Week 11- Screening for Endocrine and Metabolic Disease

Question 1

PART 1

Answer 1

PART 1

Question 2

What is the endocrine system?

Answer 2

Ductless glands that produce hormones.

Question 3

What are the (5) things that the endocrine system regulates?

Answer 3

• Metabolism
• Water/salt balance
• BP
• Stress response
• Sexual reproduction

Question 4

Endocrine System:

• Complex and integral interactions with the ___________. (______ response from endocrine system compared to nervous system)
• _________ mechanisms exist to keep hormones at normal levels.

Answer 4

• nervous system (slower)

- feedback mechanisms

Question 5

What are the organs of the endocrine system? (9)

Answer 5

• Hypothalamus
• Pineal Gland
• Pituitary Gland
• Thyroid Gland
• Parathyroid Glands
• Thymus
• Adrenal Glands
• Pancreas
• Testes/Ovaries

Question 6

Endocrine Pathophysiology:

• Disorder can be classified as ________ or _________. Describe each.
• Results in either ________ or ________ secretion of hormones.

Answer 6

• primary (dysfunction of gland itself) or secondary (dysfunction of an outside stimulus to gland)
• excessive or insufficient

Question 7

Endocrine/Metabolic Disease S/Sx. (5)

Answer 7

1. ) Muscle Weakness/Myalgia, and Fatigue
2. ) Bilateral Carpal Tunnel Syndrome
3. ) Periarthritis and Calcific Tendonitis
4. )Spondyloarthropathy and OA
5. ) Hand Stiffness/Pain

Question 8

1. ) Muscle Weakness, Myalgia, and Fatigue can be ______ manifestation of endocrine/metabolic disease. Is it always restored after treatment of underlying condition?
2. ) Bilateral Carpal Tunnel Syndrome can be due to a thickening of _________ _________ __________.
3. ) Periarthritis and Calcific Tendonitis most often occurs in the __________ in patients with endocrine disease.
4. ) Spondyloarthropathy and OA occurs in individuals with various __________/_________ diseases.
5. ) Hand stiffness/pain can occur due to _______ __________.

Answer 8

1. ) early manifestation, NO
2. ) transverse carpal ligament
3. ) shoulders
4. ) metabolic/endocrine
5. ) flexor tenosynovitis

Question 9

What is done if a cluster of S/Sx are found associated with endocrine disorder?

Answer 9

Endocrine ROS

Question 10

PART 2: ENDOCRINE PATHOLOGIES

Answer 10

PART 2: ENDOCRINE PATHOLOGIES

Question 11

List some endocrine pathologies. (6)

Answer 11

Pituitary
-Acromegaly

Adrenal Glands

• Addison’s Disease
• Cushing’s Syndrome

Thyroid Gland

• Hyperthyroidism/Grave’s Disease
• Hypothyroidism

Pancreas
-DM

Question 12

What disease(s) are associated with the pituitary gland?

Answer 12

-Acromegaly

Question 13

Acromegaly:

• What is acromegaly?
• What areas of the body does it most commonly affect?
• Occurs in adults usually due to what?

Answer 13

• HYPERSECRETION of GROWTH HORMONE (GH) resulting in abnormal enlargement of the extremities of the skeleton.
• Face, jaw, hands, and feet
• Pituitary gland tumor

Question 14

Acromegaly S/Sx. (9)

Answer 14

• Bony enlargement (face, jaw, hands, feet)***
• Carpal tunnel***
• Hand pain/stiffness***
• Myopathy and poor exercise tolerance***
• Degenerative arthropathy (large joints)***
• Amenorrhea
• DM
• Profuse sweating
• HTN

Question 15

What disease(s) are associated with the adrenal glands?

Answer 15

• Addison’s Disease

- Cushing’s Syndrome

Question 16

What is the difference between Addison’s Disease and Cushing’s Syndrome?

Answer 16

• Addison’s Disease = Adrenal INSUFFICIENCY (hyposecretion of adrenal gland)
• Cushing’s Syndrome = Adrenal OVERSUFFICIENCY (hypersecretion of CORTISOL by the adrenal cortex.

Question 17

What are the effects of cortisol on connective tissue? (3)

Answer 17

1. ) Poor wound healing
2. ) Generalized muscle weakness/wasting
3. ) Osteoporosis

Question 18

Cortisol suppresses the inflammatory response of the body, what does this mean?

