The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

1. ENDOCRANIAL DISORDERS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com

2. Introduction

Hypothalamus
is
in
overall
control
factors
(CRH)
of
adrenocortical function.

Hypothalamus
releases
stimulate pituitary to release ACTH.
www.indiandentalacademy.com
that

3. Physiology:
Adrenal cortex produces
Glucocorticoids
Cortisol
Corticosterone
Mineralocorticoids
Aldosterone
Adrenal medulla produces –
- Epinephrine
- Nor epinephrine
www.indiandentalacademy.com

4. Applied Aspects
 Corticoids: Essential part of the body’s response
to
–
–
–
–
–
–
–
–
–
Trauma
Infection
Pain
Fever
Burns
GA
Hypoglycaemia
Stress
Operation
www.indiandentalacademy.com

5. www.indiandentalacademy.com
Hypothalamus – Pituitary – Adrenocortical axis

6. Angiotensinogen
Renin
Angiotensin 1
(inactive)
Angiotensin 2
(active)
Aldosterone
www.indiandentalacademy.com
Angiotensin
converting
enzyme (ACE)

7. Mineralocorticoids

Acts on kidney to promote
– Sodium retention
– Potassium excretion
– Fluid retention
– Vasoconstriction
– Thirst
www.indiandentalacademy.com

8. Diseases
– Adrenal cortex

Hyperadrenocorticism (Cushing’s syndrome)

Hypoadrenocorticism (Addison’s disease)
– Adrenal medulla

Phaeochromocytoma
www.indiandentalacademy.com

9. Cushing’s syndrome

Etiology
– Due to overproduction of cortisol.
– Pituitary adenomas
– Ectopic ACTH from adrenal, lung carcinoma etc.
www.indiandentalacademy.com

10. Cushing’s cont’d……

C/F
– Central obesity affecting face (moon face)
– Inter scapular region (buffalo hum)
– Trunk
– Hypertension
– DM
– Osteoporosis, muscle weakness, thinning of the skin, skin
striae
– Oligomenorrhoea
– Infections
– Psychosis
www.indiandentalacademy.com

11. Cushing’s cont’d……

Dental aspects
– LA preferred
– Conscious sedation
– Patient is on corticosteroid therapy need for
corticosteroid coverage
– GA (corticosteroid coverage)
www.indiandentalacademy.com

12. Hyperaldosteronism

Etiology
– Primary hyperaldosteronism results from hyperplasia
of adrenal cortex.
Rare benign tumor
– Secondary hyperaldesteronim results in activation of
renin-angiotensin system
www.indiandentalacademy.com

13. Hyperaldosteronism Cont’d……

C/F:
– Potassium loss
– Sodium retention
– Hypokalaemia often causes muscle weakness,
cramps, parasthesia, polyurea, polydypsia
– Sodium retention leads to hypertension
www.indiandentalacademy.com

14. Hyperaldosteronism Cont’d……

General management
–
–

Aldosterone angagonist
Excision of the gland
Dental aspects
– LA for pain control
– Corticosteroid coverage, if the patient undergone
bilateral gland excision.
– If the patient is untreated hypertension and muscle
weakness of the main complications.
www.indiandentalacademy.com

15. Hypoadrenocorticism (Addison’s disease)

Etiology:
–
–
–
–
–
–
–
–
Autoantibodies to adrenal cortex.
Adrenal tuberculosis
HIV
Malignancy
Haemorrhage
Sarcodosis
Amylodosis
Adrenalectomy
www.indiandentalacademy.com

16. Hypoadrenocorticism Cont’d……

C/F:
– Hypotension
– Hypoglycaemia
– Hyperpigmentation
– Sodium depletion
– Weakness
– Anorexia, nausia, vomiting, diarrhoea
www.indiandentalacademy.com

17. Hypoadrenocorticism Cont’d……

General management
– Most of the patients are treated with oral hydrocortisone and
fludrocortisone

Dental aspects
–
–
–
–
–
–
–
Risk of hypotensive collapse
Give 200mg i.v. hydrocortisone
Medical assistance
Give glucose if there is hypoglycaemia (25g i.v. / Oral)
Repeat 200mg i.v. hydrocortisone (4 to 6 hourly)
Monitor blood pressure
Steroid supplementation to be continue for 3 days after blood
pressure returned to normal.
www.indiandentalacademy.com

18. No steroids for
previous 12 months
Conservative
No cover required
dentistry or
dentoalveolar surgery
(e.g. single extraction)
under local
anaesthetic
Intermediate surgery
(e.g. multiple
extractions, or
surgery under GA)
Maxillofacial surgery
or trauma
Steroids taken
during previous 12
months
Give usual oral
steroid dose in
morning or
hydrocortisone 2550mg iv.
Preoperatively
Steroids currently
taken
Double oral steroid dose
in morning or
hydrocortisone 25-50 mg
i.v. preoperatively
Continue normal steroid
medication
postoperatively
Consider cover if large Give usual oral
doses of steroid were steroid dose in
given.
morning plus
hydrocortisone 25Test adrenocortical
50mg i.v.
function (ACTH
preoperatively and
simulation test)
i.m. 6-hourly for 24 h
Double oral steroid dose
in morning plus
hydrocortisone 25-50 mg
i.v. preoperatively and
i.m. 6-hourly for 24 h
Consider cover if large Give usual oral
doses of steroid were steroid dose in
given
morning plus
hydrocortisone 25-50
Test adrenocortical
mg i.v. preoperatively
function (ACTH
and i.m. 6-hourly for
stimulation test)
72 h
Double oral steroid dose
in morning plus
hydrocortisone 25-50mg
i.v. preoperatively and
i.m. 6-hourly for 72 h
www.indiandentalacademy.com
Then continue normal
medication
Then continue normal
medication

19. Phaechromocytoma

C/F:
– Headache
– Palpitations
– Tachycardia
– Sweating
– Hypertension
– Glycosuria
www.indiandentalacademy.com

20. 
Dental aspects
– LA is generally safe, epinephrine is modest
amounts has no adverse effects.
– Defer the elective treatment until surgical
treatment for phaechromocytoma done.
– If emergency care required – do monitor the
blood pressure and look for the cardiac
arrhythmias.
www.indiandentalacademy.com

21. www.indiandentalacademy.com
Leader in continuing dental education
Thank you
www.indiandentalacademy.com