Endocrine Disorders

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Endocrine Disorders

• BCE 542 (Physical Disabilities, Rehabilitation
  and Employment)
• Dr. Dunn
• September 24, 2002

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Endocrine System

• Secretes various hormones that regulate the
  activities of the body.
• Endocrine organs (glands)
• Pituitary Gland
• Thyroid Gland
• Adrenal Gland
• Pancreas

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The Pituitary Gland

• Master Gland of the body--regulates the operation
  of all the other glands.
• Located at base of brain.
• Regulates growth and development through
  secretion of somatotrophin.
• Secretes Vasopressin, which regulates
  re-absorption of fluids in the kidneys.

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Pituitary Disorders of Growth Development

• Gigantism-oversecretion of somatotrophin, causes
  overgrowth of skeleton and soft tissues.
• Body organs, esp. the heart, do not keep up with
  the growth.
• Sexual dysfunction, other metabolic disturbances,
  and vision problems (optic atrophy) are common.
• Acromegaly-Complication of gigantism involving
  enlargement of the head, hands and feet.
• Pituitary Dwarfism-caused by undersecretion of
  somatotrophin, causes stunting of growth.

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Treatment of Pituitary Growth Disorders

• Gigantism/Acromegaly Removal of pituitary is
  attempted, esp. if optic atrophy is present.
  Medications must then be taken to take the place
  of other pituitary functions.
• Pituitary Dwarfism Removal of cause of
  dysfunction (tumor, cyst) administration of
  steroids (growth hormones) to promote growth and
  development

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Pituitary Growth Disorders--Rehabilitation
Considerations

• All disorders
• Adjustment to the environment (e.g., using
  utensils, furniture, tools that are too large or
  too small).
• Social Integration issues.
• Rehabilitation issues caused by complications
  (vision, endocrine dysfunction, etc.)
• Gigantism/Acromegaly
• Stereotype that large sizestrength actually the
  person is weakened by growth and complications.
• Acromegaly-issues of disfigurement.
• Pituitary Dwarfism
• Socially, small size may translate to mistaken
  notions about maturity, intelligence, eternal
  child.

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Diabetes Insipidus

• A pituitary disorder--NOT sugar diabetes.
• Caused by lack of secretion of vasopressin,
  causing the kidneys to fail in reabsorption of
  fluid.
• Person will have extreme thirst and extreme
  urinary frequency.
• Interference with sleep weakness, weight loss.
• Treatment
• If caused by a tumor, surgical removal of the
  pituitary.
• Injections of vasopressin.
• Rehabilitation Issues
• Minor, but individual may need easy access to
  toilet and drinking water on the job.

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The Thyroid Gland

• Located in the neck area.
• Secretes thyroxine, which regulates the bodys
  metabolism (pace of function)
• Problems involve overproduction of thyroxine
  (hyperthyroidism) or underproduction
  (hypothyroidism)

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Hyperthyroidism

• Overproduction of thyroxine, causing metabolism
  to speed up.
• Due to lack of iodine in the diet.
• Person usually develops goiter--swelling of
  thyroid in the neck.
• Person is agitated, restless, may lose weight,
  have trouble sleeping.
• May develop exophthalmos--bulging of the
  eyeballs.
• Treatment is removal of thyroid or destruction of
  thyroid by drinking radioactive iodine.

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Hypothyroidism

• Undersecretion of thyroxine, causing lowering of
  the bodys metabolism.
• Lethargy, weakness, tiredness, weight gain,
  brittleness of hair and skin, deepening of voice
• Increased likelihood of development of
  cardiovascular disease.
• May develop as a result of destruction of thyroid
  as treatment for hyperthyroidism.
• Treatment
• Thyroxine replacement (medications)
• Rehabilitation
• Properly treated thyroid conditions do not
  require rehabilitation intervention.

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Cretinism

• Prenatal condition caused by deficiency of
  thyroid hormones in mother. Results in
• Dwarfed stature
• Mental retardation
• Dystrophy of the bones
• Low metabolism

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The Adrenal Glands

• Located on the tops of the kidneys.
• Have a cortex (outer portion) and medulla (inner
  portion)
• Medulla secretes Epinephrine (Adrenaline) and
  Norepinephrine, which cause metabolism to
  increase during times of stress.
• Cortex secretes numerous steroids that regulate
  immune function, metabolism, and chemical
  balances in the body.
• Most disorders of the adrenal glands involve
  problems with secretion of steroids.

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Cushings Syndrome

• Caused by overproduction of steroids by adrenal
  cortex, or by overuse/abuse of steroidal drugs.
• More common in women than in men.
• Person will gain weight in face, stomach and
  buttocks but will have wasted limbs.
• Bones mass may lessen, diabetes may develop.
• Treatment
• Surgical or radiological removal of the adrenal
  cortex.
• If destruction of adrenal cortex is performed, it
  is necessary to take steroidal medications.
• Rehabilitation
• Disease is extremely debilitating. If
  rehabilitation is feasible, it must take into
  account extremely reduced capacities for physical
  activities.

