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Hormonal control · Endocrine & Neuromuscular Physiology · INBDE Patient Cases

Endocrine Physiology INBDE Patient Cases

By Dr. Isaac Sun, DDS

7 ADA INBDE-format patient cases on endocrine physiology. 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.

7 patient cases35 linked questionsADA INBDE formatFull distractor explanations

Seven ADA INBDE-format patient cases on endocrine physiology: chair-side hypoglycemia from insulin and sulfonylureas (with oral glucose and IM glucagon and SGLT2 euglycemic DKA caution), chronic corticosteroid HPA suppression and the routine-dentistry-does-NOT-need-stress-dosing rule with adrenal crisis recognition, hyperparathyroidism producing brown tumors and loss of lamina dura with parathyroidectomy as definitive treatment, uncontrolled hyperthyroidism with the epinephrine caution and thyroid storm picture, severe hypothyroidism with the sedative caution and myxedema coma picture, pheochromocytoma with epinephrine contraindication and vasoconstrictor-free local anesthetic plus preoperative alpha blockade with phenoxybenzamine, and poorly controlled diabetes oral manifestations (bidirectional periodontitis link, xerostomia, candidiasis, impaired wound healing). Topics include the hypothalamic-pituitary axis, thyroid and parathyroid, adrenal cortex and medulla, pancreas, growth hormone, ADH, and the dental safety implications of each.

Case Coverage Map
What each case is testing
Chair-side hypoglycemia in a diabetic patient:
Sulfonylurea + insulin mechanism, oral glucose vs IM glucagon, SGLT2 euglycemic DKA peri-procedural caution, and confirming the patient has eaten.
Chronic corticosteroids and the stress-dose question:
HPA axis suppression, routine outpatient dentistry usually does NOT need stress dosing, severe stress only, and adrenal crisis recognition.
Hyperparathyroidism and jaw lesions:
PTH raises Ca2+ via bone/kidney/gut; brown tumors, loss of lamina dura, ground-glass bone; parathyroidectomy is definitive treatment.
Uncontrolled hyperthyroidism and the epinephrine caution:
Arrhythmia risk + thyroid storm picture; defer elective work until medical control; capped epi when resumed.
Severe hypothyroidism and sedative caution:
Myxedema coma triggered by sedatives in severely hypothyroid patients; defer elective sedation until controlled.
Pheochromocytoma and the epinephrine contraindication:
Catecholamine-secreting adrenal medulla tumor; vasoconstrictor-free LA; preoperative alpha blockade with phenoxybenzamine before surgery.
Diabetes oral manifestations:
Bidirectional periodontitis link, xerostomia, candidiasis, impaired wound healing; coordinated medical and dental care.
Patient case: Chair-side hypoglycemia in a diabetic patient
0 of 5 answered, 0 correct
Patient
Male, 58 years old
Chief Complaint
Diaphoresis, tremor, and confusion midway through a long restorative appointment.
Background and/or Patient History
  • Type 2 diabetes on glipizide (sulfonylurea) and basal insulin
  • Skipped breakfast on the way to a long restorative appointment
  • Symptoms developed midway through the procedure
Allergies
NKDA
Medications
  • Glipizide
  • Insulin glargine
  • Empagliflozin
Current Findings
  • Diaphoresis, tremor, confusion in a fasted diabetic on insulin and a sulfonylurea
  • Likely chair-side hypoglycemia
  1. Question 1
    Easy
    The most likely cause of the symptoms is:
  2. Question 2
    Easy
    Immediate management for the conscious, swallowing patient is:
  3. Question 3
    Hard
    Sulfonylureas cause hypoglycemia by:
  4. Question 4
    Hard
    Empagliflozin (SGLT2 inhibitor) carries a peri-procedural caution for:
  5. Question 5
    Easy
    The teaching point is that diabetes patients:

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Patient case: Chronic corticosteroids and the stress-dose question
0 of 5 answered, 0 correct
Patient
Female, 64 years old
Chief Complaint
Routine restorative work; chronic prednisone for rheumatoid arthritis.
Background and/or Patient History
  • Rheumatoid arthritis on long-term prednisone 7.5 mg daily
  • Routine restorative work scheduled
  • Family asks if a 'stress dose' is needed
Allergies
NKDA
Medications
  • Prednisone 7.5 mg daily
  • Methotrexate weekly
Current Findings
  • Long-term prednisone with likely HPA suppression
  • Routine outpatient dentistry
  1. Question 1
    Moderate
    Long-term oral corticosteroids (e.g., >5 mg prednisone/day for >3 weeks) can suppress:
  2. Question 2
    Hard
    For routine outpatient dentistry, the recommendation is to:
  3. Question 3
    Moderate
    Stress-dose steroids may be warranted in:
  4. Question 4
    Hard
    Adrenal crisis presents with:
  5. Question 5
    Easy
    The teaching point is that long-term steroid use requires:

