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Thompson- spring > Screening for Endocrine > Flashcards

Screening for Endocrine Flashcards

1
Q

What is the endocrine system formed by?

A

Ductless glands that produce hormones

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2
Q

True/False

the endocrine system works in isolation

A

false

Works in tandem with the nervous system

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3
Q

What is the result of the endocrine system working together with the nervous system?

A 
Endocrine works in tandem with the nervous system to regulate:
Metabolism
Water and salt balance
BP
Response to stress
Sexual reproduction
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4
Q

Name the nine glands of the endocrine system + the one named in some sources only

A 
Pineal
Pituitary (hypophysis)
Anterior and posterior lobes
Parathyroids
Thyroid
Hypothalamus
Adrenals
Pancreas (Islets of Langerhans)
Ovaries
Testes

+ Thymus

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5
Q

Name the 3 types of hormones in the endocrine system (based on their location and effect). Briefly explain how each works.

A
  • autocrine hormones have effect on the releasing gland itself
  • paracrine hormones function regionally
  • endocrine hormones function at distance
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6
Q

True / False

The endocrine system works with the same speed as the nervous system.

A

Slower to respond, and takes longer to act, than the nervous system

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7
Q

Name the 5 glands that are solely endocrine

A

Pituitary, thyroid, parathyroids, adrenals, pineal

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8
Q

What’s the hormone produced by the pineal gland?

A

melatonin

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9
Q

Where is the control center of the endocrine system?

A

Hypothalamus

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10
Q

Explain the controlling role of the Hypothalamus

A

Hypothalamus controls pituitary function, so has enormous indirect effect on others glands.

  • Hypothalamus can synthesize and release hormones from axon terminals directly into bloodstream
  • Neurons can also have a hormone-secreting function – example, Ach, which is classified as both neurohormone and neurotransmitter – facilitates release of both
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11
Q

Name the three glands that are not solely endocrine.

A

Pancreas, ovaries, and testes are not solely endocrine

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12
Q

What endocrine gland is involved in the immune system, as well?

A

Thymus– important in T-cell production

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13
Q

Explain the field of Psychoneuroimmunology

A

Multiple feedback systems in place to keep hormones at normal levels.

Interfaces between endocrine-nervous-immunologic systems has given rise to field of psychoneuroimmunology (PNI) – interactive biologic signaling

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14
Q

Does age and sex have any effect over the endocrine glands?

A

Age-related changes in endocrine function are highly variable and sex-dependent (example: menopause)
Glands undergo tissue change with age, variable effect on function

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15
Q

When would you start thinking about endocrine screening in the context of PT (other than Init. Eval.)?

A

With patients/clients who do not respond predictably to treatment

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16
Q

What neuromusculoskeletal signs and symptoms may be associated with endocrine dysfunction?

A
  • s/s associated with RA
  • muscle weakness
  • muscle atrophy
  • myalgia
  • fatigue
  • CTS
  • synovial fluid changes
  • periartheritis
  • adhesive capsulitis (diabetes)
  • Chondrocalcinosis
  • Spondyloarthropathy
  • OA
  • hand stiffness
  • arthralgia
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17
Q

What systemic signs and symptoms may be associated with endocrine dysfunction?

A
  • excessive or delayed growth
  • polydipsia
  • polyuria
  • mental changes (nervousness, confusion, depression)
  • changes in hair (quality and distribution)
  • changes in skin pigmentation
  • changes in vitals (elevated temp., HR, BP)
  • heart palpitations
  • increased perspiration
  • Kussmaul’s respiration (deep, rapid breathing)
  • dehydration or excessive retention of body water
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18
Q

Why does the endocrine system produce so many neuromuscular and systemic changes?

A

Because connective tissue growth and development are influenced/controlled by hormones and metabolic processes, alterations in those processes may produce neuromuscular or systemic changes

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19
Q

How does muscle weakness, myalgia, and fatigue relate with the endocrine system?

A

May signal thyroid or parathyroid disease
Acromegaly, diabetes, Cushing’s syndrome, osteomalacia

Painless proximal muscle weakness – may not be restored when underlying endocrine function is addressed

20
Q

How does CTS relate with the endocrine system?

A

Soft tissue changes at wrist secondary to hormone changes, thickening of transverse carpal ligament, gout

CTS has multiple causes (Table 11-2, p. 412, G&S) – repetitive motion and occupational factors usually bring the problem to light

21
Q

What are the neuromusculoskeletal causes of CTS?

