Endocrine Disorders Question And Answers

Endocrine Disorders Question And Answers

Question 1. Discuss oral manifestations of diabetes mellitus.
Answer. Inappropriate hyperglycemia due to tissues resistance to insulin action, reduced insulin secretion or both. This is known as diabetes mellitus.

Diabetes Mellitus Oral Manifestations

1. Gingival and periodontal disease

• It will influence the onset and course of periodontal disease. Patients with diabetes are more prone to develop periodontal disease than those with normal glucose metabolism. There is tendency for bleeding on probing.
• Patient may exhibit fulminating periodontitis with periodontal abscess formation and inflamed painful abscess and even hemorrhagic gingival papillae, this factor culminated and give rise to tooth mobility.
• It will show more severe and rapid alveolar bone resorption and are more prone to develop periodontal abscess.
• It occurs in head and neck region. Tip of nose is frequent location. It involve lymph nodes, GIT, lung, liver, spleen, pancreas.
• Insulin dependent children tend to have more destruction around first molars and incisors than elsewhere.

2. Median rhomboid glossitis

• Diabetes is considered to be factor for median rhomboid glossitis as frequency of abnormal blood sugar level in diabetes and predisposition of these subjects to candidiasis.
• Impairment of blood supply to dorsum of tongue due to arteriosclerotic changes in blood vessels supplying area.
• Impairment of local immune mechanisms which decreases concentration of Langerhans’ cells in lesion.

3. Oral candidiasis: It is the infection with Candida albicans which occurs due to encouragement of local multiplication of Candida albicans due to impaired glucose level and immune mechanism.

4. Localized osteitis: Dry socket develops in the diabetes, hence, they show delayed healing and impaired immunological balance.

5. Burning mouth: It is associated with variety of otherwise unexplained oral symptoms such as burning sensation, atypical paresis, dysentheria and dysgeusia.

6. Other features:

• Increased caries activity: Due to excessive fluid, loss patient complains of xerostomia.
• Atrophy of lingual papilla with fissuring or dry tongue.
• Delay in healing of oral wound due to decreased polymorphonuclear chemotaxis.
• There is also angular cheilosis, altered taste sensation, oral lichen planus and diffuse enlargement of parotid gland.

Read And Learn More: Oral Medicine Question And Answers

Question 2. Write short note on evaluation and dental treatment and management consideration in patient with diabetes.
Answer. Following is the evaluation, dental treatment and management consideration in patient with diabetes:

• Patient should be told to continue with their normal eating and injection regimen. Morning appointments are recommended because cortisol levels are highest at this time and will provide the best blood glucose level. The morning meal should not be skipped.
• Type 1 patient should not be scheduled immediately after an insulin injection because this may result in a hypoglycemic episode. If hypoglycemia appears to be developing, dental treatment should be terminated and glucose is administered.
• Not more than 2 carpules of lidocaine 1:100,000, prilocaine HCL (1:200,000), or bupivacaine with 1:200,000 epinephrine should be delivered for anesthesia.
• An antibiotic should be prescribed following therapy.
• Prior to surgery the patient’s food intake should include the proper caloric content and protein/carbohydrate/fat ratio to maintain glucose balance.
• Type 2 diabetics should have their regular oral hypoglycemic drugs prior to surgery.
• Prior to the surgery blood sugar levels should be monitored and then only the tooth extraction should be planned. Normal blood sugar level in fasting should be from 70 to 120 mg/dL and post-prandial the reading should be less than 140 mg/dl. The random blood sugar level should be 80 to 140 mg/dl.

Management consideration in patient with diabetes:

• Post extraction patient should be given proper antibiotics along with pain killers
• Patient should have to maintain proper balanced diet and keep his/her blood sugar levels in control.
• Patient have to take his/her oral hypoglycemic or insulin regular along with other medications prescribed by dentist. If the dentist anticipates that normal dietary intake will be affected after treatment, insulin or oral antidiabetic medication dosages may need to be appropriately adjusted in consultation with the patient’s physician.
• Patient should be on regular follow up till proper healing is achieved.

