Endocrine Repro Diseases Of The Endocrine System

Front 1

What are the cells in the adenohypophysis that produce growth hormone (GH)?

Back 1

Somatotrophs

Front 2

What are the cells in the adenohypophysis that produce prolactin (PRL)?

Back 2

Lactotrophs

Front 3

What are the cells in the adenohypophysis that produce ACTH, POMC, MSH, endorphins and lipotropin?

Back 3

Corticotrophs

Front 4

What are the cells in the adenohypophysis that produce TSH?

Back 4

Thyrotrophs

Front 5

What are the cells in the adenohypophysis that produce FSH and LH?

Back 5

Gonadotrophs

Front 6

What are the two peptide hormones that are produced by pituicytes and axonal processes extending from nerve cell bodies in supraoptic and paraventricular nuclei of the hypothalamus?

Back 6

ADH/vasopressin
Oxytocin

Front 7

What types of neoplasms are more likely to produce excess secretion of trophic hormones?

Back 7

Forms of Hyperpituitarism, specifically Benign tumors (adenomas)

Front 8

What is the most common cause of hyperpituitarism?

Back 8

Adenoma

Front 9

T/F
Pituitary adenomas are classified on the basis of the hormones produced.

Back 9

True
i.e. TSH adenoma, PRL adenoma, etc.

Front 10

What is the most frquent type of hyperfunctioning pituitary adenoma?

Back 10

Prolactinomas (PRL adenoma)

Front 11

What two adenomas result in complications for dentistry?

Back 11

Excess production of ACTH
Persistent hypersecretion of GH

Front 12

What leads to the development of hypercortisolism known as Cushing syndrome?

Back 12

Excess production of ACTH by corticotroph adenoma

Front 13

What causes hepatic secretion of isulin-like growth factor (IGF-I or somatomedin C), which causes many clinical manifestations?

Back 13

Persistent hypersecretion of GH

Front 14

What happens if a somatotrophic adenoma develops in children Before the epiphyses have closed?

Back 14

The elevated levels of GH result in gigantism

Front 15

T/F
Acromegaly and gigantism can occur together or separately, depending on when the tumor develops.

Back 15

True

Front 16

What does the prefix Acro mean?

Back 16

Acro = the most distal point

Front 17

What develops if increased levels are present After closure of the epiphyses?

Back 17

Acromegally

Front 18

Which GH disorder results in hyperostosis (increases bone density)?

Back 18

Acromegally

Front 19

What GH associated disorder has growth most conspicuous in skin and soft tissues, increased bone density, prognathic jaw, frontal bossing, large ears, big nose, macroglossia, hands and feet are enlarged with broad, plump fingers, diabetes mellitus?

Back 19

Acromegally

Front 20

What causes a Diabetes insipidus and is characterized by excessive urination (polyuria) owing to an inability of the kidney to reabsorb water properly from the urin?

Back 20

ADH deficiency

Front 21

What do these lesions cause?
idiopathic sporadic mutations, familial (30%)
Tumors (25%)
Trauma (16%)
Post-hypophysectomy (20%)

Back 21

ADH deficiency resulting in Diabetes Insipidus

Front 22

What causes a deficiency in water resorption in the collecting duct?

Back 22

ADH deficiency causing Diabetes Insipidus

Front 23

What is a hypermetabolic state (increased BMR) caused by and elevation of free T3 and T4?

Back 23

Thyrotoxicosis

Front 24

What is an interchangeable term for Hyperthyroidism?

Back 24

Thyrotoxicosis

Front 25

What are the following conditions associated with?
Graves Disease (diffuse toxic hyperplasia)
Hyperfunctioning multinodular goiter
Hyperfunctioning adenoma
Iodine-induced hyperthyroidism
TSH secreting pituitary adenoma (rare)

Back 25

Hyperthyroidism

Front 26

What are the most common causes of thyrotoxicosis?

Back 26

Diffuse hyperplasia
Hyperfunctional Multinodular Goiter
Hyperfunctional Adenoma of the thyroid

Front 27

What is the term for a tumor that is producing too much of the hormone that is normally produced by healythy tissue from that area?

Back 27

Toxic tumor

Front 28

What are the clinical manifestations of hyperthyroidism and are generally referable to the hypermetabolic state and the overactivity of the sympathetic nervous system?

Back 28

1. Increased BMR (skin is soft, warm, and flushed; heat intolerance with sweating; weight loss & increased appetite)
2. Cadiac manifestations (increased CO; tachycardia; palpitations; cardiomegaly; arhythmias; CHF)
3. Neuromuscular manifestations are related to overactivity of the sympathetic nervous system. (tremor, hyperactivity, emotional liability, anxiety, inability to concentrate, insomnia, muscle weakness)
4. Occular changes (wide staring gaze like someone just said boo; lid lag; thyroid ophthalmopathy associated with exiphthalmos (only in graves disease))
5. GI Manifestations (sympathetic hyperstimulation results in hypermotility, malabsorbtion, diarhea)
6. Skeletal manifestations (Thyroid hormone stimulates bone resorption leading to osteoporosis and an increased risk of fractures

Front 29

*What is a condition associated with Graves disease, but NOT other forms of hyperthyroidism?

