This site is 100% ad supported. Please add an exception to adblock for this site.

MED2042 WEEK 1 - History taking of Endocrine system


undefined, object
copy deck
What are the endocrine glands?
Pituitary and hypothalamus
Gonads (testes or ovaries)
Pineal gland
What past history needs to be obtained for the endocrine system?
- previous pregnancies (ease of conception, post partum hemorrhage etc)
- relevant surgery (e.g. thyroidectomy, orchidoplexy)
- radiation (e.g. to gonads, thyroid)
- drug exposure (e.g. chemotherapy, sex hormones, oral contraceptives)
- childhood developmental milestones and growth
What family history needs to be obtained for the endocrine system?
- autoimmune disease
- endocrine disease
- hypertension
- diabetes
- family details
What social history needs to be obtained for the endocrine system?
- alcohol intake
- drug abuse
- occupation (exposure to chemicals)
- diet (salt, liqorice, iodine)
What other information should be obtained for the endocrine system?
- height
- weight
- body habitus
- hair growth
- age of sexual development
What is goitre?
An enlarged thyroid is called a goitre.

Enlargement can be:
- diffuse
- multinodular
- uninodular

Enlargement can be associated with
- euthyroidism
- hyperthyroidism
- hypothyroidism
What are the complications of goitre?
- Obstruction (blood vessels, airway, swallowing)
- associated with disease state
- cosmetic
How do you look for retrosternal extension?
Palation - feel for a lower border. Absence suggests retrosternal extension.
What do you look for when auscultating the thyroid gland?
Listen over each lobe for a bruit. This is a sign of increased blood supply which may occur in hyperthyroidism, or occasionally from the use of antithyroid drugs. The differential diagnosis also includes a carotid bruit (obliterated by gentle pressure over the base of the neck). If there is a goitre, apply mild compression to the lateral lobes and listen again for stridor.
What are the clinical features of hyperthyroidism?
Weight loss, increased appetite
Recent onset of heat intolerance
Agitation, nervousness
Hot, sweaty palms
Fine peripheral tremor
Bounding peripheral pulses
Tachycardia, atrial fibrillation
Lid retraction & lid lag
Goitre with or without bruit
Brisk tendon reflexes
What are the clinical features of hypothyroidism?
Constipation and weight gain
Hair loss, dry flaky skin
Hoarse croaky voice
Balding and loss of eyebrows (laterally firts)
Xanthelasma's (hyperlipidaemia)
Goitre especially with iodine deficiency
Effusions, pericardial or pleural
Delayed relaxation phase of tendon relflexes
Carpal tunnel syndrome
What are the clinical features of hyperparathyroidism?
Nonspecific symptoms (nausea, lethargy, drowsiness, constipation, muscle weakness, polydipsia, polyuria)
Kidney stones (with associated symptoms)
Peptic ulcers
Oteitis fibrosa cystica, osteopaenia
What are the clinical features of hypoparathyroidism?
Muscle spasms (carpopedal, facial grimacing, larynospasm, convulsions)
Intestinal cramps
Depression, pscyhosis
Trousseau's, Chvostek's signs
What is Trousseau's sign?
Trousseau's sign is elicited with a blood pressure cuff placed on the arm with the pressure raised above the patient's systolic pressure. Typical contraction of the hands occurs within two minutes when hypocalcaemia has caused neuromuscular irritability. The thumb becomes strongly adducted and the fingers are extended except at the metacarpophalangeal joints. The appearance is that of an obstetrician about to remove the placenta manually and is called the main d'accoucheur.
What is Chvostek's sign?
Chvostek's sign is performed by tapping gently over the facial (7th) cranial nerve under the ear. The nerve is hyperexcitable in hypocalcaemia and a brisk muscular twitch occurs on the same side of the face.
What are the clinical features of Cushing's syndrome?
Round, moon shaped plethoric face
Hirsutes, acne
Buffalo hump on neck (fatty deposit)
Central distribution of fat
Proximal muscle wasting & weakness
Purple skin striae, ecchymoses
Amenorrhoea, polyuria & polydipsia
Psychiatric changes
What are the symptoms & signs in Addisons disease?
Muscle weakness
Pigmentation (& vitiligo) - skin & mucous membranes
Malaise, nausea, vomiting & weight loss
Hypotension (esp postural)
Abdominal pain (diarrhoea & constipation)
What are the clinical features of Acromegaly?
Coarse, prominent facial features
Prognathoid jaw
Prominent nose & forehead
Thickened lips & large tongue
"Spade shaped" hands
Excessive sweating & greasy skin
Bitemporal hemianopia develops
Carpal tunnel syndrome
Impaired glucose tolerance
What are the clinical features of Hypopituitarism?
Men - loss of libido, impotence, infertility

Women - amenorrhoea, infertility, vaginal atrophy, dysparenuria, breast atrophy

Loss of axillary and pubic hair
Mild to moderate hypothyroidism
ACTH defic. - weakness, hypotension, pallor, hypoglycaemia
ADH defic - polyuria, polydipsia

Deck Info