Endocrine Overview

Endocrine System

Works with the nervous system to control and integrate body function to maintain homeostasis

How does the endocrine system send messages?

In the form of hormones via the bloodstream

5 General Functions of the Endocrine System

1. Differentiation during development

2. Stimulation of growth

3. Coordination of M and F reproductive systems

4. Homeostasis

5. Fight/flight

Hypothalamus

Main integrative center for the endocrine and autonomic nervous system

What does the hypothalamus control?

The function of endocrine organs by neural and hormonal pathways

Adipose tissue can be classified as an ___?

Endocrine gland

- Secretes several hormones responsible for metabolism, hunger, vasoconstriction, and development

2 Ways Dysfunctions of the Endocrine System are Classified

1. Hypofunction

2. Hyperfunction

Only ___ occur in the pituitary, adrenal, and thyroid function?

Subtle changes

Do older adults more commonly have hypo are hyperthyroidism?

Hypo is more common

By age 80, the weight of the anterior pituitary lobe is reduced ___%?

75%

- But function is not greatly affected

Thyroid Gland and Aging

Becomes smaller and fibrotic

Why are older adults more at risk for tumors?

Decreased hormonal levels means loss of tumor suppressor genes

Most common (and second most) endocrine disorder?

1st = DM

2nd = Hypothryoidism

DM

Chronic, systemic disorder characterized by hyperglycemia and disruption of the metabolism or carbs, fats, and proteins

Insulin

Produced in the pancrease

- Normally maintains a balanced blood glucose level

Type 1 DM

Pancreas is damaged

- Not producing insulin

Type 2 DM

Cells are resistant to insulin

- Body produces insulin but is resistant

Hypoglycemia Symptoms

- Sweating

- Pallor

- Irritability

- Hunger

Hyperglycemia Symptoms

- Dry mouth

- Increased thirst

- Weakness

- Blurred vision

- Frequent urination

PT: glycemia below 90

Have pt eat a snack

- Want to be closer to 100 before exercising

PT: glycemia above 250

No exercise

What does a MI loom like in a pt with DM?

Silent MI

- SOB, feeling unwell

Disorders of the pituitary gland occur most frequently in the ___?

Anterior lobe

Hyperpituitarism

An over-secretion of one or more of the hormones secreted by the pituitary gland

Pituitary tumors produce both ___ effects and ___ manifestations?

Systemic, local

How are pituitary tumors usually treated?

Surgical removal, drug therapy, external beam radiation therapy

Gigantism vs Acromegaly

Both d/t pituitary gland disease

- Gigantism occurs in kids

- Acromegaly occurs in adults

What can lead to amenorrhea, gynecomastia, and impotence in men?

Overstimulation of one or more target glands of the pituitary

Gigantism

Overgrowth of the long bones

Acromegaly

Increased bone thickness and hypertrophy of soft tissues

- Face, jaws, hands, and feet most commonly affected

What causes acromegaly and gigantism?

From growth-hormone secreting adenomas of the anterior pituitary gland

Acromegaly Induced Myopathy

Muscle weakness and reduced exercise tolerance

Hyperpituitarism Treatment

Remove pituitary or tumor

Hyperpituitarism Post Op: What is encouraged?

Ambulation and exercise encouraged within the first 24 hours (deep breathing also encouraged)

Hyperpituitarism Post Op: What is contraindicated?

Coughing, sneezing, and blowing the nose

Hyperpituitarism Post Op: Why does a PT need to possibly remain within the pt's visual field?

Pituitary close to the optic nerve (potentially affected)

Hyperpituitarism: Carpal Tunnel Incidence

CTS is seen in up to 50% of people with acromgaly

Diabetic Insipidus

Rare disorder that involves a physiologic imbalance of water secondary to ADH deficiency

- Result is excretion of large amounts of dilute urine

(think patient has low levels of anti-diuretic)

Diabetic Insipidus Symptoms

Muscle weakness, dizziness, hypotension

SIADH

Disorder associated with excessive release of ADH

Most common cause of SIADH

Ectopic ADH production by malignancies

SIADH Symptoms

Severe hyponatremia (sodium depletion), lethargy, nausea, anorexia, and weakness

- Possible water intoxication d/t water retention

SIADH vs DI

Opposites

- Treatment of DI with vasopressin can lead to SIADH is excessive amounts are administered

What do alterations in thyroid function produce?

