Endocrine System Disorders 2025 PDF

Endocrine System DPT581 – Medical Management I Dr. Eric Pelletier Spring 2025 Learning objectives After today’s class, the students will be able to: 1. Describe the anatomy and function of the glands of the endocrine system. 2. Understand specific endocrine dysfunction and recognize the signs and...

Endocrine System DPT581 – Medical Management I Dr. Eric Pelletier Spring 2025 Learning objectives After today’s class, the students will be able to: 1. Describe the anatomy and function of the glands of the endocrine system. 2. Understand specific endocrine dysfunction and recognize the signs and symptoms patients may present to physical therapy with. 3. Recognize the endocrine disorder signs and symptoms and their impact on physical therapy intervention and how to avoid complications with plans of care. Endocrine Overview Comprised of numerous glands that synthesize hormones ○ Hormones travel through the body via the bloodstream to their target organ where they affect function The endocrine system is responsible for: ○ Development of the reproductive system and the CNS in the fetus ○ Growth and development during childhood/adolescence ○ Coordination of the reproductive systems ○ Maintenance of the internal environment ○ Response to emergency situations Endocrine Overview Primary Function ○ Secretion of Hormones GLANDS: ○ Pituitary ○ Thyroid ○ Parathyroid ○ Adrenal ○ Pancreas ○ Pineal ○ Thymus ○ Ovaries/Testes Endocrine System Overview From Goodman. Pathology: Implications for the Physical Therapist. 2021, p. 449 From Goodman. Pathology: Implications for the Physical Therapist. 2021, p. 449 From Goodman. Pathology: Implications for the Physical Therapist. 2021, p. 450 Endocrine Dysfunction Dysfunction causes alterations in the MS system, as the endocrine system regulates growth and development Results from: ○ HYPERfunction or ○ HYPOfunction Neuroendocrine Response to Stress Immune system and Endocrine system intimately related Stress increases activation of the sympathetic nervous system → ○ adrenal gland releases catecholamines ○ pituitary gland releases ADH (AntiDiuretic Hormone) Prolactin GH (Growth Hormone) ACTH (AdrenoCorticoTropic Hormone) From: https://www.diabetes.co.uk/stress-and-blood- glucose-levels.html Neuroendocrine Response to Stress (exercise, emotional stress, changes in body temperature) Catecholamines ○ Epinephrine ○ Norepinephrine ○ Dopamine Increase HR and strength (↑ Cardiac Output) Peripheral vasoconstriction Elevated BP Increased blood glucose Stimulates breakdown of fats From: https://www.express.co.uk/life- style/health/995779/high-blood-pressure-causes-stress- reading-raise-hypertension Neuroendocrine Response to Stress (exercise, emotional stress, changes in body temperature) Cortisol released from adrenal cortex ○ Regulates proteins, carbohydrates, lipids to increase blood glucose ○ Inhibits fibroblast proliferation: Poor wound healing Increased risk of infection in those with increased glucocorticoid in blood ○ Helps with fight or flight response ○ Reduces inflammation From: https://www.everydayhealth.com/cortisol/guide/ Goodman Figure 11-2, p. 451 Manifestations of Endocrine Disorders Musculoskeletal signs and symptoms of Endocrine Disease Proximal muscle weakness; painless Hand contractures/ROM deficits Carpal Tunnel (increased fluid volume) ○ Often Bilateral whereas overuse injuries are usually unilateral ○ Establish differential diagnosis to determine if the presenting issue is within the scope of PT http://www.totalhealthchiro.info/blog/thyroid-and-carpal- tunnel-syndrome-related/ practice PITUITARY GLAND DISORDERS  Pituitary