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Addisons Disease

• Underproduction of steroids by adrenal cortex.
• Person is easily fatigued, loses weight, may have
  problems with dehydration, has low blood pressure
  and low blood sugar, may be easily susceptible to
  infection due to decreased activity of immune
  system.
• Treatment
• Replacement and regulation of steroids, which has
  to be closely monitored and is difficult.
• Rehabilitation
• Avoid physical and emotional strain in
  employment.
• Avoid environments in which there is a high
  likelihood of exposure to infectious agents.

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The Pancreas

• Located near the left kidney
• Most of pancreas produces digestive juices.
• Small area of pancreas, the Islets of Langerhans,
  produce insulin, used in metabolism of various
  substances, especially carbohydrates.

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Pancreatitis

• Inflammation of the pancreas
• Caused by gallbladder disease, excessive eating
  or overindulgence in alcohol.
• May be chronic or acute.
• Treatment Intensive hospital care with
  administration of antibiotics, surgery to repair
  abscesses or hemorrhages, intravenous feeding.
• Rehabilitation
• Not a concern if disease is treated and managed.

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Diabetes Mellitus (Sugar Diabetes)

• Inability of the body to produce or to use
  insulin, resulting in a lack of ability to use or
  metabolize glucose.
• Cause is unknown some factors involved include
• Genetic Disposition
• Smoking
• Obesity
• Lack of Activity
• High levels of stress/anxiety

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Diabetes--Symptoms

• Frequent Urination (diabetes means frequent
  urination)
• Extreme hunger and thirst.
• Blurred vision.
• Dry, itchy skin
• Poor wound healing
• Impotency in men due to vascular problems.
• Numbness and tingling in upper and lower
  extremities.

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Types of Diabetes

• Type I Diabetes (Insulinopenic or Juvenile
  Diabetes)
• Lack of production of insulin by pancreas.
• Usually appears in childhood but can appear at
  any age.
• Two forms, one causing ketoacidosis, one not
  severe enough to cause ketoacidosis (see below)
• Type II Diabetes (Adult-Onset Diabetes)
• Insulin production is normal, but body cannot use
  the insulin produced.
• Usually a disease of middle aged or older
  persons, but may begin in younger persons.

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What happens in diabetes

• Body cannot metabolize glucose, causing it to
  remain in bloodstream until it can be eliminated
  in the urine blood sugar rises level of sugar
  in urine rises.
• Because glucose is not used effectively to make
  energy, individual becomes extremely hungry.
• Body metabolizes fat to make energy, causing
  weight loss even though food intake increases.
• Metabolism of fats releases toxins into the
  bloodstream faster than the body can eliminate
  them--this condition is called ketoacidosis.

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What happens in diabetes, cont.

• Ketoacidosis gradually causes increased symptoms
  of diabetes, pain in abdomen, fruity smelling
  breath. Eventually will lead drowsiness, and
  then to a diabetic coma if not arrested.
• Ketoacidosis is an extremely serious condition
  and must be treated in a hospital setting.

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Complications of Diabetes

• Increased likelihood of stroke, heart disease,
  kidney failure.
• Interference with vascular activity--affecting
  wound healing, esp. in extremities, sexual
  function.
• Extreme vascular problems may cause lack of
  bloodflow and infarction, esp. in lower
  extremities, necessitating amputation.
• Diabetic Retinopathy--atrophy of veins in the
  retinas of the eyes, causing blindness.
• Peripheral Neuropathy--nerve damage causing lack
  of sensation in the upper or lower extremities.
• Increased likelihood of skin infection due to
  level of glucose present in blood and near the
  skin.
• Hypoglycemia--low blood sugar caused by overuse
  of insulin or other diabetic management
  therapies causes disorientation,
  drowsiness--person may appear to be drunk.
• Many diabetics carry candy with them in case of
  hypoglycemia.

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Treatment of Diabetes

• There is no cure for diabetes however, for most
  persons, the disease is quite manageable.
• Dietary regulation and close monitoring of the
  blood glucose level is key to management.
• All persons with Type I diabetes and some people
  with Type II diabetes must take insulin
  injections on a regular basis, or use an insulin
  pump.
• Most persons with Type II diabetes may regulate
  their diabetes through medications that help the
  body use glucose more effectively, or simply
  through attention to blood glucose level, dietary
  intake, and activity level.

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Diabetes--Rehabilitation Considerations

• Psychosocial adjustment to lifestyle changes.
• Dependency, depression if complications begin to
  develop.
• Vocationally, persons with diabetes may not have
  restrictions of level of activity, so long as
  physical exertion is consistent and predictable
  (glucose management).
• It is advisable that jobs not present extreme
  risks of injury, esp. to lower extremities, due
  to difficulties with wound healing.
• Complications of diabetes, if present, will
  present additional rehabilitation issues.
  Example Peripheral Neuropathy might cause
  problems with manual and finger dexterity.