PHYSIOTHERAPY IN HORMONAL DISORDERS

NEELU YIRANG

MPT- SPORTS

TYPES OF ENDOCRINE DISEASE:

Endocrine disorders may be subdivided into threegroups:

Endocrine gland hyposecretion (leading to hormonedeficiency)

Endocrine gland hypersecretion (leading to hormoneexcess)

Tumours (benign or malignant) of endocrine glands

DIAGNOSIS OF ENDOCRINE DISEASES:

Diagnosis of endocrine diseases may be difficult; itis often not possible to directly assay hormone levels inthe blood, making indirect measurements necessary.

For example, diabetes mellitus is diagnosed viameasurements of blood glucose rather than directassays of plasma insulin;

Cushing's syndrome is diagnosed by thedexamethasone suppression test rather than by directassays of serum.

GLANDS OF THE ENDOCRINE SYSTEM

Hypothalamus

Posterior Pituitary

Anterior Pituitary

Thyroid

Parathyroids

Adrenals

Pancreatic islets

Ovaries and testes

HYPOTHALAMUS

Releasing and inhibiting hormones

Corticotropin-releasing hormone

Thyrotropin-releasing hormone

Growth hormone-releasing hormone

Gonadotropin-releasing hormone

Somatostatin-=-inhibits GH and TSH

ANTERIOR PITUITARY

Growth HormoneAdrenocorticotropic hormoneThyroid stimulating hormoneFollicle stimulating hormone—ovary in female, sperm

in malesLuteinizing hormone—corpus luteum in females,

secretion of testosterone in malesProlactin—prepares female breasts for lactation

POSTERIOR PITUITARY

Antidiuretic Hormone

Oxytocin—contraction of uterus, milk ejectionfrom breasts

ADRENAL CORTEX

Mineralocorticoid- aldosterone. Affects sodiumabsorption, loss of potassium by kidney

Glucocorticoids- cortisol. Affects metabolism, regulatesblood sugar levels, affects growth, anti-inflammatoryaction, decreases effects of stress

Adrenal androgens- dehydroepiandrosterone andandrostenedione. Converted to testosterone in theperiphery.

ADRENAL MEDULLA

Epinephrine and norepinephrine- serve asneurotransmitters for sympathetic system

THYROID

Follicular cells—excretion of triiodothyronine (T3) andthyroxine (T4)—Increase BMR, increase bone andcalcium turnover, increase response to catecholamines,need for fetal G&D

Thyroid C cells—calcitonin. Lowers blood calcium andphosphate levels

PARATHYROID

Parathyroid hormone—regulates serum calcium

PANCREATIC ISLET CELLS

Insulin

Glucagon- stimulates glycogenolysis and glyconeogenesis

Somatostatin- decreases intestinal absorption of glucose

OVARIES

Estrogen

Progesterone—important in menstrual cycle, maintains pregnancy

LISTS OF SOME HORMONAL DISEASE:Conn's syndrome

Cushing's syndrome (moon face, buffalo hump)

Hyperthyroidism

Hypothyroidism

Thyroid cancer

Delayed puberty

Amenorrhea

Polycystic ovary syndrome

Cushing’s syndrome is a general term for increased secretion of cortisol by theadrenal cortex. When corticosteroids are administered externally, a condition ofhypercortisolism called iatrogenic Cushing’s syndrome occurs. When thehypercortisolism results from an oversecretion of ACTH from the pituitary, thecondition is called Cushing’s disease.

Therapists are more likely to treat people who have developed medication-inducedCushing’s syndrome. This condition occurs after these individuals have received a largedose of cortisol (also known as hydrocortisone) or cortisol derivitives. Because cortisolsuppresses the inflammatory response of the body, it can mask early signs of infection

To maintain muscle and bone mass, weight-bearingexercises such as push-ups, sit-ups, or lifting weights arehelpful.

