The document discusses several endocrine disorders and their relevance to physiotherapy. It covers topics like: - The three main types of endocrine diseases: gland hyposecretion, hypersecretion, and tumors. - The challenges of diagnosing endocrine diseases given difficulties directly assaying hormone levels. - An overview of the major endocrine glands like the hypothalamus, pituitary gland, thyroid, parathyroids, adrenals, pancreas, ovaries and testes. - Some common endocrine diseases that may benefit from physiotherapy interventions like Cushing's syndrome, hypothyroidism, hyperthyroidism, amenorrhea, and polycystic ovary syndrome.

1. PHYSIOTHERAPY IN
HORMONAL DISORDERS
NEELUYIRANG
MPT- SPORTS

2. TYPES OF ENDOCRINE DISEASE:
Endocrine disorders may be subdivided into three
groups:
Endocrine gland hyposecretion (leading to hormone
deficiency)
Endocrine gland hypersecretion (leading to hormone
excess)
Tumours (benign or malignant) of endocrine glands

3. DIAGNOSIS OF ENDOCRINE DISEASES:
Diagnosis of endocrine diseases may be difficult; it
is often not possible to directly assay hormone levels in
the blood, making indirect measurements necessary.
For example, diabetes mellitus is diagnosed via
measurements of blood glucose rather than direct
assays of plasma insulin;
Cushing's syndrome is diagnosed by the
dexamethasone suppression test rather than by direct
assays of serum.

4. GLANDS OF THE ENDOCRINE SYSTEM
Hypothalamus
Posterior Pituitary
Anterior Pituitary
Thyroid
Parathyroids
Adrenals
Pancreatic islets
Ovaries and testes

5. HYPOTHALAMUS
Releasing and inhibiting hormones
Corticotropin-releasing hormone
Thyrotropin-releasing hormone
Growth hormone-releasing hormone
Gonadotropin-releasing hormone
Somatostatin-=-inhibits GH and TSH

6. ANTERIOR PITUITARY
Growth Hormone
Adrenocorticotropic hormone
Thyroid stimulating hormone
Follicle stimulating hormone—ovary in female, sperm
in males
Luteinizing hormone—corpus luteum in females,
secretion of testosterone in males
Prolactin—prepares female breasts for lactation

7. POSTERIOR PITUITARY
Antidiuretic Hormone
Oxytocin—contraction of uterus, milk ejection
from breasts

8. ADRENAL CORTEX
Mineralocorticoid- aldosterone. Affects sodium
absorption, loss of potassium by kidney
Glucocorticoids- cortisol. Affects metabolism, regulates
blood sugar levels, affects growth, anti-inflammatory
action, decreases effects of stress
Adrenal androgens- dehydroepiandrosterone and
androstenedione. Converted to testosterone in the
periphery.

9. ADRENAL MEDULLA
Epinephrine and norepinephrine- serve as
neurotransmitters for sympathetic system

10. THYROID
Follicular cells—excretion of triiodothyronine (T3) and
thyroxine (T4)—Increase BMR, increase bone and
calcium turnover, increase response to catecholamines,
need for fetal G&D
Thyroid C cells—calcitonin. Lowers blood calcium and
phosphate levels

11. PARATHYROID
Parathyroid hormone—regulates serum calcium

12. PANCREATIC ISLET CELLS
Insulin
 Glucagon- stimulates glycogenolysis and glyconeogenesis
 Somatostatin- decreases intestinal absorption of glucose

13. OVARIES
Estrogen
Progesterone—important in menstrual
cycle, maintains pregnancy

14. 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

15. Cushing’s syndrome is a general term for increased secretion of cortisol by the
adrenal cortex. When corticosteroids are administered externally, a condition of
hypercortisolism called iatrogenic Cushing’s syndrome occurs. When the
hypercortisolism results from an oversecretion of ACTH from the pituitary, the
condition is called Cushing’s disease.
Therapists are more likely to treat people who have developed medication-induced
Cushing’s syndrome. This condition occurs after these individuals have received a large
dose of cortisol (also known as hydrocortisone) or cortisol derivitives. Because cortisol
suppresses the inflammatory response of the body, it can mask early signs of infection

16. To maintain muscle and bone mass, weight-bearing
exercises such as push-ups, sit-ups, or lifting weights are
helpful.
To prevent weight gain, aerobic exercise is good
to increase your heart rate. Examples of aerobic exercise
include fast walking, jogging, cycling, and swimming.
Education on avoiding falls and removing loose rugs and
other hazards in the home. Falling may lead to broken
bones and other injuries.
Education on proper wound healing and cleansing is
important.

17. 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.
PreferredPractice Patterns for Physical Therapy:
4C: Impaired Muscle Performance
4D: 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 Disorders
6B: Impaired Aerobic Capacity/Endurance Associated with
Deconditioning.
7A: Primary Prevention/Risk Reduction for Integumentary Disorders.

18. When myedematous hypothyroidism is treated it may cause
the patient to develop pseudogout in the joints and may affect
the spine as well. The patient may have complaints of muscle
aches, pain, or stiffness and may cause the development of
trigger points. This will require hormone therapy to resolve
the symptoms and cannot be helped with simple myofascial
release.
 Patient with hypothyroidism in the acute care setting must be
aware that dry, edematous skin is prone to breakdown or
tears. Prevention may be to keep and work to monitor and
relieve pressure points on the sacrum, coccyx, elbows and
heels whenever necessary.

