Endocrinology/ dental crown & bridge courses

A SEMINAR ON
ENDOCRINOLOGY
INDIAN DENTAL ACADEMY
Leader in continuing Dental Educationwww.indiandentalacademy.com

ENDOCRINOLOGY
CONTENTS
• INTRODUCTION
• LOCATION OF ENDOCRINE GLANDS.
• DEVELOPMENTAL ANATOMY OF
ENDOCRINE GLANDS.
ENDOCRINE GLANDS
• PITUITARY GLAND.
• THYROID GLAND.
• PARATHYROID GLAND.
• ADRENAL GLAND.
• PINEAL GLANDS.www.indiandentalacademy.com

INTRODUCTION
• What is endocrinology?
• Glands in the body- exocrine & endocrine
glands.
www.indiandentalacademy.com

Location of the endocrine glands

Developmental anatomy of Endocrine system

PITUITARY GLAND
• Structure & blood
supply of pituitary
gland

anatomically & functionally separate portions
Antetior pitutary Posterior pitutary

5 principal types of anterior pituitary gland cells

Summary of anterior pituitary
gland hormones

DISORDERS CAUSED BY PITUITARY
GLAND DYSFUNCTION
• Malfunction result from tumor growth ,
interference with circulation to the gland ,
trauma , inflammation , structural
abnormalities etc.

GROWTH HORMONE
DEFICIENCY (DWARFISM)
• Congenital- genetic & developmental
defects.
• Acquired- tumors , infection , irradiation ,
infiltration , traumatic etc.

Assessment :
Dental point of view
• Teeth may be crowded in a small jaw
• Teeth may erupt late.
• Face appears infantile , because the
mandible is recessed and immature.
• The nose is usually small.

General view :
• Child remain short.
• Childs voice may be high pitched.
• There is delayed onset of genital growth.
Therapeutic management :
• GH is administrated in a dose of 0.07-0.1
IU/kg/day (sc) until appropriate growth is attained.

PITUITARY GIGANTISM
• Is an overproduction of GH before the
epiphyseal lines of the long bones have
closed may cause excessive growth.
• Caused by anterior pituitary tumor.
(adenoma)

Assessment :
Dental point of view :
• Spacing of teeth & large lower jaw.
• Mandibular prognathism.
• Enlargement of nasal & condylar cartilages.
• Scalloping of the lateral margins of the tongue.
• Tongue may enlarge disproportionatly.
• Thickening of skin with accentuation of skin falls.
• Roots may be longer than normal.
• Mandibular teeth usually tipped to buccal /labial
side – enlargement of tongue.

Tests :
• Skull radiographs confirm enlargement of
the sella turcica .
• Oral radiographs- hypercementosis &
increase in size of jaw.
• Glucose tolerance test & growth hormone
levels.

Treatment :
• Tumor- surgery to remove tumor or cryosurgery is
the primary treatment.
• If no tumor is present- irradiation.

POSTERIOR PITUITARY GLAND (neurohypophysis)

DISORDERS OF POSTERIOR
PITUITARY GLAND
Diabetes insipidus
• Types- neurogenic DI & nephrogenic DI.
Neurogenic DI :
• Results from hyposecretion of ADH.
• Usually caused by a brain tumor , head
trauma or brain surgery that damage the
post.piutuitary gland the hypothalamic para
ventricular & supra optic nuclei.

Nephrogenic DI :
• Kidneys don’t respond to ADH or
• The ADH receptors may be non functional.
Symptoms :
• Bed wetting is common in affected children.
• Excretion of large volume of urine with resulting
dehydration & thirst.
• Dry mouth.
• In severe cases- patient may die of dehydration.

Treatment :
Neurogenic DI :-
Treated by hormone replacement either sc injection
or nasal spray application of ADH analogues
(desmopressin / hypressin) is effective.
Nephrogenic DI :-
• Treatment difficult & complex .
• Restriction of salt in the diet & paradoxically
some diuretic drugs are helpful.

