Chapter_007 - LA Institute of Massage Therapy

Mosby’s PATHOLOGY 

for Massage Therapists 

Chapter 7 

Endocrine Pathologies 

Lesson 7.1 Objectives 

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. 

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


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Endocrine System Overview 

Effects of the Endocrine System 

Regulatory system 

Responsible for helping maintain homeostasis 

Works with nervous system to coordinate 

functioning of all body systems 

Uses hormones to communicate 

Regulates activity of 

smooth/cardiac 

muscle and some 

glands 

Regulates chemical 

composition and 

volume of fluids 

Regulates growth 

and development 

Regulates 

reproductive 

processes 

Participates in 

circadian rhythms 

Alters metabolism 


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Types of Glands 

Types of Glands (cont'd.) 

Exocrine glands 

Sudoriferous: : secretes perspiration 

Sebaceous: secretes oil 

Ceruminous: : secretes earwax 

Digestive: secrete enzymes 

Mucous: secrete mucous 

Endocrine (ductless) glands 

Adrenals 

Gonads 

Pancreas (islets) 

Parathyroids 

Pineal 

Pituitary 

Thyroid 


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Location of Endocrine Glands 

Pituitary Hormones 

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

ACTH, Adrenocorticotrophic hormone 

ADH, antidiuretic hormone 

FSH, follicle-stimulating hormone 

GH, growth hormone 

LH, luteinizing hormone 

PRL, prolactin 

TSH, thyroid-stimulating hormone 

From Herlihy B, Maebuis NK: The human body in health and illness, ed 3, Philadelphia, 2007, Saunders. 



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Diseases of the Pituitary 

Hyperpituitarism 

Hyperpituitarism 

Giantism 

Acromegaly 

Hypopituitarism 

Dwarfism 

Diabetes insipidus 

Overproduction of pituitary hormones (especially 

ATCH and GH) causing overstimulation of target 

endocrine glands 

Giantism: : GH overproduction occurring during 

childhood 

Acromegaly: : GH overproduction occurring during 

adulthood 

Jt. Mobs are omitted or cautiously applied 


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Giantism 

Acromegaly 

Form of hyperpituitarism 

causing accelerated 

growth due to 

overproduction of GH 

before onset of puberty 

Jt. Mobs are omitted or 

cautiously applied 

Form of hyperpituitarism 

causing enlargement of 

hands, feet and face with 

jaw protrusion due to 

overproduction of GH after 

onset of puberty 

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. 


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Hypopituitarism 

Dwarfism 

Underproduction of pituitary hormones causing 

lack of stimulation of target endocrine glands; 

disease manifestations are directly related to 

the particular hormone shortage 

Adjust massage according to client vitality 

(lighter pressure, reduced time); reduce 

pressure over areas of decreased bone density 

Form of hypopituitarism 

causing short stature 

resulting from 

underproduction of GH in 

childhood 

No massage considerations 

From Brashear HR, Raney RB: Handbook of orthopaedic 

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



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Diabetes Insipidus 

Lesson 7.2 Objectives 

Condition caused by ADH insufficiently 


List diseases of the thyroid gland and outline 


Name diseases of the parathyroids and state 

massage considerations. 

Identify diseases of the pancreas and list 



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Lesson 7.2 Objectives (cont 

(cont’d.) 

Diseases of the Thyroid 

List causes, signs and symptoms, and 

interventions for hyperglycemia and 

hypoglycemia. 

Define adrenal cortex diseases and list 


Goiter 

Graves disease 

Cretinism 

Myxedema 


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Goiter 

Enlargement of the thyroid 

gland 

Avoid throat region (local 

contraindication) 

Graves Disease 

Condition of 

hyperthyroidism resulting 

in a goiter, anxiety and 

fatigue, overheating, hand 

tremors, eyeball protrusion 

Reduce treatment time to 

30 min if client is fatigued; 

avoid throat 

From Seidel H: Mosby’s s guide to physical examination, ed 4, 

St. Louis, 1999, Mosby. 