Changes in nails, hair, skin, eyes, GI tract, respiratory tract, heart and blood vessels, nervous tissue, bone, and muscle

Hyperthyroidism

Creates a generalized elevation of body metabolism

Thyroid Storm

Potentially fatal condition that refers to an acute episode of thyroid overactivity (hyperthyroidism)

- Fever

- Tachycardia

- Delirium

- Dehydration

- Agitation

(lose weight d/t increased metabolism)

Grave's Disease

Most common form of hyperthyroidism

Grave's Disease Symptoms

- Nervousness

- Heat intolerance

- Exophthalmos (bulging eyes)

- Proximal weakness

- Tachycardia

- Weight loss despite increased appetite

Hypothyroidism

Deficiency of thyroid hormone in the adult that results in a generalized slowed body metabolism

Most common thyroid disorder?

Hypothyroidism

Hypothyroidism Symptoms (10)

1. Bradycardia

2. Decreased GI motility

3. Slowed neurologic functioning

4. Decrease in body heat functioning

5. Dry, flaky skin

6. Dry, sparse hair

7. Hoarseness

8. Thick, brittle nails

9. Decreased cardiac output

10. Flexor tenosynovitis (Carpal tunnel syndrome)

The outer cortex of the kidneys secrete ___(3)?

1. Mineralocorticoids

2. Glucocorticoids

3. Androgens

Mineralocorticoids

Steroid hormone that regulates fluid and mineral balance

Glucocorticoids

Steroid hormones responsible for controlling the metabolism of glucose

Androgens

Sex hormones

Addison's Disease

Shiny, coppery skin

What may be contraindicated with Addison's Disease?

Aquatic therapy

- Heat and humidity causes the body to require more cortisol so that blood vessels can respond in order to increase BP and cool the body down

Addisons Disease

Result of a disorder within the adrenal gland itself

- Insufficient cortisol release from the adrenal glands causing wide range of problems

Primary Adrenal Insufficiency (Addison) Symptoms

- Weak

- Hypotensive

- Anorexia

- Vomiting

Adrenocortical Hyperfunction

Can result in excessive production of glucocorticoids, mineralocorticoids, and androgens

Cushing's Syndrome

Hypercortisolism resulting from adrenal gland over secretion or from overdoses of corticosteroid meds

Cushing's Syndrome Symptoms

- Purple striae

- Poor wound healing

- Skin thinning

- OP

- What looks like kyphosis (enlarged back of neck fat pad)

People with which disease(s) are at risk for seizure?

SIADH

People with which disease(s) are at risk for hypotension?

Adrenal insufficiency and DM

People with which disease(s) are at risk for OP?

Cushing's

People with which disease(s) are at risk for ataxia, SOB, and bilateral ankle edema?

Hypothyroidism

Why don't you want people with hyperthyroidism to engage in strenuous exercise?

Hyperthyroidism leads to over reliance on m glycogen during exercise (will tire faster and damage m)

Rhabdomyolysis

Can occur with pts with hypothyroidism that has muscle pain and weakness

- Uncommon but serious

The pituitary gland is often called the ___?

Master gland

Levothyroxine Common Condition(s)

Hypothyrodisim

Metformin Common Condition(s)

DM 2

Semaglutide (Ozempic)

DM 2, Obesity

Tirzepatide Common Condition(s)

DM 2, Obesity

Insulin Common Condition(s)

DM 1 and 2

Empagliflozin Common Condition(s)

DM 2

Methimazole Common Condition(s)

Hyperthyroidism

Hydrocortisone Common Condition(s)

Adrenal insufficiency

Alendronate Common Condition(s)

OP