Objective Physical Examination Of Patients Of Endocrine Disorders

The total clinical effect produced by an endocrine disturbance is determined by the age of onset, severity of hormone dysfunction, duration of the disorder, compensatory mechanisms, and the behaviour of the target organs. Several other factors like generic behaviour, nutritional status, intercurrent illness and the therapy, modify the expression of symptoms. Familial incidence is seen in disorders like pure gonadal dysgenesis, Kallmann’s syndrome, Laurence-Moon-Biedl syndrome, Type II diabetes mellitus, thyroid disorders and multiple endocrine adenomatosis.

Growth and development: Disorders of growth are common in many endocrine disorders.

Secondary sexual characters: Disorders of sexual development may take the form of sexual precocity, heterosexual signs (appearance of features of the opposite sex), delayed puberty or regression of secondary sexual characters.

Anthropometry: In addition to height and weight, measurement of skeletal proportion is of great value in diagnosis. At birth, the ratio of the upper segment to the lower segement is 1.7:1 with the pubic symphysis taken as the reference point. The two segments become equal by the age of 10 years and this proportion is maintained throughout. The arm span equals the height in adults. The infantile proportion is retained in conditions such as juvenile hypothyroidism and chondrodystrophies which interfere with growth in early age. In hypopituitarism and other causes of generalized short stature, the growth retardation is proportional and the ratio is maintained. The lower segment and arm span are disproportionately increased in eunucoidism, because of delay in closure of the epiphyses.

Cardiovascular abnormalities: Various grades of hypertension may be present in pheochromocytoma, hyperaldosteronism and congenital adrenal hyperplasia. Orthostatic hypotension may be a prominent symptom in Addison’s disease, hypopituitatism, and diabetic neuropathy. It may also be present in pheochromocytoma. Cardiovascular manifestations may be prominent in thyrotoxicosis and myxedema.

The integument: The text and pigmentation of the skin should be looked for. Black freckles and café ‘au lait (Er. Coffee with milk) spots are seen in gonadal dysgenesis, neurofibromatosis and some types of sexual precocity. Hirsuitism is common in virilising conditions. Presence of acne is a sensitive index of excessive androgen activity.

Breasts: Careful examination of breasts for recent change in size, tenderness, pigmentation and galactorrhea is absolutely essential in all cases. Enlargement and hyperpigmentation of breasts occurs in pregnancy, trophoblastic tumours, luteinizing tumours, Cushing’s syndrome and estrogen therapy. Though the breasts are large in size in testicular feminization, the nipples and areolae are immature. In Sheehan’s syndrome, the aerolae may undergo depigmentation.

Musculoskeletal system: Several endocrine disorders give rise to characteristic abnormalities. Excessive muscle weakness, hypotonia and localized hypertrophy or atrophy are suggestive of diseases of the thyroid or adrenal cortex.

Finally, another serious manifestation of endocrine diseases is the ocular manifestations. Exophthalmos and ophthalmoplegia may be present in thyrotoxicosis and pituitary tumours. Cattaract occurring prematurely may point to diabetes mellitus or hypoparathyroidism. Visual field defects are common in space occupying lesions in the region of the pituitary and hypothalamus.

Growth and development, sexual secondary characteristics, the cardiovascular system, the skin, the breast, the muscular system and even the Eye are very important organs to check objectively when examining a patient suspected to be affected with an endocrine disorder.