Download Systemic Disorders

Systemic Disorders
Chapter 11
Medical Considerations
Hyperpituitarism
 Excess hormone production by the anterior
pituitary gland
 Caused most often by a benign tumor
(pituitary adenoma) that produces growth
hormone
 Giantism results if it occurs before the
closure of long bones.
 Acromegaly results when hypersecretion
occurs during adult life.
Clinical Features and Oral Manifestations of
Hyperpituitarism
 Affects both men and women, most commonly during
the fourth decade of life
 Patients experience poor vision, light sensitivity, enlargement
of hands and feet, and an increase in rib size.
 Facial changes
 Enlargement of maxilla and mandible may cause separation of
teeth and malocclusion.
 Frontal bossing and an enlargement of nasal bones may lead to
deepening of voice.
 Mucosal changes
 May have thickened lips and macroglossia
Diagnosis and Treatment of Hyperpituitarism
 Diagnosis involves measurement of growth hormone.
 Treatment often includes pituitary gland surgery.
Hyperthyroidism (Thyrotoxicosis)
 Excess production of thyroid hormone
 More common in women than men
 The most common cause is Graves disease
Graves disease
Appears to be due to an autoimmune disorder
in which a substance is produced that
abnormally stimulates the thyroid gland
 Other causes include hyperplasia of the gland,
benign and malignant tumors of the thyroid,
pituitary gland disease, and metastatic tumors.
Clinical Features of Hyperthyroidism
 Rosy complexion, erythema of the palms,
excessive sweating, fine hair, softened nails
 The patient may have exophthalmos.
 Anxiety, weakness, restlessness, and cardiac
problems may also be associated.
Treatment of Hyperthyroidism
 May include surgery, medications to suppress thyroid
activity, or administration of radioactive iodine
Hypothyroidism
 A decreased output of thyroid hormone
 Causes include developmental disturbances,
autoimmune disease, iodine deficiency, drugs, and
pituitary disease
 Cretinism
When it occurs in infancy and childhood
 Myxedema
When it occurs in older children and adults
Hypothyroidism (cont.)
 Oral manifestations
 In infants
Thickened lips, enlarged tongue, and
delayed eruption of teeth
 In adults
Enlarged tongue
Addison Disease
 Primary adrenal cortical insufficiency
 In most cases, the cause of destruction of the
adrenal gland is unknown – it may be an
autoimmune disease.
 It may be due to a tumor or tuberculosis.
 To compensate, the pituitary gland increases
production of ACTH.
Addison Disease (cont.)
 Clinical features
 This hormone causes stimulation of
melanocytes.
 Bronzing of the skin may occur, as well as
melanotic macules on oral mucosa.
 Treatment
 Steroid replacement therapy
Blood Disorders
 Disorders of Red Blood Cells and Hemoglobin
 Disorders of White Blood Cells
 Bleeding Disorders
Blood Disorders (cont.)
 The complete blood count examines red blood cells,
white blood cells, and platelets.
 It provides information about the number of each
type of cell, the ratio of types, and the appearance
of the cells.
Anemia
 A reduction in the oxygen-carrying capacity of blood
 Most often related to a decrease in the number of
circulating red blood cells
Nutritional anemias
A deficiency in a substance required for the
normal development of red blood cells,
commonly vitamins
Suppression of bone marrow stem cells
Anemia (cont.)
 Clinical features
 Pallor of skin and oral mucosa
 Angular cheilitis
 Erythema and atrophy of oral mucosa
 Loss of filiform and fungiform papillae on the
dorsum of the tongue
Iron Deficiency Anemia
 An insufficient amount of iron is supplied to bone marrow for
red blood cell development.
 May occur as a result of deficient iron intake, blood loss
from heavy menstrual bleeding or chronic gastrointestinal
bleeding, poor iron absorption, or an increased requirement
for iron in situations such as pregnancy or infancy
 Plummer-Vinson syndrome may result from long standing iron
deficiency anemia.
 Includes dysphagia, atrophy of the upper alimentary tract,
and a predisposition to developing oral cancer
Clinical Features and Oral Manifestations of
Iron Deficiency Anemia
 Often asymptomatic, may have nonspecific
symptoms such as weakness and fatigue
 In severe cases may see angular cheilitis,
pallor of oral tissue, and an erythematous,
smooth, painful tongue
Diagnosis and Treatment of Iron Deficiency
Anemia
 Laboratory tests show a low hemoglobin
content and reduced hematocrit.
 Red blood cells appear smaller than normal
(microcytic) and light in color (hypochromic)
 Treatment
 Dietary supplements
Sickle Cell Anemia
 An inherited blood disorder
 When someone is heterozygous, it is called sickle cell trait.
 When someone is homozygous, they are much more severely
affected.
 Occurs before age 30 and is more common in women
than in men
 The red blood cells develop a sickle shape when there is
decreased oxygen.
 This can be triggered by exercise, exertion, administration of a
general anesthetic, pregnancy, or even sleep.
Clinical Features and Oral Manifestations of
Sickle Cell Anemia
 The person has weakness, shortness of breath,
fatigue, joint pain, and nausea.
 Radiographic
 There is a loss of trabeculation, and large,
irregular marrow spaces appear.
 A “hair-on-end” pattern may be seen in the
skull.
Diagnosis and Treatment of Sickle Cell
Anemia
 The sickle-shaped cells may be seen on a blood
smear.
 The number of red blood cells is usually low,
as is the hemoglobin content.
 Treatment is largely supportive, involves
administration of oxygen and IV and oral fluid.
Leukemia
 Malignant neoplasms of hematopoietic stem cells
 Characterized by an excessive number of abnormal
white blood cells in circulating blood
 Unknown cause; some are investigating oncogenic
viruses
 There are many different types categorized as to
whether they are acute or chronic.
Acute Leukemias
 Characterized by very immature cells and a rapidly fatal
course if not treated
 Acute lymphoblastic leukemia – involves immature
lymphocytes
Primarily affects children and young adults
Good prognosis
 Acute myeloblastic leukemia – involves immature
granulocytes
Primarily affects adolescents and young adults.
Prognosis is not as good.
Hemophilia
 A disorder of blood coagulation
 Results in severely prolonged clotting time
 Due to a deficiency in plasma proteins
involved in coagulation
Types of Hemophilia
 The two most common types are type A and type B.
 Transmitted as X-linked diseases through an
unaffected carrier daughter to a son
Type A
Caused by a deficiency of plasma
thromboplastinogen or factor VIII
Type B
Christmas disease
Less common, the clotting defect is plasma
thromboplastin or factor IX