GOOD MORNNG GOOD MORNNG

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hA1 NLW 1LAK hA1 NLW 1LAK
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NDOCRNOLOG
Y
Dr Manish BhaIIa
Cods Dvg
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CONTENTS CONTENTS
Hormone
emistry of ormone
Mec,nism of ,ction of ormone
Endocrine ormones
Pituit,ry gI,nd
Tyroid gI,nd
P,r,tyroid gI,nd
Adren,I gI,nd
P,ncre,s
Reproductive ormones
AppIied ,spect of e,c ormone
oncIusion
References
EYBLITIBX BF BEXTISTRY
A PARABIBH SHIFT
EARLIER,BEXTISTS WERE BBTHEREB
ABBIT THE TEETH IX THE PEBPLE.
BIT XBW,,
BEXTISTS ARE BBTHEREB ABBIT
PEBPLE WHB HAYE TEETH..
N INTRODUCTION TO GLNDS OF THE HUMN
BODY..
. EXOCRINE GLNDS
1. SUDORIFEROUS, & SEBCEOUS
2. MUCOUS, & DIGESTIVE
B. ENDOCRINE GLNDS
1. GLNDS PER SE..
2. organs with ENDOCRINE CELLS
secreting hormone.
hormone hormone
GUYTON: is a chemicaI substance secreted into the body
fIuids by one ceII or a group of ceIIs and has a
physioIogicaI controI effect on other ceIIs of the body
CHARACTERISTICS OF HORMONE
Hormone have powerfuI effect in Iow concentration
50 odd hormones affect "SPECIFIC CELLS"
CONCEPT OF HORMONE RECEPTORS
. TRGET CELL - RECEPTOR INTERCTION
B. DOWN ND UP REGULTION
C. CLINICL PPLICTIONS
CIRCULTING HORMONES
LOCL HORMONES
TYPES OF HORMONES
Chemistry of hormones
chemicaIIy there are 4 cIasses of hormones
1) STROD HORMON
Derived from cholesterol
. Steroid hormone corticosteroid and se hormone
2) AMNOACD TYROSN DRVATVS
Derived from aminoacid called TYROSN
. Thyroid and Adrenal medullary hormones
3) PROTN HORMON
They are large or small peptides synthesized on rR.
. Pituitary gland, parathyroid , pancreas, placenta
4) COSANODS
ikasi=20,
They are derived from 20-carbon fatty acid called ARACHDONC ACD
. Prostaglandins and Leucotrienes.
HORMONE TRNSPORT
CatechoIamine,
Peptides,
Protein hormones
Steroid
Thyroid hormone
CircuIating free
form- soIubIe in
watery bIood
pIasma
They need specific
transport protein- Iipid
soIubIe acts as a
reservoir
ONSET OF HORMONL CTION
Each hormone has its own characteristic onset and
Duration of action
drenaIin onset is immediate
Steroid Iike cortisoI requires hours
Thyroid hormones affects perceptibIe after days
Hormonal action
Hormonal receptors:
Situation of receptors
Mechanism of hormonal action
1. By altering the permeability of the cell membrane
: Neurotransmitter substances.
2.By activating the intracellular enzyme
: Protein hormones & Catecholamines.
3. By activating the gene
: Thyroid & Steroid hormones.
LTERING THE MEMBRNE PERMEBILITY
CTIVTING THE
INTRCELLULR ENZYME
CTING ON GENES
Pituitary gland
Vesalius 16
th
century
Latin pituita
phlegm/mucous
Hypo + Phycin to
grow
ANATOMY:
Sella turcica of the
sphenoid bone.
Growth hormone Growth hormone
Most abundant anterior pituitary hormone, aIso known as
SOMTOTROPIN
There are 2 types of GH,
1) hGH-N (Normal) more abundant
2) hGH V (variant)
Daily out put:
0.2- 1mg//)/////////// day in adults
Plasma half life:
6 20 min
Anterior pituitary
Growth hormone
CTIONS:
SkeIetaI growth
GeneraI body growth
MetaboIism
SkeIetaI growth:
In embryonic stage: differentiation & growth of bone ceIIs.
