MSK and endocrine function Flashcards
What are steroids biochemically classified as?
Lipids
Steroids are characterized by a ring structure of many C-H bonds.
What are the two main types of steroids?
- Direct action steroids
- Hormones: signal action in other organs
What are examples of hormones
- sex hormones
- corticosteriods
- mineralocorticoids
What are examples of direct action steroids?
- Bile salts
- Sterols
What is the primary role of bile salts?
Important for digestion and fat absorption
- made in the liver
What is the role of sterols like cholesterol?
- Produce Vitamin D
- Help with cell wall production
What are the main sex hormones?
- Male hormones (androgens, e.g., testosterone)
- Female hormones (estrogen/estradiol, progesterone)
- synthesized from cholesterol
What is the function of glucocorticosteroids like cortisol?
- Anti-inflammatory properties
- cortisol works on the liver; uses fatty acids to increase glucose levels (for energy)
- cortisol levels increase during times of stress; likely has a role in immune system function
What is the most important mineralocorticoid?
- Aldosterone
- produce in adrenal gland
What does aldosterone regulate?
Balance of Na+ and K+ by actions on the kidney
What are corticosteroids used for?
- Anti-inflammatory
- Pain management
- Allergy control
- Treatment for Addison’s disease
- can be used to greatly improve outcomes of some condittions
What is Addison’s disease?
Adrenal insufficiency with diminished production of cortisol, glucocorticoids, mineralocorticoids, and androgens
Polyarteritis Nodosa
What is it and how is it dx and tx
- rare
- affects larger, muscular ateries
- can be caused by hepatitis B
- can cause myalgia, fatigue, hypertenion, GI dysfunction, renal involvement
- Diagnosis may include: blood test, ESR, or urinalysis
- imaging: radiography, CT, MRI
- treatment: prednisone, immunosuppressants
ESR: erthrocyte sediment rate; increased = inflammation (sed rate)
How is the body/arteries affected in polyarteritis nodosa
- first arteries become weak, thin and stretched out
- narrow
- closed off
What are the signs of decreased cortisol production?
- Hypoglycemia
- Fatigue
- Confusion
occurs in addisons
What are signs of decreased aldosterone
- fluid and electrolyte imbalance
- dehydration
- important for Na/K balance
occurs in addisons disease
Signs and symptoms of addisons disease? how is this treated
- weakness
- fatigue
- weight loss
- nausea/vomiting
- muscle and joint pain
- abdominal pain
- hypotension
treatment: steriods/corticosteriods
What are the potential negative effects of corticosteroids?
- Myopathy
- Osteoporosis
- Atherosclerosis
- Immunocompromise
- Growth retardation
- impede bone and wound healing (must wait if they need surgery 8-12 weeks)
- pulmonary infections
- gastritis
- glaucoma/cataracts
- mood alterations
- headache
- skin changes
- diabetes mellitus
occurs with people who are chronically on steriods
What is Cushing’s syndrome?
- Hyperfunction of the adrenal gland, can be related to long-term steroid use
- can also be an issue with pituitary gland (not as common)
- overproduction of cortisole leads to protein catabolic state
What does prolonged steriod use lead to
- cushings
- hypervolemia, hypernatremia, and hypokalemia
- assoicated with hyperglycemia
What are physical characteristics of Cushing’s syndrome?
- Round face
- Supraclavicular fat pads
- Truncal obesity
- Muscle wasting and weakness
- pear/apple distribution
can limit these with exercises
What are the physiological effects of cushings
- osteoporosis
- HTN
- impaired wound healing
- easy bruising
- impaired reproductive function
- diabetes mellitus
- psychiatric or emotional disturbances
- women may develop fascial hair, deeper voice, breast atrophy
What are anabolic androgenic steroids?
- Synthetic substances similar to testosterone that increase muscle and male characteristics
- anabolic: increase muscle
- androgenic: increase male characteristics
- characterized as appearance and performance enhancing drugs
What are some reasons people take anabolic steroids?
- Increase muscle mass
- Improve performance
- Improve physical appearance
- can be legally prescribed in some cases
- not as addictive as other drugs but has some addictive characteristics
What are some of the psychiatric changes/mood swings that occur when people take anabolic androgenic steriods
- still addictive/effect neurotransmitters
- go through withdrawal
- mania
- aggression
- depression
- paranoid jealousy
- extreme irritability
- delusions
- poor judgement
What are the potential negative effects of anabolic steroid use?
- Hypertension
- Cardiac hypertrophy
- Atherosclerosis
- Jaundice / liver damage
- increase in LDL
- LE fluid retention
- premature skeletal maturation
- GI upset/diarrhea
- headaches
- acne
doses taken by athletes or others may be much higher than in a perscription
What gender-specific effects can anabolic steroids have on males?
- Testicular shrinkage
- Gynecomastia: enlargement of breast tissue
- Reduced sperm count/infertility
- baldness
- prostate cancer
What gender-specific effects can anabolic steroids have on females?
- Male-pattern baldness
- Facial hair/hypertrichosis
- Clitoral enlargement
- deeper voice
- change in menstrual cycle
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What is Relative Energy Deficiency in Sport (RED-S)?
Low Energy Availability (LEA) affects hormone production and release
What hormonal changes can occur in females due to LEA?
- Decrease in FSH
- Decrease in LH
- Reduction in estrogen production
- functional hypothalamic ammenrrhea
- impaired bone mineral density (osteopenia)
What hormonal changes can occur in males due to LEA
- causes decreased testosterone
- decrease BMD
What are other effects of low energy availability?
- Increased cortisol
- Decreased leptin, insulin growth factor, growth hormone
- change in mood
- decrease appetite
- fatigue
- immune function decreased
- GI dysfunction
PT role: education + monitor vitals as long term vitals can increase due to increase in cortisol from increased LEA
What is the treatment for Addison’s disease?
Corticosteroids
What is the relationship between aging and hormone levels?
Post-menopause leads to decreased estrogen and late onset hypogonadism associated with reduced testosterone
Risk factors for LEA
- decrease dietary intake
- increased exercise energy expenditure
- desire for weight loss
- disordered eating/training behavior
- sport identiy
- changes in hunger hormones
LEA: acute exposure risks
- reduced blood glucose
- reduced leptin levels
- disruption in the pulsatility of GnRH, LH, T3
- cortisol
- fatigue
- mood changes
- low sex drive
- lower muscle protein synthesis
LEA: Long term exposure risk
- endorcrine disruptions
- reproductive dysfunction
- impaired bone health
- dyslipidemia
- bradycardia/hypotension
- hypoglycemia
- low resting metabolic rate
- immunological suppression
- injuries
- impaired performance
- GI problems
- reduced appetite
- eating disorders
aging: post menopause what occurs in women and how is it treated often times
- estrogen replacement
- oral contraceptives, transdermal estrogen
- decreased estrogen during post menopause
- decreased BMD
MSK dysfunction and aging: Males
- reduced testosterone
- late onset hypogonadism
- associated with DM, overweight, obesity
- sacropenia
- osteoprosis: bisphosphonates to improve BMD?
