Podcast
Questions and Answers
What type of body fat distribution is often observed in patients with Cushing's syndrome?
What type of body fat distribution is often observed in patients with Cushing's syndrome?
Which of the following symptoms would most likely suggest hyperthyroidism during a physical examination?
Which of the following symptoms would most likely suggest hyperthyroidism during a physical examination?
Which endocrine condition is associated with elevated blood pressure and tachycardia during a physical examination?
Which endocrine condition is associated with elevated blood pressure and tachycardia during a physical examination?
What physical observation might indicate hypopituitarism?
What physical observation might indicate hypopituitarism?
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How is the function of the pancreas and parathyroid glands primarily regulated?
How is the function of the pancreas and parathyroid glands primarily regulated?
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Which symptom is least likely to be associated with endocrine disorders?
Which symptom is least likely to be associated with endocrine disorders?
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Which sign would you look for in a physical examination that may suggest Addison’s disease?
Which sign would you look for in a physical examination that may suggest Addison’s disease?
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During a physical examination, which evaluation is crucial for suspected adrenal insufficiency?
During a physical examination, which evaluation is crucial for suspected adrenal insufficiency?
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What physical signs would most likely indicate a female patient has polycystic ovary syndrome (PCOS)?
What physical signs would most likely indicate a female patient has polycystic ovary syndrome (PCOS)?
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Which condition is most closely associated with periorbital edema and lid lag?
Which condition is most closely associated with periorbital edema and lid lag?
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A patient presents with bi-temporal hemianopia. What condition should be primarily suspected?
A patient presents with bi-temporal hemianopia. What condition should be primarily suspected?
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What finding when inspecting the neck might indicate insulin resistance?
What finding when inspecting the neck might indicate insulin resistance?
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In examining the abdomen, which sign would be indicative of Cushing syndrome?
In examining the abdomen, which sign would be indicative of Cushing syndrome?
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What symptom should be assessed in the hands of a patient to evaluate for acromegaly?
What symptom should be assessed in the hands of a patient to evaluate for acromegaly?
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What is a potential consequence of over-enthusiastic examination in a patient suspected of having pheochromocytoma?
What is a potential consequence of over-enthusiastic examination in a patient suspected of having pheochromocytoma?
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Which finding in the lower extremities might suggest Graves disease?
Which finding in the lower extremities might suggest Graves disease?
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What finding in a female patient with menstrual disturbances might indicate polycystic ovary syndrome (PCOS)?
What finding in a female patient with menstrual disturbances might indicate polycystic ovary syndrome (PCOS)?
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What examining technique should be utilized for suspected thyroid disorders?
What examining technique should be utilized for suspected thyroid disorders?
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Which condition is characterized by the presence of acanthosis nigricans and a buffalo hump?
Which condition is characterized by the presence of acanthosis nigricans and a buffalo hump?
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What symptom should be assessed in male patients that might suggest Klinefelter syndrome?
What symptom should be assessed in male patients that might suggest Klinefelter syndrome?
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What might excessive sweating and overgrowth of soft tissues in the hands indicate?
What might excessive sweating and overgrowth of soft tissues in the hands indicate?
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Which of the following findings in a patient's legs could suggest diabetic complications?
Which of the following findings in a patient's legs could suggest diabetic complications?
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What examination technique is crucial when evaluating for pituitary tumors?
What examination technique is crucial when evaluating for pituitary tumors?
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What condition is typically associated with proximal muscle weakness and wasting in the extremities?
What condition is typically associated with proximal muscle weakness and wasting in the extremities?
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Which physical examination findings are most indicative of adrenal insufficiency?
Which physical examination findings are most indicative of adrenal insufficiency?
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Which of the following signs would suggest the possibility of thyrotoxicosis during a physical examination?
Which of the following signs would suggest the possibility of thyrotoxicosis during a physical examination?
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What skin findings are most commonly associated with Cushing's syndrome?
What skin findings are most commonly associated with Cushing's syndrome?
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Which symptom is often related to metabolic disturbances in endocrine disorders?
Which symptom is often related to metabolic disturbances in endocrine disorders?
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Which gland is primarily controlled by hormones released from the pituitary gland?
Which gland is primarily controlled by hormones released from the pituitary gland?
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Which abnormal skin condition may indicate hypopituitarism during a physical examination?
Which abnormal skin condition may indicate hypopituitarism during a physical examination?
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Which vital sign assessment may indicate potential issues with pheochromocytoma during a physical examination?
Which vital sign assessment may indicate potential issues with pheochromocytoma during a physical examination?
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Which symptom is most associated with endocrine-related thirst issues?
Which symptom is most associated with endocrine-related thirst issues?
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Which combination of symptoms is indicative of hyperthyroidism during a physical examination?
