Endocrinology and its disorders with reference to dentistry and orthodontics. endocrine system in detail. endocrine and orthodontics. endocrine glands inflencing orthodontic treatment

1. ENDOCRINOLOGY
AND ITS
DISORDERS
Presented by:
Dr. Khushbu Agrawal

2. CONTENT
 Introduction
 Organization of Endocrine System
 Hormones
 Pituitary Gland
 Thyroid Gland
 Parathyroid Gland
 Endocrine Functions of Other Organs
 Local Hormones
 Conclusion
 References
2

3. Human body
Nervous system Endocrine system
3
communicate rapidly communicates slower
chemical messengerselectrical conduction
INTRODUCTION

4. ORGANISATION OF ENDOCRINE
SYSTEM
Endocrinology
organized system of control communication
secreting biologically active substances
chemical messengers or hormones
maintaining healthy milieu interior
4

5. Hormones secreted by major endocrine systems
5
ORGANISATION OF ENDOCRINE
SYSTEM….
*figure from Essentials of Medical Physiology by
Sembulingam

6. HORMONES
 The term “hormone” derived from
Greek, meaning ‘to excite’ or ‘to
arouse
 Introduced by Ernest Henry Starling
in 1905
6

7. Target cell
CLASSIFICATION OF
HORMONES: (Guyton and Hall)
A] Based on nature of effect
1. Endocrine
2. Autocrine
3. Paracrine
4. Solinocrine
7
HORMONES….
Continued…
Blood vessel
a) Endocrine b) Autocrine
c) Paracrine d) Solinocrine
Target cell
Local hormone
Lumen

8. A]Based on chemical structure -
1. Steroid hormones
e.g. aldosterone, cortisol, corticosterone,
testosterone, estrogen, progesterone,etc.
2. Protein hormones
e.g. GH, TSH, ACTH, FSH, LH, prolactin,
ADH, oxytocin, parathormone, calcitonin,etc.
3. Derivatives of amino acid- tyrosine
e.g. T3, T4, catecholamines.
8
HORMONES….

9. HORMONE RECEPTOR
INTERACTIONS:
 The hormone receptors are large
proteins present in the target
cells.
 It is highly specific for one single
hormone.
 Three major classes –
membrane, nuclear and
cytoplasmic
9
HORMONES….
*figure from Essentials of Medical Physiology
by Sembulingam

10. Mode of action of protein hormones
and catecholamines through
membrane receptors
10
HORMONES….
*figures from Essentials of Medical Physiology by Sembulingam
Mode of action steroid and thyroid
hormones through cytoplasmic and
nuclear receptors

11. FUNCTIONS OF HORMONES :
1. Growth and development
2. Maintenance of homeostasis
3. Reproduction and sexual differentiation
11
HORMONES….

12. ANATOMY
 Hypophysis cerebri
 Small oval shaped gland
with a diameter of 1cm
 Weighs ~600mg
 Lies in the hypophyseal
fossa or sella turcica
 Blood supply- superior
and inferior hypophyseal
arteries 12
PITUITARY GLAND….
PITUITARY GLAND
*figure from internet sources

13. DEVELOPMENT
 Anterior pituitary
-Ectodermal
-Rathke’s pouch
 Posterior pituitary
-Neuroectodermal
-base of the brain as
downward diverticulum
13
PITUITARY GLAND….
*figure from internet sources

14. ANTERIOR PITUITARY
 Master gland
 The secretions are regulated by hypothalamus
 Nerve cells in the hypothalamus, synthesize
and secrete hormones for the pituitary
14
PITUITARY GLAND….

15. HORMONES BY ANTERIOR PITUITARY
1. Growth hormone or somatotropic
hormone
2. Thyroid stimulating hormone or
thyrotropic hormone
3. Adrenocorticotropic hormone
4. Follicle stimulating hormone
5. Lutinizing hormone (LH in
females) or interstitial cell
stimulating hormone (ICSH in
males)
6. Prolactin 15
PITUITARY GLAND….
*figure from internet sources

16. Growth hormone
 Somatotropic hormone or somatotropin
 Protein having a single chain polypeptide
with 191 amino acids
 Its molecular weight is 22,005
 The normal plasma concentration –
a. adult between 1.6 and 3ng/ml
b. child or adolescent about 6ng/ml
16
PITUITARY GLAND….

