metabolic and endocrine systems Flashcards
(100 cards)
1
Q
inherited metabolic disorders
A
- diagnosed in utero via amniocentesis or chorionic villus sampling
- s/s tend to include lethargy, apnea, poor feeding, tachypnea, vomiting, hypoglycemia, urine changes, seizures
- more immediate symptoms = more dangerous disorder
2
Q
phenylketonuria
PKU - amino/organic acid metabolic disorder
A
- intellectual disability w/ behav and cog issues secondary to elevation of serum phenylalanine - excess primarily affects brain
- deficiency in enzyme ohenylalanine hydroxylase - normally converts excessive phenylalanine to tyrosine
- etiology: autosomal recessive, white people
- s/s: within few months of birth; gait disturbances, severe intellectual disability, hyperactivity, psychoses, lighter features, abnormal body odor
- treatment: dietary restriction of phenylalanine throughout lifetime can avoid all manifestations of disease
3
Q
tay-sachs disease
lysosomal storage disorder
A
- absence of deficiency of hexosaminidase A - produces acculmulation of gangliosides (GM2) within brain
- etiology: autosomal recessive, eastern european jewish
- s/s: at 6 MO, miss developmental milestones; continue to deteriorate in motor and cog skills; die by 5 YO
- treatment: no effective treatment; rec genetic testing in high risk populations
4
Q
mitochondrial disorders
A
- over 100 forms - each has different spectrum of disability
- etiology: genetically inherited or spont mutation in DNA -> impaired function of proteins in mitochondria
- s/s: vary depending on disorder; can include loss of muscle coordination, muscle weakness, visual and hearing problems, learning disability, heart, liver, kidney disease, GI disorders, dementia
- treatment: new diagnoses w/ varied treatment to alleviate symptoms and slow progression
5
Q
wilson’s disease
hepatolenticular degeneration
A
- inherited disorder in eastern europeans but can be any group, appears in people < 40 YO and can be in children 4-6 YO
- etiology: autosomal recessive; defect in body’s ability to metabolize copper -> accumulates in brain, liver, cornea, kidny
- s/s: kayser-fleischer rings around iris d/t copper deposits, basal ganglia degenerative changes, hepatitis, ataxic gait; emotional/behav changes, eventual MSK deformity, pathologic fracture, osteomalacia, muscle atrophy, contractures
- treatment: pharm intervention w/ B6 and D-penicillamine to excrete excess copper; prevent hepatic failure
6
Q
rehab for pts with inherited metabolic disorders
A
- awareness of dietary restrictions
- training to prevent deleterious effects from metabolic disease
- facilitate developmental milestones w/in pt tolerance
7
Q
acid-base metabolic disorders
A
- metab regulated by endocrine and NS
- if acid-base balance compromised, can alter metabolic function and cause s/s
8
Q
metabolic alkalosis
A
- increase in bicarbonate accumulation or loss of acids
- pH > 7.45
- etiology: after continuous vomitting, antacid ingestion, diuretic therapy; associated with hypokalemia or nasogastric suctioning
- s/s: nausea, diarrhea, prolonged vomiting, confusion, muscle fasciculations, muscle cramp, hyperexcitability, convulsions; if untreated, comatose, seizures, resp paralysis
- treatment: manage underlying cause, correct electrolyte imbalance, KCl administration
9
Q
metabolic acidosis
A
- accumulation of acids due to acid gain or bicarb loss
- pH < 7.35
- etiology: renal failure, lactic acidosis, starvation, diabetic or alcoholic ketoacidosis, diarrhea, toxins
- s/s: compensatory hyperventilation, vomiting, diarrhea, HA, malaise, hyperkalemia, cardiac arrhythmias; untreated can cause coma and death
- treatment: treat cause, correct imabalnce, administer sodium bicarb
10
Q
rehab considerations for pts with acid-base disorders
A
- recognize high risk populations - renal, CV, pulm disease; burns, fever, sepsis; mech vent; DM; vomiting, diarrhea, enteric drainage
- recognize signs of dehydration in a diabetic pt
- injury prevention during involuntary muscle contractions secondary to metabolic alkalosis
- pts w/ diuretic therapy may be at risk for potassium depletion
- trousseau’s sign during blood pressure - indicates calcium deficiency and early stages of tetany
11
Q
metabolic bone disease
A