In Iater Iife: growth of the skeIeton - in Iength, & thickness.
protein deposition, & muItipIication of chondrocytes, osteogenic
ceIIs.
Formation of new bone.
GeneraI body growth
ResponsibIe for growth of aImost aII tissues of body, which are
capabIe of growing
Maintenance of muscIe and bone size
METBOLISM METBOLISM
EFFECT ON CRBOHYDRTE
Peripheral utilization of glucose
Deposition of glycogen in the cells
Diabetogenic effect of Growth hormone
EFFECT OF PROTEINS
Synthesis of proteins and inhibition of protein breakdown
EFFECT ON LIPIDS
Stimulates lipolysis
Mobilization of lipids
Promotes healing of injuries and tissue repair
ncreases Ca. Absorption from the GT
ReguIation of GH secretion
HYPOTHLMUS:
GHRH: stimuIates ant.pituitary to secrete GH.
GHRP: promotes GHRH, &GH reIease.
GHIH/
somatostatin: inhibits GH secretion.
deIta ceIIs of pancreas.
CONTROL OF GROWTH HRMONE SECRETION
gigantism
cessive growth of the body is called Gigantism
Causes 1) Pituitary hyperplasia
2) Hypersecretion secondary finding
- Hypogonadism
- Hypoadrenalism
- Hypothyroidism
GGANTSM Tumor grows in prepubertal life
ACROMGALY f tumor develops after the union has occurred
Signs & symptoms: Signs & symptoms:
Huge stature with a more than 7-8 feet
Diabetogenic effect
Head ache & visual disturbances
Hypopituitarism because of burning out of the cells
gigantism
Oral manifestations:
arly eruption of teeth
Mineralization is not effected
At puberty thickening of cortical bone of mandible, & increase in size of
paranasal sinuses.
Dental management:
Diabetes & hypertension.
gigantism
Cause: Hypersecretion of GH in adults.
Signs & symptoms:
Face features is called as ACROMGALY/ GURLLA FAC
nlarged visceral organs, ar nose & lips are enlarged
Diabetes with hyperglycemia and glucosuria
Hyper tension
Hyperactivity of thyroid, parathyroid & adrenal glands.
cromegaIy
PROSNATHI MANDILE AROMESALY FAE
A) MormoI
8) AcromegoIy
Oral manifestations:
Localized areas of hyperpigmentation.
Tongue enlarged disproportionately & marked papillary hypertrophy
aggerated condylar growth
Hypercementosis
Accelerated dental development and eruption
Advanced periodontal disease
Deepening of voice
cromegaIy
Hypersecretion of gh in children
(Before fusion of epiphysis)
Gigantism
f GH continues after fusion of epiphysis
Symptoms of acromegaly
Acromegalic gigantism
Mo confroindicofions exisf for comprehensive
denfoI heoIfh core
DENTL MNGEMENT
cromegalic gigantism
CAUSS
Decrease in GH secretion
Pituitary insufficiency may be congenital
Prepubertal pan hypopituitarism
Birth trauma
CRITERI FOR DIGNOSIS OF GHD
Height below 3
rd
percentile
Prepubertal growth velocity < 4 cm/yr
Bone age below the chronological age
Abnormal 24hr GH secretory pattern
Resumption of growth following GH administration
Dwarfism
$ISN$ & $YMPTOM$
Stunted skeletal growth ma.
height at adult is 3 feet
No mental retardation
Facial appearance is like "DOLL
LK
Crowding of midfacial structure
Prominent philtrum
High pitched voice
ear nose & lips are enlarged
Dwarfism Dwarfism
OraI manifestations:
Low vertical height open bite with immature facial pattern
Under developed mailla &mandible
Tooth eruption is delayed
Root formation and apical foramen closure delayed / incomplete.
Crowding of teeth
Smaller crown & root size of teeth
SIMMOND'S DISESE / PITUITRY CCHEXI:
Panhypopituitarism due to atrophy / degeneration of
ant.pituitary.