To prevent weight gain, aerobic exercise is goodto increase your heart rate. Examples of aerobic exerciseinclude fast walking, jogging, cycling, and swimming.

Education on avoiding falls and removing loose rugs andother hazards in the home. Falling may lead to brokenbones and other injuries.

Education on proper wound healing and cleansing isimportant.

Hypothyroidism is caused by an insufficient amount of the thyroid hormone in the body resulting in an overall slowing of metabolism. There are two categories to classify Hypothyroidism which are primary and secondary.

Preferred Practice Patterns for Physical Therapy:4C: Impaired Muscle Performance4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction.4E: Impaired Joint Mobility, Motor Function, Muscle Performance and Range of Motion Associated with Localized Inflammation.4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion and Reflex Integrity Associated with Spinal Disorders6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning.7A: Primary Prevention/Risk Reduction for Integumentary Disorders.

When myedematous hypothyroidism is treated it may causethe patient to develop pseudogout in the joints and may affectthe spine as well. The patient may have complaints of muscleaches, pain, or stiffness and may cause the development oftrigger points. This will require hormone therapy to resolvethe symptoms and cannot be helped with simple myofascialrelease.

Patient with hypothyroidism in the acute care setting must beaware that dry, edematous skin is prone to breakdown ortears. Prevention may be to keep and work to monitor andrelieve pressure points on the sacrum, coccyx, elbows andheels whenever necessary.

In cases of patient reported carpal tunnel it is important toget a thorough history to understand if the mechanism ofinjury is truly related to causes treatable by the therapist suchas ergonomics or if the patient needs to be referred on so thatthe underlying issue may be resolved.

Developing an exercise program for a patient withHypothyroidism can be helpful in many ways. First, it helps torebuild activity tolerance, increase muscle strength, andreduce apathy secondary to the decreased metabolism causedby the disorder.

Hyperthyroidism, often referred to as thyrotoxicosis, is a disorder thatoccurs when the thyroid gland secretes excessive amounts of thyroxine(T4) and/or triiodothyronine (T3).

Preferred Practice Patterns:

4C: Impaired muscle performance

4D: Impaired joint mobility, motor function, muscle performance, andROM associated with connective tissue dysfunction

4E: Impaired joint mobility, motor function, muscle performance, andROM associated with localized inflammation

6B: Impaired aerobic capacity/endurance assoiciated with deconditioning

Some patients with Graves’ disease suffer from heatintolerance, making exercising in a hot pool acontraindication to therapy. This patient would still be able toparticipate in aquatic therapy in a warm pool; given thepatient’s body temperature being monitored.

70% of people with hyperthyroidism develop proximal muscleweakness as a result of treatment, most often affecting thepelvis and thigh muscles.

Amenorrhea refers to absent menstruation. It is of two types:

(a) Primary where women never had a menstrual period.

(b) Secondary absence of menstrual period in woman who had established before.

Aims of physiotherapy:

To promote health and fitness, exercise tolerance, coordination, strength, staminaand concentration.

To encourage alternative ways of controlling stress level by exercises, relaxationand lifestyle adjustment.

To maintain the joint mobility, strength, endurance and treat anyneuromusculoskeletal problem as associated.

Effect of Exercise on Reproductive Hormones in Female Athletes

International Journal of Sport and Exercise Science, 5(1): 7-12

Maryam Mosavat1, Mahaneem Mohamed, MitraOssadat Mirsanjari

10 Jan 2013

Female athlete who engages in high intensity exercise is at riskas a consequence of hormonal changes which result inmenstrual disturbances. Impaired production ofgonadotrophins, which leads to luteal phase deficiency andanovulation, is a common hormonal finding with exercise-induced menstrual disturbances. There is a strong agreement inresponsibility of low energy availability due to imbalancebetween energy intake and energy expenditure during exerciseto impairment hypothalamus ovarian axis (HPO) and reductionin hypothalamus, gonadotropin hormones and subsequentlymenstrual disorder. However, increase in stress hormone levelsthrough hypothalamus adrenal axis (HPA) activated bystrenuous physical activity has been introduced as a responsiblefor HPO axis impairment by some other studies.