17.  Synthesis and secretion :
 Secreted by the acidophils of anterior
pituitary, known as somatotropes
 Secretion is controlled by complex
hypothalamic and peripheral factors.
17
PITUITARY GLAND….

18. Stimulate GH Secretion Inhibit GH secretion
Decreased blood glucose Increased blood glucose
Decreased blood free fatty acids Increased blood free fatty acids
Increased blood amino acids Aging
Starvation or fasting, protein deficiency Obesity
Trauma, stress, excitement GHIH (Somatostatin)
Exercise GH (Exogenous)
Testosterone, estrogen Somatomedins (ILGF)
Deep sleep
Growth hormone releasing hormone
Ghrelin 18
PITUITARY GLAND….

19. Actions :
A) METABOLIC
FUNCTIONS
Increased rate of
protein synthesis in
most cells of the body
Increased mobilization
of fatty acids from
adipose tissue, increased
fatty acids in blood, and
increased use of fatty
acids for energy
Decreased rate of
glucose utilization
throughout the body
19
PITUITARY GLAND….

20. B) SPECIFIC
TISSUES
Increased bone and
cartilage growth
Increased muscle
mass
Increased growth
of all internal
organs and soft
tissues
20
PITUITARY GLAND….

21. Other Hormones of Anterior Pituitary
21
PITUITARY GLAND….
Growth and secretory activity of thyroid gland
Structural integrity and secretory activity of adrenals cortex
Accelerates spermiogenesis in males; secretion of estrogen
in females
Stimulates Leydig cells to secrete testosterone in males;
ovulation and secretory function of corpus luteum in females
Milk production and secretion by mammary glands
TSH
ACTH
FSH
LH/ICSH
PRL

22. DISORDERS OF ANTERIOR PITUITARY
 The disorders of endocrine
glands occur either because
of hyperactivity with
increased secretion of the
hormones or hypoactivity of
the gland with decreased
secretion of hormones.
22
PITUITARY GLAND….

23. HYPERACTIVITY OF
ANTERIOR PITUITARY
HYPOACTIVITY OF
ANTERIOR PITUITARY
1.Gigantism 1. Dwarfism
2. Acromegaly 2. Acromicria
3. Acromegalic gigantism 3. Simmond's disease
4. Cushing’s disease 4. Panhypopituitarism
23
PITUITARY GLAND….

24. A]HYPERACTIVITY OF ANTERIOR
PITUITARY
1. GIGANTISM
 Causes:
1. Hypersecretion of the Growth hormone in
childhood or in the pre-adult life
2. It occurs before the fusion of epiphysis
with the shaft
3. Tumor of acidophil cells in the anterior
pituitary
24
PITUITARY GLAND….
*figure from HARRISON’S Principle
of Internal Medicine

25.  Clinical features:
1. Height increases
2. Increased hand and foot size
3. Genital underdevelopment,
excessive perspiration,
headache, fatigue, joint pains,
hot flashs
4. Enlarged nose, oily skin
5. Organomegaly
6. Hypertension
25
PITUITARY GLAND….
*figure from HARRISON’S Principle of Internal Medicine

26.  Oral manifestations:
1. Mandibular enlargement with
prognathism, Class III
malocclusion
2. Widened space between lower
incisors
3. Macroglossia
4. Intaoral radiographs show
hypercementosis of roots
26
PITUITARY GLAND….
*figures from internet sources

27. 2. ACROMEGALY
 Causes:
1. Acromegaly is due to hypersecretion of
GH in adults
2. It occurs after the fusion of epiphyses
with shaft of the bone
3. Adenomatous tumor of anterior
pituitary involving acidophil cells
4. Ectopic GH/GHRH secretion
27
PITUITARY GLAND….