THYROID GLAND
LOCATION OF THYROID GLAND & STRUCTURE :

SUMMARY OF THYROID HORMONES

DISORDERS OF THYROID
GLAND
CONGENITAL HYPOTHYROIDISM
(CRETINISM) :
• Thyroid hypofunction causes reduced production
of both T4 & T3 occurs as a result of an absent or
nonfunctioning thyroid gland.
• Prevalence- 1: 4,000 births.
• This condition may not be noticeable initially ,
because the mother’s thyroid hormone maintain
adequate level in fetus during pregnancy.

Assessment :
Dental point of view :
• Dentition is delayed.
• Teeth may be defective when they erupt.
• Protruding tongue in children.
• Enlarged lips.
• Flattened bridge of nose.

General view :
• Parents may report as child sleeps
excessively.
• Overall body temperature is subnormal
because of slow metabolism.
• Child’s neck becomes short & thick.
• Extremities are short with hypotonic
muscles.

Diagnostic investigations :
• X –ray studies for bone age & presence of
epiphyseal dysgenesis , numerous fragmented foci
of ossification mostly in the head of femur.
• Serum cholesterol is elevated esp children beyond
2 yrs.
• Neonates – 50- 100mg/dl , infants-100-
125mg/dl.;1-5 yrs of age- 150-200 mg/dl.
• Plasma TSH levels are high.
• T3 &T4 levels are decreased.

Treatment :
• Drug of choice :- synthetic levothyroxin
(eltroxin ).
• Dose :- 5- 10 micro gram/kg/day in case of
patient beyond 1 yr of age.
• In case of neonates & infants – 10-
15microgm/kg/day.

Precautions :
• Periodic monitoring of T4 & T3 will help to
ensure an appropriate medication dosage.if
the dose is too high , the T4 level will rise
& the child will show signs of
hyperthyroidism.

• Is the most common form of acquired
hypothyroidism in childhood.
• Age of onset- 10- 11 yrs & there may be family
history of thyroid disease.
Assessment :
• In infants , congenital goiter can lead to airway
obstruction.
• In children the condition leads to obesity , lethargy
, and delayed sexual development .
• In childhood- nodular thyroid is usually benign &
there is possibility to thyroid malignancy.
THYROIDITIS (Hashimotos disease)

Diagnosis :
• For diagnosis , children are administered
radioactive iodine .
• If the nodes are benign , there is generally a rapid
uptake of radioactive iodine (hot nodes).
• If there is no uptake (cold nodes ) ,carcinoma is
more likely diagnosis,rare at this age.

• Sodium levothyroxin .
• With adequate dosage the obesity will
diminish & growth will begin again.
• It is important that the disease be
recognised as early as possible so that there
is time to stimulate growth before the
epiphyseal lines close at puberty.

HYPERTHYROIDISM (GRAVES
DISEASE)
• More frequently hyperthyroidism &
thyrotoxicosis in children are caused by an
autoimmune reaction that results in
production of IgG which stimulates the
thyroid gland.

Assessment :
• Children experience nervousness.
• Loss of muscle strength.
• BP & pulse are increased.
• Alwys hungry & they eat constantly and do not
gain wt and may even lose wt because of increased
metabolic rate.
• Thyroid gland appears swollen on the anterior part
of neck in children confirmed by ultrasound.
• When the child protrudes tongue or extends the
hands – fine tremors.
• Lab tests- elevated T4 & T3 .

• 1st
course – beta adrergic blocking agents
(propranolol) to decrease antibody
response.
• After this antithyroid drugs – propyl
thiouracil /methemazole to suppress the
formation of thyroxin.

GOITER
Etiologic factors :
• Grave’s disease , iodine deficiency ,
dyshormonogenesis , autoimmune or infiltrative
thyroid disease or neoplasia.etc.
*congenital goiter :
Ingestion of antithyroid drugs or iodine or other
goitrogens during pregnancy or due to an inborn
biosynthetic defects.
Treatment :
• Thyroid hormone is helpful & indicated to avoid
progression to a large multinodular goiter.