- disruption in normal metab w/ skeletal system that houses calcium and phosphorus to continuously balance remodeling of cortical and trabecular bone to optimize structure of skeleton
- disruption of homeostasis - result in deformity, bone loss, frature, softening of bone, arthritis, pain
12
Q
osteomalacia
A
- metabolic condition where bones are soft secondary to calcium or phosphorous deficiency - adequat bone matrix but insufficient calcification in matrix d/t deficiency
- etiology: calcium lost d/t inadequate intestinal absorption and phosphorus lost d/t increase in renal excretion; can also be due to vit D deficiency
- s/s: aching, fatigue, weight loss; myopathy and sensory polyneuropathy w/ periarticular tenderness and pain, thoracic kyphosis deformity; bowing of LEs; struggle with trans and standing
- treatment: underlying etiology, increased nutrition, pharm intervention w/ vit D or phosphate supplements
13
Q
osteoporosis
A
- decrease in bone mass - increases risk of fracture; primarily affects trabecular and cortical bone where rate of bone resorption accelerates while rate of bone formation declines
- declining osteoblast function coupled with loss of calcium and phosphate salts will cause bones to becomes brittle
- etiology: primary - idiopathic, postmenopausal, involutional (senile); secondary - result of another primary conditoin or with meds
- s/s: compression and other spine fractures, low thoracic or lumbar pain, loss of lumbar lordosis, kyphosis, dowager’s hump
- treatment: vitamin and pharmacological intervention, nutrition, assistive and adaptive devices, some surgical intervention
14
Q
paget’s disease
A
- metabolic condition with heightened osteoclast activity - bone formation lacks true structural integrity
- bone appears enlarged but lacks strength d/t high turnover secondary to abnormal osteoclast proliferation
- etiology: genetic and geographical incidence, most common > 50 YO
- s/s: MSK pain w/ bony deformities; common with skull, clavicle, pelvis, femur, spine, and tibia; pain, HA, vertigo, hearing loss, mental deterioration, fatigue, increased cardiac output, HF
- treatment: pharmacological intervention using biphosphates to inhibit bone resporption and improve quality of involved bone; exercise, weight control, cardiac fitness
15
Q
rehab considerations for pts with metabolic bone disease
A
- awareness of signs of compression fracture
- resistance training and endurance training to build bone density and increase strength
- avoid treatments that exacerbate condition or placae pts at risk for fracture
16
Q
medical conditions that may cause low bone mass
A
- cushing’s syndrome
- osteomalacia
- hyperthyroidism
- hyperparathyroidism
- celiac
- RA
- renal failiure
- hypogonadism
- osteogenesis imperfecta
17
Q
osteopenia
A
- low bone mass not severe enough to qualify as osteoporosis
- may not have actual bone loss but naturally lower bone density than established norms
- t-score > -2.5 SD
18
Q
osteopetrosis
A
- conditions characterized by impaired osteoclast function causing bone to become thickened but fragile
- inherited condition
- s/s vary widely
19
Q
bone mineral density
A
- t-score: how many SDs above or below average young healthy adult norms in BMD is
- z-score: how many SDs above/below age and gender adjusted norms BMD is
- non-modifiable risk factors: age, early menopause, h/o fx, slender build, family history, female, Asian or white, sometimes glucotcorticoids
- modifiable: vitamin D and calcium intake, estrogen deficiency, smoking, drinking, caffeine, sedentary
- interventions for children/adolescents: nutrition, regular physical activity, avoid smoking/drinking
- interventions for adults: nutrition - vit D and calcium, regular WB exercises, avoid smoking and drinking, postural education and fall prevention
20
Q
osteoporosis
A
- t-score -2.5 SD or lower
- severe is -2.5 SD or lower w/ one or more related fractures
21
Q
endocrine system
A
- endocrine glands (specialized, ductless) secrete hormones in bloodstrem to travel to signal specific target cells throughout body
- work with NS to regulate metabolism, response to stress, sexual reproduction, BP, water and salt balance
22
Q
endocrine system vs NS
A
- endocrine system
- secreting cells send hormones through blood to signal specific target cells