28.  Clinical features:
1. Marked enlargement in bones of hands and
feet with bowing of spine, called kyphosis
2. Acromegalic or guerilla face
3. Enlargement of soft tissue organs,
visceromegaly
4. Hyperactivity of thyroid, parathyroid and
adrenals
5. Hyperglycemia and hypertension
28
PITUITARY GLAND….

29.  Oral manifestations:
1. Flaring of dental arches
2. Class III malocclusion
3. Accelerated condylar growth
4. Apertognathia
5. Macroglossia
6. Hypertrophy of palatal tissue -> cause or
accentuate sleep apnea
7. Dental radiographs – taurodontism and excessive
cementum deposition
29
PITUITARY GLAND….

30. 3. ACROMEGALIC GIGANTISM
 Shows symptoms of both gigantism and
acromegaly.
 Hypersecretion of GH in children, before
fusion of epiphysis causes gigantism; and if
this hypersecretion of GH is continued even
after the fusion of epiphysis, the symptoms of
acromegaly also appear.
30
PITUITARY GLAND….

31. 4. CUSHING’S DISEASE
 Rare disorder characterized by obesity
 Causes:
- Basophillic adenoma of
adenohypophysis
- Increased ACTH -> Release of cortisol
 Pituitary cause – Cushing’s disease;
Adrenal cause – Cushing’s syndrome
31
PITUITARY GLAND….
*figure from internet sources

32. B] HYPOACTIVITY OF ANTERIOR
PITUITARY
1. DWARFISM
 Causes:
1. GH deficiency in children
2. Deficiency of somatomedin- C
3. Atrophy of acidophilic cells
4. Non-functioning tumor of chromophobes
5. Panhypopituitarism 32
PITUITARY GLAND….
*figure from internet
sources

33.  Clinical features:
1. Stunted skeletal growth, but
well proportioned body
2. Fine, silky, sparse hair,
wrinkled atrophic skin, often
hypogonadism
3. Normal mental activity
4. Reproduction function is also
not affected
33
PITUITARY GLAND….
*figure from internet sources

34.  Oral manifestations:
1. Maxilla, mandible - smaller than
normal
2. Delayed eruption and shedding of
teeth
3. Small dental arches than normal
that cannot accommodate all
teeth
4. Absence of third molars
5. Agenesis of upper central incisor
34
PITUITARY GLAND….
*figure from internet sources

35.  Laron dwarfism :
- Genetic disorder
- GH insensitivity
- Presence of abnormal GHS receptors
 Psychogenic dwarfism :
- Child exposed to extreme emotional
deprivation or stress
- Short stature due to GH deficiency
35
PITUITARY GLAND….

36. 2. ACROMICRIA
 Causes :
1. Deficiency of GH in adults
2. Atrophy or degeneration of acidophilic cells
3. Non-functioning tumor ofchromophobes
4. Panhypopituitarism
36
PITUITARY GLAND….

37.  Clinical features :
1. Atrophy and thinning of hands
and feet
2. Lethargic and obese
3. Loss of sexual functions
4. Associated hypothyroidism
5. Hyposecretion of ACTH
37
PITUITARY GLAND….
*figure from internet sources

38. 3. SIMMOND’S DISEASE
38
PITUITARY GLAND….
 Clinical features :
1. Rapidly developing senile decay, diminished
BMR
2. Loss of hair all over the body
3. Skin become dry and wrinkled
4. Sharp features and immobile expressions
5. Loss of weight and diminished sexual
function
6. Decreased salivation
7. Loss of teeth

39. 4. PANHYPOPITUITARISM
 It means decreased secretion of all pituitary
hormones
 Cause :
1. Congenital
2. May occur suddenly or slowly at any time
during life, resulting in pituitary tumor that
destroys the gland
39
PITUITARY GLAND….

