Other hormones CH. 20

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Pituitary gland is the

master gland

Pituitary deficiency can produce

Diabetes INSIPIDUS- polyuria, polydipsea, polyphasia

Hypersecretion of pituitary hormones can produce

Goiter, acromegaly (adults), and giantism (childhood)

Anterior pituitary: used to tx infertility

Leuprolide

Posterior pituitary secretes

vasopressin (antidiuretic hormone [ADH]) and oxytocin

synthetic vasopressin treats

pituitary diabetes insipidus
clotting disorders: hemophilia A and von willebrand disease (both are genetic)

Oxytocin is used for

induce labor
control postpartum hemorrhage
induce postpartum lactation

Iodine rich foods

Marine life most common food

HYPOthyroidism in a small child is

cretinism

HYPOthyroidism in an adult is

myxedema or simple hypothyroidism

associated w/cretinism

malocclusion
delayed tooth eruption
periodontal disease is more prevalent

associated w/myxedema

drowsy
weak
expressionless

hypothyroidism is treated with

levothyroxine

HYPERthyroidism forms

*Diffuse toxic goiter (graves disease)-enlarged, highly vascular thyroid gland
*Toxic nodular goiter (plummer disease)- nodules that secrete excessive hormone while the rest is atrophied

HYPERthyroidism adverse reactions

exopthalmos
acclerated tooth eruption
rapid progressing periodontitis

HYPERthyroidism tx

radioactive iodine

Antithyroid agents if they dont tolerate surgery of R.I.

propylthiouracil (PTU)
methimazole (Tapazole)

Pancreatic hormones

Insulin: fuel storage (glucose out of the blood)
Glucagon: fuel mobilization (glucose into the blood)

Diabetes Mellitus characterized by

HYPERglycemia

Diabets Mellitus types

type 1- insulin dependent (skinny) pancreas doesn't make insulin
type 2- non-insulin dependent (fat) pancreas doesn't respond to insulin

type 1 diabetes

autoimmune destruction of pancreatic BETA cells
complete LACK of insulin secretion
INCREASED glucagon secretion

type 2 diabetes

older than 40 years old
newer cases younger than 20 years old
attributed to lack of exercise and resulting obesity
insulin resistant
prolonged HYPERglycemia
result: HYPERinsulinemia

Dental issues in diabetes

tx with caution! make sure they have taken their meds and treat 1 1/2-2 hours after eaten a normal BREAKFAST

Caution and contraindication

Drugs may DECREASE insulin release or INCREASE insulin requirements - EPINEPHRINE (GIVE MORE INSULIN)

Systemic complications of diabetes

Retinopathy- DM #1 cause of blindness
Neuropathy- especially in lower extremities
Infections- gangrene due to poor circulation, reduced sensation, and poor eyesite
Healing: slower

Evaluate pt w/diabetes

serum glucose- finger prick
glycosylated hemoglobin (hba)- blood test *more accurate test for diabetes than serum glucose

tx of hypoglycemia in an unconscious pt

Intravenous dextrose 50%

Drugs used to manage diabetes

Insulin: subcutaneous injection (belly fat)
human insulin prepared by: recombinant DNA synthesis and modifying porcine (pig) insulin

Rapid acting

insulin lispro (humalog) change 2 amino acids in its structure

MOST COMMON adverse reaction to insulin

HYPOglycemia

Symptoms are explained by:

Increased release of epinephrine from the adrenals
*sweating
*weakness
*nausea
*tachycardia

Symptoms of glucose deprivation of the brain

blurred vision
incoherent speech

type 2 antidiabetic agents

Biguanides: metformin (Glucophage)- lowers blood glucose and does NOT produce HYPOglycemia

Metformin ADE PRIMARY in the GI tract

anorexia
dyspepsia
flatulence
nausea
vomiting

The only orally active agent used to manage type 2 diabetes for many years

sulfonylureas

Mechanism of action type 2 diabetes

*STIMULATION OF RELEASE of insulin from beta cells of the pancreas
*REDUCTION of glucose
*REDUCTION in serum glucagon levels
*INCREASE of sensitivity of target tissues to insulin

Interaction of what drug causes DECREASE in serum glucose levels

ASPRIN. IMPORTANT IN BRITTLE DIABETICS

Type 2 diabetes 1st line of tx

Sulfonylureas+biguanide (metformin)

Other new drugs

1:exenatide (Byetta) big on the market. an incretin mimetic
2:pramlintide (Symlin) doesnt replace insulin:
*Decreases caloric intake
*weight loss
*Type 1 DM use of meal time insulin not achieved desired glucose control despite optimal insulin therapy ( eat within 5 minutes)
3:Colesevelam lowers LDL cholesterol

Glucoagon

is a polypeptide produced by alpha cells of the pancreas and is antagonist to insulin

Female sex hormones

Estrogen and Progestins

the female sex hormones are secreted by the

ovaries, testes and placenta

On day one

FSH and LH begin to increase

the ovarian egg matures in response to

increased FSH

on day 12

secretion of FSH and LH increase markedly, this culminates in ovulation

Estrogen therapy may promote

endometrial carinoma in postmenopausal women
cancelled out by administration of progestin

Estrogen

gingival inflammation may occur even with the decreased amount of plaque

Progestins

If implantation doesnt occur, progesteron secretion declines and mensstruation stops
If implantation occurs the trophoblasts secrete chorionic gonadotropin which substains corpus luteum

Medroxyprogersterone (depo-provera)

every 3 months

Hormonal contraceptives

increase in dry sockets
CONTRAINDICATIONS FOR ORAL USE- CARCINOMA OF THE BREAST

Side effects of birth control

blood clot , weight gain, headache nausea

male sex hormone

antiandrogenic medicine Proscar (finasteride) used to tx prostate cancer

androgens are used for

muscle mass gain and are schedule 3 controlled substance

affect sex hormones

Tamoxifen tx of breast cancer in postmenopausal women
hormone from the opposite sex are used to manage prostate, breast, and uterine cancers

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