Signs & symptoms:
Rapidly developing senile decay
Loss of hair & teeth
Face becomes dry & wrinkled
CROMICRI
Deficiency of GH in adults
C/F
Atropy and thinning of etremities of the body
Person becomes lethargy and obese
Loss of seual functions
THYROD STMULATNG HORMONS
PRODUCED Thyrotropes of anterior pituitary
TARGET CELLS FoIIicuIar ceIIs of thyroid acini
FUNCTIONS
1) HeIps in synthesis of T3 and T4 hormones
2) Size and secretary activity of the ceIIs
3) ThyrogIobuIin secretion into the foIIicIe
4) Iodination of tyrosine and coupIing to form hormone
5) ProteoIysis of thyrogIobuIin reIease hormone
REGULATION OF SECRETION OF TSH
1) HypothaIamus reIease of TRH
2) Feed back controI Negative feedback from thyroid hormone
ADRNOCORTCOTROPC HORMON ACTH
SECRETED:- By basophils of anterior pituitary
TRGET CELLS Cells of adrenal corte
FUNCTONS
Effects on adrenal cortex
Maintains structural integrity and vascularization of adrenal corte
Causes release of glucocorticoids, prolongs its actions
Other action of ACTH
t mobilizes fat from tissues
Causes pigmentation of skin ( structurally similar to MSH)
GONADOTROPHC HORMON
(S HORMON)
MLE FEMLE
cceIerates the process of
spermeogenesis in combination
with testosterone
StimuIates the theca ceIIs of
graafian foIIicIe -causes
secretion of estrogen
FoIIicIe stimuI,ting ormones
MLE FEMLE
StimuIates interstitiaI ceIIs in
testes to secrete "Testosterone"
ResponsibIe for ovuIation
Z Luteinizing ormone
PROLACTN
PROLCTIN Secretary CELLS
1) Lactotropes of the anterior pituitary
2) Cells of the uterus during pregnancy
PROLCTIN RECEPTORS
a) Breast b) T-Lymphocytes
FUNCTIONS
1) Causes synthesis of milk in the female breast
- remains high in lactating women
1) Found in males
- influences CM by T-lymphocytes
POSTROR PTUTARY
POSTERIOR PITUITRY
Hormones
1) ntidiuretic hormone/- Vasopressin
2) Oxytocin
NTIDIURETIC HORMONE
NTIDIURETIC HORMONE
adh adh
TWO MAJOR FUNCTIONS
1) CONSERVTION OF BODY WTER
- Retention of water by acting on kidney
- Concentration of urine
- Reduction of osmolality of plasma
2) VSOPRESSOR EFFECT
Doses of ADH Contraction of artery BP
FOLLOWNG HMORRHAG BP is restored by release of ADH
REGULTION OF SECRETION -DH
Applied physiology
Diabetes insipidus
Cause deficiency of ADH
Characterized by ecessive ecretion of water through urine
Signs & symptoms:
Polyuria
- dilute urine is ecreted
- daily output of urine is 4-12 lts
Polydypsia
Dehydration
Hyperthermia
Loss of weight
Poor appetite
Diabetes insipidus
Treatment
Desmopressin anaIog of DH
- ChIorpropamide to reduce poIyuria and poIydipsia
- HydrochIorthiazide
- Indomethacin
Syndrome of inappropriate hyper secretion of ADH
(SADH)
Cause:
cessive secretion of ADH
Cerebral tumors
Signs & symptoms:
in ADH urine out put retention of water.
Conc. Urine is ecreted .
Na
+
conc., decreased
Pt die convolutions & coma
CTIONS:
1) Mammary gIands
- Causes milk ejection by contraction of myo-epithelial
cells.
2) Uterus
- Oytocin means "RAPID BIRTH"
On pregnant uterus :
contraction of uterus epulsion of fetus.