A
  • amyloydosis
  • sequelae of medical or surgical procedures
  • thumb arthritis
  • cervical disc lesion
  • cervical spondylosis
    Spondyloarthropathy and osteoarthritis
    Associated with excess iron deposition in tissues (bronze diabetes, iron storage disease), DM, acromegaly ochronosis (discolored body tissues)
  • congenital anatomic differences
  • cumulative trauma disorder
  • peripheral neuropathy
  • poor posture (associated with TOS)
  • repetitive strain injury
  • tendenitis
    (Periarthritis and Calcific Tendinitis, especially at the shoulder. If cause is an underlying endocrine dysfunction, PT will not be effective)
  • trigger points
  • tenosynovitis
    Hand stiffness and pain, often with CTS and flexor tenosynovitis
  • TOS
  • wrist trauma (Colle’s fx)
22
Q

What are the systemic causes of CTS?

A
  • alcohol
  • arthritis
  • benign tumors
  • leukemia
  • liver disease
  • medication
    NSAIDs
    oral contraceptives
    statins
    Alendronate
  • multiple myeloma
  • obesity
  • pregnancy
  • scleroderma
  • hemochromatosis
  • vitamin deficiency (especially B6)
23
Q

What are the endocrine causes of CTS?

A
  • acromegaly
  • diabetes mellitus
  • hormonal imbalance
  • hyperparathyroidism
  • hyperthyroidism (Grave’s disease)
  • hypocalcemia
  • hypothyroidism
  • gout
    Chondrocalcinosis (deposit of calcium salts)
    Pseudogout – gout-like symptoms
    5-10% of people with this disorder have underlying endocrine disease
24
Q

What neuromuscular and musculoskeletal signs and symptoms may be associated with endocrine dysfunction?​

A

Periarthritis and Calcific Tendinitis, especially at the shoulder ​
If cause is an underlying endocrine dysfunction, PT will not be effective​

Chondrocalcinosis (deposit of calcium salts)​
Pseudogout – gout-like symptoms​
5-10% of people with this disorder have underlying endocrine disease​

Spondyloarthropathy and osteoarthritis​
Associated with excess iron deposition in tissues (bronze diabetes, iron storage disease), DM, acromegaly ochronosis (discolored body tissues)​

Hand stiffness and pain, often with CTS and flexor tenosynovitis

25
Q

What are the two classification​s of Endocrine Pathophysiology?

A

Primary (dysfunction of the gland)​

Secondary (caused by an external stimulus, but may be iatrogenic, such as a surgical removal)​

will result in over- or under-production of hormone​
​

26
Q

What is the function of Hypothalamus-Pituitary system​?

What makes the connection between the two?

A

Integration of neurologic and endocrine system​

Connected by pituitary stalk​

27
Q

What is the role of Hypothalamus?

A

​

Synthesizes and releases hormones that regulate gland secretion​

28
Q

What are the two parts of the Pituitary?

A

Anterior portion​

Posterior portion​

29
Q

Name 9 hormones released by the Anterior Pituitary gland and briefly describe their role.

A

ACTH- affects adrenal gland​
Cortisol and androgenic steroids​

Melanocyte-stimulating hormone (MSH)​
Melanin and lipotropin release; makes skin darker​

GH- affects muscle, bone and liver​
Regulates growth, fat metabolism; in liver produces IGF’s that act like insulin hence insulin like growth factors​

Prolactin- affects breasts​
Milk production​

TSH- affects thyroid gland​
Increase thyroid hormone and Iodine uptake​

LH- Ovarian (ovaries) and Leydig (testicles) cells​
Ovulation and progesterone; Spermatogenesis, testosterone​

FSH- Ovarian and Leydig cells​
Follicle maturation, estrogen; Spermatogenesis​

β-Lipotropin- Adipose cells​
Fat breakdown and release of fatty acids​

β-Endorphins- Brain and spinal cord​
Analgesia; Body temperature​

30
Q

Name two Pathologies of the anterior lobe of the Pituitary and decide if each is caused by hyper or hypo hormonal secretion.

