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