- hormones diffuse into blood, travel long distances to virtually every area of body
- endocrine effectors consist of virtually all tissues
- regularoty effects slow and long lasting
- nervous system
- neurons secrete NTs to signal nearby cells that have appropriate receptor site
- NTs sent short distances across synapse
- nervous effectors limited to muscle and glandular tissue
- regulatory effects appear rapidly and are often short lived
23
Q
hypothalamus
A
- part of diencephalon below thalamus and cortex
- connects to pituitary gland through infundibular or pituitary stalk
- responsible for regulation of ANS - body temp, appetite, sweating, thirst, sexual behavior, rage, fear, BP, sleep
- affects other endocrine glands through impact on pituitary
24
Q
pituitary gland
A
- normally pea sized, located at base of brain just beneath hypothalamus
- two parts: adenohypophysis (anterior) and neurohypophysis (posteroir)
- considered most important part of endocrine system d/t it releasing hormones that regulate other endocrine glands
- “master gland” influenced by seasonal changes and emotional stress
- secretes endorphins that act on NS and reduce senstivity to pain
- controls ovulation, works as catalyst for testes and ovaries to create sex hormones
25
thyroid gland
- on anterior and lateral surfaces of trachea immediately below larynx, shaped like bow tie or butterfly w/ 2 lobes (R and L) joined by an isthmus
- produces thyroxine and triiodothronine - control rate at which cells burn fuel from food
- increased thyroid hormones = increased rate of chemical reactions in body
26
parathyroid glands
- 4 found on post surface of thyroid's lateral lobes
- produce paraythyroid hormone - antagonist to calcitonin, important for maintenance of normal blood levels of calcium and phosphate
- PTH increases reabsorption of calcium and phosphate from bones to blood
- PTH secretion stimulated by hypocalcemia and inhibited by hypercalcemia
- normal calcium levels impacts neuromuscular excitability, normal clotting, and cell membrane permeability
27
adrenal glands
- 2 adrenals on top of each kidney - out portion is adrenal cortex and inner is adrenal medulla, each secrete different hormones
- adrenal cortex: corticosteroids that regulate water and sodium balance, body's response to stress, immune system, sexual development and function, metabolism
- adrenal medulla: epinephrine that increases HR and BP w/ stress
28
pancreas
- in upper L quadrant of abdomen from duodenum to spleen
- has exocrine and endocrine tissues
- islets of langerhans: cells that produce hormones in pancreas
- alpha cells - glucagon
- beta cells - insulin
- [above] work in combo to ensure consistent level of glucose in bloodstrem and maintenance of energy stores within body
29
ovaries
- provide estrogen and progesterone - contribute to regulation of menstrual cycle and pregnancy
- estrogen secreted by ovarian follicles - develop and maintain female sex characteristics (breast development, cycles)
- progesterone produced by corpus luteum - maintains lining of uterus at level necessary for pregnancy
30
testes
- in scrotum btw upper thughs
- secrete androgens (including testosterone) - regulate changes associated with sexual development and support production of sperm
31
steroid hormones
| prostaglandins
- all cells create prostaglandins from phospholipids of cell membrane
- unique as they do not circulate in blood - instead exert effects only where they are produced
- capable of variety of effects - related to inflammation, pain mechanisms, vasodilation, vasoconstriction, nutrient metabolism, blood clotting
32
amine hormones
| catecholamines
- include epinephrine, norepinephrine, dopamine - synthesized from chromaffin cells within adrenal medulla
- SMS stimulation releases catecholamines into blood stream
- epi has one of largest effects on SNS - produces fight of flight response, targets CV and metabolic systems
- catecholamines also increase cardiac contraction, blood vessel constriction, activate glycogen breakdown, block insulin secretion, increase metabolic rate, dilation of airways in lungs
33
peptide hormones
| insulin
- insulin secreted by beta cells of islets of langerhans within pancreas
