Hormones lect/certified fixed orthodontic courses by Indian dental academy

HORMONES
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

LEARNING OBJECTIVES
 At the end of the lecture, the learner should be able to
understand the role of various hormones –
 Pituitary group of hormones.
 Thyroid hormones.
 Parathyroid hormone.
 Adrenal hormones.
 Pancreatic hormones: insulin.

CONTENTS
 Pituitary group of hormones.
 Thyroid hormones.
 Parathyroid hormone.
 Adrenal hormones.
 Pancreatic hormones: insulin.

INTRODUCTION
 What are hormones-
“Hormone” comes from the Greek word hormao,
a substance that starts, urges on, initiates, irritates,
stimulates and excites.
 The chemical substance or messenger is produced from
one part of body by endocrine gland, enters into
circulation, carried to distal target organ or cell to modify
their structure and function is called hormone.

PITUITARY GROUP OF HORMONES
 The pituitary is considered as the master gland of the
body.
 Secretes 9 hormones that control other glands.
• 2 distinct parts
 – Anterior pituitary (adenohypophysis)
 – Posterior pituitary (neurohypophysis)

PITUTARY HORMONES
 ANTERIOR LOBE :
- Thyroid stimulating hormone
- Adrenocorticotrophic hormone
- Growth hormone
- Follicle stimulating hormone
- Lutenizing hormone
- Prolactin
 INTERMEDIATE LOBE :
- α and β melanocyte stimulating hormone
 POSTERIOR LOBE :
- Vasopressin
- Oxytocin www.indiandentalacademy.com

HYPOPITUITARISM-
Its caused by compression or atrophy of anterior
pituitary cells or defects in the hypothalamic control of hormonal
secretion. Before puberty, the hypo functioning leads to
dwarfism, which mainly manifests with features of growth
hormone deficiency.

 After puberty it affects other endocrine glands also.
Hypofunction of posterior lobe leads to deficiency of
vasopressin, resulting in diabetes insipidus, this results in
an inability to concentrate urine and so the patient passes
8–10 L of dilute urine per day.

Clinical features-
The typical evidences of hypopituitarism resulting in pituitary
dwarfism are –
- diminutive but well-proportioned body
- fine, silky, sparse hair on the head and other hairy regions
- wrinkled atrophic skin
- hypogonadism.

In pituitary dwarfs –
• the eruption rate and the shedding time of the teeth
are delayed.
• The clinical crowns appear smaller than normal
because, even though eruption occurs but its not
complete.
• Malocclusion is present.

Simmond’s diseases- hypopituitarism in the adult is usually
due to an infarction of the pituitary.
The skin shows atrophic alterations, changes in the head
include thin eyebrows, loss of eyelashes, sharp features, thin
lips, and immobile expression.
There will be a decreased salivary flow due to hypofunctioning
of salivary glands which leads to increased caries activity and
periodontal disease.

HYPERPITUITARISM-
abnormal growth caused by elevated hGH. This
stimulates long bone growth in children, causing gigantism.
• If hGH levels become raised in adult life after epiphyseal
fusion, there is no increase in height, but soft tissue and body
organ growth are stimulated. This is known as acromegaly.
• A persistent excess of hGH may eventually lead to elevated
blood glucose levels, i.e. diabetes mellitus results.

Clinical features -
Gigantism is characterized by a general symmetric
overgrowth of the body, some persons with this disturbance
attains a height of over 8 feet.
• It is also characterized by the presence of broad, enlarged
nose, thick and oily skin.
• Organomegaly
• hypertension is a common finding.

• Skeletal changes include frontal bossing and
prognathic mandible.
• Patient may develop class III malocclusion with
interdental spacing.
• Hypercementosis a common finding in the intraoral
radiograph.

ACROMEGALY-
There is hypersecretion by the anterior lobe, the
influence being effected after ossification is complete.
• The terminal phalanges of the hands and feet become
large.
• The ribs also increase in size.

• The tongue becomes enlarged and shows
indentation on the sides from pressure against the
teeth.
• The mandible, because of accelerated condylar
growth, becomes large. The resulting prognathism
may be extreme.

 The thyroid hormones are key metabolic regulators and are
particularly important in determining metabolic rate and
heat production.
 The thyroid gland is located in the neck, in front of and just
below the level of the larynx, and consists of two lobes
joined by a central isthmus
THYROID HORMONES

Deficient secretion
• Inadequate thyroid secretion is known as hypothyroidism.
• This may be subdivided into primary hypothyroidism and
hypothyroidism secondary to deficient TSH secretion.