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Cretinism 

Myxedema 

Condition of 

hypothyroidism occurring 

in fetal life or early infancy 

resulting in mental 

retardation (if untreated) 

Relaxing massage is 

indicated 

Condition of severe or 

long-standing 

hypothyroidism in 

adulthood 

Adjust massage according 

to client vitality (lighter 

pressure, reduced 

treatment time) 

From Schneeberg NE: Essentials of clinical endocrinology, 


From Seidel H: Mosby’s s guide to physical examination, ed 5, 



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Diseases of the Parathyroids 

Hyperparathyroidism 

Hyperparathyroidism 

Hypoparathyroidism 

Condition of PTH overproduction 

characterized by muscle weakness, fatigue, 

and hypertension 


(lighter pressure, reduced treatment time); jt. 

mobs are omitted or cautiously applied; 

reduce pressure over areas of decreased 

bone density 


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Hypoparathyroidism 

Diabetes Mellitus 

Condition of diminished parathyroid gland 

function leading to hypocalcemia (low blood 

calcium levels) 


(lighter pressure, reduced treatment time); 

reduce pressure over areas of decreased bone 

density 

Group of disorders characterized by elevated 

blood glucose levels due to: 

Insufficient insulin 

Resistance to insulin by cells 

Both 

Types are type I, type II, and gestational 

diabetes 

Diabetics must monitor and maintain their 

blood sugar in a healthy range 



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Diabetes Mellitus, Type I 

Diabetes Mellitus, Type I (cont'd.) 

Lack of insulin 

Regular injections of insulin 

needed 

Three P’s: P 

polyuria, 

polydipsia, polyphagia 

Massage considerations 

same as type II 

Hypoglycemia 

Condition of reduced blood glucose levels 

Major cause in diabetics is overdose of prescribed 

insulin; second major cause is eating too little food 

Can occur with all types of diabetics, but more 

common in type I 

May lead to insulin shock 

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. 


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Diabetes Mellitus, Type II 

Diabetes Mellitus, Type II (cont'd.) 

Body cells resistant to insulin 

Related to central obesity and 

sedentary lifestyle; strong 

genetic link also exists 

S/S similar to type I 

Can be controlled by regular 

exercise and maintaining 

healthy weight 

Hyperglycemia 

Condition of high blood glucose levels 

Major cause in diabetics is too much food, missed 

dose of medication, too little insulin or oral diabetic 

medication, or too little exercise 

May lead to diabetic coma 

Can be fatal 

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. 


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Diabetes Mellitus (cont 

(cont’d.) 

Diabetes Mellitus (cont 

(cont’d.) 

Type I and II massage considerations: 

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

has a good snack no more than 1 hour before 

massage 

Adapt massage to disease complications (reduced 

pressure, areas to avoid, etc.) 

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

d.): 

If client taking insulin, avoid vigorous massage over 

sites of recent injection for 24 hrs 

Avoid getting lubricant on drug administration 

equipment such as insulin pumps 



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Gestational Diabetes Mellitus 

Diseases of the Adrenal Cortex 

Glucose intolerance that develops in some 

women during pregnancy; usually diagnosed in 

the second trimester 

Massage considerations are same as for types I 

and II diabetes mellitus with addition of 

guidelines for prenatal massage 

Cushing disease and Cushing syndrome 

Addison disease 


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Cushing Disease and Cushing 

Syndrome 

Cushing disease – 

Overproduction of ATCH 

(hypercortisolism) 

Cushing syndrome – 

Prolonged and excessive 

use of high-dose cortisone 

drugs 

Adjust massage according 

to client vitality (lighter 

pressure, reduced time) 

Addison Disease 

Hypocortisolism; 

characterized by general 

weakness, 

hyperpigmentation of skin 

and mucosa (bronzing) 

Adjust massage 

according to client vitality 

(lighter pressure, reduced 

time) 

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

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

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


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Chapter_007 - LA Institute of Massage Therapy

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