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Chapter 13
Clinical Chiropractic: Endocrine Imbalance
From R. C. Schafer, DC, PhD, FICC's best-selling book:
“Clinical Chiropractic: Upper Body Complaints”
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to support chiropractic research. Please review the complete list of available books.Clinical Briefing CNS Endocrine Function Normal Effects General Causes of Endocrine Imbalance Basic Investigative Approach Adaptation to Stress Associated Complaints Associated Physical Findings Gonadal Dysfunction Adrenal Dysfunction Diabetes Insipidus Diabetes Mellitus Hypoglycemia Goiter Hyperthyroidism Hypothyroidism Parathyroid Dysfunction Anterior Pituitary Dysfunction Ovarian Dysfunction Testicular Dysfunction
The nervous and endocrine systems work hand in hand. The nervous system is
design to operate body functions when rapid response is necessary. For long-term duty, the endocrines take over and simulate neural activity. These two
systems can be compared to an athlete who sprints in a 100-yard dash and
another who runs a marathon. They have two different roles but are not entirely independent in either role. They are integrated, synergistic, and facili
tating.
The adrenal (suprarenal) glands are the major targets of stress stimuli,
and this affects to a great extent the body's adaptation or maladaptation to
the internal and external environment and its resistance to degeneration and
disease.
(1) Norepinephrine's primary role is to constrict arterioles and venules, which increases circulatory resistance, produces hypertension, and slows the heart. It is spurred by anticipated action.
The cortex of the adrenals is also under the control of the sympathetics.
It affects all body systems by synthesizing three groups of hormones (with
overlapping function) from cholesterol. Some are glucocorticosteroids that
principally act in muscle, bone, G-I, hematologic, carbohydrate, and water
metabolism and serve as anti-inflammatory agents. Others are mineralcorticoids
that influence the metabolism of sodium and potassium. A third group, the progestins, function in reproduction physiology.
Adrenal Cortex Hyperfunction.
Hyperfunction of the adrenal medulla cortex
is features hypertension that is persistent or manifested in paroxysmal
attacks, sweating, skin blanching, hand tremor, and dilated pupils that are
associated with either tachycardia or bradycardia. The disorder may result
from glucocorticoid excess (Cushing's disease), mineralocorticoid excess
(primary aldosteronism), or adrenal androgen excess (adrenogenital syndrome).
The clinical picture can be the result of steroid treatment or a disorder of
an adrenal gland itself (eg, tumor).
The following protocols have been design primarily for mild–moderate
adrenal cortex hypofunction.
Diagnostic Workup
Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests
(Table 16.16; Fig. 16.1). Check pertinent tendon and superficial reflexes
(Tables 16.2), and grade the reaction (Table 16.3). Check upper-extremity
joint motion and muscle strength against resistance, and grade resistance
strength (Table 16.9). Interpret resisted motion signs (Table 16.6), and perform tests for autonomic imbalance (Table 16.7). Treat acupoints GV-10, GV-11, GV-19, CV-15, LI-20, ST-36 (Table 16.21).
Treat auriculopoints 13, 22, 51, 55 (Figs 16.3 4).
Treat hand points LI-4, SI-3 (Fig. 16.5).
If the Valleix adrenal reflex areas in the feet are tender, massage each
to patient's tolerance for 20 seconds (Fig. 16.2).
Treat trigger points discovered, especially those found in the ileo-
psoas, latissimus dorsi, lower thoracic multifidi muscles, groin and calf
muscles (Tables 16.28-31).
If Chapman's adrenal points are tender, deeply massage each to patient's
tolerance for 10 seconds while simultaneously holding firm fingertip contact
against the respective spinal area with your other hand (Fig. 16.6).
These points are summarized in Figure 13.1.
In contrast to diabetes mellitus, typically an effect of hypoinsulin
secretion in the islands of Langerhans of the pancreas, diabetes insipidus is
usually the effect of posterior pituitary hypofunction; ie, a defect of the
neurohypophysial system for producing the antidiuretic hormone will produce
diabetes insipidus.
Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests
(Table 16.16; Fig. 16.1). Check pertinent tendon and superficial reflexes
(Tables 16.2), and grade the reaction (Table 16.3). Check upper-extremity
joint motion and muscle strength against resistance, and grade resistance
strength (Table 16.9). Interpret resisted motion signs (Table 16.6), and perform tests for autonomic imbalance (Table 16.7). Treat acupoints CV-4, CV-6, SP-6, UB-23, KI-7 (Table 16.21).
Treat auriculopoints 28, 55, 95, 99; Left 96 and 98 (Figs 16.3 4).
Treat hand points LI-4, HT-7 (Fig. 16.5).
If the Valleix pituitary or kidney reflex areas in the feet are tender,
massage each to patient's tolerance for 20 seconds (Fig. 16.2).
Treat trigger points discovered, especially those found in the sternocleidomastoideus, latissimus dorsi, and lower thoracic multifidi muscles
(Tables 16.28-31).
If Chapman's brain fatigue or kidney points are tender, deeply massage
each to patient's tolerance for 10 seconds while simultaneously holding firm
fingertip contact against the respective spinal area with your other hand
(Fig. 16.6).
These points are summarized in Figure 13.2.
Subnormal insulin production (diabetes mellitus) eventually leads to
hyperglycemia, ketoacidosis, and metabolic disorders manifesting early as
polyuria, nocturia, glycosuria, polyphagia, polydipsia, involuntary weight
loss, mild tachycardia, intolerance to cold, and sweetness of breath.
Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests
(Table 16.16; Fig. 16.1). Check pertinent tendon and superficial reflexes
(Tables 16.2), and grade the reaction (Table 16.3). Check upper-extremity
joint motion and muscle strength against resistance, and grade resistance
strength (Table 16.9). Interpret resisted motion signs (Table 16.6), and perform tests for autonomic imbalance (Table 16.7). Treat acupoints SP-6, ST-36, PC-6, CV-6, UB-17 (Table 16.21).
Treat auriculopoints 22, 76, 77, 96 (Figs 16.3 4).
Treat hand points LI-4, SI-3 (Fig. 16.5).
If the Valleix pancreas reflex areas in the feet are tender, massage
each to patient's tolerance for 20 seconds (Fig. 16.2).
Treat trigger points discovered, especially those found in the abdominis
rectus muscles (Tables 16.28-31).
If Chapman's pancreas point is tender, deeply massage to patient's
tolerance for 10 seconds while simultaneously holding firm fingertip contact
against the respective spinal area with your other hand (Fig. 16.6).
These points are summarized in Figure 13.3.
Advise the patient against any activity that might present a danger to
himself or others. Urine sugar must be monitored at least once daily. A
cooperative arrangement with the patient's family doctor would be ideal so
that insulin intake can be gradually reduced.
Insulin and glucagon secretions from the islets have various metabolic
effects. Abnormal insulin production is characterized by hypoglycemia and the
release of catecholamines that produce hunger, anxiety, tachycardia, dilated
pupils, and profuse sweating in the early stages. In late stages, nervous
symptoms appear such as severe headache, double vision, disorientation, obtundation, paralysis, convulsions, and possibly coma.
Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests
(Table 16.16; Fig. 16.1). Check pertinent tendon and superficial reflexes
(Tables 16.2), and grade the reaction (Table 16.3). Check upper-extremity
joint motion and muscle strength against resistance, and grade resistance
strength (Table 16.9). Interpret resisted motion signs (Table 16.6), and perform tests for autonomic imbalance (Table 16.7). Treat acupoints SP-6, ST-36, CV-12, UB-17 (Table 16.21).
Treat auriculopoints 18, 22, 55, 96 (Figs 16.3 4).
Treat hand points LI-4, SI-3 (Fig. 16.5).
If the Valleix pancreas reflex areas in the feet are tender, massage
each to patient's tolerance for 20 seconds (Fig. 16.2).
Treat trigger points discovered, especially those found in the abdominis
rectus muscles (Tables 16.28-31).
If Chapman's pancreas point is tender, deeply massage to patient's
tolerance for 10 seconds while simultaneously holding firm fingertip contact
against the respective spinal area with your other hand (Fig. 16.6).
These points are summarized in Figure 13.4.
The term goiter in its broad sense means an enlargement of the thyroid
gland for whatever reason. Fortunately, most goiters occur in the absence of
thyrotoxicosis or cancer. They are called simple or nontoxic goiters.
Early differentiation between a toxic and nontoxic goiter is important.
Thyrotoxicosis, sometimes called thyroid "storm" or thyroid crisis when
severe, resembles the normal state following severe prolonged physical exertion such as after a fast long run. The skin is hot, flushed, and sweaty.
There are obvious signs of tension, weakness, and fatigue. The respiratory
rate is rapid, the pulse is fast and bounding, and the eyes appear to bulge.
The chronic signs include nervousness, irritability, hyperkinesia, mild fever,
fine tremors, and polyphagia with weight loss. Diarrhea is common. There are
a diminished tolerance to warm temperatures, proximal muscle weakness, and
possible signs of osteoporosis or myasthenia gravis. The syndrome is commonly
related to either toxic nodular goiter or Graves' disease:
The protocols described below have been designed for the treatment of non-toxic and noncancerous goiter.
Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests
(Table 16.16; Fig. 16.1). Check pertinent tendon and superficial reflexes
(Tables 16.2), and grade the reaction (Table 16.3). Check upper-extremity
joint motion and muscle strength against resistance, and grade resistance
strength (Table 16.9). Interpret resisted motion signs (Table 16.6), and perform tests for autonomic imbalance (Table 16.7). Treat acupoints LI-11, LU-7, SP-3, SP-6 (Table 16.21).
Treat auriculopoints 17, 22, 45, 55 (Figs 16.3 4).
Treat hand points LI-4, SI-3 (Figs 16.3 4). (Fig. 16.5).
If the Valleix thyroid reflex areas in the feet are tender, massage each
to patient's tolerance for 20 seconds (Fig. 16.2).
Treat trigger points discovered, especially those found in the sterno-
cleidomastoideus, digastric, and pterygoid muscles (Tables 16.28-31).
If Chapman's thyroid point is tender, deeply massage to patient's
tolerance for 10 seconds while simultaneously holding firm fingertip contact
against the respective spinal area with your other hand (Fig. 16.6).
These points are summarized in Figure 13.5.
Iodine deficiency, neoplastic disease, and inflammatory disease may produce a thyroid gland that is diffusely swollen, nodular, and sometimes cystic.
There are three major inflammatory diseases of the thyroid gland: Hashimoto's
disease (autoimmune thyroiditis), De Quervain's disease (subacute thyroiditis), and Riedel's disease (woody thyroiditis). Thyrotoxicosis, however, may
be evident when enlargement is not palpable.
Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests
(Table 16.16; Fig. 16.1). Check pertinent tendon and superficial reflexes
(Tables 16.2), and grade the reaction (Table 16.3). Check upper-extremity
joint motion and muscle strength against resistance, and grade resistance
strength (Table 16.9). Interpret resisted motion signs (Table 16.6), and perform tests for autonomic imbalance (Table 16.7).
The thyroid sets the thermostat of the body's energy production. Thus,
body temperature is the simplest indicator of thyroid function. A patient with
a thyroid disorder of any nature should be instructed to maintain a temperature chart showing temperature on arising in the morning, noon, 6 pm, and just
before sleep. This is useless, however, unless the patient is carefully
instructed in how and when to take an oral or axillary temperature. Females
should note the first and last day of their menstrual period on the chart. Treat acupoints UB-11, SP-3, SP-6, CV-15, GV-19, LI-20 (Table 16.21).
Treat auriculopoints 22, 28, 45, 55 (Figs 16.3 4).
Treat hand points LI-4, SI-3 (Figs 16.3 4). (Fig. 16.5).
If the Valleix thyroid reflex areas in the feet are tender, massage each
to patient's tolerance for 20 seconds (Fig. 16.2).
Treat trigger points discovered, especially those found in the teres
minor, sternocleidomastoideus, digastric, and pterygoid muscles (Tables 16.28-31).
If Chapman's thyroid point is tender, deeply massage to patient's
tolerance for 10 seconds while simultaneously holding firm fingertip contact
against the respective spinal area with your other hand (Fig. 16.6).
These points are summarized in Figure 13.6.
Thyroid deficiency during infancy causes cretinism, characterized by its
distinctive facial expression, mental and physical retardation, and hoarse
cry. In the child, dwarfism may result from hypothyroidism that features
childish proportions. In the adult or child, prolonged severe hypothyroidism
results in myxedema, characterized by a puffy face and eyelids, a boggy non-pitting edema in the hands and feet, thick tongue and lips, slowed speech, and
deepened voice. The skin is thick, dry, cool, and has a rough texture. The
hair is dry, coarse, brittle, and thinning on the scalp and eyebrows. Speech,
thought, and actions are slow. Other signs include anorexia, subnormal temperature, diminished tolerance to cold, slow pulse rate, possible angina and/or
palpitations, normal to slightly high blood pressure, soft and muffled heart
sounds, hypoactive tendon reflexes that are slow to recover, menorrhagia, anemia, increased cholesterol levels, a flattened glucose tolerance curve, low
ECG voltage, and late dementia.
Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests
(Table 16.16; Fig. 16.1). Check pertinent tendon and superficial reflexes
(Tables 16.2), and grade the reaction (Table 16.3). Check upper-extremity
joint motion and muscle strength against resistance, and grade resistance
strength (Table 16.9). Interpret resisted motion signs (Table 16.6), and perform tests for autonomic imbalance (Table 16.7). Treat acupoints LI-20, ST-10, GV-16 (Table 16.21).
Treat auriculopoints 22, 28, 45, 55 (Figs 16.3 4).
Treat hand points LI-4, SI-3 (Figs 16.3 4). (Fig. 16.5).
If the Valleix thyroid reflex areas in the feet are tender, massage each
to patient's tolerance for 20 seconds (Fig. 16.2).
Treat trigger points discovered, especially those found in the sterno-
cleidomastoideus, teres minor, pectoralis major, sternalis, digastric, and
pterygoid muscles (Tables 16.28-31).
If Chapman's thyroid point is tender, deeply massage to patient's
tolerance for 10 seconds while simultaneously holding firm fingertip contact
against the respective spinal area with your other hand (Fig. 16.6).
These points are summarized in Figure 13.7.