Back 29

Thyroid Opthalmopathy associated with exophthalmos

Front 30

*What is an abrupt/acute onset of severe hyperthyroidism and is a medical emergency as some untreated patients die of cardiac arrhythmias?

Back 30

Thyroid Storm
Patient can progress on coma and death.

Front 31

*What is important regarding dental management of the hyperthyroid patient?

Back 31

1. No elective dental care should be given to a patient with hyperthyroidism until the patient has been rendered euthyroid (the condition of having normal thyroid function, as opposed to hyperthyroidism and hypothyroidism)
2. Epinephrine-containing local anesthetics and retraction cords should be avoided because of epinephrine's cardiostimulating and hypertensive action
3. Thyroid storm is a medical emergency

Front 32

*What is the most common cause of endogenous hyperthyroidism?

Back 32

Grave's Disease

Front 33

*What is the triad of clinical findings for Grave's disease?

Back 33

1. Hyperthyroidism
2. Infiltrative ophthalmopathy with exophthalmos (from the loose connective tissue pushing the eye out, not found in other forms of hyperthyroidism)
3. Localized infiltrative dermopathy (pretibial mixedema) (deposits of tissue on the skin of the leg over the tibia and down to the ankle, Not found in other types of hyperthyroidisms)

Front 34

*What makes Primary hypothyroidism primary?

Back 34

Because of an intrinsic abnormality within the thyroid gland itself.

Front 35

*What are the most common causes of Primary Hypothyroidism?

Back 35

1. Surgical or radiation induced ablation as well as thyroid agenesis or hypoplasia
2. Autoimmune hypothyroidism with the majority of cases associated with Hashimoto Thyroiditis (hashimoto's is a prototype autoimmune disease)

Front 36

What is the name for hypothyroidism developing in infants or in early childhood?

Back 36

Cretinism

Front 37

*What is hypothyoidism that develops in an older child or adult?

Back 37

Myxedema

Front 38

*What is the most important clinical feature of cretinism?

Back 38

Severe mental retardation particularly if maternal thyroid deficiency develops before development of the fetal thyroid

Front 39

*What is the most common cause of hypothyroidism in areas of the world where iodine levels are sufficient?

Back 39

Hashimoto Thyroiditis

Front 40

*How does Hashimotothyroiditis occur?

Back 40

Progressive autoimmune destruction of the thyroid gland
(immune system reacts against a variety of thyroid antigens; thyroid tissue is destroyed and it kind of looks like it is being replaced with lymphocytes)

Front 41

*What is the most common type of thyroid cancer?

Back 41

Papillary Carcinoma - this is the least aggressive 95% 10-year survival rate for papillary carcinomas of the thyroid

Front 42

*What is MEN-2A & MEN-2B associated with in Medullay carcinomas?

Back 42

MEN-2A = Sipple Syndrome
MEN-2B = Williams Syndrome
(MEN = Multiple Endocrine Neoplasia Syndromes)

Front 43

*What are neuroendocrine neoplasms derived from the Parafollicular (C) cells of the Thyroid?

Back 43

Medullary Carcinoma
(the other three types of thyroid carcinomas all arise from follicular epithelial cells)

Front 44

*What are the three types of neoplasms associated with the Thyroid?

Back 44

Papillary Carcinoma
Medullary Carcinoma MEN-2A Sipple Syndrome
Medullary Carcinoma MEN-2B Williams Syndrome*

Front 45

What are chromaffin cell tumors that produce catecholamines, particularly epinephrine?

Back 45

Pheochromocytomas (this will increase BP; these patients will often have a problem with hypertension)

Front 46

What are the manifestations of MEN-2B syndrome?

Back 46

Agressive Medullary Carcinomas and Pheochromocytomas
Neuromas or ganglioneuromas of the skin, oral mucosa, tongue, eyes and respiratory and GI tracts
Marfanoid habitus (tall, slender, long fingers)
A single AA change in the RET gene locus gives rise to the disorder
tumors have ill defined margins

Front 47

*What are the properties of Primary Hyperparathyroidism?

Back 47

Disease is within the gland
Represents an autonomous, spontaneous overproduction of PTH.

Front 48

*What are the characteristics of Secondary Hyperparathyroidism?

Back 48

Occurs as secondary phenomena most commonly associated with renal insufficiency

Front 49

What is the most common cause of Primary Hyperparathyroidism?

Back 49

Adenoma (75-80% of cases)
[Hyperplasia (10-15%), Carcinoma <5%]

Front 50

What are the Classic Clinical Presentations of Primary Hyperparathyroidism?

Back 50

Reflect the combined effects of increased PTH and hypercalcemia
The constellation of symptoms can be summarized by the statement: Painful bones, Renal stones, Abdominal groans, Psychic moans with Fatigue overtones

Front 51

What are the dental manifestations of Hyperparathyroidism?

