Endocrine and Metabolic System- Pathology

Endocrine

system made up of hormones

Hormones

chemical messengers that travel to distant target organs/tissues

Main role of hormones

maintain homeostasis and regulate long

Metabolic

set of chemical reactions in the body, Use biochemical pathways to support life functions

Examples of metabolic

breakdown of glucose for ATP (Kreb’s cycle)

Key components of the endocrine system

hypothalamic pituitary interface (hypothalamus, pituitary gland), adrenal gland, pancreas, ovaries/testes

Parathyroid Hormone

regulates calcium levels

Parathyroid hormone Targets

bone, kidney, intestines

Thyroid Hormone

increase metabolism, enhance SNS, promote cell maturation

Thyroid hormone targets

skin, bone, muscle, thyroid, gonads, kidney, breasts

Antidiuretic Hormone

maintain water balance and BP, and reduces urine output

Antidiuretic hormone targets

kidneys, vasculature, sweat glands

Growth Hormone

stimulates the growth and cell reproduction

Growth hormone targets

adipose tissue, bones/joints, muscle, liver

Cortisol

stress and immune response, fat metabolism, bone resorption

Cortisol Targets

kidneys (aldosterone), systemic (cortisol)

Insulin

promotes uptake of glucose for energy

Insulin targets

pancreas, muscle, adipose tissue, liver

Endocrine and metabolic system relationship

work together as a manager and worker relationship

Endocrine and nervous system work together to

control and integrate body systems, in order to maintain homeostasis

Negative feedback loops

Initial stimulus of decreased body temp is relayed with nerves, Causes a hormone cascade to be released into the blood, in which raises blood temp. Homeostasis is returned, until the next disturbance

Hypothalamic Pituitary Axis (HPA)

integrated chain of organs and glands that communicate to regulate function

Primary mechanism in the body's stress response

cortisol

Chronic stress

HPA overactivity/dysfunction, Immune cells develop receptor resistance, Persistent inflammation, Can cause metabolic syndrome and depression

Hypofunction

underactive

Hyperfunction

overactive

What is known about the cause/development of the following metabolic disorders (obesity, metabolic syndrome, and diabetes mellitus)

Accumulating evidence says that it is a CNS mediated neuroendocrine dysfunction, Genetic changes can cause impair signaling, HPA axis is disrupted, which effects the cascade. But, thought to be a multifactorial disease with complex interactions… focused on epigenetics.

Parathyroid hormone (calcium) is responsible for

increasing blood calcium levels in order to Stimulate bone breakdown, Increase intestinal absorption of dietary calcium, Increase calcium reabsorption in the kidneys

Hyperparathyroidism

“Stones, bones, groans, thrones”

S/S of hyperparathyroidism

Hypercalcemia, Shortened QT intervals, heart causing v. arrythmias, Kidney stones, Bone pain, fx, osteoporosis, Abdominal pain from slowed motility, Polydipsia, polyuria, Cognitive changes, Muscle weakness and endurance

PT implications for hyperparathyroidism

Watch for arrythmias, Anticipate fatigue, muscle weakness, decreased endurance, Assess balance and fall screening (Reduced bone quality), Watch for kidney symptoms and dehydration

S/S of Hypoparathyroidism

Hypocalcemia, Prolonged QT internals, heart causing v. arrythmias, NM excitability, Trousseau sign, Chvostek’s sign, Fatigue and weakness, Cataracts,

NM excitability

cramps, spasms, paresthesia's, seizures

Trousseau sign

involuntary contraction of hand and wrist

Chvostek’s sign

twitching of face muscles

PT Implications for hypoparathyroidism

Watch for arrythmias, Anticipate fatigue, muscle weakness, decreased endurance, Assess balance and fall screening, watch for NM signs, dietary (increase CA)

Thyroid Hormone (T3 & T4)

T3 & T4 is responsible for increasing metabolism, enhancing the SNS, promoting cell development

Hyperthyroidism

“High and Hot”

S/S of hyperthyroidism

Nervousness/anxiety, Heat intolerance, sweating, thirst, Tachycardic, palpitations, Increased RR, Proximal weakness and myopathy, Weight loss, Tremor and hyperreflexia, Bone loss or osteoporosis

PT Implications for hyperthyroidism

Monitor vitals (tachy), Watch for temp intolerance, Cautions with weakness, decreased exercise intolerance, Caution with bone quality

Hypothyroidism

“Low and Slow”

S/S of hypothyroidism

Fatigue, lethargy, reduced cog. Function, Cold intolerance, Bradycardia, Hyporeflexia, Weight gain, Muscle weakness and joint stiffness, Swelling of the hands, feet, face

PT Implications hypothyroidism

Watch for temp intolerance, Cautions with weakness, decreased exercise intolerance, Monitor edema for manual therapy concerns

ADH

Posterior Pituitary, maintains body water balance and BP, Increases water reabsorption in the kidneys and concentrates urine to decrease urine output

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Hyper and too much water reabsorption

S/S of SIADH

Hyponatremia water retained over nutrients, Low urine output, Weight gain (water retention), Fatigue and cramping, Headache, confusion, N/V

PT implications for SIADH

Monitor BP and lab work, Watch for hydration status (fluid restrictions), Watch for neuro signs like HA and confusion, May have dietary restrictions, Avoid overheating and excessive sweating

S/S for Diabetes Insipidus (Hypofunction)

too little water resorption, Polyuria(peeing alot) and polydipsia (excessive shirts), Dehydration, HTN, Hyponatremia (intake doesn’t match loss), Fatigue, confusion

