#4: Endocrine

Feedback Loops (Hypothalamus→AP→Gland)

• Cortisol/Aldosterone

• Thyroid

• Reproductive

• CRH→ACTH→Cortisol (adrenal gland)

• TRH→TSH→T3 and T4 (thyroid gland)

• GnRH→LH and FSH → Testosterone, Estrogen and Progesterone (Testes, Ovaries)

What does _ control?

• Parathyroid

• Adrenal

• Pancreas

• Kidney

• Acts on bone, calcium balance in blood

• Epi/NE are stress response hormones

• Insulin lowers BG, Glucagon raises BG

• EPO stimulates RBC production, Renin for BP control

What is released by posterior pituitary?

Oxytocin, ADH

Explain the three types of dysfunction!

Primary: abnormal function of the hormone gland itself

Secondary: inappropriate stimulation/inhibition of the gland

Tertiary: more distant, indirect effect on gland

What are the primary s/s of endocrine pathology?

Muscle weakness (proximal and symmetric), muscle atrophy (proximal and symmetric), myalgia

What are the primary s/s for bones and joints when endocrine pathology?

Arthropathy, chondrocalcinosis/pseudogout, tenosynovitis, adhesive capsulitis

Common conditions?

Carpal tunnel, pseudogout, DISH, adhesive capsulitis, myofascial pain syndrome

Primary effect of the thyroid hormone (HPT cascade)

Metabolism/metabolic rate

Hyperthyroidism

• What it means

• Clinical presentation

• Condition name

• PT considerations

• High T3/T4

• Heat intolerance, weight loss, tachycardia, increased appetite, frequent BMs, feeling nervous, tremor, enlarged thyroid, myopathy, opthalmopathy

• Graves’ disease

• Exercise and heat intolerance, fatigue, monitor vitals

Hypothyroidism

• What it means

• Clinical presentation

• Condition name

• PT considerations

• Decreased T3/4

• Cold intolerance, weight gain, bradycardia, low appetite, constipation, fatigue, menstrual abnormalities, dry skin/hair, depression/cognitive changes

• Hashimoto’s thyroiditis

• Fatigue and decreased tolerance to exercise and cold, possible carpal tunnel syndrome, possible myopathy, monitor vitals

What does the HPA axis manage?

The body’s response to stress

What is produced in the adrenal medulla? Cortex?

Medulla: Epi/NE

Cortex: Cortisol, Aldosterone, DHEA

What does cortisol do?

Increases alertness, increases HR and BP, produces sugar for action (gluconeogenesis)

What does aldosterone help balance?

Na+/K+

Cushing’s Syndrome/High Cortisol

• Clinical presentation

• Tx

• HTN, weakness, low BMD, altered glucose tolerance, weight gain, dorsal fat pad, round face, striae, lethargy, mood disturbances, decreased libido

• Reduction of corticosteroid use, surgical excision of tumors

Increased ADH causes what?

• What simulates it?

Increased water reabsorption, more concentrated urine

• osmotic load in blood, low blood volume

ADH increases what channels?

Aquaporins