A

Acromegaly (hyperpituitarism)
Increased release of GH- typically tumor of pituitary​

Hypopituitarism (dwarfism, non-genetic)​
Decreased secretion by anterior pituitary, may see partial/total failure of ACTS, TSH, LS, FSH, HGH, prolactin​

31
Q

List 6 clinical presentations of Acromegaly

A

Gigantism of head, face, jaw, hands and feet​

Joint stiffness, CTS in ~50% of patients​

Amenorrhea, diabetes, profuse sweating and hypertension
​
Back pain, large osteophytes along the anterior longitudinal ligament (not ankylosing spondylitis )

DISH – diffuse idiopathic skeletal hyperostosis​

Increased mortality linked to uncontrolled GH; if diagnosed early, can be treated​
​

32
Q

List 3 characteristics of hypopituitarism

A

Usually rare​

Clinical picture depends on age of onset and hormones affected (G&F, Box 11-1, p. 463)​

May see weakness, lethargy, anemia, orthostatic hypotension ​

33
Q

What are the clinical manifestations of Hypopituitarism?

A

GH deficiency
short stature
delayed growth and puberty

Adrenocortical Insufficiency
            Hypoglycemia
             Anorexia
            Nausea
            Abdominal Pain
            Orthostatic Hypotension
Hypothyroidism
            Tiredness
             Lethargy
            Sensitivity to cold
            Menstrual Disturbances
Gonadal Feilure
           Secondary Amenorrhea
           Impotence
          Infertility
          decreased libido
          absent secondary sex characteristics (children)
Neurologic Signs (produced by tumor)
         Headache
         bilateral temporal hemianopia
         loss of visual acuity 
         blindness
34
Q

true/ false

Posterior Pituitary is sometimes considered part of hypothalamus as it connects with the pituitary stalk.​

A

True

35
Q

What are the 2 hormones that Posterior Pituitary Releases?

A

ADH (antidiuretic hormone)​

Oxytocin​

36
Q

What is the role of ADH?

A

Decreases urine output by retaining fluid in distal tubules​

Stimulated by low pressure in baroreceptors with hemorrhaging and other volume issues​

37
Q

What is the role of Oxytocin?

A

Uterine contraction and breast milk ejection​

Stimulate postpartum uterine contraction to prevent excessive bleeding​
​

38
Q

Name two medical conditions caused by malfunction of the Posterior Pituitary

A

Diabetes Insipidus

Syndrome of Inappropriate Secretion of ADH (SIADH)​

39
Q

What is the hormonal mechanism behind Diabetes Insipidus and what’s the result of the dysfunction?

A

Diabetes Insipidus- lack of vasopressin (ADH, antidiuretic hormone)​
Water moves through kidneys and is not reabsorbed​

​

40
Q

Describe the clinical presentation of Nephrogenic DI.

A

Nephrogenic DI –medications, such as psychotropics- seizure medication, corticosteroids, alcohol, electrolyte imbalance, diseases of renal system​

Increased urination and dehydration​
Polyuria, polydipsia, dehydration, nocturia, fatigue, irritability, high sodium in body​

If person is unconscious or confused, will become dangerously dehydrated​

41
Q

What is the most common type of DI?

A

Central DI, most common – may be idiopathic or secondary to head trauma, infection, vascular lesion, autoimmune dysfunction, genetic​

42
Q

What is the hormonal mechanism behind Syndrome of Inappropriate Secretion of ADH (SIADH)​?

A

Excess or inappropriate secretion of vasopressin​

43
Q

What could Syndrome of Inappropriate Secretion of ADH (SIADH) be caused by?

A

Most common in oat cell carcinoma (80%), or may be caused by pituitary trauma, infection, thoracic pressure changes from compression of pressure receptors in cardiopulmonary system​

44
Q

True/ False

Syndrome of Inappropriate Secretion of ADH (SIADH)​ is the clinical opposite of diabetes insipidus.​

A

True

45
Q

What is the clinical presentation of Syndrome of Inappropriate Secretion of ADH (SIADH)

A

Neurologic/neuromuscular signs predominate​

Decreased urination or marked retention of fluid​
HA, confusion, lethargy, decreased urine with low sodium, seizures, muscle cramps, vomiting, diarrhea, weight gain​

Acute care setting – will be on strict fluid restrictions​

46
Q

What is the treatment for Pituitary pathology?

A

Pituitary may be treated surgically or with radiation​

47
Q

What is the main PT intervention after Pituitary surgery and what do we have to consider?

A

Routine mobilization post-op, but monitor VS and neurologic status​

Possibility of intracranial bleed​; treat it as a head surgery

Blood glucose monitoring – removal of GH influences insulin​

Possible visual changes due to physical location of pituitary​

Thompson- spring (13 decks)

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