7/8/13 A Massage Therapist’s Guide to Pathology, 5e Chapter 9 Endocrine System CondiCons IntroducCon •  A collecCon of glands that secrete hormones •  Hypothalamus is control center for endocrine (chemical) reacCons and autonomic (electrical) reacCons •  Hypothalamus connects to pituitary (“Master Gland”) via motor neurons and hormones •  Hormones from hypothalamus and pituitary travel through bloodstream to target organs and Cssues IntroducCon •  Many targets are other endocrine glands •  When hypothalamus (or other glands) sense that secreCons are normal, the signals stop: negaCve feedback loop •  Most hormone cycles work best in gentle, rhythmic fluctuaCons •  Cycle can last hours, days, weeks 1 7/8/13 Key Hormones for Massage Therapists to Know •  Growth hormone –  Converts fuel into new cells for growth (in children) and repair (in adults) –  Secreted mostly in Stage IV sleep •  Epinephrine –  Also called adrenaline –  From adrenal medulla, associated with short-­‐
term, high-­‐grade stress; reinforces and prolongs sympatheCc response Key Hormones for Massage Therapists to Know •  CorCsol –  A steroid glucocorCcoid from adrenal cortes –  Secreted during long-­‐term, low-­‐grade stress, measurable in saliva –  Powerful anC-­‐inflammatory, dissolves connecCve Cssue, suppresses immune system •  MineralcorCcoids –  From adrenal cortex for regulaCon of water, electrolytes; aldosterone is primary mineralcorCcoid •  Insulin/glucagon –  AntagonisCc hormones from pancreas: insulin decreases BG, glucagon raises it Key Hormones for Massage Therapists to Know •  Thyroxine –  From thyroid, in two forms: T3 and T4 –  SCmulates metabolism of fuel into energy (rather than storage or growth) •  Calcitonin –  Also from thyroid, sCmulates osteoblasts, increases bone density and decreases blood calcium •  Parathyroid hormone –  From parathyroid glands, antagonist of calcitonin: sCmulates osteoclasts, decreases bone density, increases blood calcium 2 7/8/13 Key Hormones for Massage Therapists to Know •  Testosterone, estrogens, progesterone –  From gonads and other cells for secondary sexual characterisCcs –  Environmental exposures (“estrogen dominance”) can upset balance •  Other hormones –  EPO from kidneys increases RBC producCon –  Thymosin from thymus helps mature T-­‐cells –  Melatonin from pineal gland helps determine sleep/wake cycle –  Prostaglandins are all over: promote inflammaCon, pain sensaCon, smooth muscle contracCon Diabetes Mellitus •  DefiniCon: –  Group of related disorders that all result in hyperglycemia –  98% are type 1 or type 2 –  7th leading cause of death in the US (probably underreported) –  About 26 million Americans have diabetes, about 7 million don’t know it yet –  About 1.6 million people are diagnosed each year –  Aging populaCon, obese young people, sedentary lifestyles Diabetes Mellitus •  ECology: –  Insulin is in short supply –  Insulin receptor sites develop resistance –  Either way: glucose and fats accumulate in blood, and cells have to burn stored fat then protein for fuel 3 7/8/13 Diabetes Mellitus •  ComplicaCons: –  Cardiovascular disease •  Endothelium becomes vulnerable to damage, atherosclerosis •  Plaque accumulates everywhere •  Increased risk of stroke, hypertension, aneurysm •  Most die of CV problem Diabetes Mellitus –  Edema •  Sluggish blood return, stasis dermaCCs –  Ulcers, gangrene, amputaCons •  Poor circulaCon → risk of skin, Cssue damage especially at feet •  82,000 amputaCons/year –  Kidney disease •  Renal arteries have plaque, glucose is hard on nephrons •  Number 1 cause of end stage renal failure Diabetes Mellitus –  Impaired vision •  Thickened capillaries in eye; microaneurysms, glucose in lens •  Number 1 cause of new blindness in people 20-­‐70 –  Neuropathy •  Lack of circulaCon and excess sugar contribute to peripheral nerve damage •  Tingling, pain, numbness •  At cranial nerves → poor GI moClity, low blood pressure 4 7/8/13 Diabetes Mellitus •  Types of Diabetes Mellitus –  Type 1: •  Exposure to drugs or chemicals, complicaCon of infecCons •  Autoimmune agack on beta cells → lifelong deficiency in insulin •  Symptoms usually show before age 30 Diabetes Mellitus –  Type 2: •  Used to be called NIDDM, but since many do end up supplemenCng insulin, the name is no longer accurate •  Causes probably stem from prodiabetes behaviors and geneCc predisposiCon •  Usually controllable with diet, exercise, some meds but many paCents end up supplemenCng insulin Diabetes Mellitus –  Other types: •  GestaConal diabetes (discussed with pregnancy) •  Secondary diabetes is a complicaCon of trauma, other endocrine disorder or treatment •  Diabetes insipidus is a dysfuncCon of the pituitary gland and insufficient producCon of anCdiureCc hormone 5 