- released when there is elevation in blood glucose - insulin produces increase in cellular uptake of glucose for metabolism
- insulin stimulates skeletal muscle and liver to store glucose and increase amino acid transport across hepatic, muscle, and adipose tissues
- insulin release affects all body systems w/ primary goal to reduce blood glucose levels
34
growth hormone-releasing hormone
- released by: hypothalamus
- target: pituitary gland
- function: increases release of GH
- regulation of secretion: CNS feedback, circulating levels of hormones
35
growth hormone-inhibiting hormone
- released by: hypothalamus
- target: pituitary gland
- function: decreases release of GH
- regulation of secretion: CNS feedback, circulating levels of hormones
36
gonadotropin-releasing hormone
- released by: hypothalamus
- target: pituitary gland
- function: increases release of luteinizing hormone and follicle-stimulating hormone
- regulation of secretion: CNS feedback, circulating levels of hormones
37
thyrotropin-releasing hormone
- released by: hypothalamus
- target: pituitary gland
- function: increases release thyroid-stimulating hormone
- regulation of secretion: CNS feedback, circulating levels of hormones
38
corticotropin-releasing hormone
- released by: hypothalamus
- target: pituitary gland
- function: increases release of adrenocorticotropic hormone
- regulation of secretion: CNS feedback, circulating levels of hormones
39
prolactin-releasing hormone
- released by: hypothalamus
- target: pituitary gland
- function: stimulates release of prolactin
- regulation of secretion: CNS feedback, circulating levels of hormones
40
prolactin-inhibitory factor; dopamine
- released by: hypothalamus
- target: pituitary gland
- function: decreases release of prolactin
- regulation of secretion: CNS feedback, circulating levels of hormones
41
growth hormone
- released by: pituitary
- target: bone and muscle
- function: promote growth and development; increase rate of protein synthesis
- regulation of secretion: hypothalamus
42
follicle-stimulating hormone
- released by: pituitary
- target: ovaries and testes
- function: promotes follicular development and estrogen creation in female; promotes spermatogenesis in males
- regulation of secretion: hypothalamus
43
luteinizing hormone
- released by: pituitary
- target: ovaries and testes
- function: promote ovulation with estrogen/progesterone synthesis from corpus luteum in females; promotes testosterone synthesis in males
- regulation of secretion: hypothalamus
44
thyroid-stimulating hormones
- released by: pituitary
- target: thyroid gland
- function: increases synthesis of thyroid hormones T3 and T4
- regulation of secretion: hypothalamus
45
adrenocorticotropic hormone
- released by: pituitary
- target: adrenal cortex
- function: increase cortisol sythensis (adrenal steroids)
- regulation of secretion: hypothalamus
46
prolactin
- released by: pituitary
- target: mammary glands
- function: allows for process of lactation
- regulation of secretion: hypothalamus
47
oxytocin
- released by: pituitary
- target: uterus and mammary glands
- function: increases contraction of uterine muscles; promotes release of milk from mammary glands
- regulation of secretion: nerve impulses from hypothalamus, stretching of cervix, nipple stimulation
48
antidiuretic hormone
- released by: pituitary
- target: kidneys
- function: increase water reabsoprtion, conserves water; increase BP through stimulating contraction of muscles in small arteries
- regulation of secretion: decreased water content
49
androgen
- released by: adrenal cortex
- target: ovaries and testes
- function: increases masculinization, promotes growth of pubic hair in males and females
- regulation of secretion: influenced by hypothalamic production and release of GnRH and LH
50
aldosterone (mineralocorticoid)
- released by: adrenal cortex
- target: kidneys
- function: increases reabsorption of sodium ions by kidneys to blood, increases potassium ion excretion by kidneys into urine
- regulation of secretion: low blood sodium level, high blood potassium level
51
cortisol (glucocorticoid)
- released by: adrenal cortex
- target: GI system
- function: influences metabolism of food molecules; anti-inflammatory effect in large amounts
- regulation of secretion: adrenocorticotropic hormone
