Endocrinology - Examination

Question 1

What should be noted on general inspection of a patient?

Answer 1

Note:
Height and weight 
Evidence of weight loss
Obesity and pattern of fat distribution 
Loss of secondary sexual characteristics
Evidence of virilisation in women - male pattern hair distribution, altered muscle bulk and body habitus, deep voice and cliteromegaly 

Observe for classic features of endocrinopathies:
Grave's disease
Hypothyroidism
Hyperthyroidism
PCOS
Cushing's syndrome
Acromegaly 
Altered mood 

Speech disorders:
Hoarseness 
Virilised - deep voice in women
Slow slurred speech in hypothyroidism
Pressure of speech in thyrotoxicosis

Question 2

What features in the hands should be sought in the endocrine examination?

Answer 2

Palmar erthema
Tremor (thyroid disease)
Acromegaly
Carpal tunnel syndrome
Pigmentation of creases due to high ACTH levels in Addison’s disease
Acromegalic hands (soft tissue enlargement causing “spade like” changes)

Question 3

What should be examined after the hands?

Answer 3

The skin should be examined next. Note hair distribution, dry or greasy hair, pigmentation/ pallow, bruising, vitiligo, striae and thickness.

Pay particular attention to rashes such as acanthosis nigricans and virilisation of females.

Question 4

What features should you look for in the pulse?

Answer 4

Check for AF, sinus tachycardia or bradycardia

Offer to check the blood pressure:

• hypertension is a feature of Cushing’s, Conn’s and phaeochromocytoma
• hpotension features in adrenal insufficiency

Question 5

What facial features should be looked for in endocrine examination?

Answer 5

Eyes: graves disease, diplopia, visual field defect
Hair: alopecia, frontal balding
Facial features: hypothyroid, hirsuitism, acromegaly (prognanthism), Cushing’s (moon face)
Mental state: lethargic, depression, confusion, libido

Question 6

How should the neck be examined?

Answer 6

Ask the patient to speak and not the quality of the voice - e.g. hoarseness in hypothyroid, virilised?

Make a note of an obvious neck swellings and palpate the thyroid gland from behind feeling for any nodules or goitres and describing them using the SSSCCCTT.

Ask the patient to stick out their tongue - thyroglossal cysts rise when the patient protrudes their tongue.