Mosby's PATHOLOGY for Massage Therapists

Mosby’s PATHOLOGY Lesson 7.1 Objectives

for Massage Therapists Discuss anatomic structures and physiologic processes related to the endocrine system. Outline the glandular sources of major hormones, as well as their primary effects. Define diseases of the pituitary gland and list appropriate massage considerations. Chapter 7 Endocrine Pathologies

Endocrine System Overview Effects of the Endocrine System

Regulatory system Regulates activity of Regulates growth Responsible for helping maintain homeostasis smooth/cardiac and development Regulates Works with nervous system to coordinate muscle and some Regulates functioning of all body systems glands reproductive processes Uses hormones to communicate Regulates chemical Participates in composition and circadian rhythms volume of fluids Alters metabolism

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

Exocrine glands Endocrine (ductless) glands Sudoriferous : secretes perspiration Adrenals Sebaceous: secretes oil Gonads Ceruminous : secretes earwax Pancreas (islets) Digestive: secrete enzymes Parathyroids Mucous: secrete mucous Mucous: secrete mucous Pineal Pituitary Thyroid

Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 5 6 Location of Endocrine Glands Pituitary Hormones

ACTH, Adrenocorticotrophic hormone LH, luteinizing hormone ADH, antidiuretic hormone PRL, prolactin FSH, follicle -stimulating hormone TSH, thyroid -stimulating hormone

From Salvo S: Massage therapy: principles and practice, ed 3, St. Louis, 2007, Saunders. GH, growth hormone From Herlihy B, Maebuis NK: The human body in health and illness, ed 3, Philadelphia, 2007, Saunders. Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 7 8

Diseases of the Pituitary Hyperpituitarism

Hyperpituitarism Overproduction of pituitary hormones (especially ATCH and GH) causing overstimulation of target Giantism endocrine glands Acromegaly Giantism : GH overproduction occurring during Hypopituitarism childhood Dwarfism Acromegaly : GH overproduction occurring during adulthood Diabetes insipidus Jt. Mobs are omitted or cautiously applied

Giantism Acromegaly

Form of hyperpituitarism Form of hyperpituitarism causing accelerated causing enlargement of growth due to hands, feet and face with overproduction of GH jaw protrusion due to before onset of puberty overproduction of GH after onset of puberty Jt. Mobs are omitted or cautiously applied Jt. mobs are omitted or cautiously applied

Courtesy Dr. Edmund Beard. In Thibodeau GA: Anatomy and physiology, St. Louis, 1987, Mosby College Publishing.

A, from Cooke RA, Stewart B: Colour atlas of anatomical pathology, ed 3, Sydney, 2004, Churchill Livingstone. Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 11 12 Hypopituitarism Dwarfism

Underproduction of pituitary hormones causing Form of hypopituitarism lack of stimulation of target endocrine glands; causing short stature disease manifestations are directly related to resulting from the particular hormone shortage underproduction of GH in Adjust massage according to client vitality childhood (lighter pressure, reduced time); reduce No massage considerations pressure over areas of decreased bone density

From Brashear HR, Raney RB: Handbook of orthopaedic surgery, ed 10, St. Louis, 1986, Mosby. Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 13 14

Diabetes Insipidus Lesson 7.2 Objectives

List diseases of the thyroid gland and outline Condition caused by ADH insufficiently appropriate massage considerations. Adjust massage according to client vitality Name diseases of the parathyroids and state massage considerations. Identify diseases of the pancreas and list appropriate massage considerations.

Lesson 7.2 Objectives (cont ’d.) Diseases of the Thyroid

List causes, signs and symptoms, and Goiter interventions for hyperglycemia and hypoglycemia. Graves disease Cretinism Define adrenal cortex diseases and list Cretinism appropriate massage considerations. Myxedema

Condition of Enlargement of the thyroid gland hyperthyroidism resulting in a goiter, anxiety and Avoid throat region (local fatigue, overheating, hand contraindication) tremors, eyeball protrusion Reduce treatment time to 30 min if client is fatigued; avoid throat

From Seidel H: Mosby ’s guide to physical examination, ed 4, St. Louis, 1999, Mosby.