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Patient case: Hyperparathyroidism and jaw lesions
0 of 5 answered, 0 correct
Patient
Female, 55 years old
Chief Complaint
Multiple radiolucent lesions in the mandible noted on a panoramic radiograph; recent diagnosis of primary hyperparathyroidism.
Background and/or Patient History
  • Primary hyperparathyroidism with elevated PTH and calcium
  • Panoramic radiograph shows multiple well-defined radiolucent lesions and loss of lamina dura
  • Workup includes parathyroid scan
Allergies
NKDA
Medications
  • None notable
Current Findings
  • Brown tumors (giant-cell lesions) of jaw bones
  • Loss of lamina dura, ground-glass appearance
  1. Question 1
    Hard
    PTH raises serum calcium by:
  2. Question 2
    Moderate
    Brown tumors are:
  3. Question 3
    Moderate
    Loss of LAMINA DURA on a panoramic radiograph in this patient reflects:
  4. Question 4
    Moderate
    Treatment of primary hyperparathyroidism is usually:
  5. Question 5
    Easy
    The teaching point is that endocrine disease can:

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Patient case: Uncontrolled hyperthyroidism and the epinephrine caution
0 of 5 answered, 0 correct
Patient
Female, 40 years old
Chief Complaint
Recently diagnosed Graves disease, not yet controlled; needs dental work.
Background and/or Patient History
  • Newly diagnosed Graves disease
  • Tachycardia, heat intolerance, weight loss
  • Awaiting endocrinology workup and treatment
Allergies
NKDA
Medications
  • Pending
Current Findings
  • Uncontrolled hyperthyroidism
  • Caution with epinephrine
  1. Question 1
    Moderate
    In UNCONTROLLED hyperthyroidism, epinephrine in local anesthetic should:
  2. Question 2
    Moderate
    Thyroid storm presents with:
  3. Question 3
    Moderate
    Elective dental care in this patient should:
  4. Question 4
    Easy
    Once medically controlled, dental care can:
  5. Question 5
    Easy
    The teaching point is that uncontrolled endocrine disease:

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Patient case: Severe hypothyroidism and sedative caution
0 of 5 answered, 0 correct
Patient
Male, 70 years old
Chief Complaint
Severe untreated hypothyroidism; sedation considered for a long procedure.
Background and/or Patient History
  • Long history of poorly controlled hypothyroidism
  • Cold intolerance, bradycardia, dry skin, fatigue
  • Long procedure planned with discussion of sedation
Allergies
NKDA
Medications
  • Levothyroxine (poorly adherent)
Current Findings
  • Severe hypothyroidism
  • Sedative caution
  1. Question 1
    Hard
    Sedatives in a severely hypothyroid patient can precipitate:
  2. Question 2
    Moderate
    Elective sedation in this patient should:
  3. Question 3
    Easy
    Once medically controlled, dental care:
  4. Question 4
    Moderate
    The pituitary-thyroid loop uses:
  5. Question 5
    Easy
    The teaching point is that thyroid status:

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Patient case: Pheochromocytoma and the epinephrine contraindication
0 of 5 answered, 0 correct
Patient
Male, 35 years old
Chief Complaint
Known pheochromocytoma awaiting surgical resection; needs urgent dental care.
Background and/or Patient History
  • Known catecholamine-secreting adrenal medulla tumor
  • Episodic severe hypertension, headache, sweating
  • Surgical resection planned
Allergies
NKDA
Medications
  • Phenoxybenzamine (preoperative alpha blockade)
Current Findings
  • Pheochromocytoma awaiting surgery
  • Epinephrine contraindicated
  1. Question 1
    Easy
    Pheochromocytoma secretes:
  2. Question 2
    Moderate
    In a pheochromocytoma patient, exogenous epinephrine in local anesthetic should:
  3. Question 3
    Moderate
    Urgent dental care in this patient should use:
  4. Question 4
    Hard
    Preoperative ALPHA blockade with phenoxybenzamine is used before pheochromocytoma surgery to:
  5. Question 5
    Easy
    The teaching point is that pheochromocytoma:

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Patient case: Diabetes oral manifestations
0 of 5 answered, 0 correct
Patient
Female, 55 years old
Chief Complaint
Worsening periodontitis, xerostomia, and oral candidiasis in a poorly controlled diabetic.
Background and/or Patient History
  • Type 2 diabetes with HbA1c 9.5%
  • Periodontitis, xerostomia
  • Recent oral candidiasis
Allergies
NKDA
Medications
  • Metformin
  • Insulin
Current Findings
  • Poorly controlled diabetes with multiple oral manifestations
  1. Question 1
    Moderate
    Poorly controlled diabetes affects the oral cavity through:
  2. Question 2
    Moderate
    The link between diabetes and PERIODONTITIS is bidirectional:
  3. Question 3
    Moderate
    Oral candidiasis in this patient is favored by:
  4. Question 4
    Moderate
    Long-term dental management includes:
  5. Question 5
    Easy
    The teaching point is that diabetes is:

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Endocrine Physiology core recall

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

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