• In primary hypothyroidism the fault lies within the
thyroid gland itself.
• Causes include -
- iodide deficiency.
- congenital thyroid enzyme deficiencies and
- inflammation of the gland (thyroiditis).
• In secondary hypothyroidism there is deficient TSH
secretion from the anterior pituitary.
• This leads to thyroid atrophy rather than goitre.

Clinical features
The hyposecretion of thyroxine in a child
during fetal life, infancy or childhood results in cretinism.
• In this, retarded growth and development (dwarfism), a
protruding abdomen, mental retardation, puffy skin and low
metabolic rate occurs.

Myxedema
• The disease produced by thyroid deficiency in adults.
• The metabolic rate is lowered .
• Amenorrhoea, Bradycardia, Constipation, Reduced
appetite, Sensitive to cold weather, Lethargic , Dry skin,
loss of hair and the myxedematous swelling.
• The lips, nose, eyelids and suborbitals tissues are edematous
and swollen . The tongue is enlarged and edematous
frequently interfering with speech.

Pre tibial myxoedema

HYPERTHYROIDISM-
It’s a condition caused by excess production of thyroid
hormone.
Clinical features-
• Patient may exhibit tremor, tachycardia, sweating, weight
loss, nervousness, muscle weakness, heat intolerance, and
exopthalmic goitre.
• In children, shedding of the deciduous teeth occurs earlier
than normal, and eruption of the permanent teeth is greatly
accelerated. www.indiandentalacademy.com

Exophthalmos
(Eye Protrusion)
• Patients usually present a facial expression of surprise
or excitement, with wide eyed staring. Such patients are
nervous and highly emotional.

PARATHORMONE (PTH)
This is a protein hormone secreted from four
parathyroid glands located posterior to the lobes of the
thyroid gland in the neck, that maintains plasma ionized
calcium level.

Primary hyperparathyroidism-
• It’s a disease in which the parathyroid glands elaborate an
excessive quantity of parathyroid hormones.
Secondary hyperparathyroidism
it occur secondary to other disorders, the most common being
end stage renal disease.
HYPERPARATHYROIDISM –

Clinical features-
• It’s a relatively rare disease, which is said to be three
times as common in women as in men.
• Subperiosteal resorption is virtually pathognomonic for
hyperparathyroidism and is typically seen at the radial
aspect of the middle phalanx of the index and middle
fingers.

 Development of gastric ulcers and pancreatitis.
 Another common presentation for persistently
elevated calcium levels is the development of kidney
stones.

ORAL MANIFESTATIONS -
• Gradual loosening, drifting & loss of teeth is seen.
• Acc to Schour & Massler, malocclusion caused by a
sudden drifting with definite spacing of the teeth may be
one of the first sign of the disease.
• Ocassionally the first sign of the disease may be a giant cell
tumour or a cyst of the jaw.
• The loss of phosphorus and calcium in this disturbance
results in generalized osteoporosis.

Radiographic features of jaws -
• Demineralisation & thinning of cortical boundaries of
inferior border, mandibular canal & cortical outlines of the
maxillary sinus.
• density of jaw is decreased, resulting in radiolucent
appearance that contrasts with the density of the teeth.
• changes in normal trabecular pattern is seen; ground glass
appearance.

HYPOPARATHYROIDISM-
• Elimination of the parathyroid gland- by surgical
removal, by destruction due to thrombosis of the blood vessels
or disease of the glands - leads to deficiency of parathormone.
• The disease is characterized metabolically by a decreased
excretion of calcium whereas the blood chemistry shows a low
concentration of serum calcium and a high concentration of
serum phosphorus.

 If the calcium level of the serum falls to 7-8 mg/dl,
there is increased excitability.
 When the serum level falls to 5-6mg/dl, tetany &
carpopedal spasms are apparent.
 Patients will have increased neuromuscular
excitability, resulting in muscle spasms, stiffness,
cramping and tetany.

Oral manifestation includes –
altered tooth eruption pattern
short blunted roots
enamel hypoplasia
dentin dysplasia
impacted teeth
partial anodontia
Enamel hypoplasia
Partial anodontiawww.indiandentalacademy.com

ADRENOCORTICAL HORMONES
These hormones are secreted by adrenal glands.
• There are two adrenal glands , lie at the superior poles of the
two kidneys.
• Each gland is composed of two distinct parts, the adrenal
medulla and the adrenal cortex.