Question 3. Classify endocrine diseases. Write about cretinism.
Answer.

Classification of Endocrine Diseases

1. Diseases of pituitary gland

1. Hyperpituitarism

• Gigantism.
• Acromegaly.

2. Hypopituitarism

• Hypocalcemia

3. Progeria

2. Diseases of thyroid gland

1. Hyperthyroidism

2. Hypothyroidism

• Cretinism
• Juvenile myxedema
• Myxedema.

3. Disease of parathyroid gland:

1. Hyperparathyroidism

• Primary
• Secondary
• Tertiary
• Ectopic

2. Hypoparathyroidism

3. Pseudohypoparathyroidism

4. Diseases of pancreatic gland:

Diabetes mellitus-

• Type 1
• Type 2

5. Diseases of adrenal gland:

• Addition’s disease
• Adrenogenital syndrome
• Cushing’s syndrome
• Adrenal insufficiency

6. Diseases of gonads:

• Hypergonadism
• Hypogonadism.

Cretinism

This disease occurs in children in which there is presence of hypothyroidism.

Cretinism Clinical Features

• It may be present at birth or become evidence within first few months after birth.
• There is presence of hoarse cry, constipation, feeding problem in neonates, retarded physical and mental growth.
• Delayed fusion of epiphysis and delayed ossification of paranasal air sinus.
• There is protuberant abdomen with umbilical hernia.
• Hairs are sparse and brittle, finger nails are brittle and sweat glands are atrophic.

Cretinism Oral Manifestations

1. Teeth:

• Dental development is delayed and primary teeth are slow to exfoliate.
• Enamel hypoplasia can also be present.
• Abnormalities of dentin formation lead to enlarged pulp chamber.

2. Jawbone:

• Maxilla is over developed and mandible is under developed.
• Retarded condylar growth leads to micrognathia.

3. Tongue: Enlarged by edema fluid and leads to malocclusion of teeth.

4. Lips are puffy, thickened and protruding.

5. Face is wide and fails to develop.

6. Base of skull is shortened leading to retraction of bridge of nose with flaring.

Cretinism Radiographic Features

• Delayed closing of fontanelles and epiphysis, numerous wormian bones. Transverse line of increased density involve metaphysic region.
• Teeth reveal thinning of lamina dura. Delayed dental eruption, short tooth root.
• Separation of teeth is appreciated because of widening of tongue, periodontal diseases, tooth loss and external resorption of root.
• Alveolar process is large compared to body of bone.

Cretinism Diagnosis

• Clinical diagnosis: Presence of sparse hair, delay in tooth development, macroglossia and enamel hypoplasia may provide clue to diagnosis.
• Radiological diagnosis: Lamina dura is thin, presence of multiple wormian bones and external root resorption.
• Laboratory diagnosis: Value of TSH is increased and of T3 and T4 is decreased or remains normal. Raised cholesterol and triglyceride levels with low serum sodium levels.

Cretinism Management of endocrine diseases

Patients are managed by thyroid preparation. Mainly used is levothyroxine. It is available in form of 25 µg, 50 µg and 100 µg tablets. Dosage should be started as 50 µg/day and is given for three weeks and finally to 150 µg/day. In elderly patients and in patients with ischemic heart disease 25 µg/day as initial dose is given.

Question 4. Write short note on radiographic appearance of hyperparathyroidism.
Or
Write short note on radiographic manifestations of hyperparathyroidism.

Answer. The radiographic features are as follows:

• Demineralization of skeleton: Bone matrix contains less than normal amount of calcium producing unusually radiolucent skeletal image. There is lack of normal contrast in radiograph, resulting in overall grayness, often associated with a granular appearance in bone.
• Ground-glass appearance: The rarefaction is of homogeneous nature and there may be normal, granular and ground glass appearance.
• Moth-eaten appearance: Sometimes rarefaction gives a mottled or moth eaten appearance with varying density.
• Osteitis fibrosa generalisata: Localized destruction of bone is produced by osteoclastic activity leaving residual area of fibrosis.
• Pepper pot skull: Evidence in the skull vault of osteopenia producing a fine overall stippled pattern to the bone, hence it is called as pepper pot skull.
• Teeth and alveolar bone: Teeth may become mobile and migrate. Loss of lamina dura which may be seen around one tooth or all remaining tooth.

