathyroidism include (oral findings)
1. bone demineralization observed with pano 2. loose teeth 3. completed calcified pulp canals (in ESRD)
Hyperparathyroidism musculoskeletal system findings include (3):
1. bone pain 2. bone demineralization 3. pathologic bone fractures
Name 4 general characteristics of hypothyroidism
1. cold intolerance 2. slowed thinking 3. edema in face, hands, feet 4. depression
Adults with hyperthyroidism have increased risk for
1. dental erosion 2. burning mouth syndrome 3. osteoporosis of max and mandible
Name 2 intraoral manifestations of hyperthyroidism in children
1. early exfoliation of primary teeth 2. early eruption of permanent teeth
List (2) characteristics of children affected by hypoparathyroidism
1. enamel pitting 2. abnormal tooth number
What are some dental implications of hypersecretion of the pituitary gland (oral findings of acromegaly/hyperpituitarism)?
1. enlargement of maxilla/mandible 2. class 3 malocclusion and widely separated teeth 3. macroglossia and dorsal surface of tongue is deeply fissured
Hyperadrenalism in children causes
1. growth retardation 2. lack of sexual development
Name 6 general characteristics of hyperthyroidism
1. heat intolerance 2. anxiety/nervousness 3. increased heart rate 4. hypertension 5. increased respiratory rate 6. dysnea
problems associated with hyperadrenalism include:
1. hyperglycemia 2. hypertension 3. atherosclerosis
Classic cushenoid features of hyperadrenalism include (5):
1. increased fat in abdomen and above clavicles 2. buffalo hump 3. thinning or atrophy of skin 4. rapid weight gain 5. purple striae (stretch marks) caused by collagen deficiencies
List five major endocrine glands
1. pituitary gland 2. thyroid gland 3. parathyroid glands 4. adrenal glands (cortex and medulla) 5. pancreas
Dental hygiene implications of hyperadrenalism include (3):
1. round, full moon face 2. higher risk fungal infections 3. high risk for caries if left untreated
Diabetes insipidus can be caused by the following 4 things
1. tumors of hypothalamus or pituitary 2. head trauma 3. brain aneurysms 4. infections
Name some general characteristics of primary adrenal insufficiency (4)
1. weakness and fatigue 2. weightloss 3. abdominal pain coupled with steroid use 4. hypoglycemia
Hyperadrenalism is characterized by hypersecretion of ______ by tumors of the ______________.
ACTH (adrenocorticotropic hormone) pituitary gland
Primary adrenal insufficiency is known as ____________________, in which ________________________ is the most common cause of this disorder.
Addison disease autoimmune destruction of the gland
____________________________ is the most common cause of hyperthyroidism, resulting in enlargement of the thyroid. This disorder is called ______________________ and is more common in women than men
Autoimmune reaction Graves disease
List 3 *hypothalamic hormones*, their target, and their functions. *Hint: GOV*
*1. Growth hormone-releasing hormone*- target the anterior pituitary to stimulate the release of growth hormones (GH) *2. Oxytocin*- targets the posterior pituitary to stimulate labor. *3. Vasopressin aka ADH (antidiuretic hormone) targets the posterior pituitary to stimulate the kidney to reabsorb water.
Three possible presentations in children with hypopituitarism. Hint: Think DDM.
1. *delayed eruption* of primary and permanent teeth. 2. *delayed exfoliation* of primary teeth 3. significant *malocclusion*
Targets the gonads to stimulate growth and maturation of the egg and sperm
follicle-stimulating hormone (FSH)
Patients taking ____________ steroid therapy are at higher risk for adrenal crisis. In these cases, ________________ steroids may be needed to avoid this by creating adequate steroid level in blood
long-term supplemental
Targets the gonads to stimulate the release of sex hormones from the ovaries and testes
luteinizing hormone (LH)
Secreted by the adrenal cortex, targets the kidneys to stimulate excretion of potassium and resorption of sodium from the urine
mineralcortoids
Circulating calcium is essential for functioning of ______________ and ___________________ mechanisms
muscles blood clotting
Targets the uterus and breasts to initiate labor and milk flow
oxytocin
__________________-calcemia is characteristic of hypoparathyroidism; symptoms include: *hint: CHEATR*
Hypo 1. convulsions 2.hyperreflexia 3. enamel hypoplasia 4. abnormal tooth numbering 5. tetany 6. respiratory muscle spasms
Targets the thyroid gland to stimulate the production and release of thyroxine
Thyroid-stimulating hormone (TSH)
Secreted by the thyroid gland, targets most all tissues/cells to maintain metabolism, and is crucial in the growth of the brain in the CNS
Thyroxine
Most common cause of hypothyroidism (iodine deficient diet) in the United States is ____________________, aka ___________________.
autoimmune thyroiditis Hashimoto thyroiditis
Parathyroid hormone (PTH) stimulates the release of ______________ from ___________
calcium bone
Parathyroid glands stimulate the release of _______________ and stimulate ______________. They also regulate the level of ______________ in circulation
calcium vitamin D calcium
________________ is another term for protruding eyes, characteristic in _________________ (hypo/hyper)-thyroidism.
exophthalmos hyper
________________________ is a disorder characterized by a lower than normal level of antidiuretic hormone (ADH); this hormone is also called ______________. This disorder _____________ (will/will not) result in an abnormal blood glucose level
Diabetes insipidus vasopressin will not
Targets the mammary glands to stimulate milk production
Prolactin