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🏠1.3 Endocrine: Gonads

W1, L3, Dr. Javadi

Question Bank

1
What is hyperthyroidism characterized by?
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Excess thyroid hormone

2
What are the primary causes of hyperthyroidism?
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• over functioning of thyroid • pituitary tumor • inflammation of thyroid

3
Symptoms of hyperthyroidism?
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• weight loss • heat intolerance • rapid heart rate • sweating, hyperactivity, anxiety, insomnia

4
What are the methods to target the thyroid gland in hyperthyroidism management?
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• Surgical removal/gland destruction • Inhibition of thyroid hormone synthesis • Preventing release of thyroid hormone

5
What can you use to Treat peripheral symptoms of thyroid hormone?
Show answer
β-blockers for cardiovascular effects

6
What is the mechanism of action (MOA) of Thyroid Synthesis Inhibitors?
Show answer
concentrate in thyroid and block synthesis of thyroid hormones

7
What is the primary indication for using Thyroid Synthesis Inhibitors?
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hyperthyroidism treatment

8
Which Thyroid Synthesis Inhibitor is known to cause salivary gland swelling?
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Methimazole

9
What is the primary mechanism of action for a hormone release blocker?
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inhibits iodination of tyrosine during T3 and T4 synthesis, inhibits release of thyroid hormone from thyroglobulin

10
Indication for using a hormone release blocker?
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• hyperthyroidism • thyroid storm treatment • topical antiseptic solution

11
What is a common adverse effect of hormone release blockers?
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• metallic taste • sore mouth and throat • tongue swelling • Mucus membrane ulceration

12
What is the primary cause of hypothyroidism?
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Thyroid gland not making enough thyroid hormone

13
What is secondary cause of hypothyroidism - central hypothyroidism?
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Occurs due to tumor on the anterior pituitary or damage to the hypothalamus

14
Symptoms of hypothyroidism?
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• weight gain • cold sensitivity • slower heart rate • mental slowness, lethargy • constipation

15
Goal of hypothyroidism management?
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increase T3 and T4 levels

16
Treatment for hypothyroidism?
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• iodine deficiency → iodine rich foods • primary, secondary, tertiary, or congenital → synthetic hormone replacement

17
What is one food rich in iodine recommended for hypothyroidism management?
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Fish

18
What is Levothyroxine?
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synthetic analogue of T4

19
What is Liothyronine?
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synthetic analogue of T3

20
Which synthetic analogue is a mixture of T4 and T3 in a 4:1 ratio?
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Liotrix

21
What is the primary use of Liotrix?
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used to treat/prevent enlargement of thyroid gland

22
Which synthetic analogue is the medication of choice for long-term hypothyroidism treatment?
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Levothyroxine

23
Which synthetic analogue is contraindicated in patients with a prior history of cardiovascular diseases?
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Liothyronine

24
Which synthetic analogue has a faster onset of action and is more potent?
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Liothyronine

25
Which synthetic analogue has a longer duration of action and is better tolerated by patients?
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Levothyroxine

26
What is the suffix for glucocorticoids?
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-asone, -olone

27
Indications for glucocorticoid use?
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1. Replacement hormone for adrenal insuff. 2. Suppress inflammation 3. Autoimmune disease 4. Allergies 5. lung maturation in premature fetus

28
How are glucocorticoids administered?
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via topical or systemic route

29
What are the classifications of glucocorticoids based on their duration of action?
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short, intermediate, long-acting corticosteroids

30
Adverse effects of glucocorticoids?
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correspond to drug dose and interval of treatment

31
Which side effects are associated with the use of glucocorticoids?
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increased risk of infection, peripheral edema, increased risk of diabetes/hypertension/osteoporosis

32
Why are patients advised against sudden stop of glucocorticoids?
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serious side effects: • suppression of hypothalamus, pituitary, adrenal axis • can lead to potentially fatal adrenal insufficiency

33
What is the primary use of Ketoconazole in medical treatment?
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Inhibits adrenal steroid synthesis, used for hyperadrenalism (e.g., Cushing syndrome)

34
What is the primary use of Etomidate in medical treatment?
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• “anesthetic drug” • inhibits steroid synthesis • via IV for emergency treatment of Cushing's

35
What are the female sex hormones?
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estrogen and progesterone

36
3 forms of estrogen
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estradiol estrone estriol

37
What does estradiol control
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sex specific changes at puberty • monthly ovulation • menstruation • secondary sex characteristics

38
Primary site of estrogen and progesterone?
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Ovaries

39
Which of the following is the primary source of estrogen and progesterone during the reproductive period?
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Granulosa cells

40
During pregnancy, which hormones are produced by the placenta?
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Estrogen and estriol

41
In the after menopause stage, which cells produce estrone?
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Fat cells and adrenals