The spectrum of the female athlete triad

Potential Effects of Aerobic Exercise on the Expression of Perilipin 3 in the Adipose Tissue of Women with Polycystic Ovary Syndrome: A Pilot

Study

Eur J Endocrinol. 2015 January ; 172(1): 47–58.

Polycystic Ovary Syndrome (PCOS) is a complexendocrine and reproductive disorder affectingapproximately 4–7% of women of reproductive age. As aprinciple cause of infertility in reproductive aged women,PCOS is characterized by the presence of menstrualdisturbances, hyperandrogenemia, and ovarian cysts.

Similarly, approximately 70% of women with PCOShave increased adiposity and between 20–43% haveinsulin resistance and reduced glucose control. Onepossible culprit speculated to contribute to this irregularmetabolic phenomena is defects within the adipose tissue.

Polycystic Ovary Syndrome (PCOS) is associated withreduced adipose tissue lipolysis that can be rescued byaerobic exercise. The aim was to identify differences in geneexpression of perilipins and associated targets in adiposetissue in women with PCOS before and after exercise.Women with PCOS completed a 16-week prospective aerobicexercise-training study. Sixteen weeks of aerobic exercisetraining significantly increased PLIN3 expression as well ascoatomer GTPases. Additionally, adipose cultures revealedvirtually no PLIN3 protein expression before exercise, whichwas then increased/became expressed following exercisetraining. These findings suggest that PLIN3 and coatomerGTPases are important regulators of lipolysis andtriglyceride storage in the adipose tissue of women withPCOS.

Transcranial physiotherapy in the correction of reproductive system disorders in adolescent girls

with obesity

American Journal of Internal Medicine 2014; 2(5): 83-86

It has been proved that the reproductive system disordersincluding ovarian dysfunction, early miscarriages in thepregnancy, polycystic ovary syndrome in women of young agemay be concerned with the obesity.

The study was undertaken to evaluate and optimizevarious modes of transcranial physiotherapy for reproductivesystem disorders in puberty girls with obesity.

Combined use of transcranial magnetic therapy (TMT)and transcranial electrostimulation (TES) was substantiatedby a study of the hormonal status, carbohydrate metabolism,anthropometric and clinical data, ultrasonography andelectroencephalography. The application of AMO-ATOS-Eapparatus for this purpose could normalize a menstrual cyclein 86,3% of the obese girls, by reducing body weight.

Effect of Parotid Gland Massage on Parotid Gland Tc-99m Pertechnetate Uptake

Thyroid radiology and nuclear medicine

Volume 22, Number 6, 2012

Salivary dysfunction is the most common side effectassociated with I therapy in patients with differentiatedthyroid cancer. Using Tc-99m pertechnetate, two salivaryscans were performed in all patients. In 30 patients, PGmassage was performed between the two salivary gland scans,whereas in the other 30 patients no massage was performedbetween the two scans.

PG massage was performed in a sitting positionbilaterally from posterior to anterior along the parotid ductusing both palms. During this massage, patients tightenedtheir jaw muscles and contracted their masticator muscles toprovide PG support. PG massage was performed 20 times overone minute.

Tc-99m pertechnetate scan was used to evaluate theeffect of PG massage instead of I scan. I is orally administeredfor thyroid ablation or thyroid cancer treatment, therefore it isslowly accumulated in the salivary glands. Tc-99mpertechnetate was intravenously administered and itsaccumulation to the salivary gland was faster than orallyadministered.

Further, these results indicate that PG massage can effectivelyreduce salivary accumulating radioisotope in the PG not onlyin patients with normal thyroid function but also in patientswith hyperthyroidism and be helpful to prevent salivarydamage associated with I therapy.

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