Endocrine and metabolic systems
Endocrine system
Thyroid disorders
Hypothyroidism (underactive thyroid)
- Cause: Autoimmune disease (Hashimoto’s thyroiditis), iodine deficiency, post-thyroidectomy.
- Symptoms: Fatigue, weight gain, cold intolerance, bradycardia, constipation, depression, myopathy, slow DTRs.
- PT implications:
- Monitor for exercise intolerance, muscle weakness, and risk of rhabdomyolysis.
- Low-intensity exercise with gradual progression.
- Watch for joint stiffness and slowed healing.
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https://upload.wikimedia.org/wikipedia/commons/9/9f/Signs_and_symptoms_of_hypothyroidism.png
Hyperthyroidism (overactive thyroid)
- Cause: Autoimmune disease (Graves’ disease), excess iodine, thyroid tumors.
- Symptoms: Weight loss, heat intolerance, tachycardia, hyperreflexia, muscle wasting, tremors, exophthalmos (bulging eyes).
- PT implications:
- Monitor HR and BP due to risk of tachycardia, arrhythmias, and hypertension.
- Heat intolerance → Adjust exercise environment.
- Avoid high-intensity exercise due to risk of fatigue and catabolic muscle loss.
Thyroid storm (medical emergency)
- Acute hyperthyroidism crisis with severe tachycardia, fever, and confusion → Requires emergency care.
Adrenal gland disorders
The adrenal glands (on top of the kidneys) produce cortisol, aldosterone, and catecholamines (epinephrine, norepinephrine).
Addison’s disease (adrenal insufficiency)
- Cause: Autoimmune destruction of adrenal glands → Decreased cortisol and aldosterone.
- Symptoms: Fatigue, hypotension, weight loss, salt craving, hyperpigmentation, weakness.
- PT implications:
- Monitor for hypoglycemia, hypotension, and fatigue.
- Avoid overexertion due to limited stress response.
- Risk of adrenal crisis (severe hypotension, dehydration, shock) → Medical emergency!
Cushing’s syndrome (hyperfunction of adrenal glands)
- Cause: Excess cortisol from long-term steroid use or adrenal tumor.
- Symptoms: Moon face, buffalo hump, central obesity, muscle atrophy, osteoporosis, hypertension, poor wound healing.
- PT implications:
- Fall risk due to osteoporosis and muscle weakness.
- Monitor BP and glucose levels (risk of hypertension and diabetes).
- Avoid high-impact exercises to prevent fractures.
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Diabetes mellitus (DM)
Type 1 diabetes (insulin-dependent)
- Cause: Autoimmune destruction of pancreatic beta cells → No insulin production.
- Symptoms: Polyuria, polydipsia, polyphagia, weight loss, ketoacidosis (DKA risk).
- PT implications:
- Monitor for hypoglycemia (shakiness, confusion, sweating, dizziness).
- Exercise increases insulin sensitivity → Adjust insulin and carb intake accordingly.
- Avoid exercise during peak insulin activity to prevent hypoglycemia.
Type 2 diabetes (insulin-resistant)
- Cause: Insulin resistance due to obesity, genetics, sedentary lifestyle.
- Symptoms: Polyuria, polydipsia, slow wound healing, neuropathy, blurred vision, fatigue.
- PT implications:
- Encourage aerobic and resistance exercise to improve insulin sensitivity.
- Monitor for neuropathy and fall risk.
- Check for foot ulcers and skin integrity.
Associated diabetic conditions
- Hypoglycemia
- Cause: Low blood sugar (<70 mg/dL)
- Symptoms: Sweating, confusion, dizziness, tachycardia
- PT considerations: Provide glucose immediately (juice, glucose tablets)
- Diabetic Ketoacidosis (DKA)
- Cause: No insulin production causes fat breakdown and release of ketones in bloodstream
- Symptoms: Fruity breath, deep breathing (Kussmaul), nausea, confusion
- PT considerations: Medical emergency! No exercise!
- Peripheral Neuropathy
- Cause: Nerve damage from prolonged hyperglycemia
- Symptoms: Numbness, tingling, burning pain in feet/hands
- PT considerations: Foot care education, balance training, fall prevention
- Retinopathy
- Cause: Retinal blood vessel damage due to hyperglycemia
- Symptoms: Vision loss, blurred vision
- PT considerations: Avoid high-impact or head-down exercises
- Nephropathy
- Cause: Kidney damage from diabetes due hyperglycemia
- Symptoms: Protein in urine, swelling, hypertension
- PT considerations: Monitor hydration levels and blood pressure
- Peripheral Artery Disease (PAD)
- Cause: Poor circulation in legs due to vessels damage from hyperglycemia
- Symptoms: Claudication (leg pain with walking), cold feet
- PT considerations: Use graded walking program
Metabolic disorders
The metabolic system includes chemical processes that maintain life, including energy production and nutrient utilization.
Osteoporosis
- Cause: Decreased bone density (aging, menopause, steroid use, hyperthyroidism).
- Symptoms: Fractures, kyphosis, back pain.
- PT implications:
- Weight-bearing exercise to improve bone density.
- Avoid spinal flexion exercises to prevent vertebral fractures.
- Balance training to prevent falls.
- DEXA (Dual-Energy X-ray Absorptiometry) scans are used to measure bone mineral density and are the most accurate way to assess bone health.
- Determined by T-score:
- Normal: less than -0.1
- Osteopenia : -1.0-(-2.5)
- Osteoporosis: greater than -2.5
- Determined by T-score:
Paget’s disease
- Cause: Excessive bone turnover → Weak, deformed bones.
- Symptoms: Bone pain, deformities, fractures, hearing loss.
- PT implications:
- Low-impact exercise to maintain mobility.
- Monitor for fractures and joint dysfunction.
Gout (metabolic arthritis)
- Cause: Uric acid crystal buildup in joints (linked to diet, kidney dysfunction).
- Symptoms: Severe joint pain (big toe common), redness, swelling.
- PT implications:
- Avoid excessive weight-bearing during flares.
- Encourage hydration and dietary modifications (low purine diet)
Metabolic syndrome
Criteria for metabolic syndrome:
- Abdominal obesity
- Waist circumference:
- Men: >40 inches (102 cm)
- Women: >35 inches (88 cm)
- Waist circumference:
- Elevated blood pressure
- ≥130/85 mmHg or taking antihypertensive medication
- Elevated fasting blood glucose
- ≥100 mg/dL or diagnosed diabetes
- High triglycerides
- ≥150 mg/dL or taking medication for high triglycerides
- Low HDL (good cholesterol)
- Men: <40 mg/dL
- Women: <50 mg/dL
Causes and risk factors
- Lifestyle Factors: Poor diet, sedentary lifestyle, obesity
- Genetics: Family history of diabetes or cardiovascular disease
- Hormonal Imbalance: Insulin resistance, PCOS (in women)
Symptoms
- Often asymptomatic until complications arise
- Signs may include increased waist size, fatigue, high blood sugar symptoms (thirst, frequent urination), and high blood pressure
PT considerations
- Exercise recommendations:
- Focus on aerobic exercise (brisk walking, cycling, swimming)
- Include resistance training to improve insulin sensitivity
- Gradual progression to prevent fatigue and improve adherence
- Weight management: Encourage lifestyle changes like healthy diet and activity
- Blood pressure monitoring: Avoid high-intensity exercises if diabetes is uncontrolled