Badanie fizykalne układu hormonalnego | Endocrine System Examination

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fizyczne”, “obesity”: “otyłość”, “central adiposity”: “otyłość centralna”, “muscle wasting”: “zanik mięśni”, “Cushing’s syndrome”: “zespół Cushinga”, “metabolic syndrome”: “zespół metaboliczny”, “endocrine dysfunction”: “dysfunkcja endokrynologiczna”, “short stature”: “niski wzrost”, “growth hormone deficiency”: “niedobór hormonu wzrostu”, “gigantism”: “gigantyzm”, “growth hormone excess”: “nadmiar hormonu wzrostu”, “hypogonadism”: “hipogonadyzm”, “secondary sexual characteristics”: “wtórne cechy płciowe”, “delayed puberty”: “opóźnione dojrzewanie”, “acromegaly”: “akromegalia”, “moon facies”: “twarz księżycowata”, “Graves’ disease”: “choroba Gravesa-Basedowa”, “hyperthyroidism”: “nadczynność tarczycy”, “hirsutism”: “hirsutyzm”, “polycystic ovary syndrome”: “zespół policystycznych jajników”, “adrenal hyperplasia”: “przerost nadnerczy”, “malar flush”: “rumień malarny”, “hypothyroidism”: “niedoczynność tarczycy”, “hyperpigmentation”: “hiperpigmentacja”, “Addison’s disease”: “choroba Addisona”, “adrenal insufficiency”: “niewydolność nadnerczy”, “striae”: “rozstępy”, “vitiligo”: “bielactwo”, “autoimmune endocrine disorders”: “autoimmunologiczne zaburzenia endokrynologiczne”, “depigmented skin”: “odbarwiona skóra”, “dry skin”: “sucha skóra”, “coarse skin”: “szorstka skóra”, “sweaty skin”: “spocona skóra”, “moist skin”: “wilgotna skóra”, “acanthosis nigricans”: “rogowacenie ciemne”, “insulin resistance”: “insulinooporność”, “diabetes”: “cukrzyca”, “palmar erythema”: “rumień dłoniowy”, “tremor”: “drżenie”, “thyrotoxicosis”: “nadczynność tarczycy”, “acropachy”: “akropachia”, “thyroid digital clubbing”: “pałeczkowatość palców w chorobach tarczycy”, “pseudomyotonia”: “rzekoma miotonia”, “Dupuytren’s contracture”: “przykurcz Dupuytrena”, “leukonychia”: “białe plamy na paznokciach”, “onycholysis”: “onycholiza”, “thyroid dysfunction”: “dysfunkcja tarczycy”, “cervical lymph nodes”: “węzły chłonne szyjne”, “lymphadenopathy”: “limfadenopatia”, “thyroid malignancies”: “złośliwe nowotwory tarczycy”, “Hashimoto’s thyroiditis”: “zapalenie tarczycy Hashimoto”, “thyroid gland”: “gruczoł tarczowy”, “thyroidectomy”: “tyreoidektomia”, “neck surgeries”: “operacje szyi”, “diffusely enlarged thyroid”: “rozlane powiększenie tarczycy”, “multinodular goiter”: “wole wieloguzkowe”, “thyroid neoplasia”: “nowotwór tarczycy”, “tracheal deviation”: “przemieszczenie tchawicy”, “hyperactive blood flow”: “nadczynny przepływ krwi”, “gonadal examination”: “badanie gonad”, “hormonal imbalances”: “zaburzenia hormonalne”, “Klinefelter syndrome”: “zespół Klinefeltera”, “gynecomastia”: “ginekomastia”, “androgen excess”: “nadmiar androgenów”, “proximal muscle weakness”: “osłabienie mięśni proksymalnych”, “delayed reflex relaxation”: “opóźnione rozluźnienie odruchów”, “tachycardia”: “tachykardia”, “bradycardia”: “bradykardia”, “atrial fibrillation”: “migotanie przedsionków”, “hyperaldosteronism”: “hiperaldosteronizm”, “pheochromocytoma”: “guz chromochłonny”, “postural hypotension”: “niedociśnienie ortostatyczne”, “wide pulse pressure”: “szerokie ciśnienie tętna”, “hyperdynamic precordium”: “nadmierna dynamika okolicy przedsercowej”, “congestive heart failure”: “niewydolność serca”, “organomegaly”: “powiększenie narządów”, “hepatomegaly”: “powiększenie wątroby”, “splenomegaly”: “powiększenie śledziony”, “amyloidosis”: “amyloidoza”, “abdominal striae”: “rozstępy na brzuchu”, “adrenal crisis”: “przełom nadnerczowy”, “deep tendon reflexes”: “odruchy głębokie ścięgniste”, “brisk reflexes”: “żywe odruchy”, “diabetic neuropathy”: “neuropatia cukrzycowa”, “muscle stiffness”: “sztywność mięśni”, “muscle hypertrophy”: “przerost mięśni”, “peripheral neuropathy”: “neuropatia obwodowa”, “Charcot joints”: “stawy Charcota”, “proprioception”: “czucie głębokie”, “exophthalmos”: “wytrzeszcz oczu”, “lid retraction”: “retrakcja powiek”, “periorbital edema”: “obrzęk okołooczodołowy”, “ophthalmoplegia”: “oftalmoplegia”, “lid lag”: “opóźnienie powieki”, “pituitary tumor”: “guz przysadki”, “optic chiasm”: “skrzyżowanie nerwów wzrokowych”, “pituitary adenomas”: “gruczolaki przysadki”, “bitemporal hemianopia”: “niedowidzenie połowicze dwuskroniowe”, “peripheral artery disease”: “choroba tętnic obwodowych”, “capillary refill time”: “czas powrotu kapilarnego”, “depression”: “depresja”, “cognitive decline”: “pogorszenie funkcji poznawczych”, “hyperactivity”: “nadpobudliwość”, “palmar creases”: “bruzdy dłoniowe”, “mucous membranes”: “błony śluzowe”, “goiter”: “wole”, “nodules”: “guzki”, “soft”: “miękki”, “firm”: “twardy”, “Auscultation”: “Osłuchiwanie”, “bruit”: “szmer naczyniowy”, “menstrual irregularities”: “nieregularne miesiączki”, “sweaty palms”: “spocone dłonie”, “brittle nails”: “łamliwe paznokcie”, “pitting “: “Wgłębienie”, “Pretibial Myxedema”: “Obrzęk przedgoleniowy”, “edema”: “obrzęk”, “Adrenal Glands”: “Nadnercza”, “hypotension”: “niedociśnienie”, “hypertension”: “nadciśnienie”, “Muscle Strength and Tone”: “Siła i napięcie mięśni”, “conjunctiva”: “spojówka”, “excessive tearing”: “nadmierne łzawienie”, “Visual Field Testing”: “Badanie pola widzenia”, “ulceration”: “owrzodzenie”, “dorsalis pedis”: “tętnica grzbietowa stopy”, “posterior tibial”: “tętnica piszczelowa tylna”, “slowed cognitive processing”: “spowolnione przetwarzanie poznawcze”, “poor concentration”: “słaba koncentracja”, “memory impairment”: “upośledzenie pamięci”, “anxiety”: “lęk”, “insomnia”: “bezsenność” }; // Normalize keys in the dictionary const normalizedWordsToTooltip = {}; for (const [key, value] of Object.entries(wordsToTooltip)) { const cleanedKey = key.replace(/(.*?)/g, ”).trim(); // Remove anything in parentheses normalizedWordsToTooltip[cleanedKey.toLowerCase()] = value; } function processNode(node) { if (node.nodeType === Node.TEXT_NODE && node.nodeValue.trim()) { let content = node.nodeValue; // Regex to match only the main words (ignores parentheses) const regex = new RegExp( `\b(${Object.keys(normalizedWordsToTooltip).join(‘|’)})\b`, ‘gi’ ); if 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Szacowany czas lekcji: 21 minut
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General Inspection