Cretinism Myxedema

Condition of Condition of severe or hypothyroidism occurring long -standing in fetal life or early infancy hypothyroidism in adulthood resulting in mental adulthood retardation (if untreated) Adjust massage according to client vitality (lighter Relaxing massage is pressure, reduced indicated treatment time)

From Seidel H: Mosby ’s guide to physical examination, ed 5, From Schneeberg NE: Essentials of clinical endocrinology, St. Louis, 2003, Mosby. St. Louis, 1970, Mosby.

Diseases of the Parathyroids Hyperparathyroidism

Hyperparathyroidism Condition of PTH overproduction

Hypoparathyroidism characterized by muscle weakness, fatigue, and hypertension

Adjust massage according to client vitality (lighter pressure, reduced treatment time); jt. mobs are omitted or cautiously applied; reduce pressure over areas of decreased bone density

Condition of diminished parathyroid gland Group of disorders characterized by elevated function leading to hypocalcemia (low blood blood glucose levels due to: calcium levels) Insufficient insulin Adjust massage according to client vitality Resistance to insulin by cells (lighter pressure, reduced treatment time); Both reduce pressure over areas of decreased bone Types are type I, type II, and gestational density diabetes

Diabetics must monitor and maintain their blood sugar in a healthy range

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

Lack of insulin Hypoglycemia Condition of reduced blood glucose levels Regular injections of insulin needed Major cause in diabetics is overdose of prescribed insulin; second major cause is eating too little food Three P ’s: polyuria , Can occur with all types of diabetics, but more polydipsia , polyphagia common in type I May lead to insulin shock Massage considerations same as type II Can be fatal Offer a source of sugar such as regular soda

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

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

Body cells resistant to insulin Hyperglycemia Related to central obesity and Condition of high blood glucose levels sedentary lifestyle; strong Major cause in diabetics is too much food, missed genetic link also exists dose of medication, too little insulin or oral diabetic medication, or too little exercise S/S similar to type I May lead to diabetic coma Can be controlled by regular Can be fatal exercise and maintaining Can be fatal healthy weight Offer water or sugar -free beverage and suggest a glucose level check

From Damjanov I: Pathology for the health -related professions, ed 2, Philadelphia, 2000, WB Saunders.

Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 29 30 Diabetes Mellitus (cont ’d.) Diabetes Mellitus (cont ’d.)

Type I and II massage considerations: Type I and II massage considerations (cont ’d.) : Suggest that the client eat a meal within 2 to 3 hrs or If client taking insulin, avoid vigorous massage over has a good snack no more than 1 hour before sites of recent injection for 24 hrs massage Avoid getting lubricant on drug administration Adapt massage to disease complications (reduced equipment such as insulin pumps pressure, areas to avoid, etc.)

Gestational Diabetes Mellitus Diseases of the Adrenal Cortex

Glucose intolerance that develops in some women during pregnancy; usually diagnosed in Cushing disease and Cushing syndrome the second trimester the second trimester Addison disease Massage considerations are same as for types I and II diabetes mellitus with addition of guidelines for prenatal massage

Cushing Disease and Cushing Addison Disease Syndrome

Cushing disease – Hypocortisolism ; Overproduction of ATCH characterized by general (hypercortisolism ) weakness, Cushing syndrome – hyperpigmentation of skin Prolonged and excessive and mucosa (bronzing) use of high -dose cortisone Adjust massage drugs according to client vitality Adjust massage according (lighter pressure, reduced to client vitality (lighter time) pressure, reduced time)

A, from Chew SL, Leslie D: Clinical endocrinology and diabetes: an illustrated colour text, Edinburgh, 2006, Churchill -Livingstone; From Seidel H: Mosby ’s guide to physical examination, ed 5, St. Louis, 2003, Mosby. B, from Forbes CD, Jackson WF: A color atlas and text of clinical medicine, ed 2, St. Louis, 1997, Mosby. Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 35 36