Symptoms in endocrinology Flashcards
Symptoms to ask about in endocrinology
Appetite and weight changes. Lethargy. Bowel habit. Urinary frequency and polyuria. Thirst and polydipsia. Sweating. Pigmentation. Hair distribution- loss or gain. Skin and soft tissue changes. Headache and visual disturbance. Alteration in growth. Change in sexual function. Flushing.
Endocrinology history: appetite and weight changes
Many people do not weight themselves but may have noticed the consequences of weight change such as clothes becoming looser or tighter.
Endocrinology history: lethargy
Lethargy or fatigue is a difficult symptom to pin down.
Ask the patient how the tiredness impacts on their daily life.
What are they able to do before needing to rest, and has this changed?
Fatigue may be a feature of undiagnosed endocrine disease, such as diabetes mellitus, Cushing’s syndrome, hypoadrenalism, hypothyroidism, hypercalcaemia.
Consider depression and chronic disease of any other kind (anaemia, chronic liver and renal problems, chronic infection, and malignancy).
Endocrinology history: bowel habit
Constipation is a common feature of hypercalcaemia and hypothyroidism.
Hyperthyroidism and Addison’s disease may give diarrhoea.
Endocrinology history: urinary frequency and polyuria
Diabetes mellitus.
Diabetes insipidus.
Hyperglycaemia caused by Cushing’s syndrome.
Polyuria may also be seen in the presence of hypercalcaemia.
Endocrinology history: thirst and polydipsia
Consider diabetes mellitus, diabetes insipidus, and hypercalcaemia.
Endocrinology history: sweating
Increased perspiration may be seen during episodes of hypoglycaemia as well as in hyperthyroidism and acromegaly, and is associated with the other adrenergic symptoms of phaeochromocytoma.
Endocrinology history: pigmentation
Localised loss of pigmentation may be due to vitiligo- an autoimmune disorder associated with other endocrine immune disease, such as hypo- or hyperthyroidism, Addison’s disease, and Hashimoto’s thyroiditis.
Increased pigmentation = Addison’s disease, Cushing’s syndrome.
Decreased pigmentation = generalised loss of pigmentation in hypopituitarism.
Endocrinology history: hair loss
Decreased adrenal androgen production and loss of axillary and pubic hair in both sexes can be caused by hypogonadism, adrenal insufficiency.
Endocrinology history: hair gain
Hirsutism or excessive hair growth in a female may be due to endocrine dysfunction. Polycystic ovarian syndrome. Cushing's syndrome. Congenital adrenal hyperplasia. Acromegaly. Virilising tumours.
Endocrinology history: skin and soft tissue changes, hypothyroidism
Dry, coarse, pale skin with xanthelasma formation and, classically, loss of the outer 1/3 of the eyebrows.
Endocrinology history: skin and soft tissue changes, hyperthyroidism
Thyroid acropachy is seen only in hyperthyroidism due to Graves’ disease.
Features include finger clubbing and new bone formation at the fingers.
Also pretibial myxoedema- reddened oedematous lesions on the shins, often lateral aspects.
Endocrinology history: skin and soft tissue changes, hypoparathyroidism
Generally dry, scaly skin.
Endocrinology history: skin and soft tissue changes, diabetes mellitus
Xanthelasma, ulceration, repeated skin infections, necrobiosis lipoidica diabeticorum- shiny, yellowed lesions on the shins.
Endocrinology history: skin and soft tissue changes, acromegaly
Soft tissue overgrowth with skin tags at the axillae and anus, ‘doughy’ hands and fingers, acanthosis nigricans- velvety black skin changes at the axilla.
Endocrinology history: headache and visual disturbance
Visual field defects, cranial nerve palsies, and headache may be caused by space-occupying lesions within the skull.
Pituitary tumours classically cause a bitemporal hemianopia by impinging on the optic chiasm.
Blurred vision is rather non-specific, but consider osmotic changes in the lens due to hyperglycaemia.
Endocrinology history: alteration in growth
Hypopituitarism, hypothyroidism, growth hormone deficiency, and steroid excess may present with short stature.
Tall stature may be caused by growth hormone excess or gonadotrophin deficiency.
Growth hormone excess in adults (acromegaly) causes soft tissue overgrowth. Patients notice an increase in shoe size, glove size, or facial appearance- old photographs for comparison?
Endocrinology history: changes in sexual function
Women: altered menstrual pattern in a female may be an early symptom suggestive of pituitary dysfunction.
Men: hypogonadism may result in loss of libido and an inability to attain or sustain an erection.
Endocrinology history: flushing
Flushing may be a symptom of carcinoid or the menopause.
Ask about the nature of the flushing, any aggravating or relieving factors, and any other symptoms at the time such as palpitations, diarrhoea, dizziness.
Take a full menstrual history.
Endocrinology history: drug history
Over the counter medicines. Hormonal treatments- include oral contraceptive pill, local and systemic steroids. Amiodarone. Lithium. Herbal or other remedies.
Endocrinology history: past medical history
Any previous thyroid or parathyroid surgery.
Any previous 131I (radio-iodine) treatment or antithyroid drugs.
Gestational diabetes.
Hypertension.
Any previous pituitary or adrenal surgery.
Endocrinology history: family history
Type II diabetes.
Related autoimmune disorders (pernicious anaemia, coeliac disease, vitiligo, Addison’s disease, thyroid disease, type I diabetes).
Congenital adrenal hyperplasia.
Tumours of the MEN syndromes.
General endocrine examination: hands/arms
Look at size, subcutaneous tissue, length of the metacarpals, nails, palmar erythema, sweating and tremor.
Note skin thickness (thin in Cushing’s, thick in acromegaly) and look for signs of easy bruising.
Pulse and blood pressure- lying and standing.
Test for proximal muscle weakness.
General endocrine examination: axillae
Note any skin tags, hair loss, abnormal pigmentation, or acanthosis nigricans.
General endocrine examination: face and mouth
Look for hirsutism, acne, plethora, or skin greasiness.
Look at the soft tissues of the face for prominent glabellas (above the eyes) and enlargement of the chin (macrognathism).
In the mouth, look at the spacing of the teeth and if any have fallen out.
Note any buccal pigmentation and macroglossia.
Note any prognathism (upper teeth closing behind instead of in front of lower teeth).
General endocrine examination: neck
Note any swellings or lymphadenopathy.
Examine the thyroid.
Palpate the supraclavicular regions and note excessive soft tissue.
General endocrine examination: chest
Inspect for any hair excess or loss, breast size in females and gynaecomastia in males.
Note the nipple colour, pigmentation, or galactorrhoea.
General endocrine examination: abdomen
Inspect for central adiposity/obesity, purple striae, hirsutism.
Palpate for organomegaly.
Look at the external genitalia to exclude any testicular atrophy in males or virilisation (e.g. clitoromegaly) in females.
General endocrine examination: legs
Test for proximal muscle weakness and make note of any diabetes-related changes.
General endocrine examination: height and weight
Calculate patient’s BMI.
General endocrine examination: signs of tetany
Trousseau’s sign: inflate a BP cuff just above systolic pressure for 3 minutes. When hypocalcaemia has caused muscular irritability, the hand will develop flexor spasm.
Chvostek’s sign: gently tap over the facial nerve in front of the tragus of the ear. The sign is positive if there is contraction of the lip and facial muscles on the same side of the face.
