Endocrine Flashcards
(7 cards)
Turners syndrome exam
Short stature, "stocky appearance" Upper limbs: Lymphodema of hands Short 4th metocarpal Hyperplastic nails
Upper limbs:
Cubitus valgus (wide carrying ankle of elbows)
Hypertension (coarction)
Madelung deformity of forearm - wrist volar subluxed with prominent ulnar styloid
Face: Micrognathia (small jaw) Epicanthic fold ptosis Fish like mouth Deformed or low set ears Hearing loss
Neck:
Webbed neck
Low hair line
Redundant skin folds on back of neck
Chest/back:
Scoliosis and kyphosis
Shield chest with widely spaced nipples
Heart sounds - bicuspid valve (AS/AR), coarctation (mid systolic murmur over back and precordium)
Skin:
Pigmented naevi and keloid scar
Ask for:
Blood pressure in legs
Formal hearing testing
Adrenal insufficiency
Anorexia/cachexia
Evidence of recent weight loss
Calcification of auricular cartilage calcification
Look for pigmentation (most notable in palmar creases/elbows/gums/scars)
Measure blood pressure for hypotension
Generalised muscle weakness (not limited to specific muscle group)
Remember
Primary adrenal failure - pigmentation due to ACTH, mineralcorticoid deficiency is only seen in primary
Secondary adrenal failure - no pigmentation
Ask for:
Blood glucose (hypoglycaemia)
Electrolytes (hyponatraemia, hyperkalemia, hyperchloremic acidosis)
Diagnostic test
- early morning cortisol or short synacthen test
Signs of hyperthyroidism
Anxious
Thin
Tremulous
Hands:
Warm, sweaty skin
Onycholysis of nails
Hyperpigmentation, palmar erythema
Assess for tremor - hands outstretched with paper over hands
Take pulse for tacycardia, AF common
Take blood pressure (systolic hypertension)
Eyes:
All hyperthyroidism = Stare and lid lag (get patient to follow finger down - lid lag is present if sclera can be seen above iris)
Specific to Graves = proptosis, exopthalmos (ability to see sclera below cornea when looking straight), impairment of eye muscle function, periorbital and conjunctival odema
Examine thyroid gland
- diffuse enlargement (Graves)
- multiple nodules (MNG)
CVS: ejection systolic murmur, high output heart failure
Test for proximal myopathy and hypereflexia
Pre-tibial myxedema (raised hyperpigmented skin over shins)
Ask for:
TFTs to confirm hyperthyroidism
Thyroid antibodies
Thyroid scintiscan
Hypogonadism
Loss of body hair Temporal hair recession Reduction in muscle mass, increased fat mass Decrease in testicular size Gynecomastia (more common in primary)
Hypothyroidism
Slowed movements
Slowed, hoarse speech
Weight gain
Hands: Coarse hair and skin Cool dry skin Brittle nails Pallor of palmar creases Assess for carpal tunnel - Tinnels Take pulse: Bradycardia
Test for proximal myopathy and delayed relaxation of reflexes
Face: Enlargement of tongue Yellow appearence Periorbital odema Thinning of the outer 3rd of the eyebrow
Feel thyroid gland
- goitre -> iodine deficiency
Assess heart and lungs for pericardial and pleural effusions
Legs: non pitting odema
Reflexes
Ask for:
TFTs
Thyroid antibodies
Signs of panhypopituitarism
hormone loss in the following order:
GH, PRL, Gonadotrophs, TSH, ACTH
General: Short stature (GH) Pale skin Lack of body hair (Gonadotrophs) Absence of secondary sexual characteristics if gonadotroph failure before pregnancy
Face:
Hypophysectomy scars
Eyes: bitemporal hemianopia, optic atrophy, cranial nerve palsies - CN III, IV, VI and 1st division of V (pass in the cavernous sinus)
Loss of facial hair in men (gonadotroph insufficiency)
Chest:
Men - loss of chest hair
Women - breast atrophy
Genitals:
Loss of pubic hair
Testicular atrophy
Ankle reflexes - “hung-up” ankle jerks are a sign of secondary hypothyroidism
Lying and standing BP - ACTH deficiency
Thyroid eye disease
Hyperthyroidism - increased sympathetic activity
lid-lag
thyroid stare
Specific to Grave’s Disease
Exophthalmos (protrusion of eyeball from orbit)
Proptosis
- complications include: chemosis, conjunctivitis, corneal ulceration, optic atrophy
Ophthalmoplegia
- inferior rectus muscle lost first
