i bc27f85be50b71b1 (202 page)

areas. The following areas may be affected:

• Tongue

• Heart

• Gastrointestinal tract

• Liver

• Spleen

• Kidney

• Peripheral nerves

• Pancreas

• Cerebral vessels

•

Skin

In general, the deposition of protein in these areas will result in

firmer, less distensible tissues that compromise organ function.

Management of amyloidosis consisrs of controlling any primary disease process that may promote deposition of amyloid into the tissues.l.s

648 AClJfE CARE HANDBOOK FOR I'HYSICAL THERAPISrS

References

1. Bullock BL. Pathophysiology: Adaprarions and Alrerarions in Funcrion

(4th cd). Philadelphia: Lippincott, 1996.

2. Kimberly RP. Research advances in systemic lupus erythemarosus.

JAMA 2001;285(5):650.

3. McConnell EA. Abour sysremic lupus erythemarosus. Nursing 1999;

29(9):26.

4. Wallace OJ. Updare on managing lupus erythemarosus. J Musculoskeletal Med 1999;16(9):531.

5. Chandrasoma P, Taylor CR. Concise Pathology (2nd ed). East Norwalk,

CT: Appleton & Lange, ·'995.

6. Morey 55. American Thoracic Society issues consensus statement on

sarcoidosis. Am Fam Physician 2000;61 (2):553.

7. Johns CJ, Michele TM. The clinical management of sarcoidosis a 50-

year experience ar the Johns Hopkins Hospiral. Medicine 1999;

78(2):65.

8. Goodman ec, Snyder TEK. Differential Diagnosis in Physical Therapy:

Musculoskeleral and Systemic Conditions. Philadelphia: Saunders,

1 995.

11

Endocrine System

Jaime C. Paz

lntroduction

The endocrine system consists of endocrine glands, which secrete

hormones into the bloodstream, and target cells for those hormones. Target cells are the principal sites of action for the endocrine glands. Figure 11-1 displays the location of the primary endocrine glands.

The endocrine system has direct effects on cellular function and

metabolism throughout the entire body, with symptoms of endocrine,

metabolic dysfunction, or both often mimicking those of muscle

fatigue. Also, the onset of clinical manifestations from endocrine or

metabolic dysfunction, or both, can often be insidious and subtle in

presentation. Therefore, it is important for the physical therapist to

carefully distinguish the source (endocrine versus musculoskeletal) of

these symptoms to optimally care for the patient. For example, complaints of weakness and muscle cramps can result from hypothyroidism or inappropriate exercise intensity. If the therapist is aware of the patient'S current endocrine system status, then inquiring about a

recent medication adjustment may be more appropriate than adjusting the patiem's exercise parameters.

649

650

AClJn� CARE HANDBOOK FOR PHYSICAL THERAPISTS

Hypothalamic

Nudei

PItuitary Gland

Adrenal

(Iuprarenal)

Glandl \

0,,,..,

Figure 11-1. Schematic representatiol1 of the primary endocrine glands in

women a"d me". (Figure redraw" by Marybeth Cuaycong.)

The objectives of this chapter are ro provide a basic understanding

of the following:

1. Normal functions of the endocrine system, including the thyroid,

pituitary, adrenal, and parathyroid glands, as well as the pancreas

2. Clinical evaluation of these endocrine organs

3 . Endocrine system dysfunction and subsequent medical management

4. Physical therapy guidelines for working with patients who

have endocrine system dysfunction

ENDOCRINE SYSTEM

65]

Screening for Metabolic and Endocrine Dysfunction

The following quesrions help ro provide a systemaric method ro differentiate the patient's symptoms and complaints to a specific endocrine gland. Full integrarion of the parienr's signs and symptoms with laborarory dara by the physician is, however, necessary ro accurately

diagnose the disorder. Physical therapists can use these questions to

help guide their evaluations and organize inquiries for the medical

team regarding treatment parameters. For instance, if the questions

lead the therapist to suspect pituitary involvement, seeking clarification from the physician regarding the appropriateness of physical therapy intervention may be necessary. I

I. Piruitary

a. Are menses regular? (If they are irregular, hypopituitarism

may be suspected.)

b. Has rhere been a change in vision? (Large piruitary tumors

can result in vision loss.)

2. Adrenal

a. Is rhere skin darkening? (Chronic primary adrenal insufficiency results in hyperpigmentation.)

b. Is there weight loss, nausea, vomiting, or syncope? (These

are suggestive of adrenal insufficiency.)

c. Have there been episodes of tachycardia, headaches, and

sweating? (These are suggestive of pheochromocytoma.)

3. Thyroid

a. Is there a change in the patient'S neck size? (This can indicate the presence of goiter or hyperthyroidism.)

b. What is the room-remperature preference of the patient?

(60°F suggests hyperthyroidism, whereas 80°F suggests

hypothyroidism.)

4. Parathyroid

a. Is there a history of thyroid surgery? (This is the usual

cause of hypoparathyroidism.)

b. Are kidney stones, polyuria, and constipation present?

(This could indicate hypercalcemia from hypoparathyroidism.)

652 AClfTE CARE. HANDBOOK FOR PHYSICAL THERAPISTS

5. Pancreas

a. Is there nocturia or nocridipsia (urination or drinking at

night, respectively)? (Soth of these can suggest diabetes mellitus.)

b. Has there been a weight loss or gain and increased appetite? (These also suggest diabetes.)

General Evaluation of Endocrine Function

Measurement of endocrine function can be performed by examining

(1) the endocrine gland itself, using imaging techniques, or (2) levels

of hormones or hormone-related substances in the bloodstream or

urine. When reviewing the medical record, it is important for the

physical therapist to know that high or low levels of endocrine substances can indicate endocrine dysfunction. A common method for assessing levels of hormone is radioimmunoassay (RIA).2 RIA is an

immunologic technique for comparing levels of radiolabeled hormone wirh unlabeled hormone, which compete for binding sites on a given antibody.

Another method of evaluarion, referred to as provocative testing, can be classified into suppcession or stimulation tests. Stimulation tests are used for testing endocrine hypofunction; suppressio1l tests are useful in evaluating endocrine hyperfunctionJ The most