52
epinephrine
- released by: adrenal medulla
- target: CV and metabolic systems
- function: increase HR and force of contraction; increases E production, vasodilation in skeletal muscles
- regulation of secretion: sympathetic impulses from hypothalamus in stress situations
53
norepinephrine
- released by: adrenal medulla
- target: CV and metabolic systems
- function: vasoconstriction in skin, viscera, and skeletal muscles
- regulation of secretion: sympathetic impulses from hypothalamus in stress situations
54
estrogen, progesterone
- released by: ovaries
- target: uterus and mammary glands
- function: involved in regultaion of female reproduction system and female sexual characteristics
- regulation of secretion: cyclical rise and fall of hormone levels
55
glucagon
- released by: pancrease
- target: liver
- function: increases blood glucose by stimulating conversion of glycogen to glucose
- regulation of secretion: hypoglycemia
56
insulin
- released by: pancreas
- target: all body systems
- function: decrease blood glucose and increase storage of fat, protein, carbs
- regulation of secretion: hyperglycemia
57
parathormone
- released by: parathyroids
- target: bone, kidney, intestinal mucosa
- function: increase blood calcium
- regulation of secretion: hypocalcemia
58
testosterone
- released by: testes
- target: pituitary gland
- function: involved in process of spermatogenesis and male sexual characteristics
- regulation of secretion: influenced by pituitary release of LH
59
thyroxine (T4), triiodothyronine (T3)
- released by: thyroid
- target: all tissues
- function: involved with normal development, increases cellular level metabolism
- regulation of secretion: thryoid-stimulating hormone
60
calcitonin
- released by: thyroid
- target: plasma
- function: increase calcium storage in bone, decreases blood calcium levels
- regulation of secretion: hypercalcemia
61
endocrine system dysfunction general S/S
- neuromuscular: muscle weakness, periarthritis, myalgia, arthralgia, stiffness, OA, muscle atrophy, adhesive capsulitis
- systemic: polydipsia, growth dysfunction, skin pigmentation dysfunction, polyuria, increased VS, hair dysfunction, anxiety
62
what causes endocrine system pathology
usually hypothalamus or pituitary gland affecting function of other endocrine glands
63
endocrine gland hyperfunction
- usually secondary to overstimulation of pituitary gland
- can also occur d/t hyperplasia or neoplasia of gland itself
64
hypofunction of endocrine gland
- usually secondary to understimulation of pituitary gland
- also from congenital or acquired disorders
65
hypothalamus dysfunction d/t
- hypothalamus tumors (ependymomas)
- inflammatory processes (sarcoidosis)
- sugical transection
- trauma (skull fx)
66
pituitary dysfunction d/t
- pituitary tumors (adenomas)
- ischemic necrosis or infarction of pituitary gland
- infiltrative disorders (hemochromatosis - too much iron)
- inflammatory processes (meningitis)
- iatrogenic (irradiation)
67
hypopituitarism
- decreased or absent hormonal secretion from ant pituitary gland
- rare, s/s dependent on age and deficit hormones
- short stature (dwarfism), delayed growth and puberty, secual and repro disorders, diabetes insipidus
- treatment based on deficit hormones, usually includes pharm replacement therapy
68
hyperpituitarism
- excessive secretion of hormones under pituitary control (usually GH that produces acromegaly)
- disorders and s/s dependent on hormones affected
- gigantism or acromegaly, hisutism, galactorrhea (abnormal lactation in males or female), amenorrhea, infertility, impotence
- treatment is hormone site dependent and can include tumor resection, surgery, radiation therapy, hormone suppression or replacement (if gland is dysfunctional after treatment)
69
rehab considerations for pts with pituitary dysfunction
- amb/exercise encouraged within 24 hours of surgery (tumor/gland removal)
- awareness of signs of hypoglycemia
- bilat carpal tunnel syndrome, arthritis, osterophyte formation commeon with hyperpituitarism
- orthostatic hypotension may be present with hypopituitarism
- bilat hemianopsia can occur with hypopit
70
addison's disease
- adrenal dysfunction
- presents w/ hypofunction of adrenal coretx -> decrease in production of cortisol/glucocorticoid and aldosterone/mineralocorticoid
