Endocrine disorders

Dr.linda Maher

ENDOCRINE SYSTEMA group of glands that secrete

hormones directly into the blood stream to be carried toward a distant target organ.

HORMONE:Special chemical substances which

act on specific receptors in distant organs or tissues.

Glands in human body can be classified into

1\EXOCRINE GLANDS:Glands that excrete their products by way of a

duct system that opens either inside the body or on a surface of the body

Examples:(salivary glands-sweat glands-liver)2\ENDOCRINE GLANDS:It secretes its essential product without the use

of a duct directly into the bloodstream or else by diffusion into its surrounding tissue

Examples:(pituitary gland-thyroid gland-pancreas-adrenal

gland)

FUNCTION OF THE ENDOCRINE SYSTEM: Act together with the nervous system as the control

system of the body.(regulation and control of body function)

ENDOCRINE GLANDS ARE:1\pituitary gland2\pineal body3\hypothalamus4\thyroid gland and parathyroid gland5\adrenal gland6\testis7\ovaries8\pancreas

ENDOCRINE DISORDERESEndocrine disorders, apart from

diabetes and thyroid disease, are uncommon.

They are rare causes of oral disease.Patients with particular endocrine

disorders may need special care for dental surgery (e.g. diabetes ,thyrotoxicosis and addisson’s disease)

1\PITUITARY HYPER FUNCTION(GIGANTISM AND ACROMEGALY)

PITUITARY GLAND:is an endocrine gland about the size of a pea

located below the hypothalamus at the base of the brain.

The pituitary gland secretes hormones that regulate most of the function of other endocrine glands

HORMONES OF THE PITUITARY GLAND:1\growth hormone(GH)2\thyroid stimulating hormone (TSH)3\follicle stimulating hormone(FSH) and

leuitinizing hormone(LH)

GIGANTISM AND ACROMEGALY:1\GIGANTISM: Over production of growth hormone

(GH)by the pituitary gland during the period of the growth causes the patient to become a giant.

2\ACROMEGALY:After the epiphyses have fused, over

production of growth hormone causes renewed growth, particularly of the jaws, hands and feet.

This occurs due to adenoma of the gland.

gigantism

acromegaly

CLINICAL FEATURES of ACROMEGALY:

1\enlarged and protrusive mandible2\Bones of the jaw, hands and feet become

thicker3\thickening and enlargement of facial

features , particularly the lips and nose4\weakness and diabetes5\spacing of the teeth and protrusion of lower

incisorsTREATMENT:Irradiation or resection of the pituitary tumor Mandibular resection may be needed

2\THYROID DISEASETHYROID GLAND:Endocrine gland located in the neck

below the thyroid cartilage(which forms the laryngeal prominance, or "Adam's apple")

FUNCTION OF THYROID:Regulation of body metabolism and

energy consumption.

THYROID HORMONES:1\ Thyroxin(T4)2\ Triiodothyronine(T3)2\ calcitoninTHYROID DISEASE:1\hyperthyroidism2\hypothyroidism

1\HYPERTHYROIDISM:Over production of thyroid hormonesCLINICAL FEATURES:protruding eyes (exophthalmoses),

palpitation, excess sweating, diarrhea, weight loss, muscle weakness and unusual sensitivity to heat.

it has no specific oral manifestations but the dental treatment of hyperthyroid patient may be affected.

exophthalmoses

exophthalmoses

DENTAL MANAGEMENT OF HYPERTHYROID PATIENT:

1\control of nervousness and excitability2\avoid excessive use of local anesthetic

agents that contain adrenaline3\avoid general anesthesia in patients

with long standing thyrotoxicosis particularly older patients.