Hyperparathyroidism has hypercalcemic, normocalcemic,
and hypocalcemic forms. Hypercalcemia is associated with renal disease, kidney
stones, peptic ulcers, and emotional disturbances. Normocalcemic hyperparathyroidism is seen with renal disease, kidney stones, pregnancy, and rickets or
osteomalacia. Renal disease and pseudohypoparathyroidism can produce hypocalcemic states. Typical hyperparathyroidism features the manifestations of
hypercalcemia and accompanying bone disease such as muscular hypotonia,
general weakness, disorientation, obtundation, a faint corneal band of calcium
deposits, eyelid conjunctival calcium flecks, eardrum calcification, height
loss from vertebral collapse, long bone fractures from demineralization, and
sometimes palpable bone tumors and cysts in the jaw and at the ends of long
bones. Constipation and fatigue are commonly associated, and polyuria and
secondary polydipsia are almost always associated because the hypercalcemia
creates a loss of renal concentrating ability. A patient will become insidiously disabled from the hypercalcemia associated with a parathyroid tumor.
Diagnostic Workup
Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests
(Table 16.16; Fig. 16.1). Check pertinent tendon and superficial reflexes
(Tables 16.2), and grade the reaction (Table 16.3). Check upper-extremity
joint motion and muscle strength against resistance, and grade resistance
strength (Table 16.9). Interpret resisted motion signs (Table 16.6), and per
form tests for autonomic imbalance (Table 16.7). Treat acupoints SP-6, ST-36, LV-3, UB-11, KI-27 (Table 16.21).
Treat auriculopoints 22, 45, 51, 55 (Figs 16.3 4).
Treat hand points LI-4, SI-3 (Figs 16.3 4). (Fig. 16.5).
If the Valleix thyroid or cervical spine reflex areas in the feet are
tender, massage each to patient's tolerance for 20 seconds (Fig. 16.2).
Treat trigger points discovered, especially those found in the sternocleidomastoideus, digastric, and pterygoid muscles (Tables 16.28-31).
If Chapman's thyroid point is tender, deeply massage to patient's
tolerance for 10 seconds while simultaneously holding firm fingertip contact
against the respective spinal area with your other hand (Fig. 16.6).
These points are summarized in Figure 13.8.
Anterior Pituitary Hyperfunction. Situations involving overt malfunction
of the anterior pituitary are rarely seen in the chiropractic office, yet
signs of possible giantism, acromegaly, dwarfism, and hypopituitarism may be
found in screening procedures. Growth is increased with normal body proportions in giantism and acromegaly. In common giantism, a pituitary adenoma is
usually the cause of the excessive production of growth hormone before the
epiphyses are closed. A pituitary adenoma is also often at the root of acromegaly, which is characterized by overgrowth of bone, cartilage, and soft
tissues. Early signs and symptoms include excessive sweating; the soft tissues
of the hands are warm, moist, and spongy; the forehead and facial bones become
prominent; the nose becomes broad and enlarged, and the nasolabial folds are
accentuated.
Diagnostic Workup
Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests
(Table 16.16; Fig. 16.1). Check pertinent tendon and superficial reflexes
(Tables 16.2), and grade the reaction (Table 16.3). Check upper-extremity
joint motion and muscle strength against resistance, and grade resistance
strength (Table 16.9). Interpret resisted motion signs (Table 16.6), and perform tests for autonomic imbalance (Table 16.7). Treat acupoint LI-20, PC-6, LV-3 (Table 16.21).
Treat auriculopoints 22, 25, 28, 55 (Figs 16.3 4).
Treat hand points LI-4, HT-7, PC-10 (Fig. 16.5).
If the Valleix pituitary reflex areas in the feet are tender, massage
each to patient's tolerance for 20 seconds (Fig. 16.2).
Treat trigger points discovered, especially those found in the sterno-
cleidomastoideus muscles (Tables 16.28-31).
If Chapman's brain fatigue points are tender, deeply massage each to
patient's tolerance for 10 seconds while simultaneously holding firm fingertip
contact against the respective spinal area with your other hand (Fig. 16.6).
These points are summarized in Figure 13.9.
It is sometimes difficult to differentiate between ovarian dysfunction and
adrenal dysfunction in the adolescent female. Androgen effects can be noted by
the development of external vaginal tissues, pubic and axillary hair, and
acne. Estrogen effects contribute to the development of female breast tissues,
internal vaginal tissues, and the uterus and ovaries. Poor development of
these structures suggests subnormal production of the respective hormones,
while early development indicates premature hormonal production. Early or late
hormonal production, or abnormalities in quantity or quality, affects both
sexual development and stature (epiphyseal influence).
Delayed Puberty in the Female. Retarded menstruation, pubic and axillary
hair growth, breast development, nipple pigmentation, genital growth, and
thickening of the vaginal epithelium usually have adrenal, physiologic, or
familial etiologies, especially in the presence of obesity. Chronic infections, thyroid disorders, renal failure, and diabetes mellitus may be contri
buting factors. In true ovarian failure (eg, tumor, cyst, trauma, congenital
absence), delayed epiphyseal fusion will lead to overgrowth of the long bones.
The following protocols are designed for ovarian dysfunction. Adrenal
dysfunction is described in a separate section.
Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests
(Table 16.16; Fig. 16.1). Check pertinent tendon and superficial reflexes
(Tables 16.2), and grade the reaction (Table 16.3). Check lower-extremity
joint motion and muscle strength against resistance, and grade resistance
strength (Table 16.9). Interpret resisted motion signs (Table 16.6), and perform tests for autonomic imbalance (Table 16.7). Treat acupoints SP-6, CV-6, ST-36 (Table 16.21).
Treat auriculopoints 22, 55, 58 (Figs 16.3 4).
Treat hand points LI-4, HT-7, SI-3 (Fig. 16.5).
If the Valleix pelvic organs reflex areas in the feet are tender,
massage each to patient's tolerance for 20 seconds (Fig. 16.2).
Treat trigger points discovered, especially those found in the lower
abdominis rectus, lower thoracic multifidi, piriformis, and gluteii muscles
(Tables 16.28-31).
If Chapman's uterus point is tender, deeply massage to patient's
tolerance for 10 seconds while simultaneously holding firm fingertip contact
against the respective spinal area with your other hand (Fig. 16.6).
These points are summarized in Figure 12.10.
It is often difficult to differentiate between testicular dysfunction and
adrenal dysfunction in the adolescent male. Androgen effects can be noted in
the development of the penis and testes, wrinkling of the scrotum, pubic and
axillary hair, prostate development, and voice depth, along with seborrhea and
acne development.
Delayed Puberty in the Male. A delay in the development of pubic and axillary hair, facial hair, testicular development, scrotal darkening with folds,
genital growth, and deepening of the voice usually have familial adrenal or
gonadal (rare) etiologies. Secondary endocrine manifestations and debilitating
illnesses can also delay puberty in the male.
The following protocols are designed for testicular dysfunction. Adrenal
dysfunction is described in a separate section.