 The adrenal medulla is functionally related to the
sympathetic nervous system; it secretes the hormones
epinephrine and nor epinephrine .
 The adrenal cortex secretes hormones called
corticosteroids which includes mineralocortecoids,
glucocortecoids and androgens.

 The adrenal cortex secretes a variety of steroid hormones
and can be subdivided into three histological zones -
 The outermost zona glomerulosa is responsible for
aldosterone secretion.
 Beneath it lies the zona fasciculata, while the
zona reticularis is immediately adjacent to the medulla.
 These last two regions are capable of secreting both
glucocorticoids (mainly from the zona fasciculata) and
adrenal androgens (mainly from the zona reticularis).

Insufficeny of the adrenal cortex -
• This is referred to as hypoadrenalism or Addison’s disease.
• It may be caused by a primary reduction in adrenal gland
function or arise secondary to an anterior pituitary defect.

Clinical features-
 Early manifestation includes lethargy, fatigue, and
muscular weakness that may persist for months.
 Feeble heart action, general debility, vomiting, diarrhoea
and severe anemia are also seen.
 Hypoglycemia, dehydration, hypertension, elevated
serum potassium , and postural dizziness develop.

ORAL MANIFESTATIONS -
 Due to an increased level of ACTH in the blood, the
secretion of melanocyte stimulating hormone increases,
which induces the deposition of melanin in the skin &
mucous membrane.

Cushing's syndrome is a hormonal disorder caused by
prolonged exposure of the body's tissues to high levels
of the hormone cortisol. Sometimes called
"hypercortisolism,"

Clinical features-
• characterised by a rapidly acquired adiposity about the upper
portion of the body,.
moon shaped face
buffalo hump
purple striae
muscular weakness
vascular hypertension
glycosuria not controlled by insulin
albuminuria. www.indiandentalacademy.com

Cushing syndrome

• The pancreas is a broad leaf-shaped organ that is located
at the back wall of the upper part of the abdomen. The
Greeks called it pancreas ( pan :all and kreas :flesh or meat)
because it contains no bone or cartilage.
PANCREATIC HORMONE- INSULIN

The human pancreas has 1-2 million islets of langerhans ,
contain three major type of cells : -
"alpha cells" that produce the hormone, glucagon.
“ beta cells” secretes insulin.
“delta cells” which secretes stomatostatin.

What is diabetes mellitus?
Diabetes mellitus –it is a disorder of carbohydrate
metabolism characterised by hyperglycemia and glycosuria,
reflecting a distortion in the equilibrium between utilisation of
glucose by tissues.
it’s a disorder caused by relative or absolute lack of
insulin.

The two major forms are;-
Type 1/ juvenile type/ insulin dependent diabetes
mellitus (IDDM)
Type 2 diabetes;- non insulin dependent diabetes
mellitus (NIDDM)/ adult onset/ maturity onset diabetes.

Clinical features-
glycosuria
polyuria
polydipsia
weakness and weight loss
ketoacidosis

Oral manifestations-
 Burning mouth syndrome
 Candidiasis
 Dental caries
 Gingivitis
 Glossodynia
 Lichen planus
 Neurosensory dysesthesias
 Periodontitis
 Salivary dysfunction
 Taste dysfunction
 Xerostomia

Periodontal abscess in a
mandibular right first Molar.
Salivary hypofunction, xerostomia and
dental caries in a patient

CONCLUSION
HORMONE DEFICIENCY INCREASE
PITUTARY
Dwarfism
Diabeties Insipidus
Simmond’s disease
Gigantism
Acromegaly
THYROID
Cretinism
Myxedema
Exopthalmus
PARATHORMONE
Tetany
Enamel Hypoplasia
Subperiosteal Resorption
Osteoporosis
ADRENOCORTICAL Addison’s disease
Melanosis
Cushing Syndrome
PANCREATIC Diabeties Mellitus

REFERENCES -
• Textbook of medical physiology, Guyton & Hall- 10th
edition,
page no 836.
• Shafer’s textbook of oral pathology, R Rajendran & B
Sivapathasundharam, 5th
edition, page no-892.
• Oral & maxillofacial pathology, Neville, Damn, Allen,
Bouquot, 2nd
edition, page no- 716
• Oral cells and Tissues, P. R Garant, page no 212.
• Diabetes and oral health, JADA, Vol. 134, October 2003.
• The Journal of Clinical Endocrinology & Metabolism Vol. 91,
No. 9 3439-3445 .

Hormones lect/certified fixed orthodontic courses by Indian dental academy

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