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ADRENAL INSUFFICIENCY. Adrenal Glands. They are located bilaterally at the superior pole of each kidney. They manufacture and secrete At least 3 hormones from the Adrenal cortex. The hormones of adrenal gland are:. - secreted by adrenal cortex : 1.Mineralocorticoides (aldosteron)
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Adrenal Glands They are located bilaterally at the superior pole of each kidney. They manufacture and secrete At least 3 hormones from the Adrenal cortex.
The hormones of adrenal gland are: -secreted by adrenal cortex: 1.Mineralocorticoides (aldosteron) 2.Glucocorticoids (cortisone&hydrocortisone) 3.Androgens(androgen in male & estrogen in female)
Adrenal Insufficiency may be either: 1.Primary:is caused by disorders of either the pituitary gland or adrenal glandt hemselves.It’s calledAddison’s diseaseAddison's disease is most commonly an autoimmune condition,, the disease is more frequently caused by infection, especially from tuberculosis. .2.Secondary: is caused by hypothalamic or pituitary diseases or the chronic administration of steroids resulting in the suppression of endogenous steroid production,it’s far more common.
Cortisol (hydrocortisone) is a steroid hormone, or glucocorticoid, produced by the adrenal gland. It is released in response to stress and a low level of blood glucocorticoids The adrenal glands secret about(15-20mg) cortisol a day under normal circumstances. the maximum potential output is around 300mg a day and there’s diurnal variation.
Cortisol Action • Anti-inflammatory effect. • Maintenance of vascular tone & endothelial integrity. • Antiallergic. • Immunesuppressant. • Gluconeogenesis.
Signs and symptoms • in primary type weakness, fatigue, abnormal pigmentation of the skin and mucous membrane, hypotention, anorexia and weight loss. Patients who are subjected to stress (illness, infection or surgery) may develop adrenal crisis (Addison crisis) manifested by; hypotension, weak pulse, sweating, cyanosis, nausea, vomiting, headache, dehydration, fever, dyspnea, myalgia, arthralgia, hypoglycemia, circulatory collapse and death.
In secondary type: It doesn’t usually present any symptoms in either stage unless the patient is stressed and does not have adequate circulating cortisol to stand the stress which lead to adrenal crisis.This can be prevented by increasing the amount of steroids received to cover the period of stress.
Cushing’s syndrome: It occurs to those patients who have been receiving long term ,high doses steroid therapy .which is characterized by: -weight gain -moon shaped face -acne -hypertension -heart failure Diabetes Mellitus -Impaired healing - Mental depression
Oral manifestation of adrenal insufficiency • In the oral mucosa, hyperpigmentation may been seen on the tongue and on the periodontal and buccal mucosa. There may also be hyperpigmentation of the vermillion border, in additional to common cutaneous sites of hyperpigmentation, such as the flexural creases and recent scars
Dental Management -Consultation and close relation with the patient physicians are essential before any dental treatment The patients can be divided into 2 categories: 1.Patient currently taking steroids: A-patient taking equivalent of (20mg hydrocortisone) or less daily>>safe to be treated without precautions.
B-Patient taking equivalent of up to 2 times normal daily output (20-40mg hydrocortisone) for at least a month: 1) The patient should double the normal dose on the day of appointment or give 100mg of hydrocortisone hemisuccinate I.M or I.V. and the B.P must be monitored every 10 minutes. 2) Major dental procedures may require hospitalization with parenteral steroids I.M or I.V injection of 100-200mg hydrocortisone hemisuccinate,if there’s any drop in B.P another 100mg should be given.
C- Patient taking greater than equivalent of twice normal daily output ( 40mg hydrocortisone)>>No additional supplementation is required,because these patients have already adequate coverage with the normal dose of medication. D- Patient taking topical steroids>>supplementation may be needed IF steroids have been applied to large inflamed area and occlusive dressing was used. 2. Patient with past history of steroids usage: if the patient has not taken steroid within the past 12 months>>no steroids required
If steroids have been taken during the past 12 months>>the physician should be consulted for treatment under category (1). *Antibiotics should be given postoperatively to prevent infection as steroids are anti-inflammatory drug and the patient should be kept under observation for at least an hour after operation.
