3BDS: Endocrinology 3

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what hormones are secreted zona glomerulosa, fasciculata, reticularis, medulla
g- mineralocorticoid (aldosterone), f- glucocorticoids (cortisol, cortisone)
r- androgens (DHEA and androstenedione)
medulla-adrenaline and nor adrenaline
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what do cortisol and cortisone do
effects upon glucose, carbohydrates, fat and protein metabolism, sodium and potassium balance, immune function
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what type of hormones are adrenaline and noradrenaline
stress hormones
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what are the roles of aldosterone
sodium and potassium balance and BP, PART OF RENIN-ANGIOTENSIN-aldosterone system
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what is the negative feedback system for adrenal glands
hypothalamus (corticotropin releasing hormones)+ anterior pituitary gland (ACTH)+adrenal cortex (cortisol, aldosterone, DHEA)-
1. hypothalamus (CRH)
2. Anterior pituitary (ACTH)
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adrenal glucocorticoid and mineralocorticoid excess is called=
+ what is caused by
bushings syndrome - cortisol and aldosterone

caused by: iatrogenic glucocorticoid administration
sometimes adrenal ACTH secreting adenoma
rarely due to excess ACTH from pituitary gland or ectopic by malignant disease
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what is adrenal mineralocorticoid excess called, what are the features and what is it caused by
called: hyperaldosteronism
features: hypertension, hypokalaemia, muscle weakness,
caused by: adrenal adenoma secreting aldosterone, sometimes due to adrenal hyperplasia
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what is adrenal insufficiency called, what is it caused by
hypoadrenalism
caused by autoimmune disease (Addisons disease)
insufficient replacement in context of infection or stress
less commonly TB, sepsis, malignant infiltration
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what are the adrenal investigation
 Blood: plasma cortisol and ACTH, Na, K, Glucose levels (as they are so involved with salts etc)
 Other blood tests- dexamethasone supporessin test, synthetic.
 Adrenal imaging
 Brain imaging CT/MRI
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what are the symptoms of Cushing's syndrome
weight gain, slow healing of cuts, increased risk of infection, fatigue, glucose intolerance , increased risk of fractures, depression, anxiety, irritability, new or worsened high blood pressure , irregular or absent mensural periods/ erectile dysfunction
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Treatment of Cushings syndrome
- Reverse what is reversible: minimise dose of glucocorticoids if possible
- Surgical removal of adrenal or pituitary adenomas
- If untreated, consequences of hypertension and hyperglycaemia cause excess cardiovascular morbidity (IHD, CVD, CKD, PVD
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what are the dental aspects in someone with cushings syndrome
Hyperglycaemia and immune suppression: increased risk of oral infections especially candida
Pooper wound healing
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what would you do if someone had adrenal insufficiency in the dental practice
Hospitalise
Lie flat, legs up
If available: IV fluids, hydrocortisone injection 100mg IM preferably after bloods for ACTH/ cortisol
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what are the symptoms of adrenal insufficiency if caused by infection/ stress
• Hypotension (can collapse/faint)
• Hypovolaemic shock
• Acute abdominal pain
• Low grade fever
• Vomiting
• Hypoglycaemia
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what are the signs and symptoms of adrenal insufficiency
buccal pigmentation, or pigmentation of new scars, postural hypertension, loss of weight, loss of body hair, nausea, vommining, abdominal pain , joint/backl pain
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what is the treatment of adrenal insufficiency
Replacement glucocorticoid (with hydrocortisone) and mineralocorticoid (with fludrocortisone) under direction of endocrinologist
Lifelong treatment needed
Steroid alert card to be carried/ medic alert bracelet
Increase dose of corticosteroid if under phys
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why is it important for people with Addisons disease to increase their corticosteroid cover if they are under physical stress such as period of illness or strenuous exercise or if they are prescribed antibiotics for an infection
to reduce the risk of adrenal crisis
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Card 2

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what do cortisol and cortisone do

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effects upon glucose, carbohydrates, fat and protein metabolism, sodium and potassium balance, immune function

Card 3

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what type of hormones are adrenaline and noradrenaline

Back

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Card 4

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what are the roles of aldosterone

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Card 5

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what is the negative feedback system for adrenal glands

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