Gland Master Gland Anterior Lobe (Adenohypophysis) Secretes: ○ ACTH (Adrenocorticotropic) ○ TSH (Thyroid Stimulating) ○ LH (Luteinizing) ○ FSH (Follicle Stimulating) ○ HGH (Human Growth) ○ Prolactin Posterior Lobe (Neurohypophysis) Stores: ○ ADH (AntiDiuretic) ○ Oxytocin https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/pituitary_center/conditions/ Pituitary Tumors (Adenomas) Signs/symptoms ○ Headaches Increased ICP Decreased drainage from 3rd ventricle ○ Visual disturbances Optic chiasm Bilateral temporal hemianopsia ○ Endocrine abnormalities https://www.cancer.org/cancer/pituitary- tumors/about/what-is-pituitary-tumor.html Pituitary Tumors (Adenomas) http://www.mayfieldclinic.com/PE-Pit.htm ANTERIOR PITUITARY GLAND DISORDERS Anterior Lobe Diseases: HYPERpituitarism Over secretion of at least one hormone HGH →acromegaly (adults) ○ Usually benign tumor Excessive growth Overgrowth of long bones Hypertrophy of soft tissues Widened joint spaces ○ Children – can grow to >7ft (often up to 9 feet) ○ Adults (30-50yrs)– increased size of jaw bones, hands/feet http://www.humanillnesses.com/original/ima ges/hdc_0001_0002_0_img0116.jpg http://www.faqs.org/health/images/uchr_01_img0062.jpg Anterior Lobe Diseases: HYPERpituitarism ACTH → Cushing’s disease ○ Often due to adenoma or ○ Muscle wasting exposure to glucocorticoids ○ Osteopenia ○ 5:1 women to men ○ Moon face ○ Childbearing years ○ Easy bruising ○ Obesity ○ Abdominal striae ○ Glucose intolerance ○ Acne  http://www.pediatriconcall.com/cg i_bin/cushings%20disease.jpg http://faculty.plattsburgh.edu/david.curry/images/cushing.jpeg Anterior Lobe Diseases: HYPERpituitarism Prolactin ○ amenorrhea, gynecomastia, lactation ○ Decreased libido, impotence https://www.icliniq.com/articles/pregnancy-and-trying- to-conceive/prolactin-deficiency HYPERpituitarism Medical/Surgical Treatment Benign tumors →surgery and/or radiation Medications to decrease or stunt hormone production HYPERpituitarism Physical Therapy Implications Ambulation/exercise encouraged 24 hours post-op Changes in consciousness/vision, pulse, BP may be indicative of increased ICP – report this Observe for meningitis (sx include HA, irritability, neck rigidity) HYPOPituitarism HYPOpituitarism Diminished secretion by anterior lobe (>70%) Congenital & acquired etiology: ○ Tumors ○ Destruction of pituitary gland by surgery, medications, radiation ○ Postpartum hemorrhage ○ Anorexia ○ Anemia ○ GI dysfunction Gradual Onset of symptoms and signs HYPOpituitarism HGH → stimulates liver to produce insulin-like growth factors that stimulate tissue HGH (somatotropin)→ decreased growth, delayed puberty ○ Cartilage growth stimulated by GH ○ Linear bone growth ○ Skeletal muscle ○ Connective tissue ○ Skin ○ Enhances fatty acid production for energy LH (Luteinizing Hormone)/FSH→ Sexual/reproductive disorders HYPOpituitarism – Signs and Symptoms Fatigue Muscle weakness Weight loss Poor appetite Joint stiffness Low blood pressure Headaches Erectile dysfunction Irregular menstruation Children – delayed growth/poor growth http://www.mayoclinic.com/health/hypopituitarism/DS00479/D SECTION=2 Congenital HGH deficiency Normal birth length Drop off height curve by 1-2 years of age ○ Normal intelligence ○ Obesity ○ Delayed skeletal maturation ○ Delayed puberty ○ Short HGH replacement therapy – daily shot or during growth periods Acquired HGH deficiency Tumor or treatment for tumor ? Increased cardiac disease Central adiposity Insulin resistance Poor lipid profile HYPOpituitary Disease: Gonadotropin deficiency Amenorrhea Breast atrophy Testicular atrophy Diminished libido Minimal pubic and axillary hair Hypothermia