Clinical Examination of Endocrine system

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

professordeshpande@gmail.com

www.ayurvedicfriend.com