Endocrine and Metabolic Systems Flashcards
1
Q
Pituitary gland
A
pea sized organ that sits on the base of the brain and behind the bridge of the nose
2
Q
What is another name for the pituitary gland?
A
the master gland
3
Q
What hormones are released by the pituitary gland? (FLAT PEGM)
A
F - follicle stimulating hormone (FSH)
L - luteinizing hormone (LH)
A - adrenocorticotropin (ACTH)
T - thyroid stimulating hormone (TSH)
P - prolactin
E - endorphins
G - growth hormone (GH)
M - melanocyte stimulating hormone (MSH)
4
Q
Pituitary gland hormones: LH
A
luteinizing hormone
–> stimulates spermatogenesis and androgen production in the testes
5
Q
Pituitary gland hormones: FSH
A
follicle stimulating hormone
–> stimulates spermatogenesis in the testes
6
Q
Pituitary gland hormones: ACTH
A
adrenocorticotropin
–> regulates secretion and growth of the adrenal glands
7
Q
Pituitary gland hormones: GH
A
growth hormone
–> regulates body growth, fat mobilization and stimulates glycogenolysis by the liver
8
Q
Pituitary gland hormones: MSH
A
melanocyte stimulating hormone
–> regulates secretion of lipotropin and melanin by the anterior pituitary gland, increases the darkness of the skin
9
Q
Pituitary gland hormones: TSH
A
thyroid stimulating hormone
–> regulates secretion and production of hormones by the thyroid gland
10
Q
Posterior pituitary hormones
A
- oxytocin affects breast and uterus
- anti-diuretic hormone affects kidneys
11
Q
Anterior pituitary hormones
A
- TSH
- ACTH
- LH
- FSH
- GH
- Prolactin
- MSH
12
Q
GH disorders: gigantism
A
excess GH production in childhood, before the growth plate closes
13
Q
GH disorders: acromegaly
A
excess GH production in adulthood, after the growth plate closes
- seen in extremities (hands, feet, face, jaw)
14
Q
Signs and symptoms of gigantism/acromegaly
A
- joint pain
- stiffness
- OA
- CTS
- proximal myopathy
- fibromyalgia
- back pain
- increased osteophyte formation
- profuse sweating
- HTN
- diabetes
- poor exercise tolerance
15
Q
ACTH disorders: cushing’s disease
A
caused by a primary tumor on the pituitary gland which causes and excess of ACTH
16
Q
Why does cushing’s disease cause headaches and visual changes?
A
there is an increase of pressure on the optic chiasm
17
Q
Adrenal gland
A
releases cortisol and has 2 distinct areas which differ in function
1. inner medulla
2. outer cortex
18
Q
What is the primary method of evaluating the adrenal gland?
A
measuring the cortisol levels
* cortisol is the stress hormone
19
Q
What does excess cortisol cause?
A
increases HR, BP, RR, glucose production, decreases unnecessary processes like digestion and reproduction, creates inflammation
20
Q
When do cortisol levels peak?
A
they peak in the morning and then taper during the day
–> increase = cushing’s
–> decrease = addison’s
21
Q
Cushing’s syndrome: external factor
A
exogenous
- from overuse of corticosteroids
22
Q
Cushing’s syndrome: internal factor
A
endogenous
- benign or malignant adenoma
23
Q
What are some abnormalities seen in radiographs?
A
- osteoporosis in spine
- biconcave deformities at vertebral body endplates
- compression FX
- kyphosis
- avascular necrosis
- hip acetabular protrusion
- secondary OA
24
Q
Cushing’s syndrome: characteristics
A
- centralized adiposity
- rounded face (moon face)
- fatty deposit at neck
- abdominal stretch marks
- HTN
- thinning/bruising of skin
- muscle wasting and weakness
- osteoporosis (especially in spine)
- impaired reproductive system
- slow wound healing
- women may have masculine features
25
Primary adrenal insufficiency
due to an autoimmune disease (Addison's)
* can be serious/life threatening
26
Secondary adrenal insufficiency
outside factors affect the adrenals which prevent them from making cortisol (steroid use, pituitary tumor)
* does not affect skin pigmentation or potassium problems
27
Adrenal insufficiency: characteristics
- dehydration
- low BP (orthostatic symptoms)
- loss of appetite or weight loss
- dark pigmentation of skin
- fatigue
- GI disturbances (nausea/vomiting, diarrhea)
- arthralgia, myalgia
- tendon calcification
28
Addison's disease
adrenal failure decreases cortisol and aldosterone production leading to increased adrenocorticotrophic hormone
- onset is gradual
29
Addison's disease: symptoms
- fatigue
- general weakness
- weight loss
- nausea/vomiting
- abdominal pain
- dizziness
- tachycardia
- postural hypotension
- increased bronzed hyperpigmentation
- dehydration
- anxiety
- depression
- poor tolerance to cold
- no tolerance to stress
30
Addison's disease: treatment
- life long glucocorticoid (during times of illness/stress, doses should be increased)
- diet
- hydration
31
Too little cortisol
addison's disease
32
Too much cortisol
cushing's syndrome
33
Adrenal crisis
a rapid change in hormones from increased stress on the body
* this is a medical emergency due to the lack of production of cortisol
also called "acute adrenal insufficiency"
34
Adrenal crisis: common causes
unknown but varied
- infection (bacterial, fungal, viral, parasitic)
- trauma
- pregnancy
- surgery
- emotional distress
35
Adrenal crisis: lab test values
- hyponatremia
- hyperkalemia
- hypoglycemia
- low ATCH levels
- hypercalcemia
36
Adrenal crisis: medical management
- IV hydrocortisone
- hydration
- balance blood glucose
- correct electrolyte imbalances
37
Adrenal crisis: symptoms
- weakness
- abdominal pain
- nausea/vomiting
- diarrhea
- confusion
- altered mental status
- dehydration
- hypotension
- fever
38
Adrenal crisis: differenital diagnosis
- sepsis
- shock
- chronic fatigue
- hypothyroidism
- mono
39
Thyroid gland
secretes T3 and T4 thyroid hormones
- these hormones require an adequate amount of iodine to work properly and a deficiency in the diet can affect the function of this gland
40
What does TSH do?
it is secreted from the pituitary gland and it regulates the thyroid gland
- T4 influences TSH through a negative feedback loop
41
What does low levels of T3 and T4 cause?
weakness, muscle aching, stiffness
42
Types of thyroid disorders:
1. goiter
2. hyperthyroidism
3. hypothyroidism
4. cancer
43
Thyroid disorders are more common in?
women!
5-8x more common
44
Goiter
an enlargement of the thyroid gland generally caused by iodine deficiency
45
Goiter: clinical presentation
- increased neck size
- pressure on surrounding tissue
- difficulty breathing
- swallowing
46
Thyroiditis
inflammation of thyroid tissue caused by infection or autoimmune process
- affects women more than men
- 30-50 yrs old
- leads to hypothyroidism after it breaks down over time
47
What is chronic thyroiditis also known as?
Hashimoto's thyroiditis
48
Hashimoto's: risk factors
- genetics
- women > men
- excessive body iodine
- radiation exposure
49
Hashimoto's: symptoms
- fatigue
- mild weight gain
- weak and brittle nails
- constipation
- fertility problems
50
Hashimoto's: complications
- heart problems
- high cholesterol
- anemia
- goiter
- birth defects
51
Hyperthyroidism
the thyroid gland excreting excessive amount of hormone (increased T4 production)
52
Grave's disease
autoimmune disorder that results in hyperthyroidism
- enlarged thyroid gland
- exophthalmos (protruding eyes)
- more common in women 7-8x more
53
Grave's disease: clinical presentation
- increased body metabolism
- tachycardia
- hand tremors
- trouble sleeping
- weight loss
- muscle weakness
- heat intolerance
54
Grave's disease: clinical presentation older age of onset
- tremors
- anxiety
- palpitations
- weight loss
- heat intolerance
55
Grave's disease: clinical presentation younger age of onset
- cold intolerance
- weight gain
- dry skin
- constipation
- mental and physical slowing
56
Hyperthyroidism: signs and symptoms
- faster HR
- palpitations
- increased RR
- low BP
- CHF
- heat intolerance
- brittle hair
- exophthalmos
- dilated capillaries
- sensitivity to light
- vision loss
- weak eye muscles
- increased DTR
- excessive sweating
- diarrhea
- dysphagia
-weight loss
- polyuria
- amenorrhea
- female infertility
- miscarriage
57
Musculoskeletal effects of hyperthyroidism
- chronic arthritis (pain, decreased ROM- especially in the shoulder)
- decreased bone density and osteoporosis (increased FX risk)
- proximal muscle weakness
58
What is a common differential for hyperthyroidism?
taking a statin for high cholesterol
- the symptoms common in hyperthyroidism are adverse effects to statins
59
PT considerations for hyperthyroidism
1. heat intolerance
2. generally have reduced exercise
3. monitor vitals
4. low bone mineral density
60
When do you to refer to the doctor when treating a patient with hyperthyroidism?
- any unusual swelling, enlargement, tenderness, hoarseness, dysphagia (especially in the neck)
- new onset fever, rash, arthralgia
61
Thyroid storm
occurs if hyperthyroidism is undiagnosed, untreated, incorrectly treated, following a surgery, trauma, major illness, or stop taking meds
- requires immediate medical attention
- can have life threatening complications
62
Thyroid storm: signs and symptoms
- hypermetabolism
- tachycardia
- heart failure
- restlessness
- agitation
- chest pain
- abdominal pain
- nausea/vomiting
- coma
63
Hypothyroidism
primary = thyroid gland tissue breakdown, under active thyroid is deficient in T4
secondary = pituitary gland dysfunction
64
Hypothyroidism: signs and symptoms
- cold intolerance
- excess fatigue
- drowsiness
- headaches
- weight gain
- irregular menstrual cycles
- dry skin
- thin/brittle nails or hair
- nodules in thyroid gland
- slowed DTRs
65
PT considerations for hypothyroidism
- proximal muscle weakness
- stiffness
- muscle aches and pains
- diminished reflexes
- muscle or joint edema
- back pain
- can affect all systems
66
Hypothyroidism: clinical presentation
- slowed HR
- elevated BP
- atherosclerosis
- angina
- hyperlipidemia
- CHF
- thickened skin
- myxedema
- dry skin
- yellowing skin
- dry, coarse, thinning hair
- thin, brittle nails
- myalgia
- slowed DTR
- CTS
- fibromyalgia
- back pain
- decreased absorption of nutrients
- constipation
- weight gain
- delayed glucose uptake
- respiratory muscle weakness
- infertility
- irregular, heavy menstrual cycle
- slowed speech
- hoarseness
- anxiety, depression
- forgetfulness
- hearing impairments
67
Hypothyroidism: myxedema
change in the dermal skin layer causing connective tissue separation affecting skin integrity
- causes thickening of the tongue
- contributes to hoarseness and slurred speech
- can be seen around the eyes, hands, feet
68
Hypothyroidism: myxedema coma
not really a coma --> altered mental status
- precipitated by infection, trauma, burns, stroke
- the body cannot compensated for hypothyroidism while fighting off other problems
69
Hypothyroidism: myxedema coma signs and symptoms
- delayed DTRs
- distended bladder
- elevated diastolic BP (early onset)
- hypotension (late onset)
- hypothermia
- non pitting B LE edema
- coarse hair
- facial swelling
** cardinal presentation is deteriorating mental status
70
Thyroid cancer
uncommon, slow growing, and rarely metastasizes
- initial signs are a palpable mass within thyroid tissue or the lymph nodes of head and neck lateral to SCM overlying scalenes
71
Thyroid cancer: risk factors
- female
- >40 yrs
- white
- iodine deficient
- family history
72
When is a physician referral needed in terms of thyroid cancer?
- when the patient has a palpable nodule in the neck
- presence/new onset of hemoptysis, hoarseness, HTN
73
Parathyroid glands
there are 4, secretes parathyroid hormone (PTH)
- PTH raises blood calcium levels
74
How does PTH raise blood calcium levels?
mobilizes stored calcium from bones or increases calcium resorption from kidneys/small intestine
75
Hyperparathyroidism
excessive production of PTH
- long term effects on bone density, diffuse bone pain, osteopenia, osteoporosis
76
Hyperparathyroidism: clinical presentation
- proximal muscle weakness
- muscle atrophy
- myalgia
- arthritis
- heavy LE sensations
- increased DTR
- fatigue
- loss of appetite
- weight loss
- increased thirst
- polyuria
- polydipsia
- dehydration
- GI provlems
- depression
- kidney stones
- HTN
- heart palpitations
- memory loss
- sleep disturbances
77
Hypoparathyroidism
underactivity of 1 or more glands, decreased PTH hormone resulting in low serum calcium levels
78
Hypoparathyroidism: acute
life threatening emergency
- needs to be treated rapidly with IV calcium replacement, anticonvulsants, airway prevention obstruction
79
Hypoparathyroidism: clinical presentation
- osteomalacia (adults)
- painful muscle spasms
- paresthesia
- tetany
- arrhythmias
- muscle weakness/pain
- brittle nails
- altered mental status
- dysrhythmias
- QRS or ST segment changes on EKG
80
Hypoparathyroidism: medical mangagement
- PTH replacement
- vitamin D replacement
- calcium replacement
81
Common presentation of endocrine disorders
- (B) carpal tunnel
- proximal muscle weakness
- arthritis of shoulders
82
Endocrine disorders: things to be wary of
- trigger points not alleviated by traditional methods
- palpable lymph nodes
- hemoptysis
- elevated BP
- new onset hoarseness
- muscle weakness + fatigue + diuretics (potential potassium depletion)
- muscle cramps + antacid use (metabolic alkalosis)
- severe, localized thoracic/lumbar vertebrae FX site (osteoprosis)
83
Endocrine and musculoskeletal S/S: muscle weakness, myalgia, cramps, fatigue
- early manifestations of thyroid/parathyroid disease, acromegaly, diabetes
- acquired muscle weakness should be investigated for endocrine causes because lots of them recover fully with treatment
84
Endocrine and musculoskeletal S/S: (B) carpal tunnel
common finding in a variety of systemic and neuromusculoskeletal conditions but especially certain with endocrine and metabolic disorders
85
Endocrine and musculoskeletal S/S: nocturnal parasthesia
common complaint which discomfort causes sleep disruption and can be partially relieved by shaking of the hand/changing the wrist and hand position
86
Endocrine and musculoskeletal S/S: arthritis and calcific tendinitis
- occur in most people with endocrine disease
- treatment of endocrine disorder improves clinical picture
87
Endocrine and musculoskeletal S/S: chondrocalcinosis
- refers to the deposition of calcium pyrophosphate dihydrate (CPPD) crystals in cartilage chondrocytes of joints
- pseudogout (a disease in which crystal formation leads to inflammation and mechanical damage)
88
Endocrine and musculoskeletal S/S: spondyloarthopathy
occur in individuals with various metabolic/endocrine diseases
89
Endocrine and musculoskeletal S/S: hand stiffness/hand pain
- hypothyroidism is often accompanied by CTS
- flexor tenosynovitis with stiffness is a common finding
90
Potential potassium depletion, when do you seek medical attention?
- muscle weakness
- cramping
- fatigue
- abdominal
- distention
- arrhythmias
- nausea/vomiting
** needs medical consult before exercise
91
Potential thyroid storm, when do you seek medical attention?
- tachycardia
- elevated core body temp
- restlessness
- agitation
- abdominal pain
- nausea/vomiting
** observe clients with known hyperthyroidism carefully after surgery, trauma, and infection
92
When do you need a MD referral?
- any unexplained fever
- palpable nodules or mass
- dehydration symptoms
- symptoms of endocrine/metabolic origin
93
PT considerations for people with endocrine disorders
- caution with activity progression, joint protection, fall prevention
- during med adjustments exercise intensity may be reduced
** if levels and meds are STABLE then there should be no affect on exercise intensity or tolerance
94
When to refer to other healthcare providers?
1. dietician = identify caloric intake and metabolic processes that can be altered
2. physician = when there is no improvement in m/s complaints and/or inability to find etiology of the problem
95
PT goals for endocrine system problems
- optimize function
- improve/maximize activity tolerance
- identify if other systems are involved (integumentary, cardiovascular, respiratory, neurologic)
- address pain complaints
- safety and fall prevention
