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Hormonal control · Biochemistry · INBDE Patient Cases

Endocrine Regulation INBDE Patient Cases

By Dr. Isaac Sun, DDS

6 ADA INBDE-format patient cases on endocrine regulation. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

6 patient cases30 linked questionsADA INBDE formatFull distractor explanations

Six ADA INBDE-format patient cases connecting endocrine regulation to dentistry: a patient on long-term corticosteroids with hypothalamic-pituitary-adrenal suppression and adrenal-crisis risk under surgical stress, uncontrolled hyperthyroidism (Graves disease) with epinephrine caution and thyroid storm, hypothyroidism with heightened sedative sensitivity and myxedema coma risk, pheochromocytoma where epinephrine must be avoided to prevent a hypertensive crisis, acromegaly presenting as adult mandibular growth and tooth spacing, and pre-procedure management of a diabetic patient using HbA1c. Topics include the hypothalamic-pituitary axis, thyroid and parathyroid hormones, adrenal cortex and medulla, cortisol and catecholamines, and type 1 versus type 2 diabetes.

Case Coverage Map
What each case is testing
On long-term steroids and facing surgery:
HPA-axis suppression and adrenal crisis risk, cortisol's stress role, stress-dose decision-making with the physician, and not stopping steroids abruptly.
Racing heart, tremor, and bulging eyes:
Hyperthyroidism (Graves), epinephrine caution, thyroid storm precipitants, and deferring elective care until euthyroid.
Sluggish and cold, scheduled for sedation:
Hypothyroidism, heightened sensitivity to sedatives, myxedema coma risk, slow healing, and reduced-dose sedation.
Spells of pounding headache and high blood pressure:
Pheochromocytoma and catecholamine excess, avoiding epinephrine to prevent a hypertensive crisis, and deferring elective care.
An adult whose jaw and bite keep changing:
Acromegaly from growth hormone excess, mandibular prognathism and spacing, why it is not gigantism, and referral.
Planning a safe extraction for a diabetic:
Type 1 versus type 2, HbA1c as the control marker, morning-appointment planning, when to defer for poor control, and the periodontitis link.
Patient case: On long-term steroids and facing surgery
0 of 5 answered, 0 correct
Patient
Female, 55 years old
Chief Complaint
"I take prednisone every day for my rheumatoid arthritis and I need this tooth out."
Background and/or Patient History
  • Presented for a surgical extraction
  • On daily oral prednisone for several years
  • Anxious about the procedure
  • No recent illness
Allergies
NKDA
Medications
  • Prednisone (long-term, daily)
Current Findings
  • BP 124/78 at rest
  • Non-restorable tooth requiring surgical extraction
  • Otherwise stable
  1. Question 1
    Moderate
    Her long-term steroid use is a concern because it can:
  2. Question 2
    Moderate
    Cortisol's normal role during stress is to:
  3. Question 3
    Moderate
    Signs of an adrenal crisis would include:
  4. Question 4
    Hard
    The most appropriate way to handle her steroid status is to:
  5. Question 5
    Moderate
    Sensible additional precautions for her visit include:

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Patient case: Racing heart, tremor, and bulging eyes
0 of 5 answered, 0 correct
Patient
Female, 40 years old
Chief Complaint
"My heart races, I've lost weight, and I'm always hot."
Background and/or Patient History
  • Presented for an extraction
  • Reports weight loss, heat intolerance, tremor, and palpitations
  • Has not seen a physician about these symptoms
  • Visible eye prominence and a neck fullness
Allergies
NKDA
Medications
  • None
Current Findings
  • Resting tachycardia and fine tremor
  • Exophthalmos and a goiter
  • Appears anxious and warm
  1. Question 1
    Moderate
    Her weight loss, heat intolerance, tachycardia, tremor, exophthalmos, and goiter suggest:
  2. Question 2
    Hard
    Why is epinephrine in local anesthetic a concern in an uncontrolled hyperthyroid patient?
  3. Question 3
    Moderate
    A thyroid storm is:
  4. Question 4
    Moderate
    The most appropriate action for her elective extraction is to:
  5. Question 5
    Easy
    Her thyroid makes T3 and T4 under the control of which pituitary hormone?