Motion palpate the spine, and relate findings with the patient's complaints. Confirm findings with appropriate orthopedic and neurologic tests
(Table 16.16; Fig. 16.1). Check pertinent tendon and superficial reflexes
(Tables 16.2), and grade the reaction (Table 16.3). Check lower-extremity
joint motion and muscle strength against resistance, and grade resistance
strength (Table 16.9). Interpret resisted motion signs (Table 16.6), and perform tests for autonomic imbalance (Table 16.7). Treat acupoints CV-6, SP-6, ST-36 (Table 16.21).
Treat auriculopoints 22, 55, 58 (Figs 16.3 4).
Treat hand points LI-4, HT-7, SI-3 (Fig. 16.5).
If the Valleix pelvic organs reflex areas in the feet are tender,
massage each to patient's tolerance for 20 seconds (Fig. 16.2).
Treat trigger points discovered, especially those found in the lower
abdominis rectus, lower thoracic multifidi, piriformis, and gluteii muscles
(Tables 16.28-31).
If Chapman's urethra, rectal, or adrenal points are tender, deeply
massage each to patient's tolerance for 10 seconds while simultaneously
holding firm fingertip contact against the respective spinal area with your
other hand (Fig. 16.6).
These points are summarized in Figure 12.11.
CLINICAL BRIEFING
Sympathetic stimulation increases the secretion of the adrenals, pancreas
(including islets), pineal gland, and thyroid and parathyroids. The parasym
pathetics generally have a reverse or unknown effect. See Table 16.18.
The highly integrated system of ductless glands in the body produces
internal secretions (hormones) that discharge into circulating blood or lymph
to affect remote tissues. Some of these glands also produce external secre
tions. The adrenals, isles of Langerhans of the pancreas, thyroid,
parathyroid, pituitary (hypophysis) ovaries, and testes are true endocrine
glands. The thymus and pineal body have not been shown to produce hormones.
CNS Endocrine Function
Research of recent years has shown that the brain and spinal cord also
secrete many specific and nonspecific hormone-like substances into blood or
lymph. Brain endorphins and enkephalins and spinal cord dynorphins and
enkephalins are typical examples. Many other similar substances are likely to
be discovered as investigation continues. The subtle functions of the nervous
system are pioneer fields of study.
Normal Effects
The endocrine system acts similar to a chemical nervous system. Like the
nervous system, self-contained positive and negative feedback mechanisms
(essentially hypothalamic, pituitary, or peripheral) are crucial to proper
operation and integration of body functions.
Among the physiologic processes influenced by hormones are resistance to
disease; rate of systemic metabolism; rate of metabolism of specific substances; rate of growth, development, and repair processes; rate of development
and function of the reproductive organs, primary and secondary sexual characteristics, and degree of libido; and the secretory activity of other endocrine
glands. Hormonal processes also play an important role in the development and
function of the CNS, personality formation, and how the body reacts to stress.
Thus, hormones may have a specific effect on a specific organ or tissue or
produce a wide systemic effect on the entire body.
General Causes of Endocrine Imbalance
Endocrine dysfunction may result from inadequate secretion or hypersecretion. Activity is under the control of the nervous system, certain circulating
chemical influences, and other hormones. There is barely any pathologic process having a neurologic component that does not involve to some degree parts
of the endocrine system. Because of the important role the endocrines have in
maintaining homeostasis, the effects of disease, neoplasm, stress, and maladaptation can be widespread. The extent that the imbalance will have on body
function depends on the severity and duration of the disturbance.
Basic Investigative Approach
Certain initial observations in the case history are helpful in determining endocrine imbalance. The significant features of body habitus are often
key factors in diagnosis. A patient's general appearance often offers an over
view of endocrine function because of the role that the endocrines play in
growth and maturity processes, where abnormal signs in body proportion and
pattern signal a chronic dysfunction. Endocrine function also exhibits in
secondary sexual characteristics, especially of the breast and external
genitalia. The skin is especially a mirror of endocrine activity as seen in
subcutaneous fat and body hair distribution; in skin color, pigmentation, texture, and thickness; and in hair growth and distribution on the head, face,
abdomen, pubis, and extremities. In evaluation of vital signs, it must be
remembered that the endocrines are important in temperature regulation, pulse
rate, blood pressure, homeostasis, and energy production.
Adaptation to Stress
An important factor finally receiving recognition in health science is the
effect of stress on the body through the endocrines whether the stress originates externally or internally. The effects of excessive stress can be detec-
ted in the physical examination and often in laboratory data. However, the
identification of the source of stress is usually a function of the case history. It is here that contributing stress factors must be thoroughly discussed
and evaluated. These stress factors, singularly or in combination, may be
recent or chronic, mild or severe. The quantity and quality of stress and its
duration and severity have a profound influence on adequate diagnosis, treat
ment, and prognosis.
Total stress on the body is usually a combination of environmental, physical, emotional, and nutritional factors. Emotional stress may be self-imposed
or conditioned such as in a self-image of low self-esteem, inferiority, inadequacy, with its unwarranted fears and guilts, and an inability to cope. Poor
interpersonal relations result in chronic social stress and finally
withdrawal.
Nutritional excesses or deficiencies result in stress from dietary habits.
Stress symptoms commonly result from the overuse of drugs, tobacco, tea and
coffee, alcohol, and carbonated beverages or other "empty calorie" foods.
Physical stress factors may be involved such as from posture strain,
trauma, fatigue, and occupational or athletic strains. Environmental stress
factors include water and air pollution, poor ventilation, chemicals ingested-inhaled-contacted, cold and heat exposure, and excessive noise and light expo
sure. Stress maladaptation is also the effect of underuse of sleep, rest,
relaxation, exercise, and water intake. Poor stress adaptation is always the
result when people abuse natural laws.
Associated Complaints
The history and physical examination offer a variety of early, subtle yet
sometimes cardinal, symptoms and signs in endocrine dysfunction. For instance,
a frequent complaint in Addison's disease is lightheadedness or dizziness on
sudden standing from the recumbent position. Fatigue and weakness are often
early symptoms of Cushing's and Addison's diseases, hyperparathyroidism, primary aldosteronism, hyper- and hypo-thyroidism, testicular disease, or pitui-
tary malfunction. Hyperparathyroidism, primary aldosteronism, and diabetes
(mellitus and insipidus) are associated with complaints of an excessive volume
of urination. Hypoparathyroidism and primary aldosteronism often present
muscle cramps and spasms. Hyperthyroidism manifests an intolerance to heat,
and the late stages of hypothyroidism produce an intolerance to cold. Symptoms
of headache, fatigue, lightheadedness, muscle cramps, intolerance to heat and
cold, and polyuria may point to an endocrine disturbance. A frontal or bitemporal headache is often associated with a pituitary tumor.
Associated Physical Findings
In the normal male, the shoulders are broad, the hips are narrow, the
thighs usually do not touch, and the calves turn inward. In contrast, the
shoulders are narrow, the hips are broad, the thighs usually touch, and the
calves turn outward in normal female physique. Thus, a general evaluation of
body size and proportion, body-type variations, height, weight, fat and hair
distribution, relationship between the shoulder and pelvic girdles, and body
contours, along with vital signs and other body habitus characteristics may be the first signs of endocrine imbalance.
Impaired peripheral vision, protruded eyes, increased perspiration, hand
tremor, excess body hair, forehead hair loss, axillary and pubic hair loss,
and excessive skin pigmentation may be the first signs of endocrine malfunction. Impaired peripheral vision results when the optic chiasm becomes compressed by a pituitary tumor. Excessive insulin, thyroid hormone, or epinephrine produce a hand tremor with or without a subjective sense of quivering.
