History taking and clinical examination of endocrine system

Approaches for some commonly encountered endocrinological problems & their presentation

1. HISTORY TAKING AND CLINICAL EXAMINATION OF ENDOCRINE SYSTEM Presenter- Tanmoy Mandal & Rajat Kar Chairperson- Prof S.P. Chowdhury

2. WEIGHT GAIN- Hypothyroid PCOS Cushing syndrome Insulinoma Patients on insulin therapy WEIGHT LOSS Hyperthyroid DM Adrenal failure Thyroiditis Zollinger Ellison Syndrome Pheochromocytoma SYMPTOMS

3. INCREASED APPETITE- DM Frohlich syndrome Laurence moon biedl syndrome Insulinoma DECREASED APPETITE- Adrenal failure Hypothyroid Drugs- dexamphetamine Cushing syndrome

4. OBESITY - Cushing syndrome Syndrome X Sleep apnea syndrome Laurence moon biedl syndrome Frohlich syndrome Prader willi syndrome

5. DIARRHEA Hyperthyroid Hyperparathyroid DM WDHA Syndrome Carcinoid syndrome Adrenal failure Zollinger ellison syndrome Kwashiorkor VIPOMA CONSTIPATION Hypothyroid Hypokalemia DM Porphyria Amyloidosis Pheochromocytoma Vit D excess Hypercalcemia Visceral myopathy

6. VOMITING - DKA Adrenal failure Hypercalcemia Amyloidosis Porphyria Hyperparathyroid DM Vit A toxicity Acute zinc toxicity Galactosemia DI Congenital adrenal hyperplasia Fructose intolerance MELAS

7. PAIN ABDOMEN - Hypercalcemia DKA Adrenal crisis Hyperparathyroid Acute intermittent porphyria Carcinoid Zollinger Ellison Syndrome Ovarian Hyperstimulation syndrome C1 esterase deficiency Myxedema

8. POLYDIPSIA - Central DI Nephrogenic DI Primary polydipsia DM Drugs Hypercalcemia POLYURIA - Central DI Nephrogenic DI DM Drugs Cushing syndrome Hypercalcemia Alcohol Caffeine

9. HYPERHIDROSIS- Hyperthyroid Hypogonadism Pheochromocytoma Acromegaly Mitochondrial diseases Menopause Obesity HYPOHIDROSIS- Hypothyroid DM Amyloidosis Laron syndrome Alcoholics GH receptor deficiency Fabry disease Ectodermal dysplasia

10. HEAT INTOLERANCE- Hyperthyroid Hypothalamic tumors Drugs- atropine, belladona Post menopausal syndrome Graves disease COLD INTOLERANCE- Hypothyroid Adrenal failure Hypopituitarism Anorexia nervosa Hypothalamic tumors Hashimoto thyroiditis

11. HYPERSOMNIA - Hypothyroid Pickwickian syndrome Prader willi syndrome Narcolepsy Niemann pick disease type C Sleep deprivation syndrome INSOMNIA - Graves disease Cushing syndrome Alcohol Caffeine

12. PRECOCIOUS PUBERTY- Congenital adrenal hyperplasia Adrenal tumors Hypothalamic hamartoma Mc Cune Albright syndrome Angelman syndrome Exogenous hormones DELAYED PUBERTY- Hypothyroid Constitutional Hypopituitarism Turner syndrome Klinefelter syndrome Prader willi syndrome Kallmann syndrome Cushing syndrome Androgen insensitivity syndrome

13. HIRSUITISM - PCOS Cushing syndrome Congenital adrenal hyperplasia Ovarian tumors Acromegaly Porphyria cutanea tarda Drugs- Danazol , phenytoin , minoxidil DECREASED BODY HAIR - Hypogonadotrophic hypogonadism Klinefelter syndrome Panhypopituitarism Kwashiorkor Zinc deficiency Iron deficiency

14. GYNAECOMASTIA- Klinefelter syndrome Hypopituitarism Drugs Hypogonadism Hyperthyroid Aging Adrenal tumors Prolactinoma BREAST ATROPHY- Aging PCOS Menopause HRT

15. SHORT STATURE- Growth hormone deficiency Kwashiorkor Turner’s syndrome Achondroplasia Hypothyroidism Rickets Osteogenesis imperfecta Prader willi syndrome Malnutrition TALL STATURE- Acromegaly Marfan syndrome Fragile X syndrome Androgen insensitivity syndrome Sotos syndrome Mc- Cune Albright syndrome Klinefelter syndrome Homocystinuria Hyperthyroid

