General Clinical Manifestations In Endocrine Disorders: Gynecomastia, Galactorrhea And Others
Fatigue, Weakness, Skin Changes And Others
The symptomatology of endocrine diseases is vast. Symptoms such as fatigue and weakness, gynecomastia, galactorrhea, polyuria, skin changes, vitiligo, pallor, abnormalities and the loss of hair among others sum up the major clinical manifestations of endocrinology.
Fatigue And Weakness
These are the presenting symptoms in diabetes mellitus, Addison’s disease, hypothyroidism, hypopituitarism, hyperthyroidism, Cushing’s syndrome, hyper-parathyroidism and hypogonadism.
Polyuria of recent onset should suggest diabetes mellitus, diabetes insipidus or hypercalcemia. Other rare endocrine causes include primary hyperaldosteronism and hypokalemic nephropathy. Polyuria is generally accompanied by polydipsia. Psychogenic polydipsia is not an uncommon disorder and this has to be distinguished from a primary endocrine abnormality.
Several endocrine disorders lead to characteristic abnormalities on the skin and mucous membranes. In many cases, these precede the other features of endocrinopathy. Hyperpigmentation affecting the body folds, pressure points and the oral mucous membranes and gums is seen in Addison’s disease. Cushing’s syndrome is accompanied by increased pigmentation. Pregnancy, thyrotoxicosis and use of oral contraceptives lead to spotty brown pigmentation over the face (chloasma). Acanthosis nigricans is commonly seen in acromegaly, obesity, Nelson’s syndrome, ectopic Cushing’s syndrome and juvenile myxedema.
This may occur in many endocrine disorders like Addison’s disease, hypothyroidism and hypopituitarism which have an autoimmune basis.
Hypothyroidism (myxedema) is characterized by dry scaly and yellowish skin. Panhypopituitarism manifests depigmentation and loss of hair and the skin does not tan on exposure to sunlight.
Loss Of Hair
Hair Disorders, Gynacomastia And Others
Abnormalities of hair
Hirsuitism is excessive hair growth in women and children occurring over the androgen sensitive areas (face, axillae, pubish, etc). Hirsuitism may be primary (idiopathic) or secondary to endocrine disorders. Growth of body hair and sexual hair is determined by genetic, endocrine and other factors. Hirsuitism commonly occurs in women at puberty, pregnancy or menopause. In hyperandrogenism, it is an early symptom. In such cases, it may be accompanied by other features like virilism in which there is change of voice, clitoromegaly, baldness and malodorous perspiration. Secondary hirsuitism occurs in hyperfunction of the adrenal cortex, polycystic ovaries (Stein Leventhal syndrome), testicular and ovarian tumours, carcinoma bronchus with endocrine manifestations and therapy with glucocorticoids and other drugs such as phenytoin and diazoxide.
Loss of hair
Androgenic tumours and hyperfunction of the adrenal cortex give rise to frontal baldness. Generalised loss of hair over the head and eyebrows is suggestive of myxedema. Hypopituitarism and hypogonadism are accompanied by absence or loss of facial, axillary and pubic hair. Many non endocrine disorders like cirrhosis liver and malnutrition are also characterized by loss of hair.
Benign glandular enlargement of male breast is called gynecomastia. The glandular tissue is hypertrophied in true gynecomastia. Accumulation of fat in the region of the breasts is called pseudogynecomastia. Painless bilateral breast enlargement occurs physiologically during adolescence. Pathologically gynecomastia occurs in testicular disorders like dysgenesis, atrophy and tumours, systemic diseases associated with disturbances of gonadal hormones (e.g. hepatic failure) and as an adverse side effect of several drugs like estrogens, androgens, spironolactone, digitalis, reserpine and phenothiazines. Breast enlargement may persist even after the primary cause is removed.
This refers to the condition where there is abnormal (unphysiological) secretion of milk. Normal secretion of milk occurs only during lactation and pregnancy. Galactorrhea is a common finding which may not be disclosed by the patient and, therefore, this has to be specifically looked for. Newborn infants may show galactorrhea at times (Witch’s milk). Hyperprolactinemia, acromegaly, thyroid disorders (hypothyroidism and rarely thyrotoxicosis), feminizing adrenal tumours, corpus luteum cysts, and rarely choriocarcinoma may present with galactorrhea. Drugs like phenothiazines, metoclopramide, digoxin and many others may give rise to galactorrhea.
Among other clinical manifestations of endocrine disorders, the above mentioned are of huge significance in diagnosing and treating diseases affecting our endocrine system.
© 2014 Funom Theophilus Makama