Endocrine System Pathology

Front 1

Name 5 cell types in the anterior pituitary and the hormones that they each produce.

Back 1

1. Somatotrophs--Growth Hormone
2. Lactotrophs--Prolactin
3. Corticotrophs--ACTH, POMC, MSH, endorphins and lipotrophin
4. Thyrotrophs--TSH
5. Gonadotrophs--FSH & LH

Each of these can form its own adenoma.

Front 2

Name the 2 peptide hormones produced in the posterior pituitary (neurohypophysis).

Back 2

1. ADH (Antidiuretic hormone or Vasopressin)
2. Oxytosin

Front 3

What happens in hyperpituitarism?

What is the most common cause?

Back 3

An excess secretion of pituitary hormones.

Most common cause is an adenoma (benign glandular tumor). Adenomas are classified on the basis of the hormones produced.

Front 4

Hyperpituitarism:
What is the most common type of adenoma?
What two types are of interest to dentists?

Back 4

Most common: Prolactinoma

For dentists:
Corticotrophoma (excess ACTH can lead excess Cortisol which can lead to Cushing syndrome).

Somatotroph Adenoma--Hypersecretion of GH.

Front 5

Somatotroph Adenoma can lead to these two manifestations.

Back 5

1. Gigantism

2. Acromegaly

Front 6

Gigantism:
What is it caused by?
Does it occur with acromegaly?

Back 6

A somatotrophic adenoma develops in a child before epiphyses have closed.

Can occur with acromegaly or separately from it...depending on when the tumor develops.

Front 7

Acromegaly:
How is it caused?
Common signs & symptoms?

Back 7

Caused by somatotrophic adenoma or other factor increasing GH levels after epiphyses have closed.

Conspicuous growth in skin & soft tissues, bones of face, hands and feet. Hyperostosis--increased bone density.

Front 8

What are the main Posterior Pituitary Syndromes?

Back 8

ADH excess (causing abnormal water retension, edema, etc.) and ADH deficiency (causing Diabetes insipidus).

Front 9

What is the cause of thyrotoxicosis?

What is it often referred to as?

Back 9

Elevated T3 & T4 levels.

Thyrotoxicosis is most commonly caused by hyperfunction of the thyroid--referred to as hyperthyroidism (one cause of thyrotoxicosis).

Front 10

What are the 3 most common specific causes of thyrotoxicosis?

Back 10

1. Diffuse hyperplasia of thyroid, associated with Graves disease
2. Hyperfunctional multinodular goiter
3. Hyperfunctional adenoma of the thyroid

Front 11

What are some clinical manifestations of hyperthyroidism?

Back 11

1. Increased BMR
2. Cardiac manifestations (tachycardia, irregular heartbeats)
3. Neuromuscular manifestations (tremor, anxiety, etc.)
4. Ocular changes
5. GI manifestations (hypermotility, diarrhea, etc.)
6. Skeletal manifestations (osteoporosis)
7. Thyroid Storm

Front 12

What is a hyperthyroidic manifestation that is specific to Graves disease?

Back 12

Exophthalmopathy (bulging eyes).

Front 13

What is a Thyroid storm?

Back 13

Abrupt onset of severe hyperthyroidism. A medical emergency--some patients can die of cardiac arrhythmias.

Front 14

What are 3 guidelines for dental treatment of a hyperthyroid patient?

Back 14

1. No elective dental care until patient is rendered euthryroid (normal thyroid function).

2. Epinephrine should be avoided.

3. Thyroid storm is a medical emergency.

Front 15

Graves Disease:
What type of disorder?
What happens?

Back 15

Autoimmune disorder.

TSH-receptor cell antibodies bind to TSH receptors and cause chronic production of T3 & T4.

Front 16

Graves Disease:
M vs. W?
Genes?

Back 16

Women are affected 7x more frequently. About 20-40 years old.

Genetic susceptibility associated with HLA-88 and -DR3.

Front 17

What is the most common cause of endogenous hyperthyroidism?

Back 17

Graves Disease.

