History & Physical Examination Related to Endocrine Disorders PDF
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Uploaded by leichnam
Emory & Henry College
AM&A Fleenor, MMS, PA-C
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This document provides a detailed overview of history, physical examination, and diagnosis of endocrine disorders, covering anatomy, ROS, physical examination techniques, and vital signs. It's suitable for medical professionals or students studying endocrinology.
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History & Physical Examination related to Endocrine Disorders CLINICAL SKILLS II AM&A FLEENOR, MMS, PA-C Endocrine System History, Physical Examination, & Diagnosis of Endocrine system can be challenging Symptoms of endocrine disturbance are frequently varied & non-specific...
History & Physical Examination related to Endocrine Disorders CLINICAL SKILLS II AM&A FLEENOR, MMS, PA-C Endocrine System History, Physical Examination, & Diagnosis of Endocrine system can be challenging Symptoms of endocrine disturbance are frequently varied & non-specific May affect many body systems With the exception of the thyroid & the testicles, the glands cannot be physically assessed Anatomy Review The main endocrine glands are the pituitary, thyroid, parathyroids, pancreas, adrenals & gonads: Testes & ovaries The parathyroid glands & pancreas, respond directly to metabolic signals The thyroid, adrenals, & gonads are primarily controlled by hormones released from the pituitary gland Endocrine ROS Heat or Cold Intolerance Excessive sweating Excessive thirst Excessive hunger Excessive urine output Other systems may have positives/negatives as well – general, skin, neck, cardiovascular, GI, MSK, Psych, Neurologic Physical Examination General Survey & Vital Signs Is the patient restless & agitated (hyperthyroidism) or slow & lethargic (hypothyroidism) If the patient is obese, is the adiposity centrally distributed (Cushing’s syndrome, metabolic syndrome, & growth hormone deficiency)? Assess the pulse rate, rhythm & volume - Tachycardia & atrial fibrillation may suggest thyrotoxicosis Record the blood pressure - Hypertension is a feature of several endocrine conditions (pheochromocytoma, primary hyperaldosteronism) Check for postural hypotension with lying & standing blood pressures if you suspect adrenal insufficiency Skin, Nails, & Hair Examine the entire skin surface, looking for: Abnormal pallor (hypopituitarism) Plethora (Cushing’s or carcinoid syndrome) Abnormal pigmentation (Addison’s disease) Thinning & fragility (Cushing Syndrome) Is the body hair normal in quality & amount? Look for hirsutism in females with menstrual disturbance, especially on the face, chest & abdomen (polycystic ovary syndrome (PCOS)) Thinning of lateral eyebrows (Hypothyroidism) HEENT Examine the eyes in all thyroid patients for external inflammation/edema, proptosis, diplopia, & visual function (hyperthyroidism/graves disease) Periorbital edema & lid lag (hypothyroidism) Assess visual acuities & 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 aspect of the neck for acanthosis nigricans (insulin resistance) & dorsocervical fat pad (buffalo hump – Cushing syndrome) Examine the neck for thyromegaly & goiter If this is present, record its size, surface & consistency Auscultate for thyroid bruit if suspicious for graves disease Chest & Abdomen Look for gynecomastia in men (common in Klinefelter syndrome - 47XXY), & 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 Be cautious if pheochromocytoma is suspected, as over-enthusiastic examination may precipitate a hypertensive paroxysm Genitalia Examine the external genitalia Make a pubertal staging of all adolescents using Tanner Staging Record testicular consistency & 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) Extremities Inspect the legs for: Evidence of pretibial myxedema (Graves disease) Proximal muscle wasting & weakness (Cushing’s syndrome & hyperthyroidism) Ulceration (Diabetes)
