Screening for Endocrine Flashcards
What is the endocrine system formed by?
Ductless glands that produce hormones
True/False
the endocrine system works in isolation
false
Works in tandem with the nervous system
What is the result of the endocrine system working together with the nervous system?
Endocrine works in tandem with the nervous system to regulate: Metabolism Water and salt balance BP Response to stress Sexual reproduction
Name the nine glands of the endocrine system + the one named in some sources only
Pineal Pituitary (hypophysis) Anterior and posterior lobes Parathyroids Thyroid Hypothalamus Adrenals Pancreas (Islets of Langerhans) Ovaries Testes
+ Thymus
Name the 3 types of hormones in the endocrine system (based on their location and effect). Briefly explain how each works.
- autocrine hormones have effect on the releasing gland itself
- paracrine hormones function regionally
- endocrine hormones function at distance
True / False
The endocrine system works with the same speed as the nervous system.
Slower to respond, and takes longer to act, than the nervous system
Name the 5 glands that are solely endocrine
Pituitary, thyroid, parathyroids, adrenals, pineal
What’s the hormone produced by the pineal gland?
melatonin
Where is the control center of the endocrine system?
Hypothalamus
Explain the controlling role of the Hypothalamus
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
Name the three glands that are not solely endocrine.
Pancreas, ovaries, and testes are not solely endocrine
What endocrine gland is involved in the immune system, as well?
Thymus– important in T-cell production
Explain the field of Psychoneuroimmunology
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
Does age and sex have any effect over the endocrine glands?
Age-related changes in endocrine function are highly variable and sex-dependent (example: menopause)
Glands undergo tissue change with age, variable effect on function
When would you start thinking about endocrine screening in the context of PT (other than Init. Eval.)?
With patients/clients who do not respond predictably to treatment
What neuromusculoskeletal signs and symptoms may be associated with endocrine dysfunction?
- 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
What systemic signs and symptoms may be associated with endocrine dysfunction?
- 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
Why does the endocrine system produce so many neuromuscular and systemic changes?
Because connective tissue growth and development are influenced/controlled by hormones and metabolic processes, alterations in those processes may produce neuromuscular or systemic changes
How does muscle weakness, myalgia, and fatigue relate with the endocrine system?
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
How does CTS relate with the endocrine system?
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
What are the neuromusculoskeletal causes of CTS?
- 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)
What are the systemic causes of CTS?
- alcohol
- arthritis
- benign tumors
- leukemia
- liver disease
- medication
NSAIDs
oral contraceptives
statins
Alendronate - multiple myeloma
- obesity
- pregnancy
- scleroderma
- hemochromatosis
- vitamin deficiency (especially B6)
What are the endocrine causes of CTS?
- 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
What neuromuscular and musculoskeletal signs and symptoms may be associated with endocrine dysfunction?
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
What are the two classifications of Endocrine Pathophysiology?
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
What is the function of Hypothalamus-Pituitary system?
What makes the connection between the two?
Integration of neurologic and endocrine system
Connected by pituitary stalk
What is the role of Hypothalamus?
Synthesizes and releases hormones that regulate gland secretion
What are the two parts of the Pituitary?
Anterior portion
Posterior portion
Name 9 hormones released by the Anterior Pituitary gland and briefly describe their role.
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
Name two Pathologies of the anterior lobe of the Pituitary and decide if each is caused by hyper or hypo hormonal secretion.
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
List 6 clinical presentations of Acromegaly
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
List 3 characteristics of hypopituitarism
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
What are the clinical manifestations of Hypopituitarism?
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
true/ false
Posterior Pituitary is sometimes considered part of hypothalamus as it connects with the pituitary stalk.
True
What are the 2 hormones that Posterior Pituitary Releases?
ADH (antidiuretic hormone)
Oxytocin
What is the role of ADH?
Decreases urine output by retaining fluid in distal tubules
Stimulated by low pressure in baroreceptors with hemorrhaging and other volume issues
What is the role of Oxytocin?
Uterine contraction and breast milk ejection
Stimulate postpartum uterine contraction to prevent excessive bleeding
Name two medical conditions caused by malfunction of the Posterior Pituitary
Diabetes Insipidus
Syndrome of Inappropriate Secretion of ADH (SIADH)
What is the hormonal mechanism behind Diabetes Insipidus and what’s the result of the dysfunction?
Diabetes Insipidus- lack of vasopressin (ADH, antidiuretic hormone)
Water moves through kidneys and is not reabsorbed
Describe the clinical presentation of Nephrogenic DI.
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
What is the most common type of DI?
Central DI, most common – may be idiopathic or secondary to head trauma, infection, vascular lesion, autoimmune dysfunction, genetic
What is the hormonal mechanism behind Syndrome of Inappropriate Secretion of ADH (SIADH)?
Excess or inappropriate secretion of vasopressin
What could Syndrome of Inappropriate Secretion of ADH (SIADH) be caused by?
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
True/ False
Syndrome of Inappropriate Secretion of ADH (SIADH) is the clinical opposite of diabetes insipidus.
True
What is the clinical presentation of Syndrome of Inappropriate Secretion of ADH (SIADH)
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
What is the treatment for Pituitary pathology?
Pituitary may be treated surgically or with radiation
What is the main PT intervention after Pituitary surgery and what do we have to consider?
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