Non pregnant uterus:
facilitate the transport of sperms
fallopian tube by uterine contraction
OXYTOCIN
REGULTION OF SECRETION
1) SuckIing of NippIe
2) Stretching of uterine cervix (during Iabor)
3) Various emotions, reIated to her baby
THOMS WHRTON (1616-1673) of EngIand
Greek THYROID =ShieId
Weight 15-20 gms in aduIt
LOCATION
ButterfIy shaped gIand
Inferior to Larynx, having 2 Iobes connected by isthmus
Level 5,6,7
th
CervicaI and 1
st
Thoracic vertebrae
THYROID GLND
Hormones of Thyroid gland
i. Tetra iodothyronine-T4
ii. Triiodothyronin-T3
iii. Calcitonin
T4 (Thyroxin) T3 (Triiodothyronine)
90%
>affinity p.p
Duration of action:
>4 times more
Less
cts sIowIy
9-10%
< affinity p.p
Less
Potency 4 times more
cts immediateIy on target
ceII
STORGE OF THYROID HORMONE
Only endocrine gland that stores its secretary products in
large quantity
After synthesis remain in the form of vesicles along with
thyroglobulin
Thyroglobulin = 5 or 6 molecules of thyroine
TRNSPORT OF THYROID HORMONE IN BLOOD
3 types of plasma proteins for transport
1) Thyroine binding globulin
2) Thyroin binding prealbumin
3) Albumin
Major effects:
ncreases the over all metabolic rate
Stimulate growth in children
Actions:
ncreases protein metabolism
Stimulates carbohydrate metabolism
ffect on fat metabolism
ffect on vitamin metabolism
ffect on body temperature
PhysioIogicaI functions of thyroid hormones
ffect on growth
ffect on body weight
ffect on CVS
ncrease circulation of Blood flow
Heart rate
ffect on blood pressure
ffect on respiration
ffect on GT
PhysioIogicaI functions of thyroid hormones
PhysioIogicaI functions of thyroid hormones
ffect on CNS: Development, functioning.
ffect on skeletal muscle- vigor contraction
ffect on seual function
MEN WOMEN
Thyroin mpotence
Thyroin Complete loss of
libido
Oligomenorrhea sometimes
amenorrhea
Menorrhagia and
Polymenorrhea
Calcitonin
ParafoIIicuIar ceIIs of thyroid gIand
ctions:
On bones:
mmediate effect: decreases the activity osteoclasts
Long term effect: decreases the formation of osteoclasts
On kidney: increases the ecretion
On intestine: prevents the absorption of calcium
Applied physiology
Major manifestations of thyroid disease:
Hyperthyroidism
Hypothyroidism
Thyroid enIargement
Hyperthyroidism
ncreased secretion of thyroid hormone is called
HYPRTHYRODSM
CUSES
1) Grave's disease (autoimmune disease)
2) Antibodies presence of TSH like substance
3) Thyroid adenoma
Three groups of signs and symptoms
1) Swelling of gland
2) opthalmus
3) ffects of oversecretion of thyroin
Signs & symptoms:
1) CVS
- Tachycardia
- Palpitation
- High systolic BP
3) General
- loss of weight inspite of increased appetite
- Muscular weakness
- Marked perspiration
CraniofaciaI abnormaIity
- Accelarated growth and development of craniofacial comple
- arly shedding of deciduous teeth, early eruption of Perm. T
- Natal teeth
- PDL / periapical destruction and osteoporosis
- Susceptibility to pdl disease and caries
- ncreased facial height with openbite and mild prognathism
) Mervous sysfem
- fine fremor
- menfoI resfIessness
- Anxiefy
- FeeIing excessive heof
TYPICL FETURES IN HYPERTHYROIDISM
$in pigment,tion Eopt,Imus
Hyperthyroidism
Dental management:
LA without epinephrine
Propylthiouracil agranulocytosis, hypoprothrombinemia, bleeding.
Pt should be euthyroid before rendering any treatment.
Thyroid crisis:
Propylthiouracil : 600- 1000 mg
Propranolol : 1mg / min (total <10 mg)
Supportive treatment: fluids, electrolytes, glucose & vit B.
wet packs, cool air & ice packs.
Hypothyroidism
Cause -Decreased secretion of thyroid hormone
T S A COMMON NDOCRN DSORDR OF CHLDRN
Two forms of Hypothyroidism
1) Cretinism children
2) Myedema - Adult
tiology:
1) odine deficiency
2) Congenital absence of TG
3) atrogenic (Surgical removal of TG)
4) Simmond's disease (Hypofunctioning of Ant. Pit.)
