Endocrine System & Physical Therapy

• Learning outcomes include being able to describe the anatomy and function of the glands of the endocrine system, understand specific endocrine dysfunction, recognize endocrine disorder signs, symptoms, and their impact on physical therapy intervention.

Endocrine Overview

• The endocrine system comprises numerous glands that synthesize hormones.
• Hormones travel through the body via the bloodstream to their target organ where they affect function.
• The endocrine system facilitates development of the reproductive system and CNS in the fetus, Growth and development during childhood, coordination of the reproductive system as well as maintaining the internal environment and responding to emergency situations.
• Primary function is the secretion of hormones.
• Glands include the pituitary, thyroid, parathyroid, adrenal, pancreas, pineal, thymus, and ovaries/testes.

Endocrine Dysfunction

• Dysfunction causes alterations in the musculoskeletal system because the endocrine system regulates growth and development.
• Dysfunction results from hyperfunction or hypofunction.

Neuroendocrine Response to Stress

• The immune and endocrine systems are intimately related.
• Stress increases activation of the sympathetic nervous system and causes the adrenal gland to release catecholamines.
• Stress cause the pituitary gland to release ADH, prolactin, GH and ACTH.
• Exercise, emotional stress, and changes in body temperature can affect the neuroendocrine response.
• Catecholamines include epinephrine, norepinephrine and dopamine and can increase HR and strength, cause peripheral vasoconstriction, elevate BP, increase blood glucose and stimulate the breakdown of fats.
• Cortisol released from the adrenal cortex regulates proteins, carbohydrates, and lipids to increase blood glucose.
• Cortisol inhibits fibroblast proliferation.
• Poor wound healing and an increased risk of infection are some of the detriments associated with increased glucocorticoid levels.
• Cortisol can help the body with "fight or flight" and it reduces inflammation.

Musculoskeletal Signs & Symptoms of Endocrine Disease

• Proximal muscle weakness occurs without pain.
• Hand ROM deficits or hand contractures can occur.
• Carpal Tunnel may results from an increased fluid volume.
• The carpal tunnel condition is often bilateral, whereas overuse injuries tend to be unilateral.
• Establish a differential diagnosis to determine if the presenting issue is within the scope of PT practice.

Pituitary Gland

• The pituitary gland which has anterior and posterior lobes is a master gland.
• The anterior lobe (adenohypophysis) secretes ACTH, TSH, LH, FSH, HGH and Prolactin.
• The Posterior Lobe (neurohypophysis) stores ADH and oxytocin.

Pituitary Tumors (Adenomas)

• Signs and symptoms of these tumors include headaches, visual disturbances, and endocrine abnormalities.
• Headaches are often characterized by increased ICP and decreased drainage from the 3rd ventricle.
• Visual disturbances include optic chiasm and bilateral temporal hemianopsia.

Anterior Pituitary Gland Disorders

• An endocrine disorder is considered a hyperpituitarism if there's an over secretion of at least one hormone.
• HGH can lead to Acromegaly in adults.
• Acromegaly stems from usually benign tumors, excessive growth, overgrowth of long bones, hypertrophy of soft tissues, and widened joint spaces.
• Children can grow to over 7 feet with hyperpituitarism.
• Adult hyperpituitarism (30-50yo) - increased size of jaw bones and hands/feet.
• ACTH leads to Cushing's disease, which stems from an adenoma or exposure to glucocorticoids.
• Women are more prone to Cushing's disease with a rate of :1, usually within childbearing years.
• Obesity and glucose intolerance are side affects of Cushing's disease.
• Easy bruising and abdominal striae occur commonly.
• Prolactin can additionally result from hyperpituitarism.
• Hyperpituitarism medical/surgical treatment includes surgery, radiation, or with medications to decrease or stunt hormone production.
• Physical therapy implications for hyperpituitarism includes ambulation/exercise which is encouraged 24 hours post-op.
• Changes in consciousness/vision, pulse, and BP may be indicative of increased ICP, this must be reported.

HYPOPituitarism

• Reduced section of anterior lobe ( >70%)
• Can be a congenital or acquired etiology with Tumors, destruction of pituitary gland, postpartum hemorrhage, Anorexia, Anemia, and GI dysfunction being risk factors.
• Gradual Onset of symptoms should be anticipated.
• HGH stimulates liver to produce insulin-like growth factors that stimulate tissue.
• Decreased HGH (somatotropin) can lead to decreased growth and delayed puberty.
• GH stimulates cartilage growth.
• LH/FSH can lead to sexual/reproductive disorders.
• Fatigue, muscle weakness, weight loss, poor appetite, joint stiffness, low blood pressure, headaches, erectile dysfunction, and children with delayed growth/poor growth can be attributed to hypopituitarism.
• HGH deficiency at birth results in normal birth length, but a drop off in height may develop.
• Normal intelligence, obesity, delayed skeletal maturation and puberty and a short stature all result from a congenital HGH deficiency.
• HGH replacement therapy in the form of daily shots or therapies are taken during growth periods.
• Acquired HGH deficiencies are from a current or previous tumor, it may result in cardiac disease, central adiposity, insulin resistance, and a poor lipid profile.
• Gonadotropin deficiency includes Amenorrhea, breast atrophy, testicular atrophy, diminished libido, minimal pubic and axillary hair, hypothermia, hypotension and hypoglycemia.,
• Hypopituitary disorders need bloodwork and MRIs of the pituitarys
• Radiographs of children's hands are sometimes needed to determine growth.
• Hypopituitary disease requires the removal of causative factor and hormone replacement therapy.
• May observe weakness, fatigue, lethargy, apathy and orthostatic hypotension. Prevent infections, impaired vision may occur (bilateral hemianopia).

