MSK and endocrine function

Question 1

What are steroids biochemically classified as?

Answer 1

Lipids

Steroids are characterized by a ring structure of many C-H bonds.

Question 2

What are the two main types of steroids?

Answer 2

• Direct action steroids
• Hormones: signal action in other organs

Question 3

What are examples of hormones

Answer 3

• sex hormones
• corticosteriods
• mineralocorticoids

Question 4

What are examples of direct action steroids?

Answer 4

• Bile salts
• Sterols

Question 5

What is the primary role of bile salts?

Answer 5

Important for digestion and fat absorption
- made in the liver

Question 6

What is the role of sterols like cholesterol?

Answer 6

• Produce Vitamin D
• Help with cell wall production

Question 7

What are the main sex hormones?

Answer 7

• Male hormones (androgens, e.g., testosterone)
• Female hormones (estrogen/estradiol, progesterone)
• synthesized from cholesterol

Question 8

What is the function of glucocorticosteroids like cortisol?

Answer 8

• Anti-inflammatory properties
• cortisol works on the liver; uses fatty acids to increase glucose levels (for energy)
• cortisol levels increase during times of stress; likely has a role in immune system function

Question 9

What is the most important mineralocorticoid?

Answer 9

• Aldosterone
• produce in adrenal gland

Question 10

What does aldosterone regulate?

Answer 10

Balance of Na+ and K+ by actions on the kidney

Question 11

What are corticosteroids used for?

Answer 11

• Anti-inflammatory
• Pain management
• Allergy control
• Treatment for Addison’s disease
• can be used to greatly improve outcomes of some condittions

Question 12

What is Addison’s disease?

Answer 12

Adrenal insufficiency with diminished production of cortisol, glucocorticoids, mineralocorticoids, and androgens

Question 13

Polyarteritis Nodosa

What is it and how is it dx and tx

Answer 13

• rare
• affects larger, muscular ateries
• can be caused by hepatitis B
• can cause myalgia, fatigue, hypertenion, GI dysfunction, renal involvement
• Diagnosis may include: blood test, ESR, or urinalysis
• imaging: radiography, CT, MRI
• treatment: prednisone, immunosuppressants

ESR: erthrocyte sediment rate; increased = inflammation (sed rate)

Question 14

How is the body/arteries affected in polyarteritis nodosa

Answer 14

1. first arteries become weak, thin and stretched out
2. narrow
3. closed off

Question 15

What are the signs of decreased cortisol production?

Answer 15

• Hypoglycemia
• Fatigue
• Confusion

occurs in addisons

Question 16

What are signs of decreased aldosterone

Answer 16

• fluid and electrolyte imbalance
• dehydration
• important for Na/K balance

occurs in addisons disease

Question 17

Signs and symptoms of addisons disease? how is this treated

Answer 17

• weakness
• fatigue
• weight loss
• nausea/vomiting
• muscle and joint pain
• abdominal pain
• hypotension

treatment: steriods/corticosteriods

Question 18

What are the potential negative effects of corticosteroids?

Answer 18

• Myopathy
• Osteoporosis
• Atherosclerosis
• Immunocompromise
• Growth retardation
• impede bone and wound healing (must wait if they need surgery 8-12 weeks)
• pulmonary infections
• gastritis
• glaucoma/cataracts
• mood alterations
• headache
• skin changes
• diabetes mellitus

occurs with people who are chronically on steriods

Question 19

What is Cushing’s syndrome?

Answer 19

• Hyperfunction of the adrenal gland, can be related to long-term steroid use
• can also be an issue with pituitary gland (not as common)
• overproduction of cortisole leads to protein catabolic state

Question 20

What does prolonged steriod use lead to

Answer 20

• cushings
• hypervolemia, hypernatremia, and hypokalemia
• assoicated with hyperglycemia

Question 21

What are physical characteristics of Cushing’s syndrome?

