Clinical Examination
of Endocrine system
By
Prof.Dr.R.R.Deshpande ( MD in Kayachikitsa & MD in Sharirkriya)
From his own book of
Clinical Examination with Dr.Subhash Ranade .Narendra Prakashan .Rs.120/-
(1) Examine Body Size
& Proportions of different organs.
Note - Height, weight, fat
Distribution, Limb & trunk Dimensions.
(a) Look for Gigantism, Acromegaly
(Hyperpituitarism),
Dwarfism in children (Hypo pituitarism
), Obesity of trunk with relatively thin limbs (cushing’s syndrome due
to cortical Hyperadernalism). Tall thin stature, long limbs & youthful
appearance in Klinefelter’s syndrome (by failure of testicular
development at puberty); Enlargement of peripheral parts ( Large nose, large
& prominent lower jaw & big hands) - seen in Acromegaly.
(b)Loss of weight is seen in Diabetes
mellitus & Hyperthyroidism.
(2) Examine Hair - for Amount, Texture
& Distribution.
(a) Excessive Adrenal cortical
function or ovarian tumours in
women- show musculine distribution of
hair over the faces, limbs & trunk. (Hirsutism)
(b) In Ant Hypopituitarism & in
Addison’s Disease (in wommen)
Loss of pubic & axillany hair.
(simmands sheehan Disease)
(c) Eyebrows & Hair on scalp
become sparse & Dry in -Hypothyroidism.
(3) Examine Skin - For Temperature,
texture, moisture, pallor,
Pigmentation, Bruising, Acne, striae.
(a) Thinning & striation of skin,
purpura, due to Increased
capillary fragility seen in -Long term
cortico steroid therapy (Cushing’s syndrome)
(b) Dark drown colouring on face,
hands, in cutaneous areas &
parts of budy - exposed to light or
pressure. Occurs also, where
pigmentation normally more eg axillae,
areolae of nipples, around
genitalia -seen in diminished function
of Adrenal cortex (Addison’s
disease) - patchy darkening of oral
mucaus membrane is confirmatory sign.
c) Skin cold & dry -in
Hypothyroidism.
(3) Examine Facies – Like
(a) Acromegalic- Prognathism, enlarged
nose & ears, prominent
supercilliary arches.
(b) Myxoedematous facies- puffy eyes,
full nose & Lips, pallid
complexion.
(c) Cushingoid facies- High colour,
mooning of face (& also acne
on chest)
(4) Examine- Eyes – for Acuity &
field of vision, Exophthalmos, ocular pareses, cataract,Retionpathy, Optic
Atrophy.
(a) Compression of structures,
adjacent to pituitary tumour can
give Eye problem (so, examine for
field of vision, optic fundi &
Oculomotor nerves )
(b) Exophthalmos – abnormal prominence
of eyes. In severe cases, may be associated with chemosis, corneal
lceration,visual impairment, oculomotor paresis (Exopthalmic opthalmoplegia)
Exopthalmos is caused by infiltration
of orbital tissues, with a cellular & muco-protein exudate.Exopthalmos is seen in
Hyperthyroidism.Von Graefe’s sign- To demonstrate lid-lag
the Doctor moves his finger slowly
down from above. The seated
patient is asked to watch the finger
all the way, upper eyelids is then seen to lag behind the eyeball.
(C) Deposits of Non - pitting
myxoedemas ® can be seen in
lower eyelids (& supra clavicular
fossae.)
(5) Examine mouth – for
(a) Dehydration (Dry
tongue) - In
polyuria (Diabetes Insipidus
due to deficiency of ADH); Sodium depletion
(In ACTH
insufficiency- seen in addison’s
disease or Hypopituitarism )
(b) Patchy darkening of oral mucous
membrane in Addison’s
disease.
(6) Examine Neck – For
(a) Thyrold tumour
- Goitre moves upwards during
swallowing.
- palpation (Doctor stands behind the
patient) - Diffuse & soft
in primary Grave’s disease. One or
more firm localized nodules in Toxic nodular
Goitre. Over active or vascular goitre give - soft, blowing systolic murmur over goitre. (Murmur is not
present in Non toxic Goitre)
(b) Parathyroid
tumour - Parathyroid
Adenoma gives condition
of Hyperparathyroidism ( Generalized
Ostitis fibrosa cystica)
(7) Examine
cardiovascular system for - Hypertension,
Hypotension, Heart Rate & Rhythm.
(a) Hyperthyroidism -
Palpitations,Tachycardia
(Persists during sleep,) Complication- Cardiac failure.
(b) Hypothyroidism – Bradycardia .complication
- Atheromatous coronary artery disease, due to disturbed lipid metabolism.
(c) Hypopituitarism -
Hypotension.
(d) Cushing’s
syndrome - (Adrenal
cortical hyperplasia) - prolonged use of
corticosteroid .Hyperthyroidism -
Disability & prognosis, depends on
cardiovasclar effects of
accompanying D.M, Hypertension.
