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GP2 CH5 Metabolic and endocrine diseases (Endocrine diseases (Diabetes…
GP2 CH5 Metabolic and endocrine diseases
Endocrine diseases
Hypothyroidism甲狀腺功能減退
Cretinism呆小症
Mental and physical retardation遲緩
Thick lips
large protruding tongue (macroglossia)大凸舌（巨舌症）
In areas with endemic goitre (lack of iodine)導致甲狀腺逐漸擴大，稱為甲狀腺腫
Malocclusion•咬合不正
delayed eruption of teeth: impaction of the mandibular second molars
symtoms
• Macroglossia巨舌症
• Dysgeusia味覺障礙
• delayed eruption
• poor periodontal health
• altered tooth morphology
• delayed wound healing
Addison’s disease原發性腎上腺皮質功能不全和皮質 增生症
Adrenal cortex insufficiency
ACTH elevation
Hypoaldosteronism低醛固酮減少症
Glucocorticoid insufficiency•糖皮質激素不足
Clinical feature
Fatigue, weakness,anorexia厭食, nausea and vomiting
Weight loss, abdominal pain
Cutaneous and mucosal pigmentation 皮膚和粘膜色素沉著
– Salt craving
postural hypotension體位性低血壓
Hypoglycemia低血糖
GI disturbance
Pigmentation
Oral pigmentation in early stages
Gastrointestinal symptoms and ionic disturbances紊亂
Diabetes mellitus
Types
1
caused by autoimmune destruction of insulin-producing cells (β cells) in the pancreas resulting in absolute insulin deficiency.
因β細胞缺失而無法產生足夠胰島素的結果
2
resistance to the action of insuling and an inability to produce sufficient insulin to overcome this “insulin resistance
characterised : increase in plasma blood gluclose.
Diagnosis
glucose 2 hours after an oral glucose challenge ≥11.1 mmol/L (200 mg/dL)
Fasting plasma glucose ≥7.0 mmol /L
(126 mg/dL)
A poor dental condition worsens the control of diabetes
Severity of complication depend on control of blood sugar levels
Complication
Microvascular /neuropathic
Retinopathy視網膜病變,cataract白內障 (impaired vision)
Nephropathy (renal failure):protein leaking into the urine
Peripheral neuropathy周圍神經病變 (sensory loss, pain)
Autonomic neuropathy自主神經病變 (gastrointestinal problems)
Foot disease (ulceration)
Macrovascular
Coronary circulation冠狀動脈循環 (myocardial ischaemia心肌缺血)
Cerebral circulation (stroke)
Peripheral circulation (ischemia, claudication跛行)
Endocrine disease
periodontal disease
periodontitis
gingivitis
Salivary and taste dysfunction
Oral infection
fungal
bacterial
Poor oral wound healing
Oral mucosal and golf tissue lesions
Stomatitis 口腔炎
geographic tongue
benign migratory glossitis良性遷移性舌炎
fissured tongue
traumatic ulcer
lichen planus
lichenoid reaction
angular chelitis
Neurosensory oral disorders
Dental caries and tooth loss
Parathyroid gland disorders 甲狀旁腺疾病
Hyperparathyroidism甲狀旁腺功能亢進症
brown tumor:在過度破骨細胞活動的情況下出現,不是腫瘤 ，而是簡單的腫塊。
vague jaw bone pain模糊的下巴骨痛
soft tissue calcifications軟組織鈣化
dental abnormalities
• development defects
• alterations in dental eruption
• loss of bone density
• mobile teeth
• drifting of teeth
• sensitive teeth
Hypoparathyroidism甲狀旁腺功能減退症
enamel hypoplasia發育不全
delayed eruption
• teeth appear dull white in color暗白色
• hypoplastic pitting發育不全的凹陷
• crowns are small (microdontia)
• roots short, with blunt ends末端鈍
• hypodontia牙齒發育不全 & severe caries
• chronic candidiasis慢性念珠菌病
• paresthesia感覺異常 of the tongue or lips
Nutritional deficiencies
Iron deficiencies
symtoms
sore tongue
atrophic glossitis 萎縮性舌炎
anemia
pallor
predisposition to candidiasis 易患念珠菌病
angular cheilitis 角膜炎
口腔的一個或兩個角的炎症 ,嘴角落通常是紅色的,皮膚破裂和結痂
denudation of filiform papillae絲狀剝脫
Diagnosis: A full blood picture with assays of iron
Management : Replacement therapy after underlying cause of deficiency
Vitamin deficiencies
Vitamin A
Night blindness