19.  In cases of patient reported carpal tunnel it is important to
get a thorough history to understand if the mechanism of
injury is truly related to causes treatable by the therapist such
as ergonomics or if the patient needs to be referred on so that
the underlying issue may be resolved.
Developing an exercise program for a patient with
Hypothyroidism can be helpful in many ways. First, it helps to
rebuild activity tolerance, increase muscle strength, and
reduce apathy secondary to the decreased metabolism caused
by the disorder.

20.  Hyperthyroidism, often referred to as thyrotoxicosis, is a disorder that
occurs 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, and
ROM associated with connective tissue dysfunction
4E: Impaired joint mobility, motor function, muscle performance, and
ROM associated with localized inflammation
6B: Impaired aerobic capacity/endurance assoiciated with deconditioning

21. Some patients with Graves’ disease suffer from heat
intolerance, making exercising in a hot pool a
contraindication to therapy. This patient would still be able to
participate in aquatic therapy in a warm pool; given the
patient’s body temperature being monitored.
70% of people with hyperthyroidism develop proximal muscle
weakness as a result of treatment, most often affecting the
pelvis and thigh muscles.

22. 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, stamina
and concentration.
 To encourage alternative ways of controlling stress level by exercises, relaxation
and lifestyle adjustment.
 To maintain the joint mobility, strength, endurance and treat any
neuromusculoskeletal problem as associated.

23. Effect of Exercise on Reproductive Hormones in
Female Athletes
International Journal of Sport and Exercise Science,
5(1): 7-12
Maryam Mosavat1, MahaneemMohamed, Mitra
Ossadat Mirsanjari
10 Jan 2013

24. Female athlete who engages in high intensity exercise is at risk
as a consequence of hormonal changes which result in
menstrual disturbances. Impaired production of
gonadotrophins, which leads to luteal phase deficiency and
anovulation, is a common hormonal finding with exercise-
induced menstrual disturbances. There is a strong agreement in
responsibility of low energy availability due to imbalance
between energy intake and energy expenditure during exercise
to impairment hypothalamus ovarian axis (HPO) and reduction
in hypothalamus, gonadotropin hormones and subsequently
menstrual disorder. However, increase in stress hormone levels
through hypothalamus adrenal axis (HPA) activated by
strenuous physical activity has been introduced as a responsible
for HPO axis impairment by some other studies.

25. The spectrum of the female athlete triad

26. 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.

27. Polycystic Ovary Syndrome (PCOS) is a complex
endocrine and reproductive disorder affecting
approximately 4–7% of women of reproductive age. As a
principle cause of infertility in reproductive aged women,
PCOS is characterized by the presence of menstrual
disturbances, hyperandrogenemia, and ovarian cysts.
Similarly, approximately 70% of women with PCOS
have increased adiposity and between 20–43% have
insulin resistance and reduced glucose control. One
possible culprit speculated to contribute to this irregular
metabolic phenomena is defects within the adipose tissue.

28. Polycystic Ovary Syndrome (PCOS) is associated with
reduced adipose tissue lipolysis that can be rescued by
aerobic exercise. The aim was to identify differences in gene
expression of perilipins and associated targets in adipose
tissue in women with PCOS before and after exercise.
Women with PCOS completed a 16-week prospective aerobic
exercise-training study. Sixteen weeks of aerobic exercise
training significantly increased PLIN3 expression as well as
coatomer GTPases. Additionally, adipose cultures revealed
virtually no PLIN3 protein expression before exercise, which
was then increased/became expressed following exercise
training. These findings suggest that PLIN3 and coatomer
GTPases are important regulators of lipolysis and
triglyceride storage in the adipose tissue of women with
PCOS.

29. Transcranial physiotherapy in the correction of
reproductive system disorders in adolescent girls
with obesity
American Journal of Internal Medicine 2014; 2(5):
83-86

30. It has been proved that the reproductive system disorders
including ovarian dysfunction, early miscarriages in the
pregnancy, polycystic ovary syndrome in women of young age
may be concerned with the obesity.
The study was undertaken to evaluate and optimize
various modes of transcranial physiotherapy for reproductive
system disorders in puberty girls with obesity.
Combined use of transcranial magnetic therapy (TMT)
and transcranial electrostimulation (TES) was substantiated
by a study of the hormonal status, carbohydrate metabolism,
anthropometric and clinical data, ultrasonography and
electroencephalography. The application of AMO-ATOS-E
apparatus for this purpose could normalize a menstrual cycle
in 86,3% of the obese girls, by reducing body weight.

31. Effect of Parotid Gland Massage on Parotid Gland
Tc-99mPertechnetate Uptake
Thyroid radiology and nuclear medicine
Volume 22, Number 6, 2012

32. Salivary dysfunction is the most common side effect
associated with I therapy in patients with differentiated
thyroid cancer. Using Tc-99m pertechnetate, two salivary
scans were performed in all patients. In 30 patients, PG
massage was performed between the two salivary gland scans,
whereas in the other 30 patients no massage was performed
between the two scans.
PG massage was performed in a sitting position
bilaterally from posterior to anterior along the parotid duct
using both palms. During this massage, patients tightened
their jaw muscles and contracted their masticator muscles to
provide PG support. PG massage was performed 20 times over
one minute.

33. Tc-99m pertechnetate scan was used to evaluate the
effect of PG massage instead of I scan. I is orally administered
for thyroid ablation or thyroid cancer treatment, therefore it is
slowly accumulated in the salivary glands. Tc-99m
pertechnetate was intravenously administered and its
accumulation to the salivary gland was faster than orally
administered.
Further, these results indicate that PG massage can effectively
reduce salivary accumulating radioisotope in the PG not only
in patients with normal thyroid function but also in patients
with hyperthyroidism and be helpful to prevent salivary
damage associated with I therapy.

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