OHCEPS - The Endocrine System Flashcards
Lethargy or fatigue may be a symptom of what?
- Undiagnosed DM
- Cushing’s
- Hypoadrenalism
- Hypothyroidism
- Hypercalcemia
ALSO consider: - Depression
- Chronic disease of any other kind (e.g., anemia, chronic liver and renal problems, chronic infection, and malignancy).
Constipation is a common feature of what?
Hypercalcemia + Hypothyroidism.
Diarrhea is a symptom of what?
Hyperthyroidism + Addison’s
Urinary frequency and polyuria may be a result of what?
- DM
- Diabetes insipidus
- Hyperglycemia by Cushing’s –> can give polyuria.
- Hypercalcemia –> may also give polyuria
Thirst and polydipsia?
- DM
- Diabetes insipidus
- Hypercalcemia
Sweating may be seen in what?
- Episodes of hypoglycemia
- Hyperthyroidism
- Acromegaly
- Pheochromocytoma
Vitiligo is associated with what?
- Hypo/Hyperthyroidism
- Addison’s
- Hashimoto
Incr. pigmentation is seen in what?
Addison/Cushing
Decr. pigmentation is seen in what?
Hypopituitarism, if generalized.
Hirsutism may be a sign of what?
- PCOS
- Cushing
- Congenital adrenal hyperplasia
- Acromegaly
- Virilizing tumors
Loss of axillary + pubic hair in both sexes may be a sign of what?
- Hypogonadism
2. Adrenal insufficiency –> DOWN androgen production
Skin and soft tissue changes seen in hypothyroidism?
- Dry, coarse, pale skin with xanthelasma formation.
2. Classically, loss of the outer 1/3 of the eyebrows.
Skin and soft tissue changes in hyperthyroidism?
- Thyroid achropachy (only Graves) –> Finger clubbing + new bone formation at the fingers.
- Also pretibial myxedema - reddened edematous lesions on the shins (often the lateral aspects).
Skin and soft tissue changes in hypoparathyroidism?
Generally, dry, scaly skin.
Skin and soft tissue changes in DM?
- Xanthelasma
- Ulceration
- Repeated skin infections
- Necrobiosis lipoidica diabeticorum - shin, yellowed lesions on the shins.
Skin and soft tissue changes in acromegaly?
- Soft tissue overgrowth with skin tags at axillae and anus.
- “Doughy” hands and fingers
- Acanthosis nigricans - Velvety black skin changes at the axilla
Where else may acanthosis nigricans be seen?
- Cushing
- PCOS
- Insulin resistance
What do pituitary tumors classically cause?
Bitemporal hemianopia by impinging on the optic chiasm.
Short stature may be caused by what?
- Hypopituitarism
- Hypothyroidism
- GH deficiency
- Steroid excess
Tall stature may be a sign of what?
- GH excess
2. Gonadotrophin deficiency
Mention 3 non-endocrine causes of erectile dysfunction.
- Alcoholism
- Spinal cord disease
- Psychological illness
Flushing may be a symptom of what?
- Carcinoid
2. Menopause
What should be asked about flushing?
- Any aggravating/relieving factors.
2. Other symptoms: palpitations, diarrhea, dizziness.
During history-taking, what should be especially asked during the DHx?
- OTC medicines
- Hormonal treatments - OCPs, local or systemic steroids.
- Amiodarone
- Lithium
- Herbal or other remedies
What should be asked during the PMH?
- Previous thyroid/parathyroid surgery.
- Previous radio-iodine or antithyroid drugs.
- Gestational diabetes
- HTN
- Previous pituitary or adrenal surgery.
What should be specifically asked during the FHx?
- Type II DM
- Related autoimmunes –> Pernicious anemia, celiac disease, vitiligo, Addison, thyroid disease, type I DM.
- Many patients will only have heard of these if they have a family member who suffers from them.
- Congenital adrenal hyperplasia
- MEN
Incr. appetite + Decr. weight is a sign of?
- Thyrotoxicosis
2. Uncontrolled DM
Incr. appetite + Incr. weight is a sign of?
- Cushing
- Hypoglycemia
- Hypothalamic disease
Decr. appetite + Decr. weight is a sign of?
- GI disease
- Malignancy
- Anorexia
- Addison
- DM
Decr. appetite + Incr. weight is a sign of?
Hypothyroidism
Mention some questions that should be asked during the diabetic history.
- When was it first diagnosed?
- How was it first diagnosed?
- How was it first managed?
- How is it managed now?
- If on insulin - when was that first started?
- Are they compliant with a diabetic diet?
- Are they compliant with their diabetic medication?
- How often do they check their blood sugar?
- What readings do they normally get?
- What is their latest HbA1C (many will know this)?
- Have they ever been admitted to hospital with DKA?
- Do they go to a podiatrist or chiropodist?
- Have they experienced problems with their feet?
- Do they attend a retinal screening program?
- Have they needed to be referred to an ophthalmologist?
What should be asked in the newly diagnosed diabetic?
