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