Posterior Pituitary Lode Disorders

• Rare: Caused by damage to Hypothalamus
• Anti- diuretic hormone (ADH) deficiency: Kidneys don't reabsorb enough water
• Treatment is replacement of ADH with medication.
• Increased secretion of ADH leads to a syndrome of inappropriate anti diuretic hormone Section(SIADH) which stems from infections, trauma, tumor, medications and can result in increased water retention
• Hyponatremia can result form lethargy, weakness or coma.
• SIADH - Confusion, seizures, coma stem from Hyponatremia or brain swelling.
• Treatments include the correction of the sodium levels, surgery, radiation as well as restricting fluid intake and taking diuretics.

Thyroid gland

• Located inferior to larynx, the Secretes thyroxine T4 ,Triiodothyronine – T3, Calcitonin.
• The thyroid regulates basal metabolism, Promotes growth and development, Mobilizes Fat, and Exchanges electrolytes and proteins.
• More common in women (4:1) and persons with a family history it can effect Nails Haits, Eyes GI track, Lungs, Heart Nervous tissue, Bones and Muscles.

Hyperthyroidism

• The autoimmune disease Graves' causes enlargement of the thyroid and increased secretions.
• In these cases body metabolism and sympathetic nervous system activity increase as well.
• 85 % cases are accounted for in here.
• Hyperthyroidism can cause Exophthalmos (eye protrusion)
• Periarthritis, Calcification and proximal muscle weakness can result from hyperthyroidism
• Hyperthyroidism is the result of exercise intolerance and reduction of exercise capacity
• Diagnosis includes examining TSH, and noting elevation of radioactive iodine intake

Hypothyroidism

• Causes reduction of thyroid hormones which slow Metabolism.
• Autoimmune – Hashimoto's Thyroiditis, Surgery is a risk factor.
• More prevalent in women in the ages of 30-60 years.
• Decreased Gl Tract Mobilty and weight gain can result increased cholesterol and triglycerides, anemia.
• The effect of hypothyroid on the musculoskeletal system is, proximal hip weakness, joint stiffness, joint edema, and carpal tunnel T3,T4 are normal, treatment for synthroid, and prognosis of untreated can lead to cardiac disease.

Thyroid Caner

• Usually slow growing
• More common in women of ages 20-60
• Can be the result of low iodine, radiation, exposure
• There is in a 97 % survival rate.

Parathyroid Gland

• Two glands on each lobe of thyroid
• Responsible for managing and secreting Calcium in the body
• Manages Vitamin D,

Hyperparathyroidism

• PTH is produced and causes.
• Usually brought on by hypercalcemia, resulting from benign tutors, renal failure, or even just vitamin d deficency
• increased activity of >1 parathyroid glands.
• More common in those over 60 years of age.
• Treatments includes. PTH measurement, electrolyte measurement, and the surgical removing of bones.

Hypoparathyroidism

• Decreased secretion of a parathyroid hormone.
• Results in hypocalcemia, increased Phosphate, and bone resorption
• Tetany is the result of of parathyroid is also a result.
• Systemic Effects CNS effects and musculoskeletal. Increased osteoclast activity, Treatment should start if electrolyte, can be reversed

Adrenal Gland

Located in each kidney composed outer cortex and inner medulla, these glands secret Catecholamines Adrenal cortex is normal functions, Mineralocorticoids, Glucocorticoids, and Androgens

Adrenal Medulla,

Secretes Epinephrine Increases heart rate Increases heart through contractility vasoconstriction.

Addison Disease and Physical Therapy

• Aquatic physical therapy is contraindicated for anyone with Addison disease.
• -Increase Cortisol, allow more blood vessels of body to require pressure, the adrenal gland is not a produced, regulation of temp body pressure down on the Heat/humidity body down.

Secondary Adrenal Insufficiency

• Tumors or rapid taper

Cushing Syndrome

• Increased Cortisol Levels Tumors often result high dose steroids acids, and that can leave fracture prone.

Questions about the endocrine system and its relationship to physical therapy, conditions, and potential malfunctions. Includes the 'fight or flight' response and traumatic brain injuries. Tests knowledge of glands contributing to muscle weakness.