Disorders of the ovary and/or adrenal cortex often produce excessive
development of dark body hair. When this state becomes advanced in the female,
male-pattern baldness may appear. When advanced androgenic hormone production
is decreased in either sex, especially when it is associated with panhypopituitarism, a loss of axillary and pubic hair will be noted.
A frequent sign of Addison's disease is excessive darkening of the skin,
and thyrotoxicosis presents a distinct protrusion of the eyes bilaterally.
Perspiration is increased in situations of excess insulin, thyroid, epinephrine, or growth hormone activity, while perspiration decreases when the
thyroid is subproductive.
Gonadal Dysfunction
Aberrant sexual development syndromes and gonadal dysgenesis diseases are
many and varied. The most common conditions witnessed are those of gonadal
failure before and after puberty. Sexual development depends to a large degree
on gonadal secretion at puberty. Before puberty, the sexual body habitus of
male and female is considered neutral. Testosterone is principally responsible
for the development of secondary characteristics in the male, and estrogen is
responsible in the female. When these hormones are diminished in quantity or
quality, secondary sexual characteristics tend toward the prepuberty neutral
state. On the other hand, when these hormones are excessive to the opposite
sex, feminization occurs in the male and virilization in the female.
Adrenal Dysfunction
The medulla of the adrenals (the major adjuster to stress) is under the
control of its sympathetic innervation. It synthesizes and stores three
catecholamines.
(2) Dopamine's chief function is to dilate arteries, increased heart output, and increased the flow of blood to the kidneys.
(3) Epinephrine (called adrenalin in England) constricts cutaneous and splanchnic arteries and arterioles but dilates these vessels in skeletal muscle. It also dilates the bronchi by relaxing bronchial musculature, diminishes G-I activity, increases the amount of blood fatty acid, and increases the level of blood glucose by stimulating the formation of glucose from glycogen in the liver. Extreme stress, expecially that of external stress, spurs the secretion of epinephrine and norepinephrine. The production of any these catecholamines, however, is not limited to the adrenals; they are also produced in other parts of the body.
Background
Adrenal Medulla Hyperfunction.
A tumor of the adrenal medulla (pheochromocytoma) can produce a state that mimics paroxysmal hypertension, anxiety
neurosis, thyrotoxicosis, or diabetes mellitus. Headaches, anorexia, constipation, epitaxis, hyperhidrosis, tremor, weakness, weight loss, pulmonary edema,
palpitations, possible tachycardia, postural hypotension, and an increased BMR
are commonly associated.
Adrenal Cortex Hypofunction.
Chronic hypofunction of the adrenal cortex
(Addison's disease) is characterized by high levels of circulating ACTH,
marked muscular weakness, atrophy, fatigue, lassitude, anorexia and weight
loss, salt craving, low systolic blood pressure (eg, under 100), narrow pulse
pressure, orthostatic hypotension, and tachycardia. A brownish or blue-gray
pigmentation of skin creases and mucous membranes that is accentuated in
distal areas of the extremities and at pressure points. When severe, areas of
vitiligo, decreased axillary and pubic hair, nausea and vomiting, diarrhea,
dizziness, dehydration, hypothermia, prostration, and shock manifest in an
alarming picture.
Flu-Related Hypoadrenia.
Hypoadrenia often follows influenza. The symptoms
are essentially myasthenic in character, with severe fatigue being the principal element. This asthenia extends to the involuntary muscles to cause heart
muscle weakness that is often mistakenly attributed to myocarditis even if
there is no structural change in the heart muscle. Vessel walls also lose
their tonicity, and low blood pressure follows with evidence of circulatory
insufficiency. Actually, any stress-producing situation can produce this
syndrome; eg, pregnancy, divorce, lost job, etc.
Postural Blood Pressure Method of Evaluating Adrenal Hypofunction.
This
screening test for hypoadrenia measures the body's ability to compensate for
the hydrostatic effects of gravity. To understand the significance of this
test, remember that the splanchnic veins are without valves and depend on
nerve function for their tone. As the tone of the splanchnic nerves is under
the primary control of the adrenal system, weak splanchnic veins signify weak
splanchnic nerve function and thus weak adrenals. In the healthy person,
systolic blood pressure is about 5 to 10 mm higher in the standing position
than it is in the recumbent. If, however, blood pressure is lower in the
standing position, hypoadrenia can be suspected. Drops of as much as 78 mm
have been witnessed, and the degree of drop appears to be directly related to
the degree of hypoadrenia present. The test is simply made by recording the
systolic pressure in the recumbent and standing positions and then comparing
the differences to denote the degree of suggested adrenal hypofunction.
Conduct a thorough physical examination and consider the following
workups according to clinical judgment: Blood sugar Plasma renin Urinalysis
BMR Sedimentation rate Urine aldosterone
BUN Serum alkaline phospha- Urine calcium
CBC and differential tase Urine creatine
Chest x-ray Serum bicarbonate Urine estrogen
Glucose tolerance test Serum chloride Urine hydrocortico-
Plasma ACTH Serum gamma globulins steroids
Plasma aldosterone Serum potassium Urine potassium
Plasma cortisol Serum sodium Urine proteins
Plasma deoxycortico- Spinal roentgenography Urine sodium
sterone Temperature chart Urine sugar
Eclectic Diagnostic Aids
Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig.
16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points
(Tables 16.28 16.31).
Articular Adjustment
Spinal majors will likely be found at C1, T12, SI. After relaxing the
tissues and adjusting the subluxated/fixated segments, apply deep low-velocity
percussion spondylotherapy over segments T11–L1 for 1–2 minutes (Table
16.20).
Adjunctive Therapy
To restore further neurologic homeostasis and enhance healing:
Nutritional Therapy
Supplemental adrenal and thyroid extract and ginseng are recommended. The
patient should be advised to restrict alcohol, coffee, regular tea, and any
other type of diuretic.
Monitor urine sodium and potassium at least weekly. Simple in-office tests
are available for this. An important objective during treatment is to obtain
an optimal balance of tissue sodium and potassium and to minimize sodium and
potassium loss in the urine. Results should be charted.
Elective Procedures
Other helpful forms of treatment include spinal ultrasound (Table 16.37),
vinegar baths (Table 16.46), and suprarenal interferential therapy (Tables
16.39 41) or shortwave diathermy (Table 16.36). Check for a dropped kidney
and spasms, adhesions, or taut fascia that might be interfering with the
function of the adrenals. In situations of adrenal insufficiency, the patient
must avoid exposure to ultraviolet radiation.
Diabetes Insipidus
Background
The cause may be congenital or acquired via basilar trauma, vascular
lesions (autonomic vasospasm), acute or chronic infections, neoplasms, and
cysts. Sometimes leukemia, amyloidosis, sarcoidosis, or eosinophilic granulomatosis are involved. However, diabetes insipidus can also be caused by a
congenital predisposition or acquired failure of the renal tubules to reabsorb
water.