40.  Clinical features:
1. In children
- All features of dwarfism
2. In adults
- Hypothyroidism, weight gain and lethargic
- Decreased glucocorticoids production by
adrenals
- Loss of sexual functions
40
PITUITARY GLAND….

41. Orthodontic considerations :
 The hyperpituitary patients show poor stability
after orthodontic treatment
 The hypopituitary makes a poor response to
thyroid medication, both in dentition and
mandibular growth, while pituitary growth
hormones so far available on the market have
been entirely ineffective
41
PITUITARY GLAND….

42. POSTERIOR PITUITARY
 The posterior pituitary gland
does not secrete any hormone
by itself
 The cell bodies secreting its
hormones are located in-
1. The supraoptic nuclei
2. Paraventricular nuclei of
hypothalamus
42
PITUITARY GLAND….
*figure from internet sources

43. 1. Antidiuretic hormone
 Functions :
1. Increased water reabsorption from collecting ducts
and distal convolutes tubule
2. Vasoconstrictor effect that increase arterial
pressure
 Regulation :
1. Increased osmolarity, decreased ECF volume
2. Decreased blood volume
43
PITUITARY GLAND….

44. 2. Oxytocin
 Functions :
1. Aids in milk ejection by the breasts, also
known as milk ejecting hormone
2. Causes contraction of pregnant uterus
44
PITUITARY GLAND….

45. DISORDERS OF POSTERIOR
PITUITARY
 Hypoactivity -
Diabetes Insipidus (Central)
 Hyperactivity -
Syndrome of inappropriate diuresis
(SIAD)
45
PITUITARY GLAND….

46. ANATOMY
 Butterfly shaped endocrine
gland
 Two lobes connected by isthmus
 Located anterior to trachea
between cricoid cartilage amd
suprasternal notch
 Weighs about 12-20 g
 Larger in females
46
*figure from internet sources
THYROID GLAND

47.  Blood supply :
1. Superior thyroid artery, branch of external
carotid
2. Inferior thyroid artery, branch of
thyrocervical trunk of subclavian atery
3. Also thyroid ima artery, from brachiocephalic
trunk or directly from the arch of aorta
47
THYROID GLAND….

48. DEVELOPMENT
 Develops from an
evagination of the floor of
pharynx, during third
week of gestation
 Migrates along the
thyroglossal duct to reach
the neck
 TH synthesis starts at
about 11 weeks’ gestation
48
THYROID GLAND….
*figure from internet sources

49. THYROID HORMONES
 3 Hormones :
1. Tetraiodothyronine - T4
(Thyroxine)
2. Triiodothyronine - T3
3. Calcitonin
49
THYROID GLAND….

50. IMPORTANT FACTS
 T4 about 90% ; T3 about 9-10%
 T4 – 80 ug(103nmol) ; T3 – 4 ug(7nmol) ;
RT3 – 2ug(2.5nmol) secreted / day
 T3 – less affinity for plasma cells –
combines loosely – released quickly – acts
immediately
 T4 – more affinity for plasma cells – binds
strongly – released slowly – acts slowly
 RT3 not biologically active
50
THYROID GLAND….

51. Synthesis of thyroid hormones :
 Iodine and tyrosine are essential for thyroid
hormone synthesis
 These are consumed through diet and
absorbed by GIT
 About 1 mg/week or 50 mg/year of iodine is
required
51
THYROID GLAND….

52.  Stages of synthesis :
1. Thyroglobulin
synthesis
2. Iodine trapping or
iodide pump
3. Iodination of tyrosine
4. Coupling reactions
52
THYROID GLAND….
*figure from internet sources

53. Mode of action :
53
T4 is deiodinated to T3
Binds to cellular TR
Activates the enzyme
Initiate transcription
THYROID GLAND….