Which combination of symptoms is indicative of hyperthyroidism during a physical examination?
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What findings during a physical examination might suggest adrenal insufficiency?
What findings during a physical examination might suggest adrenal insufficiency?
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During an evaluation for endocrine disorders, which skin finding might suggest Cushing's syndrome?
During an evaluation for endocrine disorders, which skin finding might suggest Cushing's syndrome?
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Which vital sign assessment is most relevant when suspecting pheochromocytoma?
Which vital sign assessment is most relevant when suspecting pheochromocytoma?
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Which disorder is likely associated with abnormal pigmentation during a physical assessment?
Which disorder is likely associated with abnormal pigmentation during a physical assessment?
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What observable sign in a patient might indicate the presence of thyrotoxicosis?
What observable sign in a patient might indicate the presence of thyrotoxicosis?
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Which gland’s hormonal regulation is primarily influenced by metabolic signals?
Which gland’s hormonal regulation is primarily influenced by metabolic signals?
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What general appearance might indicate a patient has growth hormone deficiency?
What general appearance might indicate a patient has growth hormone deficiency?
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What physical examination finding is most likely to indicate risk of hyperthyroidism in a patient?
What physical examination finding is most likely to indicate risk of hyperthyroidism in a patient?
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Which finding would suggest Addison’s disease during a physical examination?
Which finding would suggest Addison’s disease during a physical examination?
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What is the significance of examining the posterior aspect of the neck in endocrine disorders?
What is the significance of examining the posterior aspect of the neck in endocrine disorders?
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In a patient suspected of having a pituitary tumor, which examination finding would be crucial to assess?
In a patient suspected of having a pituitary tumor, which examination finding would be crucial to assess?
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What is the best indicator of potential insulin resistance in a physical examination?
What is the best indicator of potential insulin resistance in a physical examination?
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Which of these signs could suggest potential malignancy or complications during abdominal examination?
Which of these signs could suggest potential malignancy or complications during abdominal examination?
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What feature might be assessed in the hands of a patient to evaluate for acromegaly?
What feature might be assessed in the hands of a patient to evaluate for acromegaly?
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What sign in the extremities can indicate Graves disease during a physical examination?
What sign in the extremities can indicate Graves disease during a physical examination?
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Study Notes
History & Physical Examination
- Symptoms associated with endocrine disorders are frequently varied and non-specific
- Endocrine disorders can affect many body systems
- Except for the thyroid and testes, endocrine glands cannot be physically assessed
Anatomy Review
- The main endocrine glands are the pituitary, thyroid, parathyroids, pancreas, adrenals and gonads - testes and ovaries.
- The parathyroid glands and pancreas respond to metabolic signals
- The thyroid, adrenals, and gonads are controlled by hormones released from the pituitary gland
Review of Systems
- Patients should be asked about symptoms related to heat or cold intolerance, excessive sweating, thirst, hunger, and urination
General Survey & Vital Signs
- Evaluate the patient for signs of restlessness and agitation, which may suggest hyperthyroidism
- Evaluate the patient for lethargy and slowness, which may be characteristic of hypothyroidism
- Check for central adiposity, which can be associated with Cushing’s syndrome, metabolic syndrome, and growth hormone deficiency
- Assess the pulse for rate, rhythm, and volume, as tachycardia and atrial fibrillation can be seen with thyrotoxicosis
- Record the blood pressure - hypertension can be a feature of pheochromocytoma and primary hyperaldosteronism
- Check for orthostatic hypotension when assessing adrenal insufficiency
Skin, Nails, and Hair
- Examine the skin for abnormal pallor, plethora, abnormal pigmentation, and thinning and fragility
- Evaluate for the quality and quantity of body hair
- Inspect for hirsutism in females, which may be related to polycystic ovary syndrome (PCOS)
- Assess for thinning of the lateral eyebrows, which can be a symptom of hypothyroidism
HEENT Examination
- Examine the eyes for external inflammation/edema, proptosis, diplopia, and visual function in thyroid patients - these symptoms may indicate Graves’ disease or hyperthyroidism
- Check for periorbital edema and lid lag, which are often seen in hypothyroidism
- Evaluate visual fields and acuities in patients with suspected pituitary tumors, as compression of the optic chiasm can cause bitemporal hemianopia
- Inspect the oral mucosa for hyperpigmentation
Neck Examination
- Examine the posterior neck for acanthosis nigricans, which can be associated with insulin resistance, and a dorsocervical fat pad (buffalo hump) which can indicate Cushing syndrome
- Assess the neck for thyromegaly and goiter, recording size, surface, and consistency if present
- Auscultate the thyroid for a bruit if Graves’ disease is suspected
Chest & Abdomen Examination
- Look for gynecomastia in men, which can be seen in Klinefelter syndrome
- Check for galactorrhea, or milk production in men or non-breastfeeding women
- Inspect the axillae for acanthosis nigricans, which is often associated with insulin resistance and loss of axillary hair, which can be a feature of Addison’s disease.
