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