Chapter 7Chapter 7

Endocrine PathologiesEndocrine Pathologies

Mosby’s PATHOLOGY

for Massage Therapists

Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.2

Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Lesson 7.1 ObjectivesLesson 7.1 Objectives

�� Discuss anatomic structures and physiologic Discuss anatomic structures and physiologic

processes related to the endocrine system.processes related to the endocrine system.

�� Outline the glandular sources of major Outline the glandular sources of major

hormones, as well as their primary effects.hormones, as well as their primary effects.

�� Define diseases of the pituitary gland and list Define diseases of the pituitary gland and list

appropriate massage considerations.appropriate massage considerations.

3Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Endocrine System OverviewEndocrine System Overview

�� Regulatory systemRegulatory system

�� Responsible for helping maintain homeostasisResponsible for helping maintain homeostasis

�� Works with nervous system to coordinate Works with nervous system to coordinate functioning of all body systemsfunctioning of all body systems

�� Uses hormones to communicateUses hormones to communicate

4Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Effects of the Endocrine SystemEffects of the Endocrine System

�� Regulates activity of Regulates activity of

smooth/cardiac smooth/cardiac

muscle and some muscle and some

glandsglands

�� Regulates chemical Regulates chemical

composition and composition and

volume of fluidsvolume of fluids

�� Regulates growth Regulates growth and developmentand development

�� Regulates Regulates reproductive reproductive processesprocesses

�� Participates in Participates in circadian rhythmscircadian rhythms

�� Alters metabolismAlters metabolism

5Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Types of GlandsTypes of Glands

�� Exocrine glandsExocrine glands

�� SudoriferousSudoriferous: secretes perspiration: secretes perspiration

�� Sebaceous: secretes oilSebaceous: secretes oil

�� CeruminousCeruminous: secretes earwax: secretes earwax

�� Digestive: secrete enzymesDigestive: secrete enzymes

�� Mucous: secrete mucousMucous: secrete mucous

6Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Types of Glands Types of Glands (cont'd.)(cont'd.)

�� Endocrine (ductless) glandsEndocrine (ductless) glands

�� AdrenalsAdrenals

�� GonadsGonads

�� Pancreas (islets)Pancreas (islets)

�� ParathyroidsParathyroids

�� PinealPineal

�� PituitaryPituitary

�� ThyroidThyroid

7Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Location of Endocrine GlandsLocation of Endocrine Glands

From Salvo S: From Salvo S: Massage therapy: principles and practice,Massage therapy: principles and practice, eded 3, St. Louis, 2007, Saunders.3, St. Louis, 2007, Saunders.

8Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Pituitary HormonesPituitary Hormones

ACTH, ACTH, AdrenocorticotrophicAdrenocorticotrophic hormonehormone LH, luteinizing hormoneLH, luteinizing hormone

ADH, ADH, antidiureticantidiuretic hormonehormone PRL, PRL, prolactinprolactin

FSH, follicleFSH, follicle--stimulating hormonestimulating hormone TSH, thyroidTSH, thyroid--stimulating hormonestimulating hormone

GH, growth hormoneGH, growth hormoneFrom From HerlihyHerlihy B, B, MaebuisMaebuis NK: NK: The human body in health and illness,The human body in health and illness, eded 3, Philadelphia, 2007, Saunders.3, Philadelphia, 2007, Saunders.

9Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Diseases of the PituitaryDiseases of the Pituitary

�� HyperpituitarismHyperpituitarism

�� GiantismGiantism

�� AcromegalyAcromegaly

�� HypopituitarismHypopituitarism

�� DwarfismDwarfism

�� Diabetes Diabetes insipidusinsipidus

10Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

HyperpituitarismHyperpituitarism

�� Overproduction of pituitary hormones (especially Overproduction of pituitary hormones (especially

ATCH and GH) causing overstimulation of target ATCH and GH) causing overstimulation of target

endocrine glands endocrine glands

�� GiantismGiantism: GH overproduction occurring during : GH overproduction occurring during

childhoodchildhood

�� AcromegalyAcromegaly: GH overproduction occurring during : GH overproduction occurring during

adulthoodadulthood

�� Jt. Mobs are omitted or cautiously appliedJt. Mobs are omitted or cautiously applied

11Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

GiantismGiantism

�� Form of Form of hyperpituitarismhyperpituitarism

causing accelerated causing accelerated

growth due to growth due to

overproduction of GH overproduction of GH

before onset of pubertybefore onset of puberty

�� Jt. Mobs are omitted or Jt. Mobs are omitted or

cautiously appliedcautiously applied

Courtesy Dr. Edmund Beard. In Courtesy Dr. Edmund Beard. In ThibodeauThibodeau GA: GA: Anatomy and Anatomy and

physiology,physiology, St. Louis, 1987, Mosby College Publishing.St. Louis, 1987, Mosby College Publishing.

12Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

�� Form of Form of hyperpituitarismhyperpituitarism

causing causing enlargement of enlargement of hands, feet and face with hands, feet and face with

jaw protrusion due to jaw protrusion due to

overproduction of GH after overproduction of GH after

onset of pubertyonset of puberty

�� Jt. mobs are omitted or Jt. mobs are omitted or

cautiously appliedcautiously applied

AcromegalyAcromegaly

A, from Cooke RA, Stewart B: A, from Cooke RA, Stewart B: ColourColour atlas of anatomical pathology,atlas of anatomical pathology, eded 3, Sydney, 2004, Churchill Livingstone.3, Sydney, 2004, Churchill Livingstone.

13Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

HypopituitarismHypopituitarism

�� Underproduction of pituitary hormones causing Underproduction of pituitary hormones causing lack of stimulation of target endocrine glands; lack of stimulation of target endocrine glands; disease manifestations are directly related to disease manifestations are directly related to the particular hormone shortagethe particular hormone shortage

�� Adjust massage according to client vitality Adjust massage according to client vitality (lighter pressure, reduced time); reduce (lighter pressure, reduced time); reduce pressure over areas of decreased bone densitypressure over areas of decreased bone density

14Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

DwarfismDwarfism

�� Form of Form of hypopituitarismhypopituitarismcausing short stature causing short stature resulting from resulting from underproduction of GH in underproduction of GH in childhood childhood

�� No massage considerationsNo massage considerations

From Brashear HR, Raney RB: From Brashear HR, Raney RB: Handbook of Handbook of orthopaedicorthopaedic

surgery,surgery, eded 10, St. Louis, 1986, Mosby.10, St. Louis, 1986, Mosby.

15Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Diabetes Diabetes InsipidusInsipidus

�� Condition caused by ADH insufficientlyCondition caused by ADH insufficiently

�� Adjust massage according to client vitalityAdjust massage according to client vitality

16Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Lesson 7.2 ObjectivesLesson 7.2 Objectives

�� List diseases of the thyroid gland and outline List diseases of the thyroid gland and outline

appropriate massage considerations.appropriate massage considerations.

�� Name diseases of the Name diseases of the parathyroidsparathyroids and state and state

massage considerations.massage considerations.

�� Identify diseases of the pancreas and list Identify diseases of the pancreas and list

appropriate massage considerations.appropriate massage considerations.

17Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Lesson 7.2 Objectives Lesson 7.2 Objectives (cont(cont’’d.)d.)

�� List causes, signs and symptoms, and List causes, signs and symptoms, and

interventions for hyperglycemia and interventions for hyperglycemia and

hypoglycemia.hypoglycemia.

�� Define adrenal cortex diseases and list Define adrenal cortex diseases and list

appropriate massage considerations.appropriate massage considerations.

18Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Diseases of the ThyroidDiseases of the Thyroid

�� GoiterGoiter

�� Graves diseaseGraves disease

�� CretinismCretinism

�� MyxedemaMyxedema

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GoiterGoiter

�� Enlargement of the thyroid Enlargement of the thyroid

glandgland

�� Avoid throat region (local Avoid throat region (local

contraindication)contraindication)

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Graves DiseaseGraves Disease

�� Condition of Condition of

hyperthyroidism resulting hyperthyroidism resulting

in a goiter, anxiety and in a goiter, anxiety and

fatigue, overheating, hand fatigue, overheating, hand

tremors, eyeball protrusiontremors, eyeball protrusion

�� Reduce treatment time to Reduce treatment time to

30 min if client is fatigued; 30 min if client is fatigued;

avoid throatavoid throat

From Seidel H: From Seidel H: MosbyMosby’’s guide to physical examination,s guide to physical examination, eded 4, 4,

St. Louis, 1999, Mosby.St. Louis, 1999, Mosby.

21Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

CretinismCretinism

�� Condition of Condition of

hypothyroidism occurring hypothyroidism occurring

in fetal life or early infancy in fetal life or early infancy

resulting in mental resulting in mental

retardation (if untreated)retardation (if untreated)

�� Relaxing massage is Relaxing massage is

indicatedindicated

From From SchneebergSchneeberg NE: NE: Essentials of clinical endocrinology,Essentials of clinical endocrinology,

St. Louis, 1970, Mosby.St. Louis, 1970, Mosby.

22Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

MyxedemaMyxedema

�� Condition of severe or Condition of severe or longlong--standing standing hypothyroidism in hypothyroidism in adulthoodadulthood

�� Adjust massage according Adjust massage according to client vitality (lighter to client vitality (lighter pressure, reduced pressure, reduced treatment time)treatment time)

From Seidel H: From Seidel H: MosbyMosby’’s guide to physical examination,s guide to physical examination, eded 5, 5,

St. Louis, 2003, Mosby.St. Louis, 2003, Mosby.

23Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Diseases of the Diseases of the ParathyroidsParathyroids

�� HyperparathyroidismHyperparathyroidism

�� HypoparathyroidismHypoparathyroidism

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HyperparathyroidismHyperparathyroidism

�� Condition of PTH overproduction Condition of PTH overproduction

characterized by muscle weakness, fatigue, characterized by muscle weakness, fatigue,

and hypertensionand hypertension

�� Adjust massage according to client vitality Adjust massage according to client vitality

(lighter pressure, reduced treatment time); jt. (lighter pressure, reduced treatment time); jt.

mobs are omitted or cautiously applied; mobs are omitted or cautiously applied;

reduce pressure over areas of decreased reduce pressure over areas of decreased

bone density bone density

25Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

HypoparathyroidismHypoparathyroidism

�� Condition of diminished parathyroid gland Condition of diminished parathyroid gland

function leading to function leading to hypocalcemiahypocalcemia (low blood (low blood

calcium levels) calcium levels)

�� Adjust massage according to client vitality Adjust massage according to client vitality

(lighter pressure, reduced treatment time); (lighter pressure, reduced treatment time);

reduce pressure over areas of decreased bone reduce pressure over areas of decreased bone

densitydensity

26Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Diabetes MellitusDiabetes Mellitus

�� Group of disorders characterized by elevated Group of disorders characterized by elevated

blood glucose levels due to: blood glucose levels due to:

�� Insufficient insulinInsufficient insulin

�� Resistance to insulin by cellsResistance to insulin by cells

�� BothBoth

�� Types are type I, type II, and gestational Types are type I, type II, and gestational

diabetesdiabetes

�� Diabetics must monitor andDiabetics must monitor and maintain their maintain their

blood sugar in a healthy rangeblood sugar in a healthy range

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Diabetes Mellitus, Type IDiabetes Mellitus, Type I

�� Lack of insulinLack of insulin

�� Regular injections of insulin Regular injections of insulin

neededneeded

�� Three PThree P’’s: s: polyuriapolyuria, ,

polydipsiapolydipsia, , polyphagiapolyphagia

�� Massage considerations Massage considerations

same as type IIsame as type II

From Potter PA, Perry AG: From Potter PA, Perry AG: Fundamentals of nursing,Fundamentals of nursing, eded 4, St. Louis, 1997, Mosby.4, St. Louis, 1997, Mosby.

28Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Diabetes Mellitus, Type IDiabetes Mellitus, Type I (cont'd.)(cont'd.)

�� HypoglycemiaHypoglycemia

�� Condition of reduced blood glucose levelsCondition of reduced blood glucose levels

�� Major cause in diabetics is overdose of prescribed Major cause in diabetics is overdose of prescribed insulin; second major cause is eating too little food insulin; second major cause is eating too little food

�� Can occur with all types of diabetics, but more Can occur with all types of diabetics, but more common in type Icommon in type I

�� May lead to insulin shockMay lead to insulin shock

�� Can be fatalCan be fatal

�� Offer a source of sugar such as regular sodaOffer a source of sugar such as regular soda

29Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Diabetes Mellitus, Type IIDiabetes Mellitus, Type II

�� Body cells resistant to insulinBody cells resistant to insulin

�� Related to central obesity and Related to central obesity and

sedentary lifestyle; strong sedentary lifestyle; strong

genetic link also existsgenetic link also exists

�� S/S similar to type IS/S similar to type I

�� Can be controlled by regular Can be controlled by regular

exercise and maintaining exercise and maintaining

healthy weighthealthy weight

From From DamjanovDamjanov I: I: Pathology for the healthPathology for the health--related professions,related professions, eded 2, Philadelphia, 2000, WB Saunders.2, Philadelphia, 2000, WB Saunders.

30Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Diabetes Mellitus, Type II Diabetes Mellitus, Type II (cont'd.)(cont'd.)

�� HyperglycemiaHyperglycemia

�� Condition of high blood glucose levelsCondition of high blood glucose levels

�� Major cause in diabetics is too much food, missed Major cause in diabetics is too much food, missed

dose of medication, too little insulin or oral diabetic dose of medication, too little insulin or oral diabetic

medication, or too little exercisemedication, or too little exercise

�� May lead to diabetic comaMay lead to diabetic coma

�� Can be fatalCan be fatal

�� Offer water or sugarOffer water or sugar--free beverage and suggest a free beverage and suggest a

glucose level checkglucose level check

31Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Diabetes Mellitus Diabetes Mellitus (cont(cont’’d.)d.)

�� Type I and II massage considerations:Type I and II massage considerations:

�� Suggest that the client eat a meal within 2 to 3 hrs or Suggest that the client eat a meal within 2 to 3 hrs or

has a good snack no more than 1 hour before has a good snack no more than 1 hour before

massagemassage

�� Adapt massage to disease complications (reduced Adapt massage to disease complications (reduced

pressure, areas to avoid, etc.)pressure, areas to avoid, etc.)

32Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Diabetes Mellitus Diabetes Mellitus (cont(cont’’d.)d.)

�� Type I and II massage considerations Type I and II massage considerations (cont(cont’’d.)d.)::

�� If client taking insulin, avoid vigorous massage over If client taking insulin, avoid vigorous massage over

sites of recent injection for 24 hrssites of recent injection for 24 hrs

�� Avoid getting lubricant on drug administration Avoid getting lubricant on drug administration

equipment such as insulin pumpsequipment such as insulin pumps

33Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Gestational Diabetes MellitusGestational Diabetes Mellitus

�� Glucose intolerance that develops in some Glucose intolerance that develops in some

women during pregnancy; usually diagnosed in women during pregnancy; usually diagnosed in

the second trimester the second trimester

�� Massage considerations are same as for types I Massage considerations are same as for types I

and II diabetes mellitus with addition of and II diabetes mellitus with addition of

guidelines for prenatal massageguidelines for prenatal massage

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Diseases of the Adrenal CortexDiseases of the Adrenal Cortex

�� Cushing disease and Cushing syndromeCushing disease and Cushing syndrome

�� Addison diseaseAddison disease

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Cushing Disease and Cushing Cushing Disease and Cushing

SyndromeSyndrome

�� Cushing disease Cushing disease ––Overproduction of ATCH Overproduction of ATCH ((hypercortisolismhypercortisolism))

�� Cushing syndrome Cushing syndrome ––Prolonged and excessive Prolonged and excessive use of highuse of high--dose cortisone dose cortisone drugsdrugs

�� Adjust massage according Adjust massage according to client vitality (lighter to client vitality (lighter pressure, reducedpressure, reduced time)time)

From Seidel H: From Seidel H: MosbyMosby’’s guide to physical examination,s guide to physical examination, eded 5, St. Louis, 2003, Mosby.5, St. Louis, 2003, Mosby.

36Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Addison DiseaseAddison Disease

�� HypocortisolismHypocortisolism; ;

characterized by general characterized by general

weakness, weakness,

hyperpigmentationhyperpigmentation of skin of skin

and mucosa (bronzing) and mucosa (bronzing)

�� Adjust massage Adjust massage

according to client vitality according to client vitality

(lighter pressure, reduced (lighter pressure, reduced

time)time)

A, from Chew SL, Leslie D: A, from Chew SL, Leslie D: Clinical endocrinology and diabetes: an illustrated Clinical endocrinology and diabetes: an illustrated colourcolour text,text, Edinburgh, 2006, ChurchillEdinburgh, 2006, Churchill--Livingstone; Livingstone;

B, from Forbes CD, Jackson WF: A B, from Forbes CD, Jackson WF: A color atlas and text of clinical medicine,color atlas and text of clinical medicine, eded 2, St. Louis, 1997, Mosby.2, St. Louis, 1997, Mosby.