7/8/13 Diabetes Mellitus •  Signs and Symptoms: –  Three “polys”: •  Polyuria (frequent urinaCon) •  Polydipsia (increased thirst) •  Polyphagia (increased appeCte) –  Also: faCgue, weight loss, nausea, vomiCng Diabetes Mellitus •  DiabeCc emergencies: –  Ketoacidosis •  Type 1 diabetes only •  Shortage of insulin and glucose in cells •  Metabolism of fat and protein → ketones, acidosis •  Triggered by stress, infecCon, trauma –  Can lead to shock, coma death Diabetes Mellitus –  Insulin shock •  Too much insulin, BG is dangerously low •  Dizziness, confusion, weakness, tremors •  Treated with milk, juice, candy, non-­‐diet soda to replace BG 6 7/8/13 Diabetes Mellitus •  Treatment –  Four goals: improve insulin producCon if possible; inhibit release of glucose from liver; increase sensiCvity to insulin; decrease absorpCon of carbs in small intesCne –  Also: maintain eyes, feet, skin carefully –  Type 2: diet and exercise, then meds and insulin –  Renal insufficiency happens for many; hemodialysis can help while hoping for transplant •  MedicaCons –  Insulin injecCon, pen or pump –  MedicaCons to sCmulate insulin release and insulin uptake –  MedicaCons to address hyperlipidemia Diabetes Mellitus •  Massage –  Risks •  CV disease, kidney disease, skin ulceraCons, neuropathy •  InjecCon sites or insulin pump agachment sites are local contraindicaCons •  Timing bodywork around insulin doses to avoid hypoglycemic episodes –  Benefits •  Healthy, responsive Cssue and well-­‐controlled diabetes can enjoy the same benefits of bodywork as the rest of the populaCon Hyperthyroidism •  DefiniCon: –  Thyroid produces excessive hormones that sCmulate the metabolism of fuel into energy –  Most are autoimmune (Graves disease, diffuse toxic thyroid) 7 7/8/13 Hyperthyroidism •  ECology: –  Usually one of three possibiliCes: •  Autoimmune agack on thyroid •  Nodule or group of nodules that become hyperacCve •  InflammaCon of thyroid –  Can cause damage to other Cssues resulCng in osteoporosis, protrusion of eyes, preCbial myxedema, acropachy –  Thyroid storms Hyperthyroidism •  Types of Hyperthyroidism –  Graves disease •  Most common •  Thyroid sCmulaCng immunoglobulins agack; thyroid grows (goiter) •  Excess thyroxine produced •  Conversion of fuel to energy increases 60-­‐100% •  GeneCc predisposiCon but triggered by stressful event –  MulCnodular goiter: nodules on thyroid someCmes become acCve –  Toxic adenoma: iodine deficiency from benign tumors –  ThyroidiCs: infecCon or childbirth Hyperthyroidism •  Signs and symptoms: –  Related to too much thyroxine: –  Anxiety, irritability, insomnia, rapid heartbeat, tremor, increased perspiraCon, sensiCvity to heat, frequent bowel movements, and unintenConal weight loss –  Skeletal muscles become weak, lighter menstrual flow, dry skin, brigle nails, problems with skin and eyes, goiter –  Long term can lead to dangerous changes in arterial and cardiac Cssues 8 7/8/13 Hyperthyroidism •  Treatment –  Surgery: Thyroidectomy; has risks of complicaCons •  MedicaCons –  RadioacCve iodine: can kill off part of thyroid –  Beta blockers: reduce heart rate, feeling of palpitaCons –  AnCthyroid medicaCons: Can prevent thyroid from producing too much thyroid hormone Hyperthyroidism •  Massage –  Risks •  Watch for local contraindicaCons on skin –  Benefits •  Can help help with sympatheCc symptoms Hypothyroidism •  DefiniCon: –  Thyroid hormones are abnormally low: body can’t generate energy from fuel 9 7/8/13 Hypothyroidism •  ECology: –  Pituitary (under control of hypothalamus) secretes TSH –  When T3, T4 levels are high, TSH is suppressed: negaCve feedback loop Hypothyroidism •  Types of Hypothyroidism –  Hashimoto thyroidiCs •  Autoimmune agack on the thyroid –  Secondary hypothyroidism •  ComplicaCon of treatment for hyperthyroidism –  Iodine deficiency •  Most common in the world but rare in the US because of iodinized salt –  Idiopathic •  No underlying disorder Hypothyroidism •  Signs and symptoms –  Weight gain, faCgue, depression, sluggish digesCon, intolerance to cold, puffy skin –  Edema may → carpal tunnel syndrome, nerve entrapments –  Hair may become brigle, fall out (especially at lateral eyebrows) –  Heavy menstrual periods –  Goiter –  High risk of heart disease –  Severe, untreated cases can → myxedema coma 10 7/8/13 Hypothyroidism •  Treatment –  Arrive at an accurate diagnosis (challenging) –  Hormone supplements •  MedicaCons –  Supplement thyroid hormone –  SyntheCc T4 (most can metabolize to T3) –  T3 can be supplemented with dessicated pig glands or a syntheCc form Hypothyroidism •  Massage –  Risks •  Cardiovascular disease can be present –  Benefits •  May help ameliorate some of the faCgue and depression that olen accompanies this condiCon 11