Thompson Spring 2016 Endocrine Intro Deck 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? (5)
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.
False
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 it 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
What is the idea behind the field of Psychoneuroimmunology? (what gave rise to the field?)
- 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
- •Thymus– important in T-cell production (as an example I think)
Does age and sex have any effect over the endocrine glands?
Explain the relationships
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
Patients/clients who do not respond predictably to treatment may need to be screened for endocrine dysfunction
What neuromusculoskeletal signs and symptoms may be associated with endocrine dysfunction? (14 mentioned in class)
- 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
** more in Table 11-1, p. 411, G&S (same as Table 11-3, p. 459, G&F)
What systemic signs and symptoms may be associated with endocrine dysfunction? (11)
- 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
More in Table 11-1, p. 411, G&S (same as Table 11-3, p. 459, G&F)
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
What types of endocrine disorders might muscle weakness, myalgia, and fatigue be associated with? (6)
- 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 systemic causes of CTS? (12 examples)
- 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? (9)
- 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 underlyin g endocrine disease
- Pseudogout – gout-like symptoms
What should you know about Periarthritis and Calcific Tendinitis?
Periarthritis and Calcific Tendinitis could be a sign/symptom of underlying endocrine disorder,
- especially when it is at the shoulder (or maybe this is the most common place to find it)
- If cause is an underlying endocrine dysfunction, PT will not be effective
What are the two classifications of Endocrine Pathophysiology?
What are the 2 possible dysfunctions of these categories?
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
Acromegaly: what is it?
List 6 clinical presentations of Acromegaly
Can it be treated?
Increased release of GH- typically tumor of pituitary
- Gigantism or 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
- DISH – diffuse idiopathic skeletal hyperostosis
- Increased mortality linked to uncontrolled GH; if diagnosed early, can be treated
What is hypopituitarism? (list 6 affected hormones)
Other names?
Common/rare?
Clinical picture (include 4 specifics)
Hypopituitarism (dwarfism, non-genetic)
- Decreased secretion by anterior pituitary,
- may see partial/total failure of
- ACTS,
- TSH,
- LS,
- FSH,
- HGH,
- prolactin
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? (tons from book)
- GH deficiency
- short stature
- delayed growth and
- delayed puberty
- Adrenocortical Insufficiency
- Hypoglycemia
- Anorexia
- Nausea
- Abdominal Pain
- Orthostatic Hypotension
- Hypothyroidism
- Tiredness
- Lethargy
- Sensitivity to cold
- Menstrual Disturbances
- Gonadal Failure
- 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 does ADH do?
What stimulates it?
Decreases urine output by retaining fluid in distal tubules
Stimulated by low pressure in baroreceptors with hemorrhaging and other volume issues
What does Oxytocin do? (2)
- 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 DI (include 7 specific symptoms)
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?
What might cause it? (5-7)
Central DI, most common –
- may be idiopathic or
- secondary to
- head trauma,
- infection,
- vascular lesion,
- autoimmune dysfunction,
- genetic
What is another type of DI (besides central DI)?
what might cause it? (5)
Nephrogenic DI –
- medications, such as psychotropics - seizure medication (may turn off ADH)
- corticosteroids (may reduce ADH)
- alcohol,
- electrolyte imbalance,
- diseases of renal system
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 and 3 others)
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
***Dr. T said we may see it in pts with multi-trauma including the chest
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)? (2 principles, 8 specific symptoms)
What is a common restriction for these pts?
- 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? (3)
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
What should we know about Spondyloarthropathy and osteoarthritis?
It may be associated with an underlying endocrine disorder
- Spondyloarthropathy and osteoarthritis
- •Associated with excess iron deposition in tissues (bronze diabetes, iron storage disease), DM, acromegaly, ochronosis (discolored body tissues)
From Wikipedia:
Spondyloarthropathy or spondyloarthrosis refers to any joint disease of the vertebral column.[1][better source needed] As such, it is a class or category of diseases rather than a single, specific entity. It differs from spondylopathy, which is a disease of the vertebra itself. However, many conditions involve both spondylopathy and spondyloarthropathy.
Spondyloarthropathy with inflammation is called ankylosing spondylitis
https://en.wikipedia.org/wiki/Spondyloarthropathy
What should we know about Chrondrocalcinosis?
It is possibly associated with an underlying endocrine disease. It is also called pseudogout sometimes.
- Chondrocalcinosis (deposit of calcium salts)
- Pseudogout – gout-like symptoms
- 5-10% of people with this disorder have underlying endocrine disease
- Pseudogout – gout-like symptoms
What should we know about Hand stiffness and pain, often with CTS and flexor tenosynovitis?
Hand stiffness and pain, often with CTS and flexor tenosynovitis could be associated with underlying endocrine disorder.
ACTH:
- what does it stand for?
- What is its target tissue?
- What hormones are it associated with?
ACTH = AdrenoCorticoTropic Hormone
affects adrenal gland
Associated with Cortisol and androgenic steroids
MSH:
- what does it stand for?
- What hormones does it affect?
- What is the result?
Melanocyte-stimulating hormone (MSH)
Melanin and lipotropin release; makes skin darker
GH:
- what does it stand for?
- What tissues does it primarily affect (3)
- What does it regulate? (3)
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:
- What is its target tissue?
- What does it do?
Prolactin- affects breasts
Milk production
TSH:
- What is its target tissue?
- What 2 things does it do?
TSH- affects thyroid gland
Increase thyroid hormone and Iodine uptake
LH:
- What does it stand for?
- What are its target tissues?
- What does it do? (4)
LH- Luteinizing Hormone
tissues: Ovarian (ovaries) and Leydig (testicles) cells
Affects
- Ovulation and
- progesterone;
- Spermatogenesis,
- testosterone
FSH:
- What does it stand for?
- Target tissue?
- Function? (3)
FSH- Follicle Stimulating Hormone
Target: Ovarian and Leydig (testes) cells
Function:
- Follicle maturation,
- estrogen;
- Spermatogenesis
β-Lipotropin:
- Target Tissue
- Function
β-Lipotropin-
- Target tisue: Adipose cells
- Fat breakdown and release of fatty acids
β-Endorphins:
- target tissue
- function: (2)
β-Endorphins-
- Target: Brain and spinal cord
- Function: Analgesia; Body temperature