TREATMANT OF HYPERTHYROIDISM:

1\surgical removal of part of the gland2\drug therapy (e.g. carbimazole)

2\HYPOTHYROIDISM:A\CRETINISM:Deficient thyroid activity at

birthCLINICAL FEATURES: 1\delayed skeletal

development2\delayed dental eruption3\mental defects4\broad face with dry skin

and protrusive large tongue

B\ADULT HYPOTHYROIDISM:Deficient thyroid hormones in adults.frequently it is autoimmune disease

but can result from removal of excessive thyroid tissue in the treatment of hyperthyroidism.

CLINICAL FEATURES:1\weight gain2\slowed activity and thinking3\dry skin and hair loss4\intolerance of cold

DENTAL MANAGEMENT OF HYPOTHYROIDISM:

1\Avoid opioids and general anesthesia

2\local anesthesia is always preferable

3\ADRENAL GLAND DISEASEADRENAL GLANDs:are endocrine glands that sit

at the top of the kidneys. Composed of two parts ,the inner part(adrenal medulla) and outer part (adrenal cortex)

FUNCTION:Fight or flight response

(regulate the body function during stress)

ADRENAL HORMONES:1\adrenal cortex releases (cortisol)It increase blood sugar; suppress the

immune system; and aid in fat, protein and carbohydrate metabolism

2\adrenal medulla releases (adrenalin and nor adrenalin)

Increase heart rate , respiratory rate ,vasodilatation and muscle contraction

1\ADRENO CORTICAL DISEASES:

1.ADRENOCORTICAL INSUFFICIENCY:

Insufficient cortisol productionCan be primary or secondary to

corticosteroid therapy 1.addison’s disease(primary)

result from atrophy of the adrenal cortices and failure of secretion of cortisol.

CLINICAL FEATURES:1\anorexia ,weakness and fatigue.2\abnormal oral and cutaneous

pigmentations3\loss of weight 4\low blood pressure5\gastrointestinal disturbancesTREATMENT: Oral hydrocortisone

2.corticosteroid therapy(secondary)

Long term use of corticosteroids causes depression of the adrenocortical function.

SIDE EFFECT:1\depression of immune response2\depression of inflammatory response3\opportunistic infections4\raised blood sugar6\moon face

ADRENOCORTICAL HYPERFUNCTION:

(CUSHING’S DISEASE)Rarely dentally importantCLINICAL FEATURES:Moon faceTruncal Obesityhypertension

4\diabetes mellitusIt is a common endocrine disease that results

from relative or absolute deficiency of insulin ,CAUSING persistently raised blood glucose.

INSULIN: a peptide hormone, produced by beta cells in

the pancreas.FUNCTION:Regulation of carbohydrate and fat metabolismIncreases absorption of glucose from the blood

TYPES OF DIABETES:

1\TYPE1 -INSULIN DEPENDENT( JUVENILE ):

Symptoms occur before age of 25 and usually severe

CLINICAL FEATURES:Thirst – polyuria – hunger – loss of

weight –susceptibility to infections.TREATMENT:Insulin injections

2\TYPE 2-NON INSULIN DEPENDENT(ADULT ONSET)

occur in over meddle aged and obese persons.

CLINICAL FEATURES:Thirst – polyuria –fatigue –deterioration

of visionTREATMANT:1\controlled dietary restriction2\if necessary oral hypoglycemic drugs

COMPLICATIONS OF DIABETES THAT CAN AFFECT DENTAL MANAGEMENT:

1\susceptibility to infections especially candidacies

2\hypoglycemic coma3\ischemic heart disease4\acceleration of periodontal diseases if

poorly controlled5\dry mouth secondary to polyuria and

dehydration

DENTAL MANAGEMENT OF DIABETIC PATIENTS:

1\treatment should be timed early soon after patient breakfast (to avoid the risk of hypoglycemic coma)

2\dental operations under general anesthesia should only be carried out in hospital under expert supervision

3\treatment of hypoglycemic coma 1-if the patient is conscious give hem

glucose tablet or powder 2-if consciousness is lost give sterile intra

venous glucose

Thank you.