54. Functions of thyroid hormones :
A] Metabolic functions
54
THYROID GLAND….
ACTIONS
Carbohydrate metabolism Stimulates all aspects of carbohydrate metabolism
Enhanced glucose uptake, glycolysis, gluconeogenesis,
increased insulin secretion
Fat metabolism Enhanced lipid mobilization from fat tissues
Increased free fatty acids
Decreases cholesterol, phospholipids, and triglycerides
in blood
Basal metabolic rate Increases BMR

55. B] Actions On Specific Tissues
55
THYROID GLAND….
Cardiovascular system Increased heart rate
Increased cardiac output
Increased force of contraction
Respiratory system Increased rate of respiration
Gastrointestinal system Increased motility of GI tract
Central nervous system Increased rapidity of cerebration
Musculoskeletal system Slight increase excites musculoskeletal system
Excessive cause muscle weakness
Endocrine glands Increased activity in almost all glands

56. THYROID DISORDERS
A] Hyperthyroidism
1. Grave’s Disease/ Thyrotoxicosis
2. Thyroid adenoma
3. Exopthalamus
B] Hypothyroidism
1. Myxedema
2. Cretinism
C] Goiter 56
THYROID GLAND….

57. 1.GRAVE’S DISEASE
 Thyroid stimulating immunoglobulins
(TSIs) are formed against the thyroid
receptor in the thyroid gland
 Bind with the same receptors activates
the cells, resulting in hyperthyroidism
57
THYROID GLAND….
*figure from internet sources
A] HYPERTHYROIDIM

58. 2. THYROID ADENOMA
 Hyperthyroidism usually results from a
localized adenoma (tumor)
 Secrete large quantities of hormone
 Depresses the production of TSH
 Secretory function in the remainder of the
gland is totally inhibited
58
THYROID GLAND….

59. 3. EXOPTHALMOS
 Patients with hyperthyroid
develop some degree of
protrusion of the eyeballs,
this condition is called as
‘exophthalmos’
 Epithelial surfaces of eye
become dry and often
infected, resulting in corneal
ulceration
59
THYROID GLAND….
*figure from internet sources

60. Signs and symptoms of
hyperthyroidism :
 Symptoms –
1. Hyperactivity, irritability, dysphoria
2. Heat intolerance and sweating
3. Palpitations
4. Fatigue and weakness
5. Weight loss with increased appetite
6. Diarrhea
7. Polyuria
8. Oligmennorrhea, loss of libido 60
THYROID GLAND….

61.  Signs –
1. Tachycardia; atrial fibrillation in elderly
2. Tremor
3. Goiter
4. Warm, moist skin
5. Muscle weakness, proximal myopathy
6. Gynecomastia
61
THYROID GLAND….
*figure from HARRISON’S Principle
of Internal Medicine

62.  Oral manifestations –
1. Alveolar atrophy
2. Early sheeding of deciduous teeth in children
3. Accelerated eruption of permanent teeth
4. Thoma warns, that they make very poor
dental pateints (*from SHAFER’S, textbook of Oral pathology)
5. Increased susceptibility to caries and
periodontal diseases
62
THYROID GLAND….

63. B] HYPOTHYROIDISM
63
THYROID GLAND….
 Iodine deficiency is the most
common cause
 In areas of iodine sufficiency,
autoimmune disease
(Hashimoto’s thyroiditis) and
iatrogenic causes (treatment of
hyperthyroid) are most common

64. 1. MYXEDEMA
 Almost total lack of thyroid hormone function
 Increased quantities of hyaluronic acid and
chondroitin sulphate bound with protein,
causing increased total quantity of interstitial
fluid
 Non pitting edema
64
THYROID GLAND….

65. 2. CRETINISM
 It caused by extreme hypothyroidism during
fetal life, infancy, or childhood
 This condition is characterized especially by
failure of body growth and by mental
retardation
65
THYROID GLAND….

66. Signs and symptoms of
hypothyroidism :
 Symptoms –
1. Tiredness, weakness
2. Dry skin
3. Feeling cold
4. Hair loss
5. Difficulty concentrating and
poor memory
6. Constipation 66
Continued…
THYROID GLAND….