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Patient case: Sluggish and cold, scheduled for sedation
0 of 5 answered, 0 correct
Patient
Female, 62 years old
Chief Complaint
"I'm always tired and cold, and I've gained weight."
Background and/or Patient History
  • Scheduled for an extraction with oral sedation
  • Reports fatigue, cold intolerance, weight gain, and constipation
  • Admits she sometimes forgets her thyroid medication
  • Dry skin and a hoarse voice
Allergies
NKDA
Medications
  • Levothyroxine (inconsistent use)
Current Findings
  • Bradycardia
  • Dry, coarse skin and slowed responses
  • Otherwise stable
  1. Question 1
    Moderate
    Her fatigue, cold intolerance, weight gain, bradycardia, and dry skin suggest:
  2. Question 2
    Hard
    The most important anesthetic concern in a hypothyroid patient is:
  3. Question 3
    Hard
    The rare but serious decompensation of severe untreated hypothyroidism, which sedatives can precipitate, is:
  4. Question 4
    Moderate
    Given her inconsistent medication use, the most appropriate plan is to:
  5. Question 5
    Moderate
    Hypothyroidism also tends to make wound healing:

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Patient case: Spells of pounding headache and high blood pressure
0 of 5 answered, 0 correct
Patient
Male, 45 years old
Chief Complaint
"I get sudden pounding headaches with sweating and a racing heart."
Background and/or Patient History
  • Presented for routine dental care
  • Episodes of severe headache, palpitations, and sweating with spikes of very high blood pressure
  • Recently diagnosed with an adrenal tumor
  • Awaiting specialist treatment
Allergies
NKDA
Medications
  • None yet
Current Findings
  • Intermittent severe hypertension
  • Episodes of pallor, sweating, and palpitations
  • Currently between episodes
  1. Question 1
    Moderate
    His episodic headache, palpitations, sweating, and severe hypertension from an adrenal tumor describe:
  2. Question 2
    Moderate
    The tumor arises from the part of the adrenal gland that normally makes:
  3. Question 3
    Hard
    Why must epinephrine in local anesthetic be avoided or strictly minimized in this patient?
  4. Question 4
    Moderate
    The most appropriate approach to his dental care right now is to:
  5. Question 5
    Moderate
    His episodes of headache, palpitations, and sweating are most directly caused by:

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Patient case: An adult whose jaw and bite keep changing
0 of 5 answered, 0 correct
Patient
Male, 48 years old
Chief Complaint
"My lower jaw seems to have grown and gaps are opening between my teeth."
Background and/or Patient History
  • Reports his jaw has enlarged and his bite has changed over a few years
  • His rings and shoes no longer fit
  • Coarsening facial features and enlarged hands
  • No childhood history of unusual growth
Allergies
NKDA
Medications
  • None
Current Findings
  • Mandibular prognathism with new interdental spacing
  • Macroglossia
  • Enlarged hands and coarse features
  1. Question 1
    Moderate
    Adult-onset jaw enlargement, new tooth spacing, macroglossia, and enlarged hands suggest:
  2. Question 2
    Moderate
    The excess hormone in acromegaly is:
  3. Question 3
    Moderate
    It is acromegaly rather than gigantism because:
  4. Question 4
    Moderate
    Which dental finding fits acromegaly?
  5. Question 5
    Moderate
    The appropriate dental response is to:

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Patient case: Planning a safe extraction for a diabetic
0 of 5 answered, 0 correct
Patient
Male, 58 years old
Chief Complaint
"I'm diabetic and need a tooth out; what do I need to do to prepare?"
Background and/or Patient History
  • Type 2 diabetes on metformin and a long-acting insulin
  • Most recent HbA1c was 7.2%
  • Eats regularly and checks his glucose
  • Needs a routine surgical extraction
Allergies
NKDA
Medications
  • Metformin
  • Long-acting insulin
Current Findings
  • BP 130/82
  • No acute infection
  • Reasonably controlled diabetes by report
  1. Question 1
    Moderate
    His type 2 diabetes is best understood as:
  2. Question 2
    Moderate
    His HbA1c of 7.2% tells you about his:
  3. Question 3
    Moderate
    The best way to schedule and prepare him is:
  4. Question 4
    Moderate
    If instead his HbA1c were very high and his glucose poorly controlled, the appropriate plan for this elective extraction would be to:
  5. Question 5
    Moderate
    Good glycemic control matters for his oral health because high glucose:

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Keep studying
Endocrine Regulation core recall

Refresh the anatomy facts these cases depend on: nerve numbers, foramina, functions, and lesion findings.

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