- etiology: adrenal cortex produces insufficient cortisol and aldosterone hormones
- s/s: widespread metabolic dysfunction s/t cortisol deficieny and fluid/electrolyte imbalances s/t aldosterone dysfunction; hypotension, weakness, anorexia, weight loss, altered pigementation; if untreated -> shock and death
- treatment: long-term pharm intervention using synthetic corticosteroids and mineralocorticoids
71
cushing's syndrome
- adrenal dysfunction
- presents w/ hyperfunction of adrenal gland, allowing for excessive cortisol/glucocorticoid production
- etiology: pituitary gland produces excessive adrenocorticotropic hormone (ACTH) w/ subsequent hypercortisolism
- s/s: evlove over years; persistent hyperglycemia, growth failure, truncal obesity, purple abdominal striae, moon face, buffalo hump, weakness, acne, HTN, male gynecomastia; depression, poor concentration, memory loss
- treatment: pharm intervention to block production of hormones, radiation therapy, chemotherapy, sx
72
rehab considerations for pts with adrenal dysfunction
- recognize stress/exhaustion and avoid exacerbation
- notify physician w/ any signs of illness or increase intracranial pressure (papilledema) - meds need to be altered
- orthohypo common s/t long term cortisol therapy
- report sleep disturbances to MD
- increased incidence of osteroporosis, bone fx, degenerative myopathy, tendon ruptures, ataxia gait
- delayed wound healing may be common
73
hypothyroidism
- decrease levels of thyroid hormones in blood, slowing metabolic processes in body
- s/s fatigue, weakness, decreased HR, weight gain, constipation, delayed puberty, slowed growth and development
- common causes - hashimoto's thyroiditis, underdeveloped thyroid gland
- treatment: oral thyroid hormone replacement therapy
74
hyperthyroidism
- excessive levels of thyroid hormones in blood
- s/s nervousness, excessive sweating, weight loss, increased BP, exopthalmos, myopathy, chronic periarthritis, enlarged thyroid gland
- treatments - pharm intervention, radioactive iodine, surgery
75
graves' disease
- thyroid dysfunction
- most specific cause of hyperthyroidism, most common in women > 20 YO, can also occur in men and any age
- etiology: autoimmune disease, certain antibodies stimulate thyroid gland -> becomes overactive
- s/s: hyperthyroid presentation; classic signs are enlargement of thyroid gland (goiter), heat intolerance, nervousness, weight loss, tremor, palpitations
- treatment: pharm intervention and/or removal of thyroid gland using radiation or surgical intervention
76
postpartum thyroiditis
- painless inflammation of thyroid in some women after childbirth
- two phases: initially hyperthyroidism in first 1-4 months after birth, then hypothyroidism 4-8 months after delivery
77
hypothyroidism vs hyperthyroidism
- **hypo**
- depression/anxiety, lethargy, fatiue, HA, slowed speech, slowed mental function, impaired STM
- proximal weakness, carpal tunnel, trigger points, myalgia, increased bone density, cold intolerance, paresthesias
- dyspnea, bradycardia, CHF, respiratory muscle weakness, decreased peripheral circulation, angina, cholesterol increase
- anorexia, constipation, weight gain, decreased absorption of food and glucose
- infertility, irregular menstrual cycle, increased menstrual bleeding
- **hyper**
- tremors, hyperkinesias, nervousness, increased DTRs, emotional lability, insomnia, weakness, atrophy
- chronic periarthritis, heat intolerance, flushed skin, hyperpigmentation, increased hair loss
- tachycardia, palpitations increased RR, increased BP, arrhythmias
- hypermetabolsim, increased appetite, N/V, diarrhea, dysphagia
- polyuria, infertility, increased first trimester miscarriage, amenorrhea
78
rehab considerations for pts with thyroid dysfunction
- regonize exercise capacity and fatigue are typical
- acoid treatments that exacerbate condition - hot aquatic or gym d/t heat intolerance (Graves')
- avoid CV stress to eliminate secondary complication from hypotension, goiter, graves'
- provide close monitoring of VS
- recognize effects of radioiodine therapy
- recognize rhabdomyolysis risk (hypothyroidism)
79
hypoparathyroidism
- d/t hyposecretion or low-level production of parathyroid hormone by pt gland