67. 7. Weight gain with poor appetite
8. Dyspnea
9. Hoarse voice
10. Menorrhagia (later oligomenorrhea
or amenorrhea)
11. Paresthesia
12. Impaired hearing
67
THYROID GLAND….

68.  Signs –
1. Dry coarse skin; cool peripheral
extremities
2. Puffy face, hands, and
feet(myxedema)
3. Diffuse alopecia
4. Bradycardia
5. Peripheral edema
6. Delayed tendon reflex relaxation
7. Carpel tunnel
8. Serous cavity effusions
68
*figure from internet sources
THYROID GLAND….

69.  Oral manifestations –
1. Wide face, fails to develop in longitudinal
direction
2. Underdeveloped mandible, overdeveloped maxilla
3. Delayed teeth eruption
4. Prolonged retention of deciduous teeth
5. Macroglossia
6. Base of the skull is shortened
69
*figure from internet sources
THYROID GLAND….

70. 70
THYROID GLAND….

71. ORTHODONTIC CONSIDERATIONS
71
Thyroid hormones increase osteoclastic
bone resorption by stimulation of
prostaglandin synthesis.
Therefore, thyroid levels should be
recoded before starting orthodontic
treatment
THYROID GLAND….
 Calcitonin considered as inhibiting tooth
movement, thus, a delaying the
orthodontic treatment

72. 3. GOITRE
 Refers to enlargement of thyroid gland
 Different mechanism can lead to goiter, like
biosynthetic defect, iodine deficiency,
autoimmune disease, and nodular diseases
 Types :
1. Diffuse nontoxic (simple)
2. Nontoxic multinodular
3. Toxic multinodular
72
THYROID GLAND….
*figure from internet sources

73.  Clinical manifestations :
1. If thyroid function is preserved,
most goiters asymptomatic
2. Enlarged, nontender, generally
soft gland with or without
palpable nodules
3. May cause tracheal or
esophageal compression
4. Pemberton’s sign
73
THYROID GLAND….
*figures from internet sources

74. ANATOMY
 There are 4 parathyroid
glands; located immediately
behind the thyroid – one
behind each upper and lower
poles of thyroid
 About 6mm long, 3mm wide,
and 2mm long
 Macroscopic appearance of
brown fat 74*figure from internet sources
PARATHYROID GLAND

75. PARATHYROID HORMONE
 Secreted by the chief cells of the
parathyroid gland
 84-amino-acids single-chain peptide
 Its molecular weight is 9500
 The normal plasma level is 1.5-5.3
ng%
 It is the primary regulator of calcium
physiology
75
PARATHYROID GLAND…
preproPTH • Chief
cells
proPTH • ER
PTH • GB

76. Tendency towards hypocalcemia results in
increased PTH secretion which causes
Increased rate of
dissolution of
bone mineral
Increasing
flow of
calcium from
bone into
blood
Reduced renal
clearance of
calcium
More calcium
filtered at the
glomerulus into
ECF
76
PARATHYROID GLAND…
Stimulates the
production of
1,25(OH)2D
Increased
efficiency of
calcium
absorption in
intestine
Actions :

77. 1.HYPERPARATHYROIDISM
 It is because of hypersecretion of PTH
 3 types :
A. Primary hyperparathyroidism
B. Secondary hyperparathyroidism
C. Tertiary hyperparathyroidism
77
PARATHYROID GLAND…
DISORDERS

78.  Clinical features :
1. 3 times more common in women
2. Usually affects people of middle age
3. Distinctive feature- osteitis fifrosa
cystica
4. Bone pain and joint stiffness
5. Recurrent nephrolithiasis or kidney
stones
6. Poor muscle tone and decreased
neuromuscular excitability
78
PARATHYROID GLAND…
*figure from internet sources

79.  Oral manifestations :
1. Malocclusion caused by drifting with
definite spacing of teeth
2. Radiographically, large round sharply
defined radiolucencies in maxilla and
mandible
3. Jaw bones show ‘ground-glass’
appearance
4. Lamina dura around the teeth may be
partially or completely lost
79
PARATHYROID GLAND…