Hypotension Hypoglycemia HYPOPituitary Disorders: Tests & Measures Blood Work ○ Cortisol, prolactin, thyroxine TSH, testosterone, estrogen, LH/FSH, HGH MRI of hypothalamus/pituitary Radiographs of hands in children to determine growth HYPOpituitary Disease Medical Treatment Removal of causative factor (i.e. surgical removal of tumor) Hormone replacement therapy - lifelong Steroids to replace adrenal hormones Synthroid to correct for loss of TSH Sex hormones Growth hormones HYPOpituitarism – Implications for Physical Therapy May observe: ○ Weakness ○ Fatigue ○ Lethargy ○ Apathy ○ Orthostatic hypotension Prevent infections Impaired vision may occur (bilateral hemianopia) POSTERIOR PITUITARY LOBE DISORDERS Posterior Lobe: Diabetes Insipidus Rare; Caused by damage to hypothalamus or posterior pituitary Antidiuretic hormone (ADH) deficiency ○ Kidneys don’t reabsorb enough water Copious diluted urine Dehydration, dizziness, fatigue, polydipsia (increased thirst) Treatment: replacement of ADH with meds Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Increased secretion of ADH Caused by infections, trauma, tumor, medications Increased water retention ○ Hyponatremia ( sodium in blood) lethargy, weakness, coma SIADH Confusion, seizures, coma ○ Hyponatremia, brain swelling Treatment ○ Correct sodium balance ○ Surgery, chemotherapy, radiation if tumor ○ Restriction of fluid intake ○ Diuretics THYROID GLAND Thyroid Gland https://www.endocrineweb.com/conditions/thyroid-nodules/thyroid-gland- controls-bodys-metabolism-how-it-works-symptoms-hyperthyroi Thyroid Gland Located inferior to larynx Secretes: ○ Thyroxine –T4 ○ Triiodothyronine – T3 ○ Calcitonin Actions: ○ Regulates basal metabolism ○ Promotes growth and development ○ Mobilizes fat ○ Exchange of electrolytes, protein https://www.merckmanuals.com/home/hormonal-and- metabolic-disorders/thyroid-gland-disorders/overview-of- the-thyroid-gland Thyroid Disorders More common in women (4:1) and persons with a family history Affects many body systems ○ Nails ○ Hair ○ Eyes ○ GI tract ○ Lungs ○ Heart ○ Nervous tissue ○ Bones ○ Muscles HYPERthyroidism Graves Disease ○ Autoimmune disease Autoantibodies → cause enlargement of thyroid and increased secretions Increases: body metabolism sympathetic nervous system activity ○ Accounts for 85% cases of hyperthyroidism ○ Increased T4 production ○ Typically occurs between 20-40 years of age ○ Predominantly seen in women (4:1) ○ Can occur during pregnancy HYPERthyroidism – Signs & Symptoms ▪ Increased size of thyroid (goiter) ▪ Heat intolerance ▪ Weight loss ▪ Sweating ▪ Tremor ▪ Tachycardia ▪ Irritability ▪ Poor concentration ▪ Diarrhea ▪ Mood swings ▪ Exophthalmos (eye protrusion) roncevic.rs http://www.drdavidf.com/images/goiter.jpg myhousecallmd.com HYPERthyroidism – MS Signs & Symptoms Periarthritis ○ Tendons, ligaments, joint capsule ○ Decreased ROM ○ Pain Calcification in joints ○ Limitation in ROM ○ “hard end-feel” Proximal muscle weakness Decreased coordination HYPERthyroidism Diagnosis ○ Decreased or normal TSH ○ T3, T4 elevation ○ Increased radioactive iodine uptake Treatment ○ 30% go into remission w/o treatment ○ Medication to inhibit synthesis ○ Radioactive iodine (RAI) Followed by thyroid medication because the RAI treatment causes HYPOthyroidism ○ Surgery HYPERthyroidism and Physical Therapy Hyperthyroidism and exercise: ○ Hyperthyroidism associated with exercise intolerance and reduced exercise capacity Exact relationship is unknown. ○ Proximal muscle weakness with accompanying myopathy is characteristic in individuals with Graves disease and may affect exercise capability. ○ Thyrotoxicosis can do the