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Two Major Integrating and Modulating Systems of the Body
o Nervous System
o Endocrine System
Hormones - chemical mediators othe endocrine system
Three characteristics ohormones:
o 1. Produced by ductless glands
o 2. Transported by body fluids to target cells
o 3. Interact with specific receptor sites
Endocrine System: Pituitary-Thyroid, Adrenals, Pancreas, Parathyroids, Gonads
o Pituitary control oendocrine gland secretions: e.g. Thyroid and Adrenal cortex
controlled by Pituitary gland
THS (Thyroid Stimulating Hormone)
ACTH (Adrenocorticotropic Hormone)
o Pituitary gland is under control of Hypothalamus
TR(Thyrotropin Releasing Factor)
CR(Corticotropin Releasing Factor)
o Hormones othe Pituitary Gland Master Gland located at base of brain
Anterior Pituitary hormones:
ACTH adrenocorticotropic h. stimulates adrenal cortex
TSH thyroid stimulating h. stimulates thyroid
o stimulating hormone regulated by negative feedback
mechanism
other hormones of the anterior pituitary:
GH growth, FSH follicle stimulating, LH luteinizing, Prolactin
Posterior Pituitary Hormones:
ADH antidiuretic hormone (H2O reabsorption, vasoconstriction)
Oxytocin
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Glucagon secreted by alpha cells
Regulates blood glucose levels
Stimulates glycogenolysis
o Definition: production of glucose from glycogen stores
(these stores are depleted by fasting)
o Glycogen Glucose
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Insulin
Depot alone
Depot Insulin in combination with Regular Insulin
Example:
o Regular + NPH before breakfast
o NPH in evening
The above simulate the normal pattern of insulin
rising after meals
Complications of Insulin Use
Hypoglycemia vs Ketoacidosis
o Hypoglycemia
Insulin levels too high compared to glucose levels
e.g. Patient took insulin but neglected to eat
e.g. Brittle Diabetic
o Ketoacidosis
Insulin levels too low for metabolic requirements
Use of
Treatment:
Anti-thyroid Drugs
radioactive iodine: destroys gland at high
doses
propylthiouracil: affects synthesis of thyroid
hormone
Adrenal Insufficiency
o Primary Adrenal Insufficiency - Addisons Disease
Adrenal cortical insufficiency
Bronze pigmentation
Addisonian crisis: shock, fever,
hypercalcemia, hyponatremia, hyperkalemia
o Secondary Adrenal Insufficiency
Result of steroid (glucocorticoid i.e. cortisol- like)
medications which suppress the adrenal glands by
the negative feedback mechanism
May result in acute adrenal crisis
cardiovascular collapse with stress or
surgery shock
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Acute Adrenal Crisis - who is at risk?
o Acute adrenal crisis may occur
if a patient is adrenal suppressed because of
steroid medication (on steroid daily, for greater
than two weeks in the past 6 ?months *)
Problem: The adrenal gland does not respond to
stress. The result is adrenal crisis:
weakness, pain
syncope, cardiovascular collapse,
death
* Recovery time is debatable
Patient On Long Term Steroid Therapy
USES OF STEROIDS
o Replacement
Addisons disease (adrenal insufficiency)
where portions of the adrenals have been surgically
removed e.g. Cushings disease (overactive adrenal
cortex)
o Emergencies:
shock, anaphylaxis
adrenal crisis
o Anti-inflammatory effects:
acute and chronic inflammatory diseases
asthma, allergies, rheumatoid arthritis, Connective
Tissue diseases
Specific Uses in Dentistry
o Apthous ulcers and other ulcerative diseases such as
Lichen Planus often topically applied Exception: Herpes
infections (steroid not used)
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Adverse reactions of Glucocorticoids:
o Metabolic changes - diabetogenic, fat deposits (moon
face, buffalo hump)
o Infections - mask infection, decrease resistance to
infection
o CNS effects - agitation, behavioral effects, PSYCHOSES,
depression
o Peptic ulcer - increase acid and pepsin, impair healing of
ulcer
o Delayed wound healing - (catabolic effect) osteoporosis
o Electrolyte - fluid balance (some mineralocorticoid effect,
weight gain fluid retention)
Hypertension and heart failure
o Adrenal crisis (secondary adrenal insufficiency)
Cautiou with use:
o Gastric Ulcers
o Hypertension
o Infection
o Behavioral disorders
o Osteoporosis
o Glaucoma - may increase intraocular pressure