80. 2. HYPOPARATHYROIDISM
 It is because of decreased secretion of PTH
 Causes :
a. Surgical removal of parathyroid glands
b. Removal of parathyroids during thyroidectomy
c. Autoimmune disease
d. Deficiency of PTH receptors
80
PARATHYROID GLAND…

81.  Signs and symptoms :
1. Hypocalcemic tetany- hyperexcitability
of nerves and skeletal muscles resulting
in spasms. Also carpopedal spams,
laryngeal stridor, and cardiovascular
changes
2. Dry skin with brittle nails
3. Hairloss
4. Seizures
5. Signs of mental retardation
81
PARATHYROID GLAND…
*figures from internet sources

82.  Oral manifestations :
1. Altered tooth eruption pattern
2. Short, blunted roots
3. Enamel hypoplasia and dentin
dysplasia
4. Impacted teeth, and partial anodontia
5. Circumoral paresthesia
6. Chronic candidiasis, non responsive
to antifungal therapy
82
PARATHYROID GLAND…
*figures from internet sources

83. ORTHODONTIC CONSIDERATIONS
 The local use of PTH may enhance
orthodontic tooth movement.
 The discrete removal of the alveolar bone prior
to force application may reduce resistance to
tooth movement, permitting a selective tooth
movement.
83
PARATHYROID GLAND…

84. ENDOCRINE FUNCTIONS OF
OTHER ORGANS
 ADRENAL CORTEX
 ADRENAL MEDULLA
 PANCREAS
 OTHERS
Pineal gland
Thymus
Kidneys
84

85. ADRENAL CORTEX
85
ENDOCRINE FUNCTIONS
OF OTHER ORGANS…
ADRENAL MEDULA
ADRENAL GLAND
ADRENAL CORTEX
1. Mineralocorticoids
2. Glucocorticoids
3. Sex hormones
1. Adrenaline
2. Noradrenaline
3. Dopamine

86. Disorders of Adrenal Cortex
A]Hypersecretion
1. Cushing’s Syndrome
2. Hyperaldosteronism
3. Adrenogenital
Syndrome
B]Hyposecretion
1. Addison’s Disease
2. Addisonian crisis/Acute
Adrenal insufficiency
3. Congenital Adrenal
hyperplasia
86
ENDOCRINE FUNCTIONS
OF OTHER ORGANS…

87. Cushing’s Syndrome
 Caused by hypersecretion of glucocorticoids,
cortisol
 Clinical features:
1. Moon face, buffalo hump, pot belly
2. Thinning of extremities
3. Muscle weakness
4. Bone resorption and osteoporosis
5. Hypertension
6. Immunosuppression 87
ENDOCRINE FUNCTIONS
OF OTHER ORGANS…
*figure from internet sources

88. Addison’s Disease
 Failure of adrenal cortex to secrete all
corticosteroids
 Clinical features :
1. Pigmentation of skin and mucous
membrane
2. Muscular weakness
3. Dehydration, nausea, vomiting
4. Inability to withstand stress
88
ENDOCRINE FUNCTIONS
OF OTHER ORGANS…
*figure from internet sources

89. ADRENAL MEDULLA
 Inner 20% of the adrenal gland
 Adrenal medullary hormones amines derived from
catechol i.e. catecholamines
 They are:
1. Adrenaline or epinephrine
2. Noradrenaline or norepinephrine
3. Dopamine
 Hypersecretion of catecholamines –
Pheochromocytoma 89
ENDOCRINE FUNCTIONS
OF OTHER ORGANS…

90. PANCREAS
 Endocrine function of pancreas performed by the
islets of Langerhans
 It consists 4 types of cells :
1. A cells – Glucagon
2. B cells – Insulin
3. C cells – Somatostatin
4. D cells – Pancreatic polypeptide
 Hypoactivity causes Diabetes Mellitus
 Hyperactivity causes Hyperinsulinism
90
ENDOCRINE FUNCTIONS
OF OTHER ORGANS…