Answer 18

-Early signs of infection may not be present. (Any unexplained fever without other symptoms should warrant MD referral)

Question 19

Addison’s Disease S/Sx. (10)

Answer 19

• Dark pigmentation of the skin, especially mouth and scars***
• Progressive fatigue (improves with rest)***
• Hyperkalemia (results in generalized weakness and muscle flaccidity)***
• Arthralgias, myalgias (secondary only)***
• Tendon calcification***
• Hypotension
• GI disturbances
• Anorexia and weight loss
• N/V
• Hypoglycemia

Question 20

Cushing’s Syndrome S/Sx. (10)

Answer 20

• “Moonface” appearance***
• Buffalo hump***
• Protuberant abdomen w/ accumulation of fatty tissue and stretch marks***
• Muscle wasting and weakness, thin extremities***
• Decreased bone density, kyphosi, and back pain***
• HTN
• Easy bruising and slow wound healing
• Psychiatric and/or emotional disturbance
• Impaired reproductive function; masculinizing effects
• DM

Question 21

What disease(s) are associated with the thyroid gland?

Answer 21

• Hyperthyroidism/Grave’s Disease

- Hypothyroidism

Question 22

Hyperthyroidism:

• Disorder in which the thyroid secretes excessive amounts of ________ hormone.
• Results in generalized ________ in body metabolism affecting every system in the body.
• What are some MSK implications of Hyperthyroidism/Grave’s Disease? (3)

Answer 22

• thyroid hormone
• elevation in body metabolism
• Periarthritis (most common in SHOULDER, can progress to ADHESIVE CAPSULITIS), Acute calcific tendonitis of the wrists, PROXIMAL muscle weakness and myopathy (pelvic girdle/thigh)

Question 23

Hyperthyroidism S/Sx. (7)

Answer 23

• Exophthalmos***
• Enlarged thyroid
• Tachycardia
• Weight loss
• Diarrhea
• Warm skin, sweaty palms
• Hyperreflexia

Question 24

Hypothyroidism:

• Disorder in which the thyroid has under production of _______ hormone.
• Results in generalized _________ of body metabolism.
• Are men or women more likely to have hypothyroidism?
• What are (2) other things hypothyroidism can result in?

Answer 24

• thyroid hormone
• depression in body metabolism
• women (10x more likely)
• Carpal Tunnel Syndrome (usually bilateral), Proximal muscle weakness

Question 25

Hypothyroidism S/Sx. (8)

Answer 25

- Excessive fatigue and drowsiness - Dry skin, ichthyosis - Thin and brittle hair and nails - Hoarseness and thick, slurred speech - Weight gain - Headaches - Cold intolerance - Edema of the extremities

Question 26

Thyroid Storm: - Is it associated with hyperthyroidism or hypothyroidism? - What is it? - What are the (3) main precipitating factors?

Answer 26

- Hyperthyroidism (Grave's Disease) - Rare, life threatening complication of hyperthyroidism that can present when the disease is untreated or the disease is incorrectly treated. - TRAUMA, INFECTION, SURGERY

Question 27

Thyroid Storm S/Sx. (8)

Answer 27

- Severe tachycardia with HF - Shock - Hyperthermia (up to 105.3 degrees) - Restlessness - Agitation - Abdominal pain - N/V - Coma

Question 28

What disease(s) are associated with the pancreas?

Answer 28

-Diabetes Mellitus

Question 29

Diabetes Mellitus (DM): - Deficient or defective _______ action in the body. - Characterized by ______glycemia. - What is the difference between Type I and Type II?

Answer 29

- deficient of defective INSULIN action - hyperglycemia - Type I (little/no insulin produced in pancreas), Type II (defective insulin and/or impaired cell receptor binding of insulin)

Question 30

How is DM diagnosed?

Answer 30

1. ) Two different days of fasting blood glucose levels at >126mg/dL 2. ) Values >100mg/dL are considered “pre-diabetic”

Question 31

PT can offer clients with pre-diabetes or diabetes education regarding ___________ and _________ as a means of lowering their risk of diabetes or reducing the risk of complications from diabetes.

Answer 31

physical activity and exercise

Question 32

- What specific drugs have a contribution to hyperglycemia due to their glucogenic effect? - Otherwise controlled diabetes can become uncontrolled during times of ________.

