Endocrine disorders Dr.linda Maher

ENDOCRINE SYSTEM A 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 (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 gland 2\pineal body 3\hypothalamus 4\thyroid gland and parathyroid gland 5\adrenal gland 6\testis 7\ovaries 8\pancreas

ENDOCRINE DISORDERES Endocrine 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: 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.

acromegaly gigantism

CLINICAL FEATURES of ACROMEGALY: 1\enlarged and protrusive mandible 2\Bones of the jaw, hands and feet become thicker 3\thickening and enlargement of facial features , particularly the lips and nose 4\weakness and diabetes 5\spacing of the teeth and protrusion of lower incisors TREATMENT: Irradiation or resection of the pituitary tumor Mandibular resection may be needed

2\THYROID DISEASE THYROID 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\ calcitonin THYROID DISEASE: 1\hyperthyroidism 2\hypothyroidism

1\HYPERTHYROIDISM: Over production of thyroid hormones CLINICAL 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 excitability 2\avoid excessive use of local anesthetic agents that contain adrenaline 3\avoid general anesthesia in patients with long standing thyrotoxicosis particularly older patients. TREATMANT OF HYPERTHYROIDISM: 1\surgical removal of part of the gland 2\drug therapy (e.g. carbimazole)

2\HYPOTHYROIDISM: A\CRETINISM: Deficient thyroid activity at birth CLINICAL FEATURES: 1\delayed skeletal development 2\delayed dental eruption 3\mental defects 4\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 gain 2\slowed activity and thinking 3\dry skin and hair loss 4\intolerance of cold

DENTAL MANAGEMENT OF HYPOTHYROIDISM: 1\Avoid opioids and general anesthesia 2\local anesthesia is always preferable

3\ADRENAL GLAND DISEASE ADRENAL 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 production Can 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 pigmentations 3\loss of weight 4\low blood pressure 5\gastrointestinal disturbances TREATMENT: Oral hydrocortisone

2.corticosteroid therapy(secondary) Long term use of corticosteroids causes depression of the adrenocortical function. SIDE EFFECT: 1\depression of immune response 2\depression of inflammatory response 3\opportunistic infections 4\raised blood sugar 6\moon face

ADRENOCORTICAL HYPERFUNCTION: (CUSHING’S DISEASE) Rarely dentally important CLINICAL FEATURES: Moon face Truncal Obesity hypertension

4\diabetes mellitus It 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 metabolism Increases absorption of glucose from the blood

1\TYPE1 -INSULIN DEPENDENT( JUVENILE ): 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 vision TREATMANT: 1\controlled dietary restriction 2\if necessary oral hypoglycemic drugs

COMPLICATIONS OF DIABETES THAT CAN AFFECT DENTAL MANAGEMENT: 1\susceptibility to infections especially candidacies 2\hypoglycemic coma 3\ischemic heart disease 4\acceleration of periodontal diseases if poorly controlled 5\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 .