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Storage for later > Thompson Spring 2016 Endocrine Intro Deck > Flashcards

Thompson Spring 2016 Endocrine Intro Deck 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? (5)

A

Endocrine works in tandem with the nervous system to regulate:

  1. Metabolism
  2. Water and salt balance
  3. BP
  4. Response to stress
  5. Sexual reproduction
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4
Q

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

A
  1. Pineal
  2. Pituitary (hypophysis), Anterior and posterior lobes
  3. Parathyroids
  4. Thyroid
  5. Hypothalamus
  6. Adrenals
  7. Pancreas (Islets of Langerhans)
  8. Ovaries
  9. 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

False

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
  1. Pituitary,
  2. thyroid,
  3. parathyroids,
  4. adrenals,
  5. 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 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
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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

What is the idea behind the field of Psychoneuroimmunology? (what gave rise to the field?)

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
    • •Thymus– important in T-cell production (as an example I think)
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14
Q

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

Explain the relationships

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

Patients/clients who do not respond predictably to treatment may need to be screened for endocrine dysfunction

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16
Q

What neuromusculoskeletal signs and symptoms may be associated with endocrine dysfunction? (14 mentioned in class)

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

** more in Table 11-1, p. 411, G&S (same as Table 11-3, p. 459, G&F)

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17
Q

What systemic signs and symptoms may be associated with endocrine dysfunction? (11)

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)
  11. -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)

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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

What types of endocrine disorders might muscle weakness, myalgia, and fatigue be associated with? (6)

A
  1. May signal thyroid or parathyroid disease
  2. Acromegaly,
  3. diabetes,
  4. Cushing’s syndrome,
  5. osteomalacia
  6. Painless proximal muscle weakness – may not be restored when underlying endocrine function is addressed
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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
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21
Q

What are the systemic causes of CTS? (12 examples)

A
    • alcohol
    • arthritis
    • benign tumors
    • leukemia
    • liver disease
    • medication
    • NSAIDs
    • oral contraceptives
    • statins
    • Alendronate
    • multiple myeloma
    • obesity
    • pregnancy
    • scleroderma
    • hemochromatosis
    • vitamin deficiency (especially B6)
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22
Q

What are the endocrine causes of CTS? (9)

A
    • acromegaly
    • diabetes mellitus
    • hormonal imbalance
    • hyperparathyroidism
    • hyperthyroidism (Grave’s disease)
    • hypocalcemia
    • hypothyroidism
    • gout?
  9. Chondrocalcinosis (deposit of calcium salts)
    • Pseudogout – gout-like symptoms
      • 5-10% of people with this disorder have underlyin g endocrine disease
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23
Q

What should you know about Periarthritis and Calcific Tendinitis?

A

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
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24
Q

What are the two classification​s of Endocrine Pathophysiology?

What are the 2 possible dysfunctions of these categories?

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​​

25
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​

26
Q

What is the role of Hypothalamus?

A

​Synthesizes and releases hormones that regulate gland secretion​

27
Q

What are the two parts of the Pituitary?

A

Anterior portion​

Posterior portion​

28
Q

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

A
  1. ACTH- affects adrenal gland
    • Cortisol and androgenic steroids
  2. Melanocyte-stimulating hormone (MSH)
    • Melanin and lipotropin release; makes skin darker
  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
  4. Prolactin- affects breasts
    • Milk production
  5. TSH- affects thyroid gland
    • Increase thyroid hormone and Iodine uptake
  6. LH- Ovarian (ovaries) and Leydig (testicles) cells
    • Ovulation and progesterone; Spermatogenesis, testosterone
  7. FSH- Ovarian and Leydig cells
    • Follicle maturation, estrogen; Spermatogenesis
  8. β-Lipotropin- Adipose cells
    • Fat breakdown and release of fatty acids
  9. β-Endorphins- Brain and spinal cord
    • Analgesia; Body temperature
29
Q

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

A
  1. Acromegaly (hyperpituitarism)
    • Increased release of GH- typically tumor of pituitary​
  2. Hypopituitarism (dwarfism, non-genetic)​
    • Decreased secretion by anterior pituitary,
    • may see partial/total failure of
      • ACTS,
      • TSH,
      • LS,
      • FSH,
      • HGH,
      • prolactin​
30
Q

Acromegaly: what is it?

List 6 clinical presentations of Acromegaly

Can it be treated?

A

Increased release of GH- typically tumor of pituitary

  1. Gigantism or head, face, jaw, hands and feet
  2. Joint stiffness, CTS in ~50% of patients
  3. Amenorrhea, diabetes, profuse sweating and hypertension
  4. Back pain, large osteophytes along the anterior longitudinal ligament
  5. DISH – diffuse idiopathic skeletal hyperostosis
  6. Increased mortality linked to uncontrolled GH; if diagnosed early, can be treated
31
Q

What is hypopituitarism? (list 6 affected hormones)

Other names?

Common/rare?

