MSK and endocrine function Flashcards

1
Q

What are steroids biochemically classified as?

A

Lipids

Steroids are characterized by a ring structure of many C-H bonds.

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2
Q

What are the two main types of steroids?

A
  • Direct action steroids
  • Hormones: signal action in other organs
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3
Q

What are examples of hormones

A
  • sex hormones
  • corticosteriods
  • mineralocorticoids
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4
Q

What are examples of direct action steroids?

A
  • Bile salts
  • Sterols
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5
Q

What is the primary role of bile salts?

A

Important for digestion and fat absorption
- made in the liver

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6
Q

What is the role of sterols like cholesterol?

A
  • Produce Vitamin D
  • Help with cell wall production
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7
Q

What are the main sex hormones?

A
  • Male hormones (androgens, e.g., testosterone)
  • Female hormones (estrogen/estradiol, progesterone)
  • synthesized from cholesterol
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8
Q

What is the function of glucocorticosteroids like cortisol?

A
  • 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
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9
Q

What is the most important mineralocorticoid?

A
  • Aldosterone
  • produce in adrenal gland
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10
Q

What does aldosterone regulate?

A

Balance of Na+ and K+ by actions on the kidney

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11
Q

What are corticosteroids used for?

A
  • Anti-inflammatory
  • Pain management
  • Allergy control
  • Treatment for Addison’s disease
  • can be used to greatly improve outcomes of some condittions
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12
Q

What is Addison’s disease?

A

Adrenal insufficiency with diminished production of cortisol, glucocorticoids, mineralocorticoids, and androgens

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13
Q

Polyarteritis Nodosa

What is it and how is it dx and tx

A
  • 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)

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14
Q

How is the body/arteries affected in polyarteritis nodosa

A
  1. first arteries become weak, thin and stretched out
  2. narrow
  3. closed off
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15
Q

What are the signs of decreased cortisol production?

A
  • Hypoglycemia
  • Fatigue
  • Confusion

occurs in addisons

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16
Q

What are signs of decreased aldosterone

A
  • fluid and electrolyte imbalance
  • dehydration
  • important for Na/K balance

occurs in addisons disease

17
Q

Signs and symptoms of addisons disease? how is this treated

A
  • weakness
  • fatigue
  • weight loss
  • nausea/vomiting
  • muscle and joint pain
  • abdominal pain
  • hypotension

treatment: steriods/corticosteriods

18
Q

What are the potential negative effects of corticosteroids?

A
  • 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

19
Q

What is Cushing’s syndrome?

A
  • 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
20
Q

What does prolonged steriod use lead to

A
  • cushings
  • hypervolemia, hypernatremia, and hypokalemia
  • assoicated with hyperglycemia
21
Q

What are physical characteristics of Cushing’s syndrome?

A
  • Round face
  • Supraclavicular fat pads
  • Truncal obesity
  • Muscle wasting and weakness
  • pear/apple distribution

can limit these with exercises

22
Q

What are the physiological effects of cushings

A
  • 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
23
Q

What are anabolic androgenic steroids?

A
  • 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
24
Q

What are some reasons people take anabolic steroids?

A
  • 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
25
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
26
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 ## Footnote doses taken by athletes or others may be much higher than in a perscription
27
What gender-specific effects can anabolic steroids have on males?
* Testicular shrinkage * Gynecomastia: enlargement of breast tissue * Reduced sperm count/infertility - baldness - prostate cancer
28
What gender-specific effects can anabolic steroids have on females?
* Male-pattern baldness * Facial hair/hypertrichosis * Clitoral enlargement - deeper voice - change in menstrual cycle | -
29
What is Relative Energy Deficiency in Sport (RED-S)?
Low Energy Availability (LEA) affects hormone production and release
30
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)
31
What hormonal changes can occur in males due to LEA
- causes decreased testosterone - decrease BMD
32
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 ## Footnote PT role: education + monitor vitals as long term vitals can increase due to increase in cortisol from increased LEA
33
What is the treatment for Addison's disease?
Corticosteroids
34
What is the relationship between aging and hormone levels?
Post-menopause leads to decreased estrogen and late onset hypogonadism associated with reduced testosterone
35
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
36
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
37
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
38
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
39
MSK dysfunction and aging: Males
- reduced testosterone - late onset hypogonadism - associated with DM, overweight, obesity - sacropenia - osteoprosis: bisphosphonates to improve BMD?