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The Endocrine System

According to Talley!
Doctor, mi pispiss biwan!!
THYROID
1. Inspect first! Lump? Mass?
2. sip from water
3. scars
4. veins
5. palpate from behind:
a. site
b. size
c. shape
d. consistency
e. tenderness
f. mobility
g. repeat with swallowing
h. thrill
6. cervical LN
7. trachea
8. percussion manubrium
9. auscultate
10. pembertons sign
THYROTOXICOSIS:
1. wt loss, anxiety, frightened facies
2. hands: tremor, onycholysis, acropachy,
palmar erythema, warmth/sweatiness
3. pulse: tachycardia, AF
4. reflexes: brisk, proximal myopathy
5. eyes: exophthalmos and cx: chemosis,
conjunctivitis, corneal ulcer, optic
atrophy, ophthalmoplegia
6. thyroid stare, lid retraction, lid lag
7. neck: enlargement, TMNG, tenderness
8. gynaecomastia
9. heart:systolic flow murmur, CCF
10. legs: pretibial myxoedema, brisk
reflexes, proximal myopathy
HYPOTHYROIDISM:
1. mental/physical sluggishness
2. hands: cyanosis, swelling, cool, palmar
crease pallor
3. pulse: small volume, slow
4. carpal tunnel syndrome
5. prox myopathy and hung up reflexes
6. face: hypercarotenaemia, alopecia,
vitiligo, periorbital oedema, loss
eyebrows, xanthalesma, thin hair,
swollen tongue
7. speech: coarse, slow
8. thyroid gland: often not enlarged
9. chest: effusions
10. legs: hung up reflexes, nonpitting
oedema, peripheral neuropathy

ACROMEGALY
=excess growth hormone. Usually due to
pituitary adenoma.
1. characteristic face and body habitus
2. hands: spade like, sweat, warm, thick
skin, OA, tinels sign
3. arms: prox myopathy, radial n thickening
4. axilla: skin tags (molluscum fibrosum),
greasy skin, acanthosis nigricans
5. face: frontal bossing, thick lips,
prognathism, vis field defects, fundi optic
atrophy, angioid streaks, diabetic
retinopathy, ocular palsy, macroglossia,
splayed teeth, square firm jaw
6. enlarged thyroid, hoarse voice
7. chest: coarse hair, gynaecomastia,
arrhythmias, cardiomegaly, CCF, HT
8. kyphosis
9. abdo: organomegaly, testic atrophy
10. LL: OA, pseudogout, foot drop
11. UA: glucose
12. signs of activity: skin tag nos, sweating,
glycosuria, vis field loss, enlarging goitre,
HT, headache
13. diagnosis:
a. skull X ray: enlarged sella
b. CT/MRI
c. IGF-1, somatomedin C levels
d. GTT
e. TRH test
DIABETES MELLITUS:
1. general: dehydration, obesity, endocrine
facies, pigmentation, comatose
2. Lower Limbs 1st!!
a. Skin: hairless, atrophied,
ischaemic changes, ulcers
b. Infections
c. Pigmented scars
d. Injection sites on thighs
e. Quad wasting: MM femoral n.
f. Knees: charcots joints
g. Peripheral pulses, temp, Cap refill
h. Periph neuro exam: dorsal
column, reflexes, power
3. Upper Limbs next!!
a. Nails: candida
b. Injection sites
c. BP lying and standing
4. face: visual acuity, fundoscopy:
a. pre-proliferative: dot & blot
hemor, microaneurysms, hard &
soft exudates
b. proliferative changes:
neovascularisation, retinal
detachment, laser scars
c. CN exam: especially III, IV, VI
d. Mouth: candida
5. Neck/shoulders: carotid artery,
scleroedema, acanthosis nigricans
6. abdo: hepatomegaly
7. UA: glucose and protein