Sports Medicine: Just the Facts

190 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE

•Preparticipation examination

1. Stable control
   (1) Glycosylated hemoglobin
   (2) Self-monitoring around activity
   (3) Urine ketone measurement if warranted
   (4) Insulin regimen, peak action time, and injec-
   tion sites
   (5) Meal planning
   2. Assess level of self-care
   (1) Recognition of hypo/hyperglycemia
   (2) Treatment strategies for hypo/hyperglycemia,
   ketoacidosis, and sick day regimen
   (3) Changes in insulin types, dosage, and injection
   site
   (4) Medical identification
   (5) Monitoring regimen

TABLE 32-10 Clinical Implications

GLAND/HORMONE HYPERSECRETION HYPOSECRETION

Anterior Pituitary Hormones

1. GH


2. TSH


3. ACTH


4. FSH/LH


5. PRL


6. Endorphins

Posterior Pituitary Hormones

1. Oxytocin


2. Vasopressin

Adrenal Cortex Hormones

1. Cortisol


2. Aldosterone

Adrenal Medulla Hormones

1. Epinephrine/Norepinephrine

Thyroid Hormones

1. T4/T3

Pancreatic Hormones

1. Insulin


2. Glucagon

Parathyroid Hormones

1. PTH

Ovarian Hormones

1. Estrogen/Progesterone

Testes

1. Testosterone

1) Insulin resistance; peripheral neuropathy

2) Increased BMR; weight loss; arrhythmia

3) Hyperglycemia; muscle wasting; bone protein

loss; water and salt retention; hypertension

4) Unknown

5) Menses cessation in females; impotence in

males

6) Unknown

1) Unknown

2) Hyponatremia; low plasma osmolality; poor

fluid control

1) Hypertension; hypokalemia; protein depletion;

muscle weakness; osteoporosis; decreased Ca

absorption and increased excretion of Ca;

suppressed immune function; impaired CHO

metabolism

2) Sodium and water retention; hypokalemia;

hypertension

1) Hypertension; increased BMR

1) Elevated BMR; heat intolerance; excessive

perspiration; weight loss; muscle weakness;

tachycardia; arrhythmias; hypertension;

increased metabolism of CHO, fat, protein;

decreased ovarian function

1) Hypoglycemia; anxiety, overall weakness

2) Hyperglycemia

1) Loss of Ca from bone; hypercalcemia;

weakening of bone; muscle weakness;

neurologic symptoms; kidney stones

1) Progesterone may enhance masculinization

1) Masculization; liver disorders; lipid alterations;

muscle hypertrophy

1) Increased insulin sensitivity; decreased muscle

strength, decreased bone density

2) Decreased BMR; weight gain; dry skin; fatigue

3) Rare

4) Decline in sexual maturation; menstrual

disorder

5) Decreased milk production in women

6) Endorphins

1) Unknown

2) Increased urine production; poor fluid control

1) Abnormal CHO, fat, and protein metabolism;

muscle weakness; loss of appetite; weight loss;

decreased sodium; increased potassium;

hypotension; dehydration

2) Loss of sodium; hyperkalemia; hypotension;

dehydration

1) Rare

1) Reduced BMR, cold intolerance; dry skin;

fatigue; slow reflexes, muscle cramping;

weight gain; CNS affects (poor memory, slow

mentation); bradycardia; decreased

contractility of heart; hypotension; increased

cholesterol levels; decreased ovarian function

1) Diabetes mellitus; hyperglycemia; altered

CHO, fat, protein metabolism; increased

ketogenesis; glucosuria; hypotension,

dehydration; weight loss; fatigue

2) Hypoglycemia; decreased plasma protein

levels

1) Hypocalcemia; uncontrolled muscle spasm

1) Menstrual disorders; decreased bone growth;

decreased BMR;

1) Feminization; muscle atrophy