Metabolic and Endocrine Disorders

Original Editor - Elaine Lonnemann Top Contributors - Lucinda hampton, Elaine Lonnemann, Admin, Kim Jackson, Sam A. Ayeni, Karen Wilson and Claire Knott

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The Endocrine System.

Endocrine and metabolic diseases span a vast range of conditions. The endocrine system works via chemical messages (hormones) secreted from glands directly into the circulatory system to regulate the function of distant target organ. Feedback loops works to maintain the release of these hormones and so maintain homeostasis i.e the state of steady conditions vital for life.

Glands of the Endocrine System

Each gland of the endocrine system releases specific hormones into your bloodstream. These hormones travel through your blood to other cells and help control or coordinate many body processes.

They include:

• Adrenal glands: Two glands that sit on top of the kidneys that release the hormone cortisol.
• Hypothalamus: A part of the lower middle brain that tells the pituitary gland when to release hormones.
• Ovaries: The female reproductive organs that release eggs and produce sex hormones.
• Islet cells in the pancreas: Cells in the pancreas control the release of the hormones insulin and glucagon.
• Parathyroid: Four tiny glands in the neck that play a role in bone development.
• Pineal gland: A gland found near the center of the brain that may be linked to sleep patterns.
• Pituitary gland: A gland found at the base of brain behind the sinuses. It is often called the "master gland" because it influences many other glands, especially the thyroid. Problems with the pituitary gland can affect bone growth, a woman's menstrual cycles, and the release of breast milk.
• Testes: The male reproductive glands that produce sperm and sex hormones.
• Thymus: A gland in the upper chest that helps develop the body's immune system early in life.
• Thyroid: A butterfly-shaped gland in the front of the neck that controls metabolism.

The diagram on the right shows the glands of the endocrine system ( Pineal gland, Thalamus, Pituitary gland,Thyroid, Adrenal glands, Pancreas, Uterus,Ovaries, Testes).

Endocrine Disorders- Pathological Process

A malfunction in the endocrine systems (either the glands, hormones, receptors or organs impacted by hormones) can cause an endocrine disorder. The various dysfunctions can cause wide-ranging effects on the body.The disorders arise from the multitude of effects caused by too little or too much secretion of a hormone, too little or too much action of a hormone, or problems with receiving the hormone. A metabolic disorders occurs when an improper level of a hormones alters the body’s metabolism and affect its function (diabetes is an example).

Causes of Endocrine Disorders

There many causes of endocrine disorders, but they are typically grouped into two categories:

• Endocrine disease that results when a gland produces too much or too little of an endocrine hormone, called a hormone imbalance.
• Endocrine disease due to the development of lesions (such as nodules or tumors) in the endocrine system, which may or may not affect hormone levels.

In a body that is functioning at optimum capacity the endocrine's feedback system assists in controlling the balance of hormones in the bloodstream. The system can detect when a body has too much or too little of a certain hormone, the feedback system then sends signals to the appropriate gland(s) to regulate the discrepancy with a view of restoring homeostasis. If this equilibrium cannot be restored or maintained then a hormone imbalance may occur resulting and increase or decrease of hormone levels in the blood.

The most common causes of increased or decreased levels of endocrine hormones are:

• A problem with the endocrine feedback system
• Disease
• Failure of a gland to stimulate another gland to release hormones (for example, a problem with the hypothalamus can disrupt hormone production in the pituitary gland)
• A genetic disorder, such as multiple endocrine neoplasia (MEN) or congenital hypothyroidism
• Infection
• Injury to an endocrine gland
• Tumor of an endocrine gland - Most endocrine tumors and nodules (lumps) are noncancerous. They usually do not spread to other parts of the body. However, a tumor or nodule on the gland may interfere with the gland's hormone production.

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Causes of Endocrine Disorders

Endocrine disorders are typically grouped into two categories:

• Endocrine disease that results when a gland produces too much or too little of an endocrine hormone, called a hormone imbalance.
• Endocrine disease due to the development of lesions (such as nodules or tumors) in the endocrine system, which may or may not affect hormone levels.

<section> The endocrine's feedback system helps control the balance of hormones in the bloodstream. If your body has too much or too little of a certain hormone, the feedback system signals the proper gland or glands to correct the problem. A hormone imbalance may occur if this feedback system has trouble keeping the right level of hormones in the bloodstream, or if your body doesn't clear them out of the bloodstream properly.

Increased or decreased levels of endocrine hormone may be caused by:

• A problem with the endocrine feedback system
• Disease
• Failure of a gland to stimulate another gland to release hormones (for example, a problem with the hypothalamus can disrupt hormone production in the pituitary gland)
• A genetic disorder, such as multiple endocrine neoplasia (MEN) or congenital hypothyroidism
• Infection
• Injury to an endocrine gland
• Tumor of an endocrine gland

Most endocrine tumors and nodules (lumps) are noncancerous. They usually do not spread to other parts of the body. However, a tumor or nodule on the gland may interfere with the gland's hormone production. </section>

Epidemiology

Endocrine disorders with U.S. prevalence estimates of at least 5% in adults included diabetes mellitus, impaired fasting glucose, impaired glucose tolerance, obesity, metabolic syndrome, osteoporosis, osteopenia, mild-moderate hypovitaminosis D, erectile dysfunction, dyslipidemia, and thyroiditis. Erectile dysfunction and osteopenia/osteoporosis had the highest incidence in males and females, respectively. The least prevalent conditions, affecting less than 1% of the U.S. population, were diabetes mellitus in children and pituitary adenoma. Conditions with the lowest incidence were adrenocortical carcinoma, pheochromocytoma, and pituitary adenomas. Certain disorders, such as hyperparathyroidism and thyroid disorders, were more common in females. As expected, the prevalence of diabetes mellitus was highest among ethnic minorities.

Clinical Presentation

Due to the complex and interconnected nature of the endocrine system, a wide range of conditions with distinct clinical presentations, can result in endocrine disorders. including:

• Addison's Disease
• Cushing's Syndrome
• Diabetes
• Gout
• Hyperthyroidism
• Hypothyroidism
• Obesity
• Osteoporosis
• Paget's Disease

Diagnostic Testing

Due to the wide range of symptoms and conditions diagnosis can sometimes be difficult and where available a referral to an endocrinologist may be made. In most cases blood and urine analysis will be carried out to determine hormone levels. If a nodule or a tumor is suspected imaging tests may be done to help locate and/or confirm any abnormalities. Due to the complex nature of hormones and their interactions a change in one hormone level can have a detrimental impact on another, which can affect diagnosis and treatment.

Management / Interventions

Many of the symptoms of endocrine disorders and be helped by physiotherapy. Although management may vary depending on the disorder diagnosed some of the goals are the some. (for the management of individual disorders see above). Common goals are the management of pain, advice on the effects of stress on the body and how to manage through exercise and relaxation techniques, planning of exercise programmes which benefit muscle strength and flexibility, helps to manage weigh gain, releases chemicals such as endorphins which help with stress and anxiety and also induce feelings of well-being and relaxation.