Answer 21

• Round face
• Supraclavicular fat pads
• Truncal obesity
• Muscle wasting and weakness
• pear/apple distribution

can limit these with exercises

Question 22

What are the physiological effects of cushings

Answer 22

• osteoporosis
• HTN
• impaired wound healing
• easy bruising
• impaired reproductive function
• diabetes mellitus
• psychiatric or emotional disturbances
• women may develop fascial hair, deeper voice, breast atrophy

Question 23

What are anabolic androgenic steroids?

Answer 23

• Synthetic substances similar to testosterone that increase muscle and male characteristics
• anabolic: increase muscle
• androgenic: increase male characteristics
• characterized as appearance and performance enhancing drugs

Question 24

What are some reasons people take anabolic steroids?

Answer 24

• Increase muscle mass
• Improve performance
• Improve physical appearance
• can be legally prescribed in some cases
• not as addictive as other drugs but has some addictive characteristics

Question 25

What are some of the psychiatric changes/mood swings that occur when people take anabolic androgenic steriods

Answer 25

- still addictive/effect neurotransmitters - go through withdrawal - mania - aggression - depression - paranoid jealousy - extreme irritability - delusions - poor judgement

Question 26

What are the potential negative effects of anabolic steroid use?

Answer 26

* Hypertension * Cardiac hypertrophy * Atherosclerosis * Jaundice / liver damage - increase in LDL - LE fluid retention - premature skeletal maturation - GI upset/diarrhea - headaches - acne ## Footnote doses taken by athletes or others may be much higher than in a perscription

Question 27

What gender-specific effects can anabolic steroids have on males?

Answer 27

* Testicular shrinkage * Gynecomastia: enlargement of breast tissue * Reduced sperm count/infertility - baldness - prostate cancer

Question 28

What gender-specific effects can anabolic steroids have on females?

Answer 28

* Male-pattern baldness * Facial hair/hypertrichosis * Clitoral enlargement - deeper voice - change in menstrual cycle | -

Question 29

What is Relative Energy Deficiency in Sport (RED-S)?

Answer 29

Low Energy Availability (LEA) affects hormone production and release

Question 30

What hormonal changes can occur in females due to LEA?

Answer 30

* Decrease in FSH * Decrease in LH * Reduction in estrogen production - functional hypothalamic ammenrrhea - impaired bone mineral density (osteopenia) | `

Question 31

What hormonal changes can occur in males due to LEA

Answer 31

- causes decreased testosterone - decrease BMD

Question 32

What are other effects of low energy availability?

Answer 32

* Increased cortisol * Decreased leptin, insulin growth factor, growth hormone - change in mood - decrease appetite - fatigue - immune function decreased - GI dysfunction ## Footnote PT role: education + monitor vitals as long term vitals can increase due to increase in cortisol from increased LEA

Question 33

What is the treatment for Addison's disease?

Answer 33

Corticosteroids

Question 34

What is the relationship between aging and hormone levels?

Answer 34

Post-menopause leads to decreased estrogen and late onset hypogonadism associated with reduced testosterone

Question 35

Risk factors for LEA

Answer 35

- decrease dietary intake - increased exercise energy expenditure - desire for weight loss - disordered eating/training behavior - sport identiy - changes in hunger hormones

Question 36

LEA: acute exposure risks

Answer 36

- reduced blood glucose - reduced leptin levels - disruption in the pulsatility of GnRH, LH, T3 - cortisol - fatigue - mood changes - low sex drive - lower muscle protein synthesis

Question 37

LEA: Long term exposure risk

Answer 37

- endorcrine disruptions - reproductive dysfunction - impaired bone health - dyslipidemia - bradycardia/hypotension - hypoglycemia - low resting metabolic rate - immunological suppression - injuries - impaired performance - GI problems - reduced appetite - eating disorders

Question 38

aging: post menopause what occurs in women and how is it treated often times

Answer 38

- estrogen replacement - oral contraceptives, transdermal estrogen - decreased estrogen during post menopause - decreased BMD

Question 39

MSK dysfunction and aging: Males

Answer 39

- reduced testosterone - late onset hypogonadism - associated with DM, overweight, obesity - sacropenia - osteoprosis: bisphosphonates to improve BMD?