F00574 020 g001

Blood pressure „

Hypertension in Cushings a and Conns syndromes. ^ phaeochromocyloma Hypotension in adrenal insufficiency

@ Hcad

Eyes

Graves' dtóease Diplopia

Visual field defect (see opposite)

Hair

Aiopecia Frontal baldmg

Pulse

Atrial łibrfllation Sinus tachycardia Bradycardia

Skin

Hair distnbution A. Dry/greasy Pigmentation/pallor Bruising Vitiligo Striae Thickness

Facial features Hypoihyroid Hirsutism Acromegaiy Cushings Mentai State Lethargy Depression Confusion Libido

A Prognathism in acromegaiy

Nock

Voice

Hoarse, e.g. hypothyroid Viriiised

Thyroid gland (see opposite)

Goitre

Nodules

Vitiiigo in organ-specilic A autoimmune disease

Hands

Patmar erythema a Tremor ^

Acromegaiy Carpai tunnei syndrome

Pigmentation of creases A due to high ACTH leveis in Addison s disease

Acromegalic hands. Notę soft A tissue enlargement causing spade-like’ changes

Height and weight Q

A Multinodular goitre

Brcasts

Galactorrhoea

Gynaecomastia

Body fat

Central obesity in

Cushing s syndrome and h h(

growth normone deficiency

Boncs

Fragility fractures (e.g. of vertebrae, neck of femur or distal radius)

Genitalia

Virilisation

Pubertal development Testicular volume

Legs

Proximal myopathy Myxoedema

Obsorvation

• Most examination in endocrinology is by observation

• Astute observation can often yield spot' diagnosis of endocrine disorders

• The emphasis of examination varies depending on which gland or hormone is thought to be involved

A Pretibial myxoedema in Graves’ disease