Clinical picture (include 4 specifics)

A

Hypopituitarism (dwarfism, non-genetic)​

  • Decreased secretion by anterior pituitary,
  • may see partial/total failure of
    1. ACTS,
    2. TSH,
    3. LS,
    4. FSH,
    5. HGH,
    6. prolactin​

Usually rare​

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

  • ​May see
    1. weakness,
    2. lethargy,
    3. anemia,
    4. orthostatic hypotension ​
32
Q

What are the clinical manifestations of Hypopituitarism? (tons from book)

A
  • GH deficiency
    1. short stature
    2. delayed growth and
    3. delayed puberty
  • Adrenocortical Insufficiency
    1. Hypoglycemia
    2. Anorexia
    3. Nausea
    4. Abdominal Pain
    5. Orthostatic Hypotension
  • Hypothyroidism
    1. Tiredness
    2. Lethargy
    3. Sensitivity to cold
    4. Menstrual Disturbances
  • Gonadal Failure
    1. Secondary Amenorrhea
    2. Impotence
    3. Infertility
    4. decreased libido
    5. absent secondary sex characteristics (children)
  • Neurologic Signs (produced by tumor)
    1. Headache
    2. bilateral temporal hemianopia
    3. loss of visual acuity blindness
33
Q

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

A

True

34
Q

What are the 2 hormones that Posterior Pituitary Releases?

A

ADH (antidiuretic hormone)

​Oxytocin​

35
Q

What does ADH do?

What stimulates it?

A

Decreases urine output by retaining fluid in distal tubules

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

36
Q

What does Oxytocin do? (2)

A
  1. Uterine contraction and breast milk ejection​
  2. Stimulate postpartum uterine contraction to prevent excessive bleeding​​
37
Q

Name two medical conditions caused by malfunction of the Posterior Pituitary

A
  1. Diabetes Insipidus
  2. Syndrome of Inappropriate Secretion of ADH (SIADH)​
38
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​​

39
Q

Describe the clinical presentation of DI (include 7 specific symptoms)

A

Increased urination and dehydration​

  1. Polyuria,
  2. polydipsia,
  3. dehydration,
  4. nocturia,
  5. fatigue,
  6. irritability,
  7. high sodium in body​

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

40
Q

What is the most common type of DI?

What might cause it? (5-7)

A

Central DI, most common –

  • may be idiopathic or
  • secondary to
    1. head trauma,
    2. infection,
    3. vascular lesion,
    4. autoimmune dysfunction,
    5. genetic​
41
Q

What is another type of DI (besides central DI)?

what might cause it? (5)

A

Nephrogenic DI –

  1. medications, such as psychotropics - seizure medication (may turn off ADH)
  2. corticosteroids (may reduce ADH)
  3. alcohol,
  4. electrolyte imbalance,
  5. diseases of renal system​
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? (most common and 3 others)

A

Most common in oat cell carcinoma (80%),

or may be caused by

  1. pituitary trauma,
  2. infection,
  3. 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

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)? (2 principles, 8 specific symptoms)

What is a common restriction for these pts?

A
  • Neurologic/neuromuscular signs predominate​
  • Decreased urination or marked retention of fluid​
    1. HA,
    2. confusion,
    3. lethargy,
    4. decreased urine with low sodium,
    5. seizures,
    6. muscle cramps,
    7. vomiting, diarrhea,
    8. 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? (3)

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​
48
Q

What should we know about Spondyloarthropathy and osteoarthritis?

A

It may be associated with an underlying endocrine disorder

  1. 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

49
Q

What should we know about Chrondrocalcinosis?

A

It is possibly associated with an underlying endocrine disease. It is also called pseudogout sometimes.

  1. Chondrocalcinosis (deposit of calcium salts)
    • Pseudogout – gout-like symptoms
      • 5-10% of people with this disorder have underlying endocrine disease
50
Q

What should we know about Hand stiffness and pain, often with CTS and flexor tenosynovitis?

A

Hand stiffness and pain, often with CTS and flexor tenosynovitis could be associated with underlying endocrine disorder.

51
Q

ACTH:

  • what does it stand for?
  • What is its target tissue?
  • What hormones are it associated with?
A

ACTH = AdrenoCorticoTropic Hormone

affects adrenal gland

Associated with Cortisol and androgenic steroids

52
Q

MSH:

  • what does it stand for?
  • What hormones does it affect?
  • What is the result?
A

Melanocyte-stimulating hormone (MSH)

Melanin and lipotropin release; makes skin darker

53
Q

GH:

  • what does it stand for?
  • What tissues does it primarily affect (3)
  • What does it regulate? (3)
A

GH- affects muscle, bone and liver

Regulates

  1. growth,
  2. fat metabolism;
  3. in liver produces IGF’s that act like insulin hence insulin like growth factors
54
Q

Prolactin:

  • What is its target tissue?
  • What does it do?
A

Prolactin- affects breasts

Milk production

55
Q

TSH:

  • What is its target tissue?
  • What 2 things does it do?
A

TSH- affects thyroid gland

Increase thyroid hormone and Iodine uptake

56
Q

LH:

  • What does it stand for?
  • What are its target tissues?
  • What does it do? (4)
A

LH- Luteinizing Hormone

tissues: Ovarian (ovaries) and Leydig (testicles) cells

Affects

  • Ovulation and
  • progesterone;
  • Spermatogenesis,
  • testosterone
57
Q

FSH:

  • What does it stand for?
  • Target tissue?
  • Function? (3)
A

FSH- Follicle Stimulating Hormone

Target: Ovarian and Leydig (testes) cells

Function:

  • Follicle maturation,
  • estrogen;
  • Spermatogenesis
58
Q

β-Lipotropin:

  • Target Tissue
  • Function
A

β-Lipotropin-

  • Target tisue: Adipose cells
  • Fat breakdown and release of fatty acids
59
Q

β-Endorphins:

  • target tissue
  • function: (2)
A

β-Endorphins-

  • Target: Brain and spinal cord
  • Function: Analgesia; Body temperature

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