Cretinism
Features
Retardation of growth in all forms mental, physical
and seual
Child is dwarf and pot bellied
Mentally idiot
Skin is dry, thick, and coarse
Respiratory difficulties Noisy breathing, nasal
obstruction and apnea
No maturation of eternal genitalia and sec. se
characters
Cretinism
NEONTL HYPOTHYROIDISM
Craniofacial manifestation:
Skin of the face is coarse, thick, dry & wrinkled.
Lips are enlarged, puffy & pale.
Mailla widened & mandible is under developed.
Decreased vertical facial growth
nlarged tongue
Malocclusion is a constant finding.
ruption & efoliation of teeth delayed.
ncreased susceptibility to pdl disease, caries and oral ulceration
ncomplete formation and closure of apical area of tooth
CRETINISM
FACIAL FORM OF A 9 YEAR OLD GIRL BEFORE AND
AFTER HORMONE REPLACEMENT THERAPY
HYPOTHYROIDISM.
&nerupted perm,nent teet
RETAINED PRIMARY TEETH
Signs & symptoms:
dematous appearance through out the body
Swelling of the face
Bagging under the eyes
Atherosclerosis
MYXEDEM MYXEDEM
MYXEDEM MYXEDEM
Oral manifestations:
Skin & lips are pale, dry & scaly.
Swelling of tongue scalloping of the lateral margin.
Mouth breathing
Swelling of vocal cords husky & low pitched voice.
Dental caries & periodontal diseases.
MACROGLOSSIA SECONDARY TO MYXEDEMA
Discovered Sandstorm of Sweden (1880)
4 small glands present behind thyroid gland
HISTOLOGY
1) Chief cells Parathormone
2) Oyphil cells
PRTHORMONE
Maintains blood Ca.
Normal blood Ca. 9-11 mg%
It acts on Bones, Kidney and GIT by
1) Resorption of Ca. from bone
2) Absorption of Ca, from GT
3) cretion of Ca. through kidney
4) t facilitates the conversion of Vit. D to Calcitrial
PRTHYROId GLNDS
2) Calcitriol PTH production
3) Vit D and Ca. in diet PTH production
1) Serum calcium level
REGULTION OF PTH SECRETION
Applied physiology
Hypoparathyroidism
Causes:
Surgical removal
Thyroidectomy
Autoimmune disease
Defect in receptors
Signs and Symptoms:
Tingling and numbness of fingers, toes,lip
(circumoral anesthesia)
Carpopedal spasm
Laryngeal stridor
Stridor spasm of muscles of respiration
ntracranial pressure and papilledema
Convulsions
Hypoprarathyroidism
Decreased resorption of Ca
++
Hypocalcemia
Neuromuscular hyperecitability
Tetany
Plasma Ca
+
-- < 6 mg %
TETNY TETNY
CraniofaciaI manifestation
Circumoral paresthesia
Spasm of facial muscle
Oral candidiasis
Hypoplasia of enamel
Hypodontia
Root dysmorphogenesis
Thickened lamina dura
Delayed or arrested tooth eruption
Malformed teeth, anodontia,
Short blunt root apices,
longated pulp chambers,
Multiple impacted teeth & mandibular eostoses.
ENAMEL HYPOPLASIA SECONDARY TO
HYPOPARATHYROIDISM
$ort met,t,rs,Is ,nd met,c,rp,Is
Hyperparathyroidism Hyperparathyroidism
Primary: Tumor
Secondary: Compensatory to long standing hypocalcaemia
(hypertrophy).
Tertiary: Chronic secondary hyperparathyroidism leading to
hyperplasia of all parathyroids.
Depression of nervous system
Sluggishness of refle activities
Changes in CG
Lack of appetite
Constipation
Ostitis fibrosa cystica
Stone formation
Signs &&and &&symptoms
Loss of lamina dura with widening of pdl space
Brown tumor lesion
Tooth mobility
Malocclusion
Metastatic soft tissue calcifications
Periapical radiolucencies & root resorption.