Asia is most notably affected
Irreveble blindness in young children
Keratinisation of cornea角膜角化 (xerophtalmia乾眼症)
Keratinization of mucosa and leukoplakia粘膜和白斑的角化
Cheilitis
Atrophy of mucosa 粘膜萎縮
Xerostomia口腔乾燥症
Vitamin B
B2
Deficiency is rare in developed countries
Apart from mouth, genitals生殖器 may be affected
Skin affection (sebaceous glands皮脂腺)
Cheilitis唇炎
glossitis舌炎
angular stomatitis
B3(pelagra糙皮病)
Formerly endemic among poor people who subsisted chiefly on maize玉米 (body can not use as vit B3)
Remain in Africa and alcoholism
3 Ds
Dermatitis皮炎
Diarrhea 腹瀉
Dementia 癡呆
Symtoms
Atrophy of mucosa 粘膜萎縮
Stomatitis口腔炎
Glossitis
Angular cheilitis
B6
Involved in the metabolism of amino acids參與氨基酸的代謝
Rare
Glossitis
Cheilitis
Burning mouth syndrome
Ulcers
Fissure in the lips
B12
Megaloblastic anemia巨幼紅細胞性貧血
Important in DNA synthesis in red blood cells
Older people, alcoholism
Glossitis
Taste impairment
Mucosa atrophy
Needed for integrity of myelin髓鞘的完整性
Vitamin c(scury血病)
Caused defective缺陷 formation of colagen
Impaired healing of wounds傷口癒合受損,
High-dose vitamin C improves inmune function
capillary haemorrage 毛細血管血栓形
reduced platelet adhesiveness血小板粘附性降低
Oral manifestation
Swollen and bleeding gums
Loosening of teeth
symptoms of scurvy
tiredness
nausea噁心
muscle and joint pain
easy bruising
swollen and bleeding gum
losing of teeth
young heeling slowing and poorly
dry skin and hair
bleeding into muscle and joint causing pain
folic acid deficiencies葉酸
Directly involved in DNA and RNA synthesis
cause 3 major birth defects
anencephaly無腦畸形:缺乏端腦
encephalocelec腦膨出
spina bifida脊柱裂
symtoms
Stomatitis口腔炎:影響口腔和嘴唇粘膜的任何炎症過程
Recurrnt sore ulcers 復發性潰瘍
Glossitis (depapilated glossy失去光澤 red tongue)
Cheilitis angular
Csndidiasis
zinc deficiencies
Tastes change
eczematoid dermatitis濕疹性皮炎(mouth)
Zinc-free parenteral nutrition
Dietary deficiency膳食缺乏:膳食缺乏症是由於飲食中缺乏必需營養素而導致的疾病，或者因為一旦食用它們就不能吸收和處理這些營養素。 大多數飲食缺乏症是由缺乏蛋白質，維生素或礦物質引起的。
malabsorption syndromes吸收不良綜合徵
alcoholism酒精中毒
Metabolic disturbance
Fabry’s disease
It is a lysosomal溶酶體 deposit disease caused by a deficit of
alpha-galactosidase A 半乳糖苷酶
Buildup of a particular type of fat in the body's cells
X-linked
Show angiokeratomas血管角化瘤 in mouth and lips mucosa(Small maculas due to deposit of glycolipid醣脂)
symtom
Eyes
changes the appearance of eyes
corneal opacities角膜混濁
Ear
hearing loss
tinnitus耳鳴
vertigo眩暈
Kidneys
problems including cysts progressive kidney failure囊腫進行性腎衰竭
Skin
small raised dark red spots
excessive sweating
temperature sensitivity
burning or tingling刺痛 sensation
Brian
Dizziness
severe cases
strokes
Heart
irregular or abnormal heart rhythm or beat
Gastriointestinal tract
vomiting
constipation 便秘
nausea
Abdominal pain
diarrhorea
Lipoid proteinosis脂質蛋白沉積症
It is a deposit disease caused by accumulation of
a hyaline substance透明物質 in skin, mucosa and viscera
The classic manifestation is onset in infancy with a hoarse cry 聲音嘶啞due to laryngeal infiltration
Autosomal recessive隱性
Mouth, lips and tongue mucosa become enlarged and nodular
CNS中樞 and respiratory tract might cause seizures癲癇 & airway obstruction
Amyloidosis澱粉樣變性病
local or generalized
It is a deposit disease caused by accumulation of
a substance called amyloid (insoluble proteins)
Causes macroglosia
Diagnosis is established by biopsy
腹瀉 ，體重減輕，感覺疲倦，舌頭腫大，出血，麻木， 站立時感覺暈眩，腿部腫脹或脾臟腫大
Management
Liver transplantation may provice deffinitive treatmet in patients with some types of amyloidosis.
aims of treatment are to support the function of affected organs