Diagnostic Workup
Conduct a thorough physical examination and consider the following
workups according to clinical judgment: Blood sugar Plasma insulin concen- Serum chloride
BMR tration Serum sodium
CBC and differential Renal function tests Serum growth hormone
Chest x-ray Sedimentation rate Skull x-ray
Fluid input and out- Serum alkaline phospha- Spinal roentgenography
put monitoring tase Urinalysis
Glucose tolerance test Serum calcium Urine sodium
Eclectic Diagnostic Aids
Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig.
16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points
(Tables 16.28 16.31).
Articular Adjustment
Spinal majors will likely be found at C1, T11–L1. After relaxing the
tissues and adjusting the subluxated/fixated segments, apply deep low-velocity
percussion spondylotherapy over segments T10–L2 for 1–2 minutes (Table
16.20).
Adjunctive Therapy
To restore further neurologic homeostasis and enhance healing:
Nutritional Therapy
Supplemental pituitary and adrenal extract are recommended. Advise the
patient to restrict diuretic-acting foods and beverages.
Elective Procedures
Other helpful forms of treatment include upper thoracic ultrasound (Table
16.37) and mild interferential therapy (Tables 16.39 41) or shortwave
diathermy (Table 16.36) to the kidney area. Check for muscle spasms, arteriosclerosis, adhesions, or taut fascia that might interfere with the function of
the basilar circulation and the kidneys.
Diabetes Mellitus
Background
The hyperglycemic state expresses as nervousness, fatigue, headache,
hyperhidrosis, scrotal or perianal pruritus, boils or rashes, tremor, faintness, diplopia, scotomata, pallor, and irrational behavior. Later, metabolic
disorders manifest as weakness and malaise, deep respirations, paresthesia,
cramps, intermittent claudication, nausea and vomiting, abdominal and/or chest
pain, flank pain, diarrhea, dyspnea, tongue atrophy, dry mucous membranes,
vaginal discharge, hypotension, diminished tendon reflexes, progressing tachycardia, softening of the eyeballs, extraocular palsy, cataracts, glaucoma,
impotency, pedal ischemia, psychoneurosis, and drowsiness leading to stupor and coma. In the chronic stages, effects on nervous and vascular tissues
become pronounced.
The following protocols have been designed for early diabetes mellitus or
those cases well controlled by insulin therapy.
Diagnostic Workup
Conduct a thorough physical examination and consider the following
workups according to clinical judgment: Blood glucose Glucose tolerance test Serum alkaline phospha-
Blood pH Plasma acetone tase
BMR Plasma insulin concen- Serum electrolytes
CBC and differential tration Spinal roentgenography
Chest x-ray Renal function tests Urinalysis
Fluid input and out- Sedimentation rate
put monitoring
Eclectic Diagnostic Aids
Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig.
16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points
(Tables 16.28 16.31).
Articular Adjustment
Spinal majors will likely be found at C1, T7–T8. After relaxing the
tissues and adjusting the subluxated/fixated segments, apply deep low-velocity
percussion spondylotherapy over segments T6–T8 for 1–2 minutes (Table
16.20).
Adjunctive Therapy
To restore further neurologic homeostasis and enhance healing:
Nutritional Therapy
Prescribe a high-protein low-carbohydrate diet. Supplemental pancreas
extract or nutrients A, C, B-complex, E, niacin, chromium, manganese, pangamic acid, potassium, and zinc are recommended. Counsel the patient to avoid
appropriate antivitamin and antimineral factors (Tables 16.56 and 16.58).
Onions and garlic should be eaten frequently; white sugar and white flour
should be avoided.
Elective Procedures
Other helpful forms of treatment include spinal ultrasound (Table 16.37),
interferential therapy (Tables 16.39 41) or shortwave diathermy (Table 16.36)
to the pancreas area, and local vibration-percussion (Tables 16.19 20). Check
for spasms, adhesions, or taut fascia that might be interfering with the
function of the pancreas. In conjunction with spinal adjustments and niacin,
lumbar interferential therapy will do much to halt and often reverse associated advanced peripheral vascular disease in the lower extremities.
Hypoglycemia
Hypoglycemia, hyperinsulinism, and hypoadrenia are frequently linked in
the presenting syndrome. Isolated endocrine dysfunction is not typical.
Diagnostic Workup
Conduct a complete physical examination, including a thorough analysis of
heart sounds, and consider the following workups according to clinical
judgment: Blood glucose Glucose tolerance test Serum alkaline phospha-
Blood pH Plasma acetone tase
BMR Plasma insulin concen- Serum electrolytes
CBC and differential tration Spinal roentgenography
Chest x-ray Renal function tests Urinalysis
Fluid input and out- Sedimentation rate
put monitoring
Eclectic Diagnostic Aids
Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig.
16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points
(Tables 16.28 16.31).
Articular Adjustment
Spinal majors will likely be found at C1, T7–T8. After relaxing the
tissues and adjusting the subluxated/fixated segments, apply deep low-velocity
percussion spondylotherapy over segments T6–T8 for 1–2 minutes (Table
16.20).
Adjunctive Therapy
To restore further neurologic homeostasis and enhance healing:
Nutritional Therapy
Prescribe a high-protein low-carbohydrate diet. Supplemental pancreas
and adrenal extract or nutrients A, C, B-complex, E, niacin, chromium, manganese, pangamic acid, potassium, and zinc are recommended. Counsel the patient
to avoid appropriate antivitamin and antimineral factors (Tables 16.56 and
16.58). White sugar and white flour should be avoided. The patient should be
advised to eat light main meals with a protein-rich snack between meals.
Elective Procedures
Other helpful forms of treatment include spinal ultrasound (Table 16.37),
interferential therapy (Tables 16.39 41) or shortwave diathermy (Table 16.36)
to the pancreas area, and local vibration-percussion (Tables 16.19 20). Check
for spasms, adhesions, or taut fascia that might be interfering with the
function of the pancreas.
Goiter
The cause of goiter may be due to hyperthyroidism or hypothyroidism. Common direct causes of goiters generally include endemic iodine deficiency,
follicular hypertrophy, thyroiditis, cyst formation, encapsulated adenomata,
and thyroid tumor.
Background
Palpation of a goiterous thyroid will reveal enlargement. One or masses
(cysts or tumors) or firm nodes may be felt, and pulsations are sometimes
sensed.
Thyrotoxicosis is commonly related to toxic nodular goiter and Graves'
disease:
(1) Besides thyrotoxicosis, the only other major physical signs in
toxic nodular goiter are a lumpy thyroid on palpation and a moderate
exophthalmos.
(2) In Graves' disease, signs besides thyrotoxicosis include
distinct exophthalmos, a diffusely enlarged thyroid gland, possible infiltration under the skin of the shins, finger clubbing, and a systolic bruit may be
heard over the thyroid.
Diagnostic Workup
Conduct a thorough physical examination and consider the following workups
according to clinical judgment: Blood sugar Sedimentation rate Serum thyroxine
BMR Serum alkaline phospha- Serum total lipids
CBC and differential tase Spinal roentgenography
Chest x-ray Serum calcium Temperature chart
Fluid input and out- Serum carotene Urinalysis
put monitoring Serum cholesterol Urine ketosteroids
Glucose tolerance test Serum electrolytes Urine sugar
Eclectic Diagnostic Aids
Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig.
16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points
(Tables 16.28 16.31).
