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 diseaseAppears 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

CretinismWhen it occurs in infancy and childhood

MyxedemaWhen it occurs in older children and adults

Hypothyroidism (cont.) Oral manifestations

In infantsThickened 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 cellsNutritional 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

lymphocytesPrimarily affects children and young adultsGood 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 ACaused by a deficiency of plasma

thromboplastinogen or factor VIIIType B

Christmas diseaseLess common, the clotting defect is plasma

thromboplastin or factor IX