The examination begins with a general inspection of the patient, focusing on clinical signs that may suggest endocrine pathology. Endocrine disorders can present with signs affecting a variety of body systems, and their manifestations are highly diverse:

  • General Appearance: Note any obvious physical changes such as obesitycentral adiposity, or muscle wasting, which may indicate Cushing’s syndrome, metabolic syndrome, or long-standing endocrine dysfunction. Look for height abnormalities, such as short stature (often linked to growth hormone deficiency) or gigantism (due to growth hormone excess). Also, observe any signs of hypogonadism, such as a lack of secondary sexual characteristics or delayed puberty.
  • Facial Features: Inspect the patient’s face for characteristic features that may indicate endocrine disorders. For example, coarse facial features may suggest acromegaly, while moon facies could indicate Cushing’s syndrome. Look for exophthalmos (protruding eyes) and lid retraction, common in Graves’ disease, an autoimmune form of hyperthyroidism. Hirsutism (excess facial or body hair) in females can be indicative of polycystic ovary syndrome (PCOS) or adrenal hyperplasia. Observe for malar flush, which may indicate hypothyroidism, particularly when combined with other signs.
  • Skin Changes: Inspect the skin for hyperpigmentation, particularly in sun-exposed areas, palmar creases, or mucous membranes, which can indicate Addison’s disease (adrenal insufficiency). Striae, especially wide, purple stretch marks on the abdomen, are common in Cushing’s syndromeVitiligo, patches of depigmented skin, may indicate autoimmune endocrine disorders such as autoimmune thyroid disease. Dry, coarse skin can be associated with hypothyroidism, whereas sweaty, moist skin is more typical of hyperthyroidism. Check for acanthosis nigricans—thickened, dark patches of skin often found in body folds—which may suggest insulin resistance or diabetes.
  • Hand Changes: Inspect the hands for palmar erythema, often seen in hyperthyroidism, and tremor, which can suggest thyrotoxicosis. Look for acropachy (thyroid digital clubbing), which may be associated with Graves’ disease. Pseudomyotonia (delayed relaxation after a handshake) may indicate hypothyroidism. Also check for Dupuytren’s contracture, which can be seen in diabetes or alcoholism. Inspect the nails for leukonychia (white spots) and onycholysis (separation of the nail from the nail bed), which are commonly associated with thyroid dysfunction.

Lymph Node Examination

  • Palpation of Cervical Lymph Nodes: Palpate the cervical lymph nodes for any enlargement or tenderness. Lymphadenopathy can be associated with thyroid malignancies or infectious processes. Enlargement of lymph nodes, particularly in the cervical chain, can sometimes accompany thyroid pathologies like thyroid cancer or Hashimoto’s thyroiditis.

Thyroid Examination

The thyroid gland is a central organ of the endocrine system, and its examination is a critical component of the overall assessment:

  • Inspection: Observe the patient’s neck while they are sitting upright, noting any swelling or asymmetry in the thyroid area. Ask the patient to swallow a sip of water and watch for the upward movement of the thyroid gland, which may reveal goiter or nodules. Look for surgical scars that could indicate previous thyroidectomy or other neck surgeries.
  • Palpation: Stand behind the patient, gently palpating the thyroid gland while they swallow. Feel for sizeconsistencytenderