Endocrine/Metabolic Flashcards
glands of the endocrine system
pineal
parathyroid
thyroid
pancreas
ovaries
testes
adrenal
thymus
pituitary
hypothalamus
pituitary gland controls the release of which hormones?
luteinizing hormone
follicle stimulating hormone
adrenocorticotropin
growth hormone
melanocyte stimulating hormone
thyroid stimulating hormone
prolactin
luteinizing hormone functions
stimulates spermatogenesis, androgen production
follicle stimulating hormone functions
stimulate spermatogenesis
adrenocorticotropin hormone function
regulate secretion and growth of adrenal glands
growth hormone functions
regulate body growth, fat mobilization, stimulate glycogenolysis
melanocyte stimulating hormone function
lipotropin and melanin release secretion
which hormones are secreted by the posterior pituitary gland?
oxytocin
anti-diuretic hormone (ADH)
which hormones are secreted by the anterior pituitary?
TSH
ACTH
LH
FSH
GH
prolactin
MSH
disorders of the pituitary: GH
gigantism: excess growth in childhood before growth plates fuse
acromegaly: excess growth in adulthood after growth plates fuse, large extremities
disorders of the pituitary: ACTH
Cushing’s disease: ACTH dependent
Secondary Adrenal Deficiency
disorders of the pituitary: pituitary tumor
often benign but affects hormone secretion and therefore other body systems
s/s of GH disorders
joint pain/stiffness, OA, myopathy proximal, fibromyalgia, back pain and increased osteophyte formation, profuse sweating, HTN, DM, poor exercise tolerance
ACTH Cushing’s disease cause
pituitary tumor on the gland
causes increased ACTH secretion
stimulates the adrenal glands to secrete excess cortisol
Most common ACTH Cushing’s disease s/s
headaches
visual changes from pressure on optic chiasm
adrenal gland
made of cortex and medulla
releases cortisol
cortisol function
released during stress to increase BP, HR, RR, GLC production and decrease digestion, reproduction functions
increases inflammation
cortisol levels - daily and pathological
peaks in morning, tapers throughout the day
high - cushing’s
low - addison’s disease
causes of Cushing’s syndrome
chronic cortisol production
exogenous corticosteroid overuse
endogenous/benign or malignant adenoma
Cushing’s syndrome s/s
Integumentary: red cheeks, thin skin, red striae
MSK body comp: moon face, osteoporosis, fat pad, thin arms/legs due to sarcopenia, pendulous abdomen, OA, avascular necrosis, fractures
CV: high BP, ecchymosis
constitutional: poor wound healing
primary adrenal insufficiency
addison’s disease - autoimmune
life threatening
secondary adrenal insufficiency
outside factors affecting adrenals, unable to make cortisol
due to steroid use or pituitary issue
no effect on skin pigmentation or potassium
s/s of adrenal insufficiency
CV: low BP, OH
constitutional: loss of appetite, weight loss, fatigue, dehydration
MSK: fatigue, arthralgia, myalgia, tendon calcification
Integumentary: dark pigmentation
GI disturbances
Addison’s disease
decreased cortisol (autoimmune)
leads to decreased aldosterone and elevated ACTH
gradual onset
addison’s disease s/s
constitutional: fatigue, general weakness, weight loss, dehydration, anxiety, depression, cold intolerance, poor stress tolerance
GI: abdominal pain,
CV: dizzy, tachycardia, OH
skin: bronze hyperpigmentation
addison disease medical management
life long glucocorticoids
increase dose if ill or stressed
manage diet and hydration
adrenal crisis
acute adrenal insufficiency
when cortisol is already low, is the system is stressed the body can’t produce more
causes: infection, trauma, pregnancy, surgery, emotional distress
tests for adrenal crisis
electrolyte levels, low ACTH
adrenal crisis s/s
weakness, abdominal pain, N/V, disrrhea, confusion, altered mental status, dehydration, hypotension, fever
thyroid gland function
secrete T3, T4 and requires iodine
regulated by TSH from pituitary
negative feedback loop of T4 on TSH
s/s of low T3/T4
weakness, muscle ache, stiffness
goiter - causes
enlarged thyroid gland caused by iodine deficiency
increased neck size can cause pressure on surrounding tissues/airways
thyroiditis
causes: autoimmune or infection
inflammation of thyroid tissue
can turn into hashimoto’s disease hypothyroidism due to thyroid breakdown
progressive
hashimoto’s thyroiditis
type, causes/risk factors
most common causes of hypothyroidism
can be caused by genetics, women, iodine excess, radiation exposure
s/s of hashimotos hypothyroidism
fatigue
weight gain
weak/brittle nails
constipation
fertility problems
complications: heart problems, high cholesterol, anemia, goiter, birth defects
grave’s, hashimotos - hypo or hyper?
graves hyper
hashimotos hypo
thyroid
grave’s disease
autoimmune causing hyperthyroidism
hyperthyroidism
excess excretion of T4
s/s of hyperthyroidism
enlarged gland
exophthalamos
older: tremors, anxiety, palpitations, weight loss, heat intolerance
younger; cold intolerance, weight gain, dry skin, constipation, mental/physical slowing
+ tachycardia, sleep trouble, muscle weakness
generally increased metabolism
MSK complications of hyperthyroidism
chronic arthritis/ adhesive capsulitis
osteoporosis
proximal muscle weakness
PT considerations of hyperthyroidism
heat intolerance
exercise intolerance
vitals monitoring
osteoporosis - fall risk
thyroid storm
rare complication of poorly treated hyperthyroidism or after trauma/surgery/illness
life threatening
due to high levels of T3/T4 increasing metabolism
s/s of thyroid storm
hypermetabolism
tachycardia, heart failure, chest pain
shock, hyperthermia, restless, agitated
abdominal pain, nausea/vomiting
coma
causes of hypothyroidism
iodine deficiency
thyroid inflammation/removal
environment/radiation
congenital
meds depressing thyroid function
hypothalamus damage
pituitary gland dysfunction
thyroid tissue breaksdown and T4 deficiency forms
hypothyroidism s/s
cold intolerance
fatigue/drowsy
headaches
weight gain
irregular periods
dry skin
thin hair/nails
thyroid nodules
slowed DTRs
hypothyroidism PT considerations
proximal muscle weakness
stiffness
muscle pain
diminished reflexes
joint edema
back pain
+ systemic on CV, integ, MSK, GI, GU, neuro
myxedema
change in dermal skin layer including under eye edema, puffy face with dull, dry skin
thin lateral eyebrows
thickening of the tongue
sign of hypothyroidism
myxedema coma
altered mental state, often does NOT progress to a coma
infection/trauma/etc, hypothyroidism causes body to not be able to fight of event/trauma causing rapid progression
major sign is deteriorating mental status
thyroid cancer
uncommon
slow growing
rarely metastatic
thyroid cancer risk factors
femaoe
over 40
caucasian
iodine deficient
family hx
thyroid cancer s/s
palpable mass in neck found incidentally
homptysis
new hoarseness
HTN
function of parathyroid glands
secrete PTH
raise blood Ca to mobilize Ca from bones
increase Ca resorption from kidneys
hyperparathyroidism s/s
increased DTR, fatigue, loss of appetite, weight loss, increased thirst, polyuria, polydipsia, dehydration, GI problems, depression, kidney stones, HTN, heart palpitations, memory loss, sleep disturbances
hyperparathyroidism effects/complications
diffuse bone pain
osteoporosis
hypermobility
proximal m weakness, myalgia, arthritis, heavy LE
hypoparathyroidism
underactivity of 1 or more glands
less PTH results in low serum Ca levels
life threatening if acute - treat w electrolyte replacement, resp support
manage with vit D, Ca
hypoparathyroidism s/s
osteomalacia, painful m spasm, parasthesia, tetany, arrhythmias, m weakness, brittle nails, altered mental status, dysrhhythmia
common presentations of endocrine disorders include:
BL carpal tunnel
proximal m weakness
shoulder arthritis
signs of endocrine disorder in MSK
trigger points not alleviated by PT
palpable lymph nodes
muscle weakness w fatigue, diuretics
muscle cramps
severe localized spinal pain (osteoporosis/Fx)
arthritis and calcific tendinitis indicate
endocrine disease
can improve if endocrine condition improves
chondrocalcinosis indicates:
CPPD crystals in cartilage of joints
pseudogout
red flags to seek immediate medical care
signs of hypokalemia
thyroid storm
fever
palpable nodes
dehydration
recurrent arthritis