91. Diabetes Mellitus
 Metabolic disorder associated with high blood
sugar(glucose) levels
 Develops due to deficiency of insulin
 Types :
1. Type I DM (IDDM)
2. Type II DM (NIDDM)
91
ENDOCRINE FUNCTIONS
OF OTHER ORGANS…

92. OTHERS
92
ENDOCRINE FUNCTIONS
OF OTHER ORGANS…
PINEAL GLAND THYMUS KIDNEYS
1. Erythropoietin
2. Thrombopoietin
3. Renin
4. 1,25 –
dihydroxycholecalc
iferol
5. Prostaglandins
1.Thymosin
2.Thymin
Melatonin

93. LOCAL HORMONES
93
 Substances which act on the same area of
their secretion or in the immediate
neighbourhood
 These hormones are usually released in
an inactive form and are activated by
some conditions or substances
 These can be produced in the tissues and
blood

94. A] Synthesized in the tissues :
1. Prostaglandins and its related substances
a) Prostaglandins
b) Thromboxanes
c) Leukotrienes
d) Lipoxins
94
LOCAL HORMONES…

95. 2. Others
a) Acetylcholine
b) Serotonin
c) Histamine
d) Substance P
e) Heparin
f) Leptin
95
LOCAL HORMONES…

96. B] Synthesized in blood :
 The local hormones produced in blood are :
1. Serotonin
2. Angiotensinogen
3. Kinins
- Bradykinin
- Kallidin
96
LOCAL HORMONES…

97. ORTHODONTIC CONSIDERATIONS
97
LOCAL HORMONES…
PGs may act as important mediators of
mechanical stress during orthodontic tooth
movement. They stimulate bone resorption by
increasing the number of osteoclasts and by
activating the already existing osteoclasts
The use of leukotriene inhibitors can delay the
orthodontic treatment, whereas leukotrienes and
PGs can have future clinical applications, causing
enhanced tooth movements

98. CONCLUSION
 The endocrine system is responsible for hormonal
secretion and is closely related to the central
nervous system. It controls physiological processes
and maintains homeostasis. The neuroendocrine
system is responsible for adaptation to
environmental changes.
 Awareness is therefore necessary of the risks and
difficulties for managing stressful situations in
dental clinics during the dental and orthodontic
management of patients with endocrine disorders
and most common oral manifestations. 98

99. REFRENCES
1. Textbook of physiology, by Guyton and Hall, 11th edition; Chapter 14
Endocrinology; Page number 925
2. Textbbok of Medical Physiology, by Ganong;
3. Essentials of Medical Physiology, by K Sembulingam; 4th edition; Chapter
Endocrinology; Page number 337
4. Essentials of Internal Medicine by Harrison; 17th edition; Chapter 19
Endocrinology; Page number 2187
5. API textbook of Medicine, by Shah; 7th edition; Chapter 17 Endocrinology;
Page number 1038
6. Textbook of Oral Pathology by Shafer; 6th edition; Chapter 15 Oral aspects of
Metabolic Diseases; Page number 613
99

100. 7. Oral manifestations of growth hormone disorders; Indian J Endocrino
Metab. 2012 May-June 16(3): 381-383
8. Endocrine disorders and its effects in orthodontics; by Sunil Gupta, Rajendra
Khare and Amit Prakash; issue Oct Dec 2013 pp. 280-285
9. Endocrine problems in Orthodontics by B.N. Tager
10. Role of Endocrinology in Orthodontics by Litchwitz; American J of
Orthodontics and Oral Surgery ; Nov 1938
11. Dental Management of Endocrine Disorder patietns by Laura Carlos Fobue et
al; J of Oral medicine and Pathology; nov 2010
12. Relationship of Orthodonticd to Oral Pathology by Raymond Gettinger;
13. Miscellaneous internet sources
100