Ground glass appearance of alveolar bone.
OraI manifestations
OSTEITIS FIBROSIS CYSTIC
SRO&ND SLA$$ APPEARANE
LO$$ OF LAMINA D&RA
PALATAL ENLARGEMENT
rown" Si,nt ceII tumor
Dental management
No Contraindication for comprehensive dental health care
Care should be taken to avoid iatrogenic fractures.
TRATMNT
SURGRY OF PARATHYROD GLANDS
DRENL GLNDS
2 adrenal glands situated on the upper pole of each kidney
Triangular in shape
Weight of each gland 4 gm
IT HS 2 PRTS
1) Adrenal corte 80 % outer part
2) Adrenal medulla 20 % nner part
Hormones of drenaI cortex &
meduIIa
MineraIocorticoids Idosterone
Functions:
Increase Na
+
reabsorption
Increase excretion of K+
Increase in ECF voIume
Increases B.P
Reabsorption of Na
+
- sweat, & saIivary gIands
Increases thirst.
Idosterone escape phenomenon
TOTAL LOSS OF CORTCOSTRODS USUALLY CAUSS DATH TOTAL LOSS OF CORTCOSTRODS USUALLY CAUSS DATH
WTHN 3 DAYS WTHN 3 DAYS - -2 WKS 2 WKS
GIucocorticoids GIucocorticoids
Functions: Functions:
Increases bIood gIucose IeveI
Increases cataboIism of protein
Causes mobiIization of fat obesity
HeIps in maintenance of water baIance
EssentiaI for normaI function of CNS
Other functions
Permissive action
Resistance to stress
nti infIammatory effects
nti-aIIergic actions
Immunosuppressive effects
Ex. CortisoI
Corticosterone
Signs & Symptoms:
Redistribution of fat, round face.
Thin skin & subcutaneous
tissues
Purple striae
Poor wound healing
Osteoporosis
Hyperglycemia
Hypertension
Susceptible to infection
isorder chorocferi;ed by obesify due fo hyper secrefion of 0C's.
Cushing's syndrome
Signs & symptoms
Hirsutism
cchymosis
Growth retardation
OraI manifestations
Retardation in skeletal & dental age
Gingival enlargement
Osteoporosis in jaw bones
A CHILD WITH CUSHING`S SYNDROME
MANIFESTATIONS OF CUSHING`S SYNDROME IN AN
ADULT.
Signs &symptoms:
Pigmentation of skin & mucous membrane
Muscular weakness
Hypotension
Decreased cardiac output, work load -- size of heart
Hypoglycemia
Nausea, vomiting & diarrhoea
Susceptibility to infection
nability to withstand stress
F,iIure of ,dren,I corte to secrete corticosteroids
Addison's dise,se Addison's dise,se
OraI manifestations:
Pigmentation on gingiva, palate, tongue & lips
Gingival, periodontal diseases & candidal infection
DentaI management:
ncreased risk of infections & adrenal crisis.
Atraumatic & aseptic techniques
Cortisol supplementation-
Minor stress 75 to 100 mg of hydrocortisone
More stress 150 to 200 mg of hydrocortisone
Better performed in hospital settings.
&AL M&O$A
FLOOR OF MO&TH AND
VENTRAL $&RFAE OF TONS&E
PISMENTATION IN ADDI$ON'$ DI$EA$E,
DRENL CORTICL INSUFFICIENCY
MNGEMENT
Dental treatment should be stopped
Medical assistance should be sought
Pt. Should be placed in trendelenburg position
Vital signs should be monitored
Oygen at 6-8 lts/mt should be administered
Hydrocortisone 100-200 mg i.v, immediately b4 lab report.
PREVENTION IS BETTER
1) f pt. is using steroid on long term basis
- administer additional dose of steroids prior to surgery
2) pt. require major surgery
- dose should be double or triple levels 2-3 days prior,
DENTIST MUST BE WRE OF DISORDERS WHERE STEROID THERPY
IS INSTITUTED
PTIENT SHOULD HVE IDENTIFICTION BRCELET
ADRENAL $EX HORMONE ADRENAL $EX HORMONE
Hormones secreted are
1) |ostly male sex hormones
0ehydroepIandrosterone - actIve androgen
AndrostenedIone
Testosterone
2) Estrogen and progesterone Small quantIty.