(e) Conn’s syndrome
(Rare) - due
to Aldosterone secreting
tumour. - Hypertension due to sodium
Retention.
(f) Addison's Disease
- (Hypoadrenalism
- diminished function
of Adrenal cortex )- Due to Low Na+
& Cl– -dehydration ®
Hypotension.
(g) Hyper-adrenalism
- medullary
(Phaeochromocytoma) -
Attacks of sweating & trembling
with dramatic rise of B.P
(h) D.M- Diabetic
keto acidosis - Vomiting,
Dehydration,
Hypotension.
(8) Examine -
Respiratory system for
- Hyperventilation or
Hypoventilation.
(a) Hyperthyroidism -
Dyspnoea
(b) Diabetic keto
acidosis - Hyperventilation
due to acidosis
(Air Hunger.)
(9) Examine - Abdomen
for
Adrenal or panereatic tumour & for G I tract problems.
(a) Hyperthyroidism -
Diarrhoea
(b) Hypothyroidism - constipation
(complication -Intestinal
obstruction from paralytic ileus)
(c) Hypoadrenalism - Cortical - Addisonian
crisis- Dehydration
+ Hypotension + abdominal tenderness.
(d)
Hyperparathyroidism - Excessive mobilization of Ca from
bones. So hypercalcaemia can cause
peptic ulceration.
(10) Examine -
Genitalia -
For size & configuration of genitalia &
breasts.
(a) Adults
Hypopituitarism - Impaired
sexual function, Genital
Atrophy.
(b) Hyperadrenalism -
cortical
(Adrenal virilizing syndrome)-
Clitoris is enlarged (Mistaken for a
penis & fused labia for a scrotum - so infant may be brought up as a boy -
which is pseudo - hermaphroditism. ) In boys - Precocious development of
secondary sex character.
(C) Primary
Testicular Defects - Eunuchoidism - Abscence
or Infantile character of testes. (Mumps
with orchitis may also be
causative factor)
(d) Klinefelter’s
syndrome - Failure
of Testicular development
at puberty & enlargement of
mammary glands.
(e) Turner’s syndrome
- In
women, deficiency in ovarian
function results into Amenorrhoea
& lack of feminine contour.
(11) Examine - Nervous system for
mental changes, stupor, Tremors, Tetany, Refiexes.
(a) Hyperthyroidism -
Nervousness,
Tremors of out stretched
hands, sweats, Intolerance to Hot
weather.Complication - Psychosis.
(b)Hypothyroidism - Lethargy, Difficulty
in concentration, feeling
of cold, slowing up of patient's
physical & mental processes, Deafness, movements are sluggish, reactions
delayed, voice-slow, deep & husky, Delayed relaxation of Tendon reflex
responses. Thyroid deficiency in children - cretinism - mental Retardation. Complication
- Organic psychosis (myxoedema madness)
(c) Hyperadrenalism -
medullary
- phaeochrmocytoma- Attacks
of sweating, trembling, fear &
pallor.
(d)
Hyperparathyroidism - Hypercalcaemia causes mental
disorders.
(e)
Hypoparathyroidism - Hypocalcaemia
causes mental
derangement & convulsions.
(f) Diabetic Keto
acidosis - Drowsiness
& coma .Complications of D.M - strokes & ischaemic changes, in toes (Gangrene),
Diabetic Neuropathy ® paraesthesiae with Loss of ankle
jerks & vibration sense.
(g) Hypoglycemia - Faintness, dizziness,
sweating. (Hunger,
palpitation - all relived by taking
sugar)
(12) Examine muscuto
skeletal system for
kyphosis, fractures & deformities.
(a) Hyperpituitarism
- Gigantism
in childhood & Acromegaly
in adults. Aeromegaly - Supercilliary
arches, cheek bones, Lower jaw are greatly enlarged. (Prognathism = Projecting
jaw) Teeth are separated by enlargement of jaw, Hands & feet are enlarged,
kyphosis
(b) Hypopituitarism -
Dwarfism.
(c) Cushing’s
syndrome - (obesity
of trunk ) with relatively thin
limbs, kyphosis.
(d) Klinefelter’s
syndrome - (failure
of testicular development
at puberty) - Tall, thin stature, long
limbs & youth full appearance.
(e)
Hyperparathyroidisn - Excess mobilization of Ca from
skeleton leads to tender swellings
& deformity of bones (Generalized osteitis fibrosa cystica.)
(f)
Hypoparathyroidism - Most
IMP sign is “Tetany”- Diagnosis by carpopedal spasms (Hands are
in a state of painful
spasm with fingers tightly apposed,
thumb flexed & adducted across palm, terminal phalanges hyper extended,
wrist flexed.
- Trousseau’s sign - Squeezing the arm
(arm can be
compressed by cuff of
sphygmomanometer.) or leg & evoking
carpopedal spasms, which are latent.
- Chvostek’s sign - Tapping over facial
Nerve, as it emerges
from stylomastoid foramen; which will
cause catraction of facial muscles on one side & angle of mouth is drawn up
Prof.Dr.R.R.Deshpande
9226810630