- s/s hypocalcemia, seizuers, cog deficits, short stature, tetany, muscle pain, cramps
- treatment: elevation in serum calcium through IV calcium, LT includes pharm management and dietary modifications
- decreased bone resorption, hypocalcemia, elevated serum phosphate levels, shortened 4th and 5th metacarpals (psudohypoparathyroidism), compromised breathing d/t intercostal and diaphragm spasms, cardiac arrhythmias and potential HF, increased NM activity that can result in tetany
80
hyperparathyroidism
- d/t excessive hormone production by parathyroid gland that leads to disruption of calcium, phosphate, and bone metabolism
- s/s: renal stones and kidney damage, ddepression, memory loss, muscle wasting, bone deformity, myopathy
- treatment: pharm for lowering of serum calcium w/ diuretics or antiresoptive meds, surgical intervention
- increased bone resorption, hypercalcemia, decreased serum phosphate levels, osteitis fibrosa, subperiosteal resorption, arthritis, bone deformity, nephrocalcinosis, renal HTN, renal damage, gout, decreased NM irritability
81
rehab considerations for pts w/ parathyroid dysfunction
- be familiar w/ s/s
- recognize s/s of excess or inadequate pharm intervention
- recognize increased risk for fracture and effects for osteogenic synovitis - achilles, triceps, obturator tendons most affected
82
type 1 diabetes mellitus (DM)
| insulin-depenent or juvenile DM
- pancreas dysfunction - fails to produce enough or any insulin
- normally diagnosed in childhood but can occur at any age
- etiology: unknown, genetic predisposition in combo w/ exposure to viral or environmental trigger -> immune reaction that damages pancreas
- s/s: rapid onset of symptoms, polyphagia, weight loss, ketoacidosis, polyuria, polydipsia, blurred vision, dehydration, fatigue
- treatment: exogenous insulin, nutrition, insulin pumps, no cure, control blood glucose levels
83
type 2 diabetes mellitus
- pancreas dysfunction - typically > 45 yo, increase in childhood cases s/t childhood obesity, retain ability to produce some endogenous insulin
- etiology: s/t array of dysfunctions resulting from combination of insulin resistance and inadequate insulin secretion; hyperglycemia when body cannot respond properly to insulin; obesity contributes by increasing insulin resistance
- s/s: relatively same as DM 1 but no ketoacidosis
- treatment: blood glucose control through diet, exercise, oral meds, insulin injections when necessary
84
early signs of hyperglycemia
- blood glucose > 180-200 mg/dl
- increased thirst and frequent urination
- ketoacidosis - diabetic coma, ommon in DM 1, life-threatening -> dyspnea, fruity breath odor, dry mouth, nausea, vomiting, confusion, LOC
85
hypoglycemia early symptoms
- blood glucose < 70 mg/dl
- hunger, sweating, shaking, dizziness, clumsiness, HA, LOC
- treated with glucose/carb-rich substance - sugar, honey, juice, crackers
86
exercise response and DM
- physical/mental stressors elevate blood glucose
- exercise increases blood glucose uptake by muscles w/o impacting insulin levels
- if hypo concern, ingest carb snack before exercise to compensate for inc glucose demands and/or increased insulin absorption
87
T1 vs T2 DM
- **T1**
- < 25 YO onset
- abrupt onset
- 5-10% all cases
- etiology: destruction of islets of langerhans cells s/t autoimmune or virus
- very little to no insulin production
- ketoacidosis can occur
- insulin injections, exercise, diet
- **T2**
- older than 45 onset
- gradual onset
- 90-95% all cases
- etiology: resistance at insulin receptor sites usually s/t obesity, ethnic prevalence
- variable insulin production
- ketoacidosis rare
- weight loss, oral insulin, exercise, diet
88
rehab considerations for pts with DM
- risk for peripheral neuropathies, small vessel angiopathy, tissue ischemia and ulceration, impaired wound healing, tissue necrosis, amputation
- recognize acute metabolic changes
- recognize signs of sudden hypoglycemia and necessary treatment
- focus on management of insulin intake, diet, physical activty
- provide education for proper skin care, shoe eval, shoe wear
89
gestational diabetes
- increase in insulin resistance and blood glucose levels w/ pregnancy in last trimester
- no known etiology but likely hormones that assist fetus growth and development lead to insulin resistance