Articular Adjustment
Spinal majors will likely be found at C2–C4, T1. After relaxing the
tissues and adjusting the subluxated/fixated segments, apply deep low-velocity
percussion spondylotherapy over segments C7–T4 for 1–2 minutes (Table
16.20).
Adjunctive Therapy
To restore further neurologic homeostasis and enhance healing:
Nutritional Therapy
Supplemental thyroid and parotid extract and iodine are recommended. Counsel the patient to avoid appropriate antimineral factors (Tables 16.58).
Elective Procedures
Other helpful forms of treatment include upper-thoracic ultrasound (Table
16.37) or interferential therapy (Tables 16.39 41). Check for spasms, adhesions, or taut fascia that might be interfering with the function of the
thyroid. It is common to find taut fascia or binding adhesions between the
anterior border of the sternocleidomastoideus and the thyroid.
Hyperthyroidism
Background
A hum, systolic bruit, or thrill will often be noted because of the
increased blood flow. The associated hypermetabolism produces weight loss and
deficient subcutaneous fat, nervousness and hand tremor, exaggerated tendon
reflexes, protruding eyes, high and bounding pulse rate, elevated systolic
pressure, hyperactive heart sounds, and a skin that is warm, moist, and
smooth.
Diagnostic Workup
Conduct a thorough physical examination and consider the following
workups according to clinical judgment: Blood sugar Sedimentation rate Serum thyroxine
BMR Serum alkaline phospha- Serum total lipids
CBC and differential tase Spinal roentgenography
Chest x-ray Serum calcium Temperature chart
Fluid input and out- Serum carotene Urinalysis
put monitoring Serum cholesterol Urine ketosteroids
Glucose tolerance test Serum electrolytes Urine sugar
Importance of a Temperature Chart
Eclectic Diagnostic Aids
Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig.
16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points
(Tables 16.28 16.31).
Articular Adjustment
Spinal majors will likely be found at C2–C4, T1. After relaxing the
tissues and adjusting the subluxated/fixated segments, apply deep high-velocity
percussion spondylotherapy over segments C7–T4 for 3–4 minutes (Table
16.20).
Adjunctive Therapy
To restore further neurologic homeostasis and enhance healing:
Nutritional Therapy
Supplemental thyroid, thymus, and pituitary extract or B6, PABA, iodine,
niacin, and potassium are recommended. Counsel the patient to avoid
appropriate antimineral factors (Tables 16.58).
Elective Procedures
Other helpful forms of treatment include upper-thoracic ultrasound (Table
16.37) or interferential therapy (Tables 16.39 41). Check for spasms, adhesions, or taut fascia that might be interfering with the function of the
thyroid.
Hypothyroidism
Common Subclinical Forms
Most cases of hypothyroidism will not show such overt signs. Subclinical
hypothyroidism is far more common than generally suspected. The first signs
will be cool hands, a slightly subnormal body temperature, teres minor
weakness, frequent colds, constipation, abnormal hair loss (as observed in the
hairbrush), memory deficits, an odd taste in the mouth, unusual procrastination to duties, easily provoked to crying, and self-isolation from social
events and crowds. A "what's the use, to hell with it all" attitude is common.
The general apathy and forgetfulness so often seen with the hypothyroid
patient can easily be confused with early senile dementia in the elderly or
depression in younger patients.
Normal temperature variances are in the 97.8°F–98.2°F range. Mild hypo-thyroid patients will show daily temperatures varying between 97°F and 97.6°F;
severe hypothyroidism, 95.8°F to 96.6°F.
Hypothyroidism vs Hyperthyroidism
Symptoms of lassitude, weakness, constipation, menorrhagia, or weight gain
point toward hypothyroidism. As advanced thyroid diseases cause profound metabolic effects, symptoms of diarrhea, weight loss, oligomenorrhea, fatigue, or
tremor are suspicious of hyperthyroidism. The hyperthyroid patient tends to be
heat tolerant; the hypothyroid patient, cold tolerant. In shaking hands, the
hyperthyroid patient will present a hand that is warm and moist; the hypothyroid patient, one that is cool and dry. The hypothyroid patient may be overly
dressed on a warm day; the hyperthyroid patient may wear a light jacket on a
cold winter day. Obese female patients who do not have a demonstrable thyroid
condition may have a low tolerance to heat. Hypothyroidism is often secondary
to pituitary or hypothalamic disease and other glandular diseases. Prior
thyroid treatment and surgery should be carefully evaluated.
Diagnostic Workup
Conduct a thorough physical examination and consider the following
workups according to clinical judgment: Blood sugar Sedimentation rate Serum thyroxine
BMR Serum alkaline phospha- Serum total lipids
CBC and differential tase Spinal roentgenography
Chest x-ray Serum calcium Temperature chart
Fluid input and out- Serum carotene Urinalysis
put monitoring Serum cholesterol Urine ketosteroids
Glucose tolerance test Serum electrolytes Urine sugar
Eclectic Diagnostic Aids
Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig.
16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points
(Tables 16.28 16.31).
Articular Adjustment
Spinal majors will likely be found at C2–C4, T1. After relaxing the
tissues and adjusting the subluxated/fixated segments, apply deep low-velocity
percussion spondylotherapy over segments C7–T4 for 1–2 minutes (Table
16.20).
Adjunctive Therapy
To restore further neurologic homeostasis and enhance healing:
Nutritional Therapy
Supplemental thyroid, parotid, adrenal, and pituitary extract or amino
acids, potassium, niacin, pangamic acid, and iodine are recommended. Counsel
the patient to avoid appropriate antivitamin and antimineral factors (Tables
16.56 and 16.58).
Elective Procedures
Other helpful forms of treatment include upper-thoracic ultrasound (Table
16.37) or interferential therapy (Tables 16.39 41). Check for spasms, adhe
sions, or taut fascia that might be interfering with the function of the
thyroid.
Parathyroid Dysfunction
Hypoparathyroidism features hypocalcemic manifesta
tions such as carpopedal spasm, as elicited by Trousseau's sign, and other
overt signs of tetany. A positive Chvostek's sign (elicited in 10% of normal
people) may manifest. Other characteristics of chronic hypoparathyroidism are
cataracts, papilledema, defective teeth enamel, brittle nails, thin and patchy
body hair, and a dry scaly skin.
Conduct a thorough physical examination and consider the following
workups according to clinical judgment: Blood sugar Hemoglobin level Serum growth hormone
BMR Kidney x-ray Serum phosphorus
Bone-age roentgenography Sedimentation rate Serum uric acid
CBC and differential Serum alkaline phos- Skull x-ray
Chest x-ray phatase Spinal roentgenography
Fluid input and out- Serum calcium Urinalysis
put monitoring Serum electrolytes Urine calcium
Glucose tolerance test Serum globulins Urine phosphorus
Eclectic Diagnostic Aids
Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig.
16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points
(Tables 16.28 16.31).
Articular Adjustment
Spinal majors will likely be found at C2–C4, T1. After relaxing the
tissues and adjusting the subluxated/fixated segments, apply deep low-velocity
percussion spondylotherapy over segments C7–T4 for 1–2 minutes (Table
16.20).