FUNCTIDNS
1) FesponsIble for masculIne features of body
2) n normal condItIon, It has InsIgnIfIcant effect
CongenItaI hyperpIasIa or tumor of ZP
Females causes - |asculIne features and hIrsuItIsm.
ADRENAL MED&LLA ADRENAL MED&LLA
Adrenal medulla Is Inner part of the adrenal gland
HIstoIogy
2 types ChromaffIn cells or pheochrom cells
1) AdrenalIne secretary cells
2) NoradrenalIne secretary cells
HDPhDNES DF A0PENAL hE0ULLA
CofochoIomines:
I. AdrenoIine /epinephrine
. Mor odrenoIine
3. opomine
- BIood gIucose IeveI
- BIood coaguIation time
- RBC and HemogIobin content
- Heart rate,
- Force of contraction
- GeneraI vasoconstrictor
ctions of drenaIine and Nor adrenaIine
ctions of drenaIine and Nor adrenaIine
Effects on skIn
Sweat secretIon
Effects on CNS
ActIvIty of braIn
FIght or flIght
Effects on blood pressure
AdrenalIne SystolIc 8P, 0IastolIc 8P
Fate and force of respIratIon
ppIied physioIogy
PHEOCHROMOCYTOMa Secretion of catecholamines
features
anxiety
chest pain
fever, headache
hypergIycemia
nausea, vomiting
sweating and fIushing
tachycardia
weight Ioss
f hos bofh exocrine ond endocrine porf
Eocrine p,rt
Acini ond ducfs - oiding in digesfion
Endocrine p,rt
sIefs of Longerhons (I- miIIions)
types of ceIIs ,re present in IOL
I) A or o ceIIs 0Iucogon ()
) 8 or ceIIs nsuIin (o0)
3) or deIfo ceIIs Somofosfofin (I0)
4) F or PP ceIIs Poncreofic poIypepfide ()
PNCRES PNCRES
,rIes Herbert est (I9I) discovered MSULM
$YNTHE$I$
ATION$ OF IN$&LIN
nsuIin is on "onoboIic hormone". f couses onoboIism of
Corbohydrofe-fof-profein.
f couses sforoge of corbohydrofe, fof ond profeins in forgef orgons
T,rget org,ns ore I) Liver
) MuscIe
3) Adipocyfes (Fof ceIIs)
Proinsulin

Peptide clevages

Mature insulin
INSULIN RECEPTOR INSULIN RECEPTOR
1) 2 o subunits
2) 2 subunits
EFFET OF IN$&LIN ON TARSET ORSAN$ EFFET OF IN$&LIN ON TARSET ORSAN$
I, LIVER
0Iycogenesis
Profein synfhesis
0Iucose enfry
Fof synfhesis
0Iuconeogenesis
0Iucose enfry
Amino ocid upfoke
MuscIe gIycogenesis
Profein synfhesis
Pofossium upfoke
0Iucose enfry
Foffy ocid synfhesis
TrigIyceride formofion
Pofossium upfoke
IipoIysis
II, $ELETAL M&$LE III, ADIPO$E TI$$&E
AROHYDRATE
- Sforoge of gIycogen
- 8Iood gIucose IeveI
Z FAT
- Sforoge of fof
- 8Iood IeveIs of FFA
3 PROTEIN
- Profein synfhesis
- AA in bIood
DNA $yntesis
PeguIatIon of InsuIIn secretIon
ActIons of gIucagon ActIons of gIucagon
Glucagon is antagonist to nsulin
t increases blood sugar level
ncreases peripheral utilization of lipids
ncreases secretion of bile
nhibits gastric juice secretion
PeguIatIon of secretIon
- Hypoglycemia stimulates
- ncrease Amino acid level stimulates
Other factors
stimulates ercise, stress , cortisol
nhibits somatostatin, insulin, free fatty acid
ppIied physioIogy
Diabetes meIIitus Diabetes meIIitus
- nsulin dependent/ Juvenile DM
Types:
- non insulin dependent
DM asso with other endocrine disorders
Type :
Disorder / absence of cells
Type :
Absence / reduced no of insulin receptors in the cells of the body
Major manifestations:
ncreased blood sugar level
levated fatty acid count
Depletion of proteins from
the tissues.