42
What hormone is responsible for the development of the follicle in the ovary?
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FSH and LH

43
Which cell within the follicle produces progesterone?
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Theca cell

44
What hormone is released by the hypothalamus to stimulate the pituitary gland?
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Gonadotropin-Releasing Hormone (GnRH)

45
Functions of the corpus luteum?
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• Synthesizes Progesterone • maintains the uterine lining

46
What is caused by high levels of estrogen?
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• endometrium thickens • endometrial gland growth • emergence of spiral arteries • pituitary becomes more sensitive to GnRH

47
two phases of ovulation?
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follicular and luteal phase

48
What effect does estrogen have systemically?
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protective effect • blood vessels’ walls flexible • helps sustain bone density • Protects against CV disease • lowering LDL

49
estrogen effect on bone density?
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increase OB, decrease OC

50
Progesterone systemic function
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plays a role in bone strength and keeping the skin elastic

51
What are synthetic estrogens primarily used for in therapeutic settings?
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• primary hypogonadism • primary amenorrhea • contraceptives • estrogen deficiency

52
What is the primary purpose of hormone replacement therapy for women with an intact uterus?
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Prevent endometrial hyperplasia

53
What hormone combination is recommended for all women with an intact uterus?
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Progesterone + Estrogen

54
What is the increased risk associated with the use of DES in utero?
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• vaginal bleeding • nausea • breast tenderness • risk of thromboembolic events • risk of endometrial cancer (when given without progesterone) • risk of breast cancer

55
What happens when females are exposed to DES in utero?
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• vaginal adenosis • clear cell adenocarcinoma

56
What are progestins?
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Synthetic progestogens with similar effects to natural progesterone.

57
What type of derivatives do progestins include?
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Progesterone and testosterone derivatives

58
Side effects noted at typical doses of progestins?
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• fluid retention • ↑ blood pressure • fatigue • mood changes & depression • breast discomfort • changes in libido • menstrual irregularities (breakthrough bleeding)

59
What is a potential long-term effect of high doses of progestins?
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• Delay in ovulation • decraese in bone density

60
How does the unbound sex hormone enter the cell?
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by diffusion and binding to receptors

61
What does the activated steroid-receptor complex interact with?
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nuclear chromatin to initiate hormone-specific RNA synthesis

62
What is the final result of hormone-specific RNA synthesis?
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synthesis of specific proteins that mediate physiologic functions

63
What are Selective Estrogen Receptor Modulators (SERMs)?
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Agonists in some tissues, antagonists in others

64
What are SERMS used to treat?
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• ER positive breast cancer • osteoporosis • infertility

65
What are full agonists used to treat?
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breast cancer resistant to tamoxifen

66
Examples of SERMS
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• tamoxifen • raloxifene • clomiphene

67
What is tamoxifen primarily used to treat?
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ER-Positive Breast Cancer

68
What effect can estrogen have on corticosteroids?
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Estrogen can increase the effects of corticosteroids.

69
Progestins drug-drug interactions?
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Some hepatic enzyme-inducing medications decrease progestins' effects

70
What is the potential impact of antibiotics on oral contraceptives?
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Antibiotics may reduce oral contraceptive efficacy.

71
androgens drug-drug interactions
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• anticoagulants, antidiabetics, insulin, and cyclosporine are ↑ w/ androgens • androgens + corticosteroids = ↑ edema and exacerbate cardiac or hepatic disease

72
What is the first step in assessing dental implications for a pregnant or menopausal patient?
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thorough history including asking key questions from physician and patient

73
Questions to ask pregnant patient?
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• What trimester? • Any sign or symptoms of a high-risk pregnancy (e.g. hypertension) • Any intraoral changes?

74
Questions to ask menopausal pateint?
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Any oral pain/dryness/burning?

75
Questions to ask patient physician?
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• Delivery date? • Is it a high-risk pregnancy? • Any special concerns? • What medications for pain control, antibiotic, anesthetic?

76
What is the recommended trimester for elective dental treatment during pregnancy?
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second trimester or early half of the third trimester

77
When is emergency dental treatment during pregnancy typically needed?
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As needed any time during pregnancy

78
What should be considered when dental radiographs are required during pregnancy?
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Untreated dental infections may pose a greater risk to fetus than potential radiation exposure

79
What is one of the key dental implications related to early oral hygiene education?
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Cleaning and improved OH care

80
What is a potential interaction to consider when prescribing antibiotics to a woman taking oral contraceptives?
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Decreased efficacy of oral contraceptives

81
Untitled question
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• Increased body’s inflammatory response to oral irritants • Increased risk of dry socket and post-op pain

82
Symptoms of menopausal oral mucosal symptoms?
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• Pain or burning sensation • altered taste • dryness: palliative treatments