- most return to normal glucose metabolism after pregnancy but if > 6 weeks after birth -> dif form of DM
- babies born after GD have increased glucose levels and increased risk for macrosomia (larger than average size) - difficult delivery and more dangerous; may also exp breathing difficulties, jaundice, hypoglycemia after birth
- children more likely to experience insulin resistance, obesity, behavior and health issues -> hyperactivity disorders, delays in gross and fine motor skills
90
fasting plasma glucose
- blood glucose testing at least 8 hours after last food or drink
- (+) for DM if blodo glucose level is > 125 mg/dl
- normal is < 100 mg/dl
| need 2 occasions of testing to confirm DM diagnosis
91
oral glucose tolerance test
- 2 hours after ingestion of sugary drink
- (+) if BG is 200 mg/dl or greater
- normal < 140 mg/dl
92
A1c testing
- blood test based on attachment of glucose to hemoglobin - measures average blood glucose level over last 2-3 months
- (+) if A1c is 6.5% or greater
- normal is < 5.7%
93
in males, the hypothalamus produces
- hypothalamus produces gonadotropin-releasing hormone (GnRH) and pituitary responds by producing luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
- leydig cells of testes respond and produce testosterone
- occurs daily
94
in female, hypothalamus produces
- hypothalamus produces gonadotropin-releasing hormone (GnRH) and pituitary responds by producing luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
- in ovaries, LH acts on theca and interstitial cells to produce progestins and androgens
- FSH acts on granulosa cells to stimulate precursor steroids to estrogen
95
male hypogonadism
- primary hypogonadism: deficiency of testosterone s/t failure of testes to respond to LH and FSH (Kleinfelter's syndrome)
- secondary hypogonadism: failure of hypothalamus or pituitary to produce hormones to stimulate production of testosterone ->
- before puberty: sparse body hair, underdeveloped skeletal muscles, long arms and legs s/t delay in closure of epiphyseal plates
- in adults: decreased libido, ED, infertiltiy, decreased cog skills, mood changes, sleep disturbances
- treatment: hormone replacemnt
96
female hypogonadism
- primary hypogonadism: when gonad does not produce amount of sex steroid sufficient to suppress secretion of LH and FSH at normal levels (Turner syndrome)
- secondary hypogonadism: failure of hypothalamus or pituitary to produce hormones to stimulate production of estrogen ->
- before puberty: gonadal dysgenesis, short stature, failure to progress through puberty or primary amenorrhea, premature gonadal failure
- in adults: secondary amenorrhea
- treatment: hormone replacement therapy
97
bone mineral regulating agents
| endocrine management
- action: indications: enhance and maximize bone mass and prevent bone loss or rate of bone resoroption; estrogens, calcium and vit D, biphosphates, calcitonin, anabolic agents
- indications: paget's disease, osteoporosis, hyperparathyroidism, rickets, hypoparathyroidism, osteomalacia
- side effects: agent dependent, GI distress, dysphagia, anorexia, bone pain, cardiac arrhythmias
- PT implications: risk for fracture and side effects from drug therapy; use amb and WB activities to stimulate bone formation
- examples: estrogens - premarin; calcium and vit D; tums, calderol; biphosphates; calcitonin
98
hormone replacement agents
| endocrine management
- actions: restore normal endocrine function when endogenous production of particular hormone is deficient or absent
- indications: decrease in endogenous hormone secretion
- side effects: vary by replacement used
- PT implications: s/s of hormone deficit and s/s of hormone therapy
99
hyperfunction agents
| endocrine management
- action: manage hyperactive endocrine function to allow for inhibition of hormone function; accomplished through (-) feedback loops or hormone antagonists
- indications: hyperactive or excessive endocrine function, excessive hormone levels
- side effects: variable
100
metabolic system
- governs chemical and physical changes that take place within body to enable growth and function
- catabolism: organic compounds breaking down
- anabolism: combining simple molecules for tissue growth