following: Aggravate preexisting heart disease. Lead to atrial fibrillation, congestive heart failure, and worsening angina pectoris. Increase the risk for myocardial infarction. HYPOThyroidism HYPOthyroidism Decreased thyroid hormones ○ Slows metabolism Causes ○ Autoimmune – Hashimoto’s Thyroiditis ○ Surgery that effects thyroid ○ Overmedicated for hyperthyroid disease ○ Diet ○ Congenital More prevalent in women 30-60 years HYPOthyroidism Type I – hormone deficient ○ Caused by loss of thyroid tissue Type II – hormone resistant ○ Failure of pituitary synthesizing adequate TSH HYPOthyroidism Pathology ○ Destruction of thyroid tissue→ decreased secretion of thyroid hormone→ increased secretion of TSH from anterior pituitary HYPOthyroidism Slowed metabolism ○ Decreased GI tract mobility and weight gain Bradycardia Slowed neurological functioning ○ Slow speech ○ Decreased short term memory Increased sleep Headache Cerebellar ataxia Mood changes Increased cholesterol and triglycerides Anemia HYPOthyroidism Musculoskeletal Effects ○ Proximal hip weakness ○ Myalgia ○ Stiffness in small joints ○ Paresthesia without objective findings ○ Joint edema ○ Increased bone density ○ Carpal tunnel HYPOthyroidism Diagnosis ○ TSH elevated ○ T3 normal ○ T4 decreased ○ CPK-MB elevated (cardiac muscle) Treatment ○ Synthetic thyroid hormones (Synthroid) Prognosis ○ Untreated can have severe CAD Increased triglycerides and cholesterol HYPOthyroidism and Physical Therapy Correlation between hypothyroidism and fibromyalgia syndrome (FMS) continues to be investigated. Thyroid dysfunction is seen at least three times more often in women with rheumatoid arthritis. Increased activity and exercise are especially helpful for the client who is constipated secondary to slowed metabolic rate and decreased peristalsis. Thyroid Cancer Rare; usually slow growing More prevalent in women 20-60 years of age Risk factors: low iodine, radiation exposure Papillary carcinoma ○ Develops in one lobe and spreads to lymph nodes Follicular carcinoma ○ Spreads to lungs and bones Thyroid Cancer - Treatment Surgery Radioactive iodine Chemotherapy Radiation 5 year survival rate 97% PARATHYROID GLAND Parathyroid Glands blogs.law.harvard.edu/ heydan/ Parathyroid Two glands on each lobe of thyroid Secretes: ○ Parathyroid hormone (PTH) Manages Calcium levels in the body If blood calcium levels are low, PTH causes the bones to release calcium and/or more calcium is absorbed from the GI tract HYPERparathyroidism In Primary HYPERparathyroidism, too much PTH is produced and causes HYPERCALCEMIA ○ Most common cause is a tumor in one or both glands Mild hypercalcemia may be asymptomatic. Other symptoms include: ○ Thirst ○ Frequent urination ○ HTN ○ Heartburn ○ Mental confusion ○ Kidney stones ○ Joint pain Secondary HYPERparathyroidism This is caused by low calcium levels in the blood that stimulate the parathyroids to increase production of PTH. ○ Most common causes are low vitamin D and kidney disease which affects phosphate HYPERparathyroidism Increased activity of >1 parathyroid glands Onset after age 60 Risk Factors/ Etiology ○ Benign tumor ○ Renal failure Cause ○ Paget’s disease hypocalcemia which triggers ○ Multiple myeloma parathyroid to ○ Cancer with bone metastasis increase ○ Laxative abuse secretions ○ Vitamin D deficiency HYPERparathyroidism Diagnosis ○ PTH measurement ○ Electrolyte measurement ○ X-ray of bones Treatment ○ Parathyroidectomy ○ IV Hydration to drop calcium levels HYPERparathyroidism and Physical Therapy Early ambulation (although uncomfortable) is essential, because weight bearing and pressure on bones speed up recalcification. The