Front 18

Graves Disease:
What are the clinical "triad" of findings?

Back 18

1. Hyperthyroidism.
2. Infiltrative ophthalmopathy with exophthalmos.
3. Localized infiltrative dermopathy (pretibial myxedema). Deposits of tissue around ankles. Not usually found with other hyperthyroid disorders.

Front 19

What is primary hypothyroidism?
Secondary?
Tertiary?

Back 19

Primary: Intrinsic abnormaility in the thyroid itself.

Secondary: Secondary to pituitary disease or failure.

Tertiary: Due to Hypothalmic failure (rare).

Front 20

What are the most common causes of primary hypothyroidism?

Back 20

1. Surgical or radiation-induced ablation (done intentionally).

2. Autoimmune hypothyroidism (typically Hashimoto thyroiditis).

Drugs also.

Front 21

What is hypothyroidism called when it occurs in infants or during early childhood?

In the older child or adult?

Back 21

Cretinism.

Myxedema.

Front 22

Cretinism:
What are its clinical features?

Back 22

1. Severe mental retardation--especially if a maternal thyroid deficiency develops before the fetus' thyroid has developed.
2. Short stature.
3. Coarse facial features.
4. Protruding tongue.
5. Umbilical hernia.

Front 23

Myxedema:
Another name?
Symptoms?

Back 23

Gull Disease.

Generalized fatigue, apathy, mental sluggishness, speech and intellectual functions slowed.

Front 24

What type of hypothyroidism is most dominant in populations with sufficient iodine?

Back 24

Hashimoto Thyroiditis.

Front 25

Hashimoto Thyroiditis:
What causes it?
M vs. W?
Genes?

Back 25

Progressive autoimmune destruction of the thyroid gland.

Women affected about 10x more often. (45-65).

Multiple genes involved. Increased incidence in patients with Turner or Down syndromes.

Front 26

Hashimoto Thyroiditis:
What is the overriding feature?

Back 26

Progressive depletion of thyroid epithelial cells.
Painless enlargement of thyroid with some hypothyroidism.

Front 27

What is the most common manifestation of thyroid disease?

Back 27

Goiter.

Front 28

Impaired synthesis of thyroid hormone, usually because of a dietary iodine deficiency causes what?

Back 28

Diffuse and multinodular goiters.

Front 29

How does a goiter occur?

Back 29

Decreased amounts of T3 & T4 leads to a compensatory rise in TSH levels in serum. Hypertrophy and hyperplasia follow with enlargement of gland.

Front 30

What is the most common type of thyroid cancer?

Back 30

Papillary carcinoma.

Front 31

What is the most indolent (least aggressive) form of thyroid cancer?

Back 31

Papillary carcinoma. 95% 10 year survival rate.

Front 32

Medullary Carcinoma:
What is it derived from?
Hereditary?

Back 32

Parafollicular cells (C cells) of the thyroid.

Usually not hereditary, arise sporadically.

Front 33

Patients with this syndrome often develop aggressive Medullary carcinomas of the thyroid.

Back 33

MEN-2B (Williams Syndrome).

Front 34

What does MEN stand for?

Back 34

Multiple Endocrine Neoplasia Syndromes.

Front 35

What are pheochromocytomas?

Back 35

Chromaffin cell tumors that produce catecholamines, especially epinephrine.
They often have high BP and develop neuromas of the skin, oral mucosa, eyes, respiratory & GI tracts.

Front 36

What is more common, hypoparathyroidism or hyperparathyroidism?

Back 36

Hyperparathyroidism by far.

Front 37

Describe primary hyperparathyroidism.

Secondary?

Back 37

Primary: Disease within parathyroid gland. Autonomous, spontaneous overproduction of PTH.

Secondary: Usually associated with renal insufficiency.

Front 38

Primary hyperparathyroidism:
Common?
Causes what?
Usually caused by what?
What are 2 ways in which it presents?

Back 38

One of the most common endocrine disorders.

Hypercalcemia.

75-80% of the time it is due to an adenoma.