- Inspect the abdomen for striae which can suggest Cushing’s syndrome.
- Assess the abdomen for palpability of adrenal tumors
- Remember that adrenal tumor palpation can be dangerous if pheochromocytoma is suspected because it may trigger a hypertensive crisis
Genitalia Examination
- Examine the external genitalia, and perform Tanner staging in adolescents.
- Assess testicular consistency and volume
Extremities Examination
- Examine the hands for excessive sweating, soft tissue overgrowth (acromegaly), skin crease pigmentation (Addison’s disease), wasting of the thenar muscles due to carpal tunnel syndrome (hypothyroidism, acromegaly), and acropachy (Graves’ disease)
- Inspect the legs for pretibial myxedema (Graves’ disease), proximal muscle wasting and weakness (Cushing’s syndrome and hyperthyroidism), and ulceration (diabetes)
Endocrine System
- Examining and diagnosing endocrine disorders can be difficult.
- Symptoms are often diverse and nonspecific.
- Endocrine disorders can affect numerous body systems.
- Except for the thyroid and testicles, endocrine glands cannot be physically assessed.
Anatomy Review
- The main endocrine glands include the pituitary, thyroid, parathyroids, pancreas, adrenals, and gonads (testes and ovaries).
- The parathyroid glands and pancreas respond directly to metabolic cues.
- The thyroid, adrenals, and gonads are primarily regulated by hormones released from the pituitary gland.
Endocrine ROS
- Important questions to ask include:
- Heat or cold intolerance
- Excessive sweating
- Excessive thirst
- Excessive hunger
- Excessive urine output
- General, skin, neck, cardiovascular, gastrointestinal, musculoskeletal, psychiatric, and neurologic system reviews are important to assess for other signs and symptoms.
General Survey & Vital Signs
- Observe for signs associated with hyperthyroidism (restlessness, agitation) or hypothyroidism (slowness, lethargy).
- Evaluate for central adiposity (Cushing’s syndrome, metabolic syndrome, growth hormone deficiency) in obese patients.
- Assess pulse rate, rhythm, and volume, noting tachycardia and atrial fibrillation as potential indicators of thyrotoxicosis.
- Record blood pressure. Hypertension is a hallmark of various endocrine conditions (pheochromocytoma, primary hyperaldosteronism).
- Measure lying and standing blood pressures to assess for postural hypotension, suggestive of adrenal insufficiency.
Skin, Nails & Hair
- Examine the skin surface for:
- Abnormal pallor (hypopituitarism)
- Plethora (Cushing's or carcinoid syndrome)
- Abnormal pigmentation (Addison's disease)
- Skin thinning and fragility (Cushing syndrome)
- Assess hair quality and quantity, noting hirsutism (polycystic ovary syndrome (PCOS)) in women with menstrual disturbances, evident on the face, chest, and abdomen.
- Note thinning of lateral eyebrows (hypothyroidism).
HEENT Examination
- Examine the eyes in all thyroid patients for:
- External inflammation/edema
- Proptosis
- Diplopia
- Visual function (hyperthyroidism/Graves disease)
- Assess for periorbital edema and lid lag (hypothyroidism).
- Evaluate visual acuity and fields in patients with suspected pituitary tumors (bi-temporal hemianopia due to optic chiasm compression).
- Inspect the oral mucosa for hyperpigmentation.
Neck Examination
- Inspect the posterior neck for acanthosis nigricans (insulin resistance) and a dorsocervical fat pad (buffalo hump – Cushing syndrome).
- Examine the neck for thyromegaly and goiter.
- If present, record its size, surface features, and consistency.
- Auscultate for a thyroid bruit if Graves disease is suspected.
Chest & Abdomen Examination
- Look for gynecomastia in men (common in Klinefelter syndrome - 47XXY) and galactorrhea (milk production in men or non-breastfeeding women).
- Inspect the axillae for acanthosis nigricans (insulin resistance) or axillary hair loss (Addison's disease).
- Inspect the abdomen for striae (Cushing syndrome).
- Adrenal tumors may be palpable in the abdomen.
- Exercise caution if pheochromocytoma is suspected, as aggressive examination may potentially trigger a hypertensive episode.
Genitalia Examination
- Examine the external genitalia.
- Use Tanner staging for pubertal development in adolescents.