Answer 32

- Corticosteroids (also epinephrine, glucocorticoids, and growth hormone) - Stress (surgery, trauma, pregnancy, puberty, or infectious states)

Question 33

Diabetes Mellitus S/Sx. (4)

Answer 33

- Xanthomas (fat buildup under skin)*** - Numbness/tingling in hands and feet*** - Wounds that are slow to heal*** - Fatigue and weakness

Question 34

What are some physical complications of DM? (5)

Answer 34

- Impaired wound healing/infection*** - Neuropathy (diabetic neuropathy, carpal tunnel, Charcot's)*** - Periarthritis*** - Hand stiffness (limited joint mobility syndrome, flexor tenosynovitis, Dupuytren's contracture, complex regional pain syndrome)*** - Atherosclerosis

Question 35

Diabetic Neuropathy: - What is the most common chronic complication of long-term DM? - Caused by decreased ________ _________ to nerve tissue. - What nervous system does it affect first? - How does peripheral sensory neuropathy present? - How does peripheral motor neuropathy present?

Answer 35

- Diabetic Neuropathy - vascular perfusion - PNS - Burning/itching/numbness/sensitivity in the FEET and HANDS (stocking/glove syndrome) - Weakness, atrophy, and foot drop resulting in decreased balance and absence of DTRs.

Question 36

Diabetic Neuropathy: - Can also result in Charcot joints. What is this? - Results in _____, _______ and _____ disorders. - Increases the likelihood of _________ development.

Answer 36

- Loss of proprioception and sensation predisposing joints to repeated trauma and progressive joint destruction. - hand, shoulder, and foot disorders - ulceration development

Question 37

Periarthritis: - What is it? - Does it regress, stay stable, or progress? - Higher incidence in ________ _________.

Answer 37

- Inflammation of the structures around a joint. - May regress, remain stable, or progress spontaneously. - Adhesive Capsulitis

Question 38

Hand Stiffness: - Syndrome of limited joint mobility (SLJM or LJM) is painless stiffness and limitation of the _____ joints. Results in development of _______ contractures. - Stiff hand syndrome is seen more frequently in Type __ DM and those with poorly controlled blood glucose. Paresthesia progressing to pain, subcutaneous tissue changes.

Answer 38

- finger joints, flexion contractures | - Type I

Question 39

Flexor Tenosynovitis: - What is it? - Results in formation of _________.

Answer 39

- Accumulation of excessive dermal collagen in the tendon sheath. - nodules

Question 40

Dupuytren's Contracture: - What is it? - Strong association with ____. - Usually involves ____/____ digits. - Presentation of _____ and decreased _____.

Answer 40

- Characterized by formation of flexion contracture and thickening band of palmar fascia. - DM - 3rd/4th - pain and decreased ROM

Question 41

Chronic Regional Pain Syndrome: - May develop in patients with DM in the _____ or _____. - Does it get better or worse over time?

Answer 41

- hands or feet | - Can spontaneously improve or result in permanent loss of function.

Question 42

PT Role In Screening For DM. (7)

Answer 42

- Assess for neuropathy - Assess for signs of neuropathic arthropathy - Monitor for signs/symptoms of changes in blood glucose levels during exercise - Monitor vital signs - Conduct periodic lower extremity vascular examination - Screen for depression - Encourage regular screenings with other disciplines

Question 43

DM Exercise Related Considerations: - Blood glucose >____mg/dL = hold exercise - Blood glucose

Answer 43

- >250 = hold exercise | - <100 = eat snack before exercise

Question 44

- ____________ is a severe insulin deficiency resulting in severe hyperglycemia caused by undiagnosed DM or situation where insulin need becomes greater than usual. - It is more common with Type I or II?

Answer 44

- Diabetic Ketoacidosis (DKA) | - DM Type I

Question 45

DKA S/Sx. (13)

Answer 45

- Fruity Breath*** - Gradual onset - Thirst - Hyperventilation - Lethargy/confusion - Coma - Muscle/abdominal cramps - Polyuria/dehydration - Flushed face - Hot/dry skin - Elevated temperatures - Blood glucose >300mg/dL - Serum pH <7.3

Question 46

-Hypoglycemia = blood sugar

Answer 46

- <70mg/dL | - Treated via sugar administration (10-15g)

Question 47

Hypoglycemia S/Sx. (13)

Answer 47

Sympathetic Activity - Pallor - Perspiration - Irritability/nervousness - Weakness - Hunger - Shakiness CNS Activity - HA - Double/blurred vision - Slurred speech - Fatigue - Numbness of lips/tongues - Confusion - Convulsion/coma

Question 48

DM Key Points: - Clients taking __________ medication must be monitored for changes in blood glucose levels. - ________ must be carefully planned because significant complications can result from strenuous exercise. - Insulin requirements often _______ for clients under physical, emotional, or physiological stress. Symptoms may present even though diabetes normally controlled.