1. Asymptomatic (discovered in routine chemistry profile)
2. Symptomatic--Increased PTH and hypercalcemia. Painful bones, renal stones, abdominal groans, psychic moans with fatigue overtones.

Front 39

Primary hyperparathyroidism:
Painful Bones?

Renal Stones?

Abdominal Groans?

Back 39

Generalized osteoporosis, osteitis fibrosa cystica (radiolucencies in bone).

Nephrolithiasis due to elevated serum calcium levels.

Constipation, nausea, gallstones, etc.

Front 40

Primary hyperparathyroidism:
Psychic moans?

Fatigue overtones?

Cardiac?

Back 40

Depression, lethargy, seizures.

Weakness, fatigue.

Aortic and/or mitral valve calcifications.

Front 41

Primary hyperparathyroidism:
What dental manifestations?

Back 41

Loss of lamina dura.

Ground glass appearance.

Osteoporosis.

Brown tumor.

Osteitis fibrosa cystica.

Front 42

Secondary hyperparathyroidism:
What is the most common cause?

Back 42

Renal failure. Retention of phosphate, low serum calcium levels. This causes a hyperplasia of the gland and more PTH is produced in an attempt to increase serum calcium.

Front 43

What are the 3 types of hyperadrenal clinical syndromes?

Back 43

1. Cushing syndrome
2. Hyperaldosteronism
3. Adrenogenital or virilizing syndrome

Front 44

Cushing Syndrome:
1. Due to?
2. What are the 4 ways of developing it?

Back 44

1. Elevation of glucocorticoid levels. Can happen in clinical practice due to administration of exogenous glucocorticoids.

2. a. Pituitary Cushing Syndrome
b. Adrenal Cushing Syndrome
c. Iatrogenic Cushing Syndrome
d. Paraneoplastic Cushing Syndrome

Front 45

Pituitary Cushing Syndrome:
How?

Back 45

Excess ACTH from pituitary (tumor)...creates excess cortisol.

Front 46

Adrenal Cushing Syndrome:
How?

Back 46

A disease process in the adrenal cortex.

Front 47

Iatrogenic Cushing Syndrome:
How?

Back 47

Due to administered steroids. Adrenal gland undergoes atrophy.

Front 48

Paraneoplastic Cushing Syndrome:
How?

Back 48

Small cell carcinoma of the lung that produces ACTH...leads to increased cortisol.

Front 49

Cushing Syndrome:
Manifestations?

What do glucocorticoids induce?

Collagen?

Back 49

Hypertension & weight gain. Buffalo hump & moon facies. Truncal obesity.
Loss of muscle mass.

Glucocorticoids induce gluconeogenesis & inhibit glucose uptake. (Hyperglycemia, glucosuria, polydipsia).
Suppress immune response***

Loss of collagen.

Front 50

Cushing Syndrome:
Dental management?

Back 50

Regulation of the steroid level before treatment.
Consider antibiotic treatment before oral surgery. Closely monitor healing.

Front 51

Adrenal Insufficiency (AI):
Primary Acute.
What are the 2 causes?

Back 51

1. Chronic AI that can have an acute exaceration that can lead to an adrenal crisis.

2. Waterhouse-Friderichsen Syndrome: Bact. infection induces adrenal gland hemorrhage.

Front 52

Adrenal Insufficiency:
Primary Chronic:
What is it called?
Clinical features?

Back 52

Addison's Disease.

1. Weakness & Fatigue.
2. Anorexia, nausea, vomiting, weight loss, diarrhea.
3. Hyperpigmentation.
4. Hyperkalemia, hyponatremia, hypotension.

Front 53

Addison Disease:
What are the dental considerations?

Back 53

1. Hypotension
2. Hypoglycemic syncopy
3. Low coping under stress

Front 54

What types of cells is the adrenal medulla made of?

Back 54

Chromaffin cells.

Front 55

Pheochromocytoma:
What is it?
What happens?

Back 55

Chromaffin cell tumors.

Tumors synthesize and release catecholamines-->give rise to hypertension. May result in chf, mi, arrhythmias, cva (all related to hypertension).