Back 51

1. Loss of lamina dura
2. Ground glass appearance (Little radiolucencies and radiopacities right next to each other; looks foggy or stippled)
3. Osteoporosis
4. Brown tumor (brown appearance from osteoclasts RBCs and Hemosiderin from the breakdown of RBCs, cellular fibrous CT)
5. Osteitis Fibrosa Cystica

Front 52

What is the Most common cause of the secondary form of Secondary Hyperparathyroidism?

Back 52

Renal Failure
(causes retention in phosphate, which means we have low serum levels; This causes hyperplasia of the gland and more PTH is produced in an attempt to increase serum calcium)

Front 53

What is the most likely cause of Cushing Syndrome?

Back 53

Administration of Exogenous Glucocorticoids

Front 54

What are the four different ways that one can develop Cushing Syndrome?

Back 54

1. Pituitary Cushing Syndrome
2. Adrenal Cushing Syndrome
3. Latrogenic Cushing Syndrome
4. Paraneoplastic Cushing Syndrome

Front 55

Which Cushing Syndrome is caused by ACTH causes hyperplasia of adrenal cortex and excess cortisol levels?

Back 55

Pituitary Cushing syndrome

Front 56

Which Cushing Syndrome occurs when the disease process is in the adrenal cortex?

Back 56

Adrenal Cushing Syndrome

Front 57

Which Cushing Syndrome is caused by the physician? When you are taking steroids your adrenal gland undergoes atrophy.

Back 57

Laterogenic Cushing Syndrome

Front 58

Which Cushing Syndrome occurs when there is small cell carcinoma of the lung that can produce ACTH or ACTH-like cmpds, leading to hypercortisolism?

Back 58

Paraneoplastic Cushing Syndrome

Front 59

What is the biggest negative effect can glucocorticoids have on the body?

Back 59

Glucocorticoids suppress the immune response so these patients are prone to infection.

Front 60

What are the clinical features of Cushings Syndrome?

Back 60

Emotional Disturbance
Enlarged Sella Turcica
Moon Faced
Osteoporosis
Cardiac Hypertrophy (hypertension)
Buffalo Hump
Obesity
Adrenal Tumor or Hyperplasia
Thin wrinkled skin
Abdominal Striae
Amenorrhea
Muscle Weakness
Purpura
Skin Ulcers (poor wound healing)

Front 61

What are the two types of Primary Adrenal Insufficiency?

Back 61

Primary Acute Adrenal Insufficiency (Waterhouse-Friderichsen Syndrome)
Primary Chronic Adrenal Insufficiency (Addison Disease)

Front 62

What are the two causes of Primary Acute Adrenal Insufficiency?

Back 62

1) Chronic AI that can undergo an acute exacerbation that can lead to an adrenal crisis
2) Waterhouse-Friedrich Syndrome (bacterial infection where you get hemorrhage into the adrenal gland, which destroys the gland. May turn into a sack of blood)

Front 63

What is the cause of primary Chronic Adrenal Insufficiency?

Back 63

Addison Disease - Described by the constellation of symptoms of the disease as including general languor and dibility, remarkable feebleness of the heart's action and a peculiar change in color of the skin associated with a disease of the adrenal glands

Front 64

What are the dental considerations of Primary Chronic AI?

Back 64

1)Low Coping under stress
2)Hypotension
3)Hypoglycemic syncope
4)Most diagnosed pts are taking steroids and under control
5)Non-diagnosed pts should be referred for a steroid therapy consult

Front 65

What are the four disorders that cause 90% of adrenal cortex damage cases?

Back 65

1)Autoimmune Adrenalitis (mostly)
2)Tuberculosis
3)AIDS
4)Metastatic cancers

Front 66

What are the clinical manifestations of Grave's Disease?

Back 66

1) Muscle Wasting
2) Fine Hair
3) Exophthalmos
4) Goiter
5) Sweating
6) Tachycardia (high output failure)
7) Weight loss
8) Oligomenorrhea
9) Tremor

Front 67

What are the clinical features of Mixedema aka Gull Disease?

Back 67

1) Muscle Weakness
2) Course Brittle Hair
3) Loss of Lateral Eyebrows
4) Myxedema Madness
5) Periorbital Edema and puffy face
6) Pallor
7) Large Tongue
8) Hoarseness
9) Mixedema Heart (cardiomegally)
10) Gastric Atrophy
11) Constipation
12)Menorrhagia (anovulatory cycles)
13) Peripheral Edema (hands, feet)

Front 68

What are the Clinical Features of Primary Chronic Adrenal Insufficiency?

Back 68

1) Doesn't present clinically until 90% of the cortex is destroyed
2) Progressive weakness and patient is easily fatigued
3) GI disturbances including anorexia, nausea, vomiting, weight loss and diarrhea
4) Hyperpigmentation of the skin and oral mucosa particularly on sun exposed areas, pressure points.
5) Decreased mineralcorticoid activity results in electrolyte disturbaces which manifest as hyperkalemia, hyponatremia, volume depletion and hypertension
6) Stresses such as infections trauma and surgery may precipitate an acute crisis manifest by vomiting, abdominal pain, hypotension, coma and vascular collapse; death may occur unless corticosteroid therapy begins at once.

Front 69

What is a neoplasm of the Adrenal Medulla?

Back 69

Pheochromocytoma