- Record testicular consistency and volume
Extremities Examination
- Examine the hands for:
- Excessive sweating
- Soft tissue overgrowth (acromegaly)
- Skin crease pigmentation (Addison's disease)
- Wasting of the thenar muscles (carpal tunnel syndrome – hypothyroidism, acromegaly)
- Acropachy (Graves disease)
- Inspect the legs for:
- Pretibial myxedema (Graves disease)
- Proximal muscle wasting and weakness (Cushing's syndrome and hyperthyroidism)
- Ulceration (Diabetes)
Endocrine System
- Diagnosing endocrine issues can be difficult due to varied and non-specific symptoms
- Endocrine glands affect multiple bodily systems
- Endocrine glands cannot be physically assessed except for the thyroid and testicles
Anatomy Review
- Main endocrine glands include pituitary, thyroid, parathyroid, pancreas, adrenal glands, and gonads (testicles and ovaries)
- Parathyroid glands and pancreas directly respond to metabolic signals
- Thyroid, adrenal glands, and gonads are primarily controlled by hormones released from the pituitary gland
Endocrine ROS
- Heat or Cold Intolerance: Can indicate thyroid dysfunction
- Excessive Sweating: Can suggest hyperthyroidism or other endocrine issues
- Excessive Thirst: Can be a sign of diabetes or other disorders affecting fluid balance
- Excessive Hunger: Can be associated with diabetes, but also other conditions
- Excessive Urine Output: May indicate diabetes, diabetes insipidus, or other renal issues
- Other Systems: Review general, skin, neck, cardiovascular, GI, MSK, Psych, and Neurologic systems for potential clues
Physical Exam
General Survey & Vital Signs
- Observe for restlessness and agitation (hyperthyroidism) or slowness and lethargy (hypothyroidism)
- Evaluate body mass distribution for central adiposity (Cushing's syndrome, metabolic syndrome, growth hormone deficiency)
- Assess pulse rate, rhythm, and volume for tachycardia and atrial fibrillation (may suggest thyrotoxicosis)
- Record blood pressure for hypertension as a feature of several endocrine conditions (pheochromocytoma, primary hyperaldosteronism)
- Check for postural hypotension with lying and standing blood pressures if adrenal insufficiency is suspected
Skin, Nails, & Hair
- Examine for abnormal pallor (hypopituitarism), plethora (Cushing's or carcinoid syndrome), abnormal pigmentation (Addison's disease), and thinning/fragility (Cushing's syndrome)
- Assess hair quality and amount
- Look for hirsutism in females with menstrual disturbance, especially on the face, chest, and abdomen (polycystic ovary syndrome (PCOS))
- Note thinning of lateral eyebrows (hypothyroidism)
HEENT
- Examine eyes in all thyroid patients for external inflammation/edema, proptosis, diplopia, and visual function (hyperthyroidism/Graves disease)
- Observe for periorbital edema and lid lag (hypothyroidism)
- Assess visual acuities and fields in patients with suspected pituitary tumors (bi-temporal hemianopia due to compression of the optic chiasm)
- Inspect the oral mucosa for hyperpigmentation
Neck
- Inspect the posterior neck for acanthosis nigricans (insulin resistance) and dorsocervical fat pad ("buffalo hump" - Cushing syndrome)
- Examine for thyromegaly and goiter and note its size, surface, and consistency
- Auscultate for thyroid bruit if Graves disease is suspected
Chest & Abdomen
- Look for gynecomastia in men (common in Klinefelter syndrome - 47XXY) and for evidence of milk production in a man or non-breastfeeding woman (galactorrhea)
- Inspect the axillae for acanthosis nigricans (insulin resistance) or loss of axillary hair (Addison's disease)
- Inspect the abdomen for striae (Cushing syndrome)
- Adrenal tumors may occasionally be palpable in the abdomen
- Use caution if pheochromocytoma is suspected, as over-enthusiastic examination may precipitate a hypertensive paroxysm
Genitalia
- Examine the external genitalia
- Perform pubertal staging of all adolescents using Tanner Staging
- Record testicular consistency and volume
Extremities
- Examine the hands for:
- Excessive sweating
- Soft tissue overgrowth (acromegaly)
- Skin crease pigmentation (Addison's disease)
- Wasting of the thenar muscles due to carpal tunnel syndrome (hypothyroidism, acromegaly)
- Acropachy (Graves disease)
- Inspect the legs for:
- Evidence of pretibial myxedema (Graves disease)
- Proximal muscle wasting and weakness (Cushing's syndrome and hyperthyroidism)
- Ulceration (Diabetes)
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Description
This quiz covers the essential aspects of endocrine disorders, including symptoms, anatomy, and assessment techniques. You will learn about the main endocrine glands, how they are regulated, and the various signs that indicate potential disorders. Perfect for those studying medicine or healthcare related fields.