16. ERECTILE DYSFUNCTION- Hyperthyroid Hypothyroid Hypogonadism Hemochromatosis DM Obesity Hypercholesterolemia Syndrome X LOSS OF LIBIDO- Hypothyroid DM Menopause Hyperprolactinemia Adrenal insufficiency Drugs-SSRI

17. LACTATIONAL FAILURE - Sheehan syndrome Drugs- metoclopramide GALACTORRHEA - Hypothyroid Hyperprolactinemia Pituitary adenoma Drugs- antipsychotics, antidepressants Male hypogonadism CKD

18. RECURRENT FRACTURE- Cushing syndrome Osteoporosis Hypogonadism Hyperthyroid RTA-2 Rickets Osteogenesis imperfecta Hyperparathyroid Osteopetrosis BONE PAIN- Hypercalcemia Rickets Hyperparathyroid Paget disease of bone Osteomalacia Gaucher’s disease Acromegaly

19. POOR SCHOLASTIC PERFORMANCE- Hypothyroid Type 1 DM Lead poisoning Down’s syndrome Fragile X syndrome Klinefelter syndrome FAILURE TO THRIVE- Down’s syndrome Inborn errors of metabolism Cystic fibrosis Hyperthyroid Juvenile DM

20. HYPERPIGMENTATION - Adrenal failure Hemochromatosis Drugs- minocycline Cushing disease Porphyria Nelson syndrome Graves disease Mercury poisoning VITILIGO - Hyperthyroid Pernicious anemia PGA syndrome Drugs Adrenal failure

21. AMBIGUOUS GENITALIA- 21 alpha hydroxylase def 3 beta hydroxylase def 5 alpha reductase def 11 beta hydroxylase def Androgen receptor defect Drug induced DECREASED TESTICULAR VOLUME- Klinefelter syndrome Hemochromatosis Congenital adrenal hyperplasia Cushing syndrome Hyperprolactinemia Kallman syndrome Laurence moon biedl syndrome Alcohol

22. FLUSHING - Carcinoid Pheochromocytoma Post menopausal Hyperthyroid Mastocytosis Alcohol Vit B3 excess POSTURAL DIZZINESS- Adrenal failure DM Hypoglycemia Hyperthyroid Hypothyroid Hyperventilation syndrome

23. HOARSENESS OF VOICE- Hypothyroid Goitre Hashimoto thyroiditis Acromegaly Adrenocortical carcinoma PROPTOSIS - Graves disease Cushing syndrome Pheochromocytoma Hypothyroidism Acromegaly

24. TREMORS - Hyperthyroid Hypercalcemia Hyperparathyroid FAHR Syndrome Hypomagnesemia Thiamine def Hypoglycemia Alcohol withdrawal DEAFNESS - Hypothyroid Pendred syndrome Alport syndrome Usher syndrome Drugs- aminoglycosides

25. SEIZURES - Hypoglycemia Hypercalcemia Hypocalcemia Hypomagnesemia VISUAL DISTURBANCE- DM Pituitary adenoma Prolactinoma Galactosemia Hypothyroid Zinc def. Vit A def. Storage diseases

26. HEADACHE - Pituitary adenoma Nelson syndrome Hypothyroid Hypercalcemia PARAESTHESIA - DM Cushing syndrome Hypothyroid Carcinoid syndrome Myxedema GH excess Vit B 12 def

27. Lithium Amiodarone Iodine supplements Diuretics Steroid Vitamin A, D Heparin Anticonvulsant DRUG HISTORY

28. Onset of menses Cycle Duration Flow Dysmenorrhea Menopause MENSTRUAL HISTORY

29. AMENORRHEA - Hypothyroid Hyperthyroid Sheehan syndrome Hyperprolactinemia Hemochromatosis PCOS Turner syndrome Congenital adrenal hyperplasia Androgen insensitivity syndrome OLIGOMENORRHEA - PCOS Hyperprolactinemia Anorexia nervosa Bulimia nervosa Drugs- antipsychotics Thyrotoxicosis Prader willi syndrome

30. PRIMARY - Mullerian agenesis Turner syndrome Septo optic dysplasia Kallmann syndrome Swyer james syndrome SECONDARY - Hypothyroid Hyperthyroid Cushing syndrome DM PCOS INFERTILITY

31. Number of children Last child birth Vaginal delivery/ LSCS Emergency / planned delivery Prolonged third stage of labour Gestational diabetes History of large baby Postpartum complication History of severe blood loss postpartum Lactational failure History of infertility Use of drugs for pregnancy OBSTETRIC HISTORY

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