Answer 48

- corticosteroid - exercise - increase

Question 49

PART 3: METABOLIC DISEASE

Answer 49

PART 3: METABOLIC DISEASE

Question 50

What are the 2 main metabolic pathologies?

Answer 50

- Gout | - Osteoporosis

Question 51

Gout: - What is it? - What joint is affected first 90% of the time? - When should a PT refer anyone being treated for gout?

Answer 51

- TINY URIC ACID CRYSTALS forming that collects in the joints, triggering a PAINFUL INFLAMMATORY RESPONSE. - first MTP 90% - Therapist should refer anyone being treated for gout who has recurrent symptoms.

Question 52

Gout S/Sx. (5)

Answer 52

- Joint pain and swelling (esp 1st MTP)*** - Redness*** - Fever/chills - Malaise - Tophi

Question 53

Osteoporosis: - What is it? - Postmenopausal osteoporosis particularly involves the ________. - What may be the only (2) early signs of osteoporosis? - What are the (3) cardinal signs of established osteoporosis?

Answer 53

- Decreased mass per unit of normally mineralized bone compared with age- and gender-matched controls. - vertebrae - mild-severe back pain and loss of height - bone fracture, pain, and deformity

Question 54

Osteoporosis Risk Factors: - Caucasian or Asian ___________ - ___________ (older than 65) - Early or surgically induced ____________ - Family Hx of _________ or ________ - _________ habits including smoking, excessive alcohol, inadequate Ca+, and little-no WB exercise - Prolonged exposure to what medications? - Thin-small frame - Chronic disease that affects the kidneys, lungs, stomach, and intestines

Answer 54

- females - postmenopause - menopause - osteoporosis or fractures - lifestyle habits

Question 55

Osteoporosis S/Sx. (4)

Answer 55

- Back Pain (episodic, acute LBP)*** - Compression Fx of spine*** - Decreased height*** - Severe kyphosis, Dowager's hump*** - Bone Fx

Question 56

What are some clues to recognize osteoporosis? (5)

Answer 56

- Severe, localized pain to Fx site. - Aggravating factors: prolonged sitting/standing/bending, Valsalva. - Not accompanied by sciatic or nerve root impingement pain. - Rib/spinal deformity, Dowager's hump - Loss of height

Question 57

Patient is at increased risk for osteoporosis if they answer "Yes" to ________ questions on the Osteoporosis Screening Evaluation.

Answer 57

-3 or more

Question 58

Vertebral Compression Fracture: - Back pain with highest incidence at levels __-__ and __-__. - What position relieves symptoms? - What aggravates symptoms? - May note _______ thoracic kyphosis. - Describe common MOI?

Answer 58

- T7-T8 and T12-L1 - lying in supine - standing/walking, TTP - increased - MOI: Typically secondary to trauma, can be as simple as sneezing.

Question 59

Vertebral Compression Fracture Nonmodifiable Risk Factors. (7)

Answer 59

- Advanced age - Female - Caucasian - Presence of dementia - Susceptibility to falling - Hx of fracture in adulthood - Hx of fracture in a 1st degree relative

Question 60

Vertebral Compression Fracture Modifiable Risk Factors. (8)

Answer 60

- Alcohol/tobacco use - Presence of osteoporosis and/or estrogen deficiency - Early menopause - Frailty - Impaired eye-sight - Insufficient physical activity - Low BW - Ca+ and/or Vitamin D deficiency

Question 61

PMH Clues to Screen for Endocrine/Metabolic Disease. (5)

Answer 61

- Previously diagnosed endocrine/metabolic disorder. - Bilateral carpal tunnel syndrome. - Proximal muscle weakness. - Periarthritis of shoulders. - Long term corticosteroid use.

Question 62

Guidelines for immediate medical attention with diabetes?

Answer 62

confusion, lethargy, changed mental function, profuse sweating, signs of DKA

Question 63

Guidelines for Physician Referral: - Presence of multiple eruptive _________ on anyone with DM. - Signs of fluid loss/dehydration in anyone taking _________. - Recurrent arthritic symptoms in client with _____ who is already taking urate-lowering drugs. - Any episode or suspected episode of ______glycema.

Answer 63

- zanthomas - diuretics - gout - hypoglycemia