Ask about history of weight loss (will differentiate between type I and II).
What is the inheritance pattern in MEN?
AD
What are the features of MEN1?
The 3”Ps”
- Parathyroid hyperplasia (100%)
- Pancreatic endocrine tumors (40-70%)
- Pituitary adenomas (30-50%)
What are the features of MEN2?
- Medullary cell thyroid carcinoma (100%)
- Pheochromocytoma (50%)
- MEN2a –> Parathyroid hyperplasia (80%)
- MEN2b –> Mucosal and bowel neuromas - Marfanoid habitus.
What should be examined in the hands/skin regarding the endocrine system?
- Size
- Subcutaneous tissue
- Length of the metacarpals
- Nails
- Palmar erythema
- Sweating
- Tremor
- Thickness –> Thin in Cushing, Thick in acromegaly
- Signs of easy bruising.
- Pulse + BP - Lying and standing.
- Proximal muscle weakness.
What should be examined in the axillae?
- Skin tags
- Loss of hair
- Abnormal pigmentation
- Acanthosis nigricans
What should be looked during examination of the face and mouth?
- Hirsutism
- Acne
- Plethora or skin greasiness
- Look soft tissues for prominent glabellas (above the eyes)
- Enlargement of chin (macrognathism)
- In the mouth –> Look at the spacing of teeth, and if any have fallen out.
- Buccal pigmentation + tongue enlargement (macroglossia).
- Normally the upper teeth close in front of the lower set - reversal is termed “prognathism”.
What should be looked for in the neck?
- Note any swellings or lymphadenopathy
- Examine thyroid
- Palpate the supraclavicular regions
- Note excessive soft tissue
What should be examined in the chest?
- Any hair excess or loss
- Breast size in females
- Gynecomastia in men
- Nipple color/pigmentation/galactorrhoea
What should be examined in the abdomen?
- Central adiposity/obesity
- Purple striae
- Hirsutism
- Palpate for organomegaly
- Look external genitalia to exclude any testicular atrophy in males or virilization (e.g., clitoromegaly) in women.
What should be examined in the legs?
Test for proximal muscle weakness - make note of any diabetes-related changes.
What is the Trousseau’s sign?
- Inflate a blood pressure cuff above the systolic pressure for 3 minutes.
- When HYPOCALCEMIA has caused muscular irritability, the hand will develop flexor spasm.
What is the Chvostek’s sign?
- Gently tap over the facial nerve (in front of the tragus of the ear).
- The sign is positive if there is a contraction of the lip + facial muscles on the same side.
What are the 2 signs of tetany?
- Trousseau
2. Chvostek
What should be the position of the patient during thyroid examination?
The patient should be sitting upright on a chair or the edge of a bed.
What does inspection of the thyroid gland involve?
- Look at the thyroid region.
- If the gland is quit enlarged (goitre) –> may notice it protruding as a swelling just below the thyroid cartilage.
- Normal thyroid gland is usually neither visible nor palpable.
What is the location of thyroid gland?
Lies 2-3cm below the thyroid cartilage and has 2 equal lobes connected by a narrow isthmus.
What should be asked if the a localized or generalized swelling is visible on the thyroid?
Ask the patient to take a mouthful of water then shallow - watch the neck swelling carefully.
ALSO, ask the patient to protrude their tongue and watch the neck swelling.
Will enlarged lymph nodes move during shallowing?
NO - Hardly move.
Will thyroglossal cysts move with shallowing?
Yes - will move upwards with protrusion of the tongue.
What should be examined regarding the rest of the neck?
- Carefully inspect the neck for any obvious scars - thyroidectomy scars are often hidden below a necklace and are easily missed.
- Look for the JVP and make note of dilated veins which may indicate retrosternal extension of a goitre.
- Redness or erythema –> suppurative thyroiditis.
Palpation of the thyroid should be done from behind?
YES - Stand behind the patient and place a hand either side of their neck.
Patient’s neck should be slightly flexed to relax the sternomastoids.
What are the steps during thyroid examination?
- Ask if there is any tenderness.
- Place the 3 middle fingers of either hand along the midline of the neck, just below the chin.
- Gently “walk” your fingers down until you reach the thyroid gland.
- If enlarged - determine if symmetrical.
- Are there any discrete nodules?
- Assess size, shape, mobility of any swelling.
- Repeat examination while the patient shallows.
- Ask them to hold a small amount of water in their mouth - then ask them to shallow once your hands are in position.
- Consider consistency of any palpable thyroid tissue.
- Feel for a palpable thrill which may be present in metabolically active thyrotoxicosis.
What may be the consistency of thyroid gland?
- Soft - normal.
- Firm - simple goitre.
- Rubbery hard - Hashimoto’s
- Stony hard - cancer, cystic calcification, fibrosis, Riedel’s.
Is the central isthmus of the thyroid palpable?
Almost never palpable.
What other structures of the neck should be palpated?
- Cervical lymph nodes
- Carotid arteries - check for patency, can be compressed by a large thyroid.
- Trachea for deviation.