Question 5. Write short note on dental considerations in diabetes mellitus.
Answer.

1. Diabetics should go for check up to the dentist on a regular basis.

2. Diabetic patients under good medical control are generally eligible and able to tolerate any and all types of dental care. One of the common complications dentist wants to avoid having to manage is hypoglycemia (low blood sugar) for this one should always:

• Eat normal meal prior to your appointment.
• Take all medications on schedule.
• Bring glucometer with you to your dental appointment.
• Follow any post operative instructions your dentist gives you and take any prescriptions as directed.
• Inform your dentist and reschedule your appointment if you are not feeling well, and check with your physician as necessary.

3. Whenever patient visit his or her dentist, always advise him or her of any changes regarding your medications or disease-related complications.

4. Dentist should enquire about how you monitor your blood sugar and your current status (e.g. most recent HbA1c, medication profile).

5. Patient should be told to continue with their normal eating and injection regimen. Morning appointments are recommended because cortisol levels are highest at this time and will provide the best blood glucose level. The morning meal should not be skipped.

6. For most routine dental procedures (e.g. examinations, simple fillings, routine cleanings), no special alterations in the delivery of dental care are necessary.

7. However, more involved procedures, such as extensive surgery or treatment of serious infection, may interfere with normal diabetes management. For such cases, dentist will work with patient’s physician to ensure the most appropriate approach to care is undertaken.

8. If patient notice any unusual changes in your mouth (e.g. swelling, pain, red areas), then they should see their dentist as soon as possible. These changes may indicate the presence of an infection that may compromise their normal blood sugar control and lead to a worsening of ability to fight infection. As a result, infection could become more difficult to treat.

Question 6. Write short note on Brown’s tumor.
Answer. It is also known as Brown’s tumor of hyperparathyroidism.

1. It is known as Brown’s tumor because color of the tissue specimen is dark red – brown due to abundant hemorrhage and hemosiderin deposition within the tumor.

2. The brown tumor is a bony lesion that arises in settings of excess osteoclast activity, such as hyperparathyroidism. It is not a true neoplasm, as the term “tumor” suggests; however, it may mimic a true neoplasm.

3. Brown tumors in modern medicine are rare occurrences due to early detection.

Brown’s tumor Clinical Features

• It occurs during the age of 30 to 60 years.
• Women predilection is usually present.
• Areas commonly affected are mandible, clavicle, ribs and pelvis.
• Lesion can be solitary but often multiple long-standing lesions can cause cortical plate expansion.
• Most severe skeletal manifestation is presence osteitis fibrosa cystic which develops from the central degeneration and fibrosis of long-standing brown tumors.
• Brown tumor can occur either centrally (in bone) or peripherally (in soft tissue). It is presented as swelling which can be seen intraorally or extraorally.

Brown’s tumor Radiological Features

• On radiographical examination, the lesion is a well demarcated unilocular or multilocular radiolucency.
• Lesion present ground-glass radiographic appearance of numerous, small, randomly oriented trabeculae.
• Lesion can be multiple and have variably defined margins and cause cortical expansion.
• Periapical radiographs show loss of lamina dura.
• Tooth root can have tapered appearance due to loss of lamina dura which leads to decreased image contrast.
• Skull radiographs show patchy regions of demineralization which is known as salt and pepper appearance.

Investigations of Brown’s tumor

• Alkaline phosphatase levels are high.
• Serum calcium level is elevated, i.e. 10.5 mg/dL.
• Phosphate levels vary from normal to low
• Serum PTH is elevated.
• Level of 1,25-dihydroxy vitamin D is also high.