原文題目

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口腔病理科 On-Line KMU Student Bulletin

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原文題目(出處)： Dental abnormalities in pituitary dwarfism: A Case report and review of the literature. Case Rep Dent Volume 2017, Article ID 5849173

原文作者姓名： Franco Ferrante, Sergio Blasi, Rolando Crippa, and Francesca Angiero

通訊作者學校： Department of Surgical Medical Sciences and Integrated Diagnostic, University of Genoa, Genoa, Italy

報告者姓名(組別)：邱艾欣 (Intern K 組)

報告日期： 106.06.06

I. Introduction

Pituitary dwarfism 垂體性侏儒症

- the body fails to use the pituitary growth hormone (GH) - congenital(rare) or acquired 先天(罕見)或後天

- nonsecreting adenomas 腺瘤

- ischemic necrosis of the pituitary gland 缺血性壞死

- surgical removal or irradiation of the pituitary adenohypophysis 手術切除或放療

Hormone deficiency

- no or decreased production

- inadequate absorption by the tissues responsible

- period of onset : expressed either in childhood or in adulthood

If expressed in childhood:

- Characteristic : underdeveloped forehead or retrognathism, small nose, childish face, and thin skin

- the maxilla and mandible being abnormally small - lead to tooth malformation

- hypodontia, delayed tooth eruption, abnormalities of tooth shape and size, and double or impacted teeth.

- The skeletal age is below the stature age - height below120cm

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II. Case Presentation

- A woman of 50 with very short stature (affected by pituitary dwarfism)

- Hypodontia together with multiple abnormalities, including tooth shape, small size, and double teeth (圖 1, 2)

- Panorex : five impacted teeth; fused roots of tooth 32-33 (圖 3) - rejected any form of removable partial denture.

- Fixed ceramic prosthesis : 43-42-41-x-32-33 (with zirconium substructure) - tooth prepare→ impression→ temporary prosthesis→ delivery(圖 4)

圖 1: Initial clinical situation 圖 3: multiple dental anomalies: hypodontia, radicular fusion of tooth 32–33, and impacted permanent teeth.

圖 2: The initial situation 圖 4: The final phase of prosthetic rehabilitation.

III. Discussion

The anterior lobe of the pituitary gland : - secretes :

i. Growth hormones 生長激素(GH) ii. Prolactin 泌乳激素(PRL)

iii. Thyroid stimulating hormone 促甲狀腺素(TSH) iv. Follicle stimulating hormone 促濾泡生成素(FSH)

v. Luteinizing hormone 黃體生成素(LH)

vi. Adrenocorticotropic hormone 腎上腺皮質素(ACTH)

- Metabolic control, puberty and reproduction, stress response, and lactation

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Etiology of pituitary hormone deficiency : - genetic background

- environmental factors

Literature search :

 57 cases with the presence of numerous anomalies (in particular 13 abnormalities in pituitary dwarfism)-- searching in PubMed for“oral cavity

hypopituitarism”)

- Solitary median maxillary central incisor : occurred in almost 60% of cases of dwarfism

- deficient number of teeth, including diffused or generalized hypodontia : hypothesized the most frequent anomaly.

The case reported here:

- She had not received GH replacement therapy nor thyroid, gonadal, or corticoid replacements.

- very short stature (about 120 cm).

- had 69.2% of all reported anomalies of dwarfism.(表格列出 13 種只有 2 種沒有) - not associated with any other particular disorder

Challenging:

- Prosthetic rehabilitation in the aesthetic zone 美觀區 - Patients with serious syndromes or hormonal dysfunction

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Solution:

- a conservative therapeutic 保守治療

- Fixed prosthesis— the metal most used :zirconium 鋯 - frequent followups are essential

IV. Conclusion

A good prosthetic rehabilitation can be achieved without resorting to surgery

V. Question

題號題目

1 下列哪項不是垂體性侏儒症常見的異常?

(A) Hypodontia (B) Short stature (C) Macrodontia

(D) Delayed shedding of deciduous teeth 答案

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出處：Oral and Maxillofacial PATHOLOGY, Chapter17,Pituitary Dwarfism, p.831

題號題目

2 下列何者關於 Hypodontia 的敘述不正確 ?

(A) Genetic control appears to exert a strong influence on the development of teeth. Thus disordered expression of some genes might be

implicated in the etiology of hypodontia.

(B) The number of missing teeth in a patient with anodontia is less than the number of missing teeth in a patient with oligodontia.

(C) Most commonly involves the third molars, second premolars, and maxillary lateral incisors.

(D) Hypodontia is uncommon in the deciduous dentition.

答案 ( B)

出處：Oral and Maxillofacial PATHOLOGY, Chapter 2, p.77-82, [Developmental alterations in the number of teeth]