PARATHYROID GLANDS
Location of parathyroid gland :

PARATHYROID HORMONES &
DISORDERS

Hypoparathyroidism :
History :
• Thyroid surgery with concurrent remaoval
of parathyroid gland.
• Radiation therapy to thyroid region .
• Idiopathy.

Symptoms :
• Discoloured teeth & delayed eruption due to the
reduced serum calcium.
• Symptoms of tetany may occur ,with numbness &
tingling of the arms and legs together with facial
twitching.
• Severly mottled teeth due to enamel hypoplasia.
• Candidiasis.
• Radiographs reveals delayed eruption & shortened
roots.
• In hypoparathyroidism following surgery or
radiotherapy- no abnormal dental findings.

Diagnostic tests :
• Reduced serum calcium .
• Reduced serum phosphate.

Hyperparathyroidism :
History :-
• Primary- caused by an adenoma or rarely a
carcinoma of the parathyroid gland.
• Secondary- due to low serum calcium , the result
of renal disease.
• Tertiary- result of prolonged secondary disease.
Oral symptoms :
• Swellings on gums which are usually painless
(epulides).

Diagnostic tests :
Primary & tertiary hyperparathyroidism:-
• Serum calcium levels are raised.
• Serum phosphate may be normal/ decreased.
Secondary hyperparathyroidism:-
• Serum calcium levels are normal / decreased.
• Serum phosphate levels are normal or increased in
renal failure.

ADRENAL-GLANDS
Location of adrenal gland-

• Adrenal gland hormones-

DISORDERS OF ADRENAL
GLANDS
Acute adrenocortical insuffiency
• In this case the entire cortical adrenal gland
function suddenly becomes insufficient.
• Generally it occurs in association with
infection in which there is hemorrhagic
destruction of the adrenal glands.
• Seen most commonly in meningococcemia.

Assessment –
• Blood pressure drops to extremely low levels.
• Temperature is elevated.
• Dehydration and hypoglycemia are marked.
• Sodium and chloride blood levels will be very
low.
• But serum potassium will be elevated.

TREATMENT-
• Immediate replacement of cortisol ( I/V) and
deoxycorticosterone acetate (D.O.C.A.).
• Vasopressor may be necessary to elevate the
blood pressure.

CUSHING’S SYNDROME
• Caused by the over production of adrenal
hormone ( cortisol ) which may result from
benign increase ACTH production .
• But generally it is associated with the malignant
tumor of adrenal cortex.

SIGNS AND SYMPTOMS OF CUSHING’S
SYNDROME

ASSESSMENT
• Elevated plasma cortisol and
• Increased urinary free-cortisol levels
THERAPEUTIC-MANAGEMENT
• Surgical removal- causative tumor
• Cortisol therapy indefinitely- if a major part of
adrenal gland is surgically removed.
PRECAUTION
• Following surgery,the child must be observed
carefully for signs of shock bcoz the adrenal gland
has been removed. Without epinephrine from the
adrenal gland,the body’s ability to maintain B.P. is
severely compromisedwww.indiandentalacademy.com

PINEAL GLAND
• It is attached to the roof of 3rd
ventricle.
• Secretes melatonin , which is thought to
promote sleepiness.
• Melatonin is secreted in a diurnal rhythm
that is linked to the dark –light cycle, with
highest secretion during darkness.

REFERENCES
• PRINCIPLES OF ANATOMY &
PHYSIOLOGY- TORTORA-8TH
EDITION.
• CHILD HEALTH NURSING,CARE OF THE
CHILD & FAMILY- ADELE PILLITTERI.
• BIRNBAUM, DUNNE ,-ORAL
DIAGNOSIS,THE CLINICIAN’S GUIDE –2ND
EDITION.
• IAP TEXTBOOK OF PEDIATRICS-
PARTHASARATHY,MENON PSN , NARI
MKC- 2ND
EDITION.
• UNDERSTANDING PATHOPHYSIOLOGY-
HEUTHER & McANCE.www.indiandentalacademy.com

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