Di,betes meIIitus Di,betes meIIitus
ppIied physioIogy
SIGNS & SYMPTOMS
Loss of glucose in urine
Polyphagia
Polyuria
Polydipsia
Asthenia
Kussmaul's breathing
Circulatory shock
Coma
Change in vision
Unexpected wt. Ioss
Itered in wound heaIing
Ketoacidosis
Weakness and maIaise
Di,betes meIIitus Di,betes meIIitus
CompIications:
Retinopathy
Nephropathy
Neuropathy
OraI manifestations
Burning mouth
Dry mucosal surface, erostomia
ncrease incidence of candidal infection
ncreased severity of gingivitis & periodontitis
ncreased risk of attachment loss
.
ORAL MANIFESTATIONS OF DIABETES MELLITUS
,ndidi,sis wit ,nguI,r stom,titis
DentaI management
Short morning appointments
Adjunctive sedation
Normal diet before the procedure
Treatment of periodontal diseases & acute infections aggressively
Frequent recall visits
Post operative antibiotic prophylais
MNGEMENT
Diet
ercise
Weight control
Medication
- nsulin injection s.c, Pfizer's inhaled insulin
- Oral hypoglycemic drugs
INSULIN SHOCK (HYPOGLYCEMIC)
CUSE :- inadequate intake of food following usual dose of
insulin or oral hypoglycemic agent
CONSCIOUS PTIENT :-
food containing simple sugar (orange juice etc.)
UNCONSCIOUS PTIENT:
Call assistant,
Position of the patient
Basic life support
Monitor vital signs
50% detrose i.v
Glucagon 1mg i.m/ i.v
Honey or syrup may be placed in pt. buccal fold
f neither glucogan nor 50% detrose sol. Available then
- 1:1000 epinephrine s.c or i.m given and repeated every 15 mts
HYPERGLYCEMI/DIBETIC COM/ KETOCIDOSIS
CUSE :- PT. OMTS HS DOS OF NSULN AND
RMANS LL FOR A FW DAYS
MNGEMENT
Call assistant,
Position of the patient
Basic life support if unconscious
Monitor vital signs
i.v drip NORMAL SALN should be given
Usual dose of insulin may be given
WHEN IN DOUBT, IT IS SFER TO SSUME INSULIN SHOCK
THN DIBETIC HYPERGLYCEMIC COM
Estrogen:
Secreted by ovarian follicles, corpus luteum & placenta.
ctions:
On uterus: growth of myometrium
proliferation of endometrium
At puberty responsible for dev. Of breast
Metabolism: hyperglycemia, hyperlipidemia, hyperbilirubinemia.
Reproductive system
Actions of estrogen & progesterone on gingival tissues:
strogen increases cellular proliferation in blood vessels.
ncreases epithelial keratinization
Progesterone increases vascular dilatation & permeability
Progesterone increases proliferation of newly formed capillaries.
Alters the rate & pattern of collagen production
Accelerates the immune system.
ctions:
n fetus se differentiation
n puberty growth of eternal genitalia
dev of secondary seual charactristics.
Spermatogenesis & sperm mobility.
ncreases bone thickness by deposition of Ca
++
.
ncreases retention of Na
+
,.
Male reproductive system
Testosterone.
REFERENCES REFERENCES
-Text book of MedicaI PhysioIogy, 10
th
edition, Guyton and
HaII
- EssentiaIs of medicaI physioIogy - 3
rd
edition,
SambuIingum K and SambuIingum prema.
- MedicaI emergency in dentaI office - 5
th
edition, MaIamad.
- EssentiaI Pediatrics - 6
th
Edition, Ghai, Piyush Gupta and
PauI
- Website www.googIe.com
- www.dentistpro.org
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