use of light ankle weights or light weight-resistive elastic for the lower extremities provides tension at the musculotendinous/bone interface, accomplishing the same response. HYPOparathyroidism Decreased secretion of parathyroid hormone ○ Results in hypocalcemia ○ Increased phosphate ○ Tetany ○ Decreased bone reabsorption HYPOparathyroidism In HYPOparathyroidism there are low levels of calcium or hypocalcemia Iatrogenic (most common) ○ Accidental removal during thyroidectomy or neck surgery ○ Hypovolemia and infarction of parathyroid ○ Scar tissue ○ Tumor ○ Trauma ○ Low Vitamin D HYPOparathyroidism – Systemic Effects CNS effects ○ Irritable ○ Anxiety ○ Agitation Musculoskeletal effects ○ Increased osteoclast activity ○ Tetany ○ Spasm of respiratory musculature Cardiac effects ○ Dysrhythmia HYPOparathyroidism Diagnosis ○ Electrolyte evaluation ○ Decreased PTH Treatment ○ If tetany →emergency ○ IV calcium ○ Vitamin D supplementation ○ Maintain open airway ○ Medications Reversible if treated early ○ Late treatment: cataracts, basal ganglia calcification ○ Death from respiratory involvement ADRENAL GLAND Adrenal Cortex www.biosbcc.net/barron/ physiology/endo/adren.htm Adrenals Located in each kidney ○ Outer cortex ○ Inner medulla Adrenal Cortex: Normal functions Secretes: ○ Mineralocorticoids Aldosterone reabsorption of sodium Regulation of excretion of potassium BP ○ Glucocorticoids Cortisol – food metabolism, response to stress, decreases inflammation ○ Androgens (sex hormones) Testosterone Estrogen Progesterone  Adrenal Medulla: Normal Functions Secretes ○ Epinephrine Increases heart rate Increases heart contractility Increases BP through vasoconstriction Increases blood glucose Primary Adrenal Insufficiency – Addison Disease Can affect all ages (most during middle age 40-60 years) Possible etiologies: ○ Complication of TB ○ Autoimmune ○ Radiation ○ Neoplasm ○ Infections Addison Disease Risk Factors ○ Surgery ○ Pregnancy ○ Trauma ○ Infection Addison Disease Pathogenesis Drop in the secretion of: ○ Aldosterone (mineralcorticoid) Dehydration Hypotension Increased workload on heart Poor coordination ○ Cortisol (glucocorticoid) Hypoglycemia Weakness Hypotension https://www.msdmanuals.com/en- Nausea pt/professional/multimedia/image/hyperpigmentation-of- addison-disease Emotional lability Paranoia Increase in skin pigmentation on extensor surfaces Addison Disease Diagnosis ○ Cortisol levels Treatment ○ Corticosteroids Prognosis ○ If untreated → fatal Addison Disease and Physical Therapy Aquatic physical therapy may be contraindicated for anyone with Addison disease. ○ Heat/humidity of the pool environment causes the body to require more cortisol Increased in cortisol allow blood vessels to respond to increase blood pressure and cool the body down. ○ Adrenal gland is unable to produce enough cortisol to regulate body temp Secondary Adrenal Insufficiency Causes ○ Tumors in hypothalamus or pituitary gland ○ Rapid taper of corticosteroids Symptoms ○ Arthralgia ○ Myalgia ○ Tendon Calcification Treatment ○ Replacement of ACTH ○ Managing fluid/electrolyte balances Cushing Syndrome Increased cortisol levels Results from: ○ Tumor of adrenal gland ○ High dose steroid treatments Cushing Syndrome Muscles lose amino acids (protein) ○ Stretch marks ○ Decreased wound healing ○ Thin skin ○ Muscle weakness ○ Osteoporosis Fractures ○ Cushingoid face ○ Increased weight ○ Hair growth ○ Buffalo hump Cushing Syndrome and Physical Therapy Adverse effects of corticosteroid treatment ○ change in sleep and mood ○ GI irritation Can result in feelings of mild anxiety, confusion, and/or ○ Hyperglycemia psychosis ○ fluid retention