PT implications for Diabetes Insipidus

Monitor BP and lab work, Watch for hydration status (fluid increase), Watch for neuro signs like HA and confusion, May have dietary restrictions (restrict salt or caffeine), Avoid overheating and excessive sweating

Growth Hormone (Anterior Pituitary HGH)

stimulates the cellular growth of all body tissues, fat breakdown, protein synthesis, and has an anti

S/S for Acromegaly (Hyperfunction)

overgrowth of tissues, Enlarged skeleton, Joint pain, thickened skin, HA and visual field deficits, HTN and CV issues, Insulin resistance/DM, Sleep apnea

PT Implications for acromegaly

Cardiac involvement (reduced exercise intolerance), Monitor vitals, Watch for insulin resistance signs, Avoid excessive joint/bone stress (OA), Watch for paresthesia and carpal tunnel

Growth Hormone Deficiency

undergrowth of Tissues

S/S for Growth Hormone Deficiency

Increased fat mass, obesity, dyslipidemia, Decreased muscle mass, Low bone mineral density,

Growth Hormone deficiency in Children

dwarfism, short stature, delayed growth

Growth Hormone deficiency in adults

osteoporosis, fatigue, insulin resistance, increased CV risk

PT Implications for growth hormone deficiency

Cardiac involvement, Monitor vitals, Watch for insulin resistance signs, Avoid excessive joint/bone stress (Osteoporosis),Anticipate reduced muscle mass and weakness (Promote motor development in children)

Cortisol is release from the

adrenal glands for carb, protein, and fat metabolism, Used in stress and immune response and for bone resorption

Cushing’s Disease/Syndrome

“Big, Round, and Hairy”

S/S of Cushing’s Disease

Fat distribution, Purple striae on skin, easily bruise, Proximal weakness, Osteoporosis, Hyperglycemia, maybe DM, HTN, Depression and cognitive changes

Fat distribution for Cushing's

moon face, buffalo hump

PT implications for Cushing's

Monitor BP (HTN), Watch blood sugar (hyperglycemia), Anticipate muscle weakness, Caution with skin and bone quality

Addison’s Disease

“Small, Weak, and Tanned”

S/S of Addison’s Disease

Fatigue and weakness, Weight loss, anorexia, hyponatremia, Hyperpigmentation, Hypotension, dizziness, hypoglycemia, N/V

PT Implications for Addison's disease

Monitor BP (hypotension), Watch blood sugar (hypoglycemia), Anticipate muscle weakness, Monitor for electrolyte disturbances (dizziness, cramps)

Adrenal crisis

medical emergency

Insulin is in the and promotes

Pancreas (beta cells) and promotes the uptake of glucose into the tissues for energy, Suppresses glucose production by the liver

Hyperinsulinism

hypoglycemia

S/S of hyperinsulinism

Confusion, irritability, dizziness, LOC, Tremor, palpitations, sweating, anxiety, Weight gain due to frequent eating

PT Implications of hyperinsulinism and diabetes mellitus

Monitor glucose during, before, after exercise, Have supplements readily available, Moderate exercise to improve glucose utilization, Stress increases insulin requirements, Fall risk during hypo or hyperglycemic episodes

Prevention of hyperinsulinism and hypoinsulinism

monitor HbA1c levels

Diabetes Mellitus (DM)

hyperglycemia

3 P’s of Diabetes Mellitus

polyuria, polydipsia, polyphagia

S/S of Diabetes Mellitus

Fatigue, blurred vision, Watch for ketoacidosis in T1, Watch for hyperosmolar/hyperglycemic state (HHS) in T2

Ketoacidosis

Body turns to fat breakdown for energy, which leads to the production of acidic ketones

Hyperosmolar/hyperglycemic state (HHS) in T2

Insulin presence not enough, so glucose rises to extreme levels and pulls water into the urine

Type 1 Diabetes Mellitus

destruction of the beta cells in the pancreas due to an autoimmune disorder, Usually genetically passed, and triggered environmentally

Type 2 Diabetes Mellitus

insulin receptor resistance, Usually over age 40, has metabolic syndrome, obesity

Microvascular and macrovascular complications associated with diabetes mellitus

CAD (MI), CVD, PVD/PAD, neuropathy, retinopathy

Diabetic Dermopathy

decreased sensation and blood flow

How are endocrine disorders diagnosed and treated

typically by S/S,Muscle weakness, CT syndrome, periarthritis, As well as systemic issues, Then, are identified through lab work and identifying the underlying cause. Usually treating the underlying cause.

How is metabolic syndrome diagnosed and treatment

Increased waist circumference, increased triglycerides, increased fasting glucose. Treated by lifestyle management

How is diabetes diagnosed and treated

diagnosed by glucose level. Treatment includes diet, exercise, medication, CSII insulin pump, and medications

Key clues for the thyroid problem,

Change in neck size, Temperature preference, Weight loss/gain

Key clues for parathyroid problem

Previous thyroid surgery, Skeletal changes/pain, Kidney stones

Irregular menses

gonads

Fluid imbalances

ADH

Changes in growth

GH

BP irregularities

ADH

Key Clues for adrenal problem

Weight loss/gain, Syncope, Episodes of tachy/HA/sweating, BP or fluid irregularities, Easy bruising, Skin color changes (Addison’s), Long tern steroid use

Key Clues for pancreas problems

Blood sugar irregularities, Nocturia/noctidipsia, Increased appetite, Weight loss/gain, Changes in mental status or vision, Sensory motor changes, Repeated infections or poor wound healing

When is referral warranted for individuals with established or potential endocrine/metabolic disease

Any client who has generalized S/S associated with endocrine dysfunction without a known/established diagnosis should be evaluated by a physician