Adjunctive Therapy
To restore further neurologic homeostasis and enhance healing:
Nutritional Therapy
Supplemental C, D, calcium, niacin, pangamic acid, magnesium, and
potassium are recommended. Counsel the patient to avoid appropriate antivitamin and antimineral factors (Tables 16.56 and 16.58).
Elective Procedures
Other helpful forms of treatment include upper-thoracic ultrasound (Table
16.37) or interferential therapy (Tables 16.39 41). Check for spasms, adhesions, or taut fascia that might be interfering with the function of the
parathyroids.
Anterior Pituitary Dysfunction
Anterior Pituitary Hypofunction. Nongenetic dwarfism such as that from a
pituitary hypofunction is rare. It is characterized by normal body proportions, childish features, subnormal sexual development, and deficient function
of other endocrines. Adult hypopituitarism is also associated with a wide-spread hypoendocrine decrease such as moderate myxedema, hair loss, postural
hypotension, weight loss, emaciation, asthenia, pallor, a dry smooth skin, and
skin depigmentation associated with a difficulty to suntan.
Conduct a thorough physical examination and consider the following
workups according to clinical judgment: Blood sugar Glucose tolerance test Serum phosphorus
BMR Sedimentation rate Skull x-ray
Bone-age roentgenography Serum ACTH Spinal roentgenography
CBC and differential Serum alkaline phos- Urinalysis
Chest x-ray phatase Urine gonadotrophins
Fluid input and out- Serum electrolytes
put monitoring Serum growth hormone
Eclectic Diagnostic Aids
Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig.
16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points
(Tables 16.28 16.31).
Articular Adjustment
Spinal major will likely be found at C1. After relaxing the tissues and
adjusting the subluxated/fixated segments, apply deep low-velocity percussion
spondylotherapy over segments T1–T4 for 1–2 minutes (Table 16.20).
Adjunctive Therapy
To restore further neurologic homeostasis and enhance healing:
Nutritional Therapy
Supplemental pituitary and adrenal extract and nutrients niacin and panga
mic acid are recommended. Counsel the patient to avoid appropriate antivitamin
and antimineral factors (Tables 16.56 and 16.58).
Elective Procedures
Other helpful forms of treatment include spinal ultrasound (Table 16.37),
and upper thoracic interferential therapy (Tables 16.39 41) or shortwave
diathermy (Table 16.36). Check for cervical spasms, arteriosclerosis, adhe
sions, or taut fascia that might be interfering with basilar circulation.
Ovarian Dysfunction
Background
Virilization. In virilization (female body habitus tending toward the
male), the patient expresses many male secondary sexual characteristics such
as a receding hairline on the scalp, a deepening of the voice, and axillary
hair growth on the face, abdomen, chest, and back. The frontal recession of
hereditary male pattern baldness, influenced by testosterone, helps to
distinguish virilization in the female from hirsutism or from the unusual
pattern of alopecia secondary to toxic or drug effects upon hair follicles.
The cause may be either ovarian or adrenal in origin.
Skin texture in virilization becomes coarse and waxy, and acne is usually
present. Strength and muscle development increases, especially in the shoulder
girdle. Hip fat deposition decreases. Pubic hair increases and usually extends
up the abdomen and sometimes into the chest. There is little change in breast
size, but areolae tend to flatten. The clitoris becomes enlarged and unusually
erectile. Vulva atrophy may be noted.
Diagnostic Workup
Conduct a thorough physical examination and consider the following
workups according to clinical judgment: Blood sugar Plasma androsterone Skull x-ray
BMR Plasma cortisol Spinal roentgenography
CBC and differential Plasma estrogen Urinalysis
Chest x-ray Plasma gonadotrophins Urine gonadotropins
Fluid input and out- Plasma testosterone Urine estrogen
put monitoring Sedimentation rate Urine ketosteroids
Glucose tolerance test Serum electrolytes
Pap smear Serum growth hormones
Eclectic Diagnostic Aids
Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig.
16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points
(Tables 16.28 16.31).
Articular Adjustment
Spinal majors will likely be found at C1, T11–T12. After relaxing the
tissues and adjusting the subluxated/fixated segments, apply deep low-velocity
percussion spondylotherapy over segments T10–L1 for 1–2 minutes (Table
16.20). It should be noted that low levels of estrogen (such as seen in early
menopause) are closely linked to hypoadrenia.
Adjunctive Therapy
To restore further neurologic homeostasis and enhance healing:
Nutritional Therapy
Supplemental ovary and adrenal extract or nutrients B6, E, niacin, pangamic acid, and iodine are recommended. Counsel the patient to avoid appropriate
antivitamin and antimineral factors (Tables 16.56 and 16.58).
Elective Procedures
Other helpful forms of treatment include spinal ultrasound (Table 16.37),
and thoracolumbar junction interferential therapy (Tables 16.39 41) or short
wave diathermy (Table 16.36). Check for spasms, adhesions, or taut fascia that
might be interfering with the function of the ovaries. These are common especially if pelvic or abdominal surgery has been performed.
Testicular Dysfunction
Background
Feminization. If feminization occurs (male body habitus tending toward the female), scalp hair is fine with no recession at the hair line, and facial
hair is scanty, requiring infrequent shaving. The voice is high pitched.
Strength and muscles are poorly developed, especially in the shoulder girdle.
Chest, pubic, and extremity hair is scanty. The skin has a fine texture, and
there is little or no acne. Fat deposition around the hips plus narrow
shoulders contribute to the classic female appearance. Excessive development
of the male mammary glands (gynecomastia) is noted, even to the functional
state in some cases. If feminization occurs after puberty, most of the signs
described will be absent or greatly minimized. There may be some reduction in
shaving and some excessive hip fat deposition. The only clinical finding may
be gynecomastia.
Diagnostic Workup
Conduct a thorough physical examination and consider the following
workups according to clinical judgment: Blood sugar Sedimentation rate Spinal roentgenog-
BMR Semen analysis raphy
Bone-age roentgenography Serum alpha-fetoprotein Urinalysis
CBC and differential Serum electrolytes Urine gonadotropins
Chest x-ray Serum growth hormone Urine ketosteroids
Plasma testosterone Skull x-ray
Eclectic Diagnostic Aids
Check alarm points (Table 16.15), visceral Valleix areas of the foot (Fig.
16.2), Chapman's points (Fig. 16.6), and potential contributing trigger points
(Tables 16.28 16.31).
Articular Adjustment
Spinal majors will likely be found at C1, T11–T12. After relaxing the
tissues and adjusting the subluxated/fixated segments, apply deep low-velocity
percussion spondylotherapy over segments T10–L1 for 1–2 minutes (Table
16.20).
Adjunctive Therapy
To restore further neurologic homeostasis and enhance healing:
Nutritional Therapy
Supplemental testis and adrenal extract or nutrients B6, E, niacin, pangamic acid, iodine, and zinc are recommended. Counsel the patient to avoid ap-
propriate antivitamin and antimineral factors (Tables 16.56 and 16.58).
Elective Procedures
Other helpful forms of treatment include spinal ultrasound (Table 16.37),
and thoracolumbar junction interferential therapy (Tables 16.39 41) or short
wave diathermy (Table 16.36). Check for spasms, adhesions, or taut fascia that
might be interfering with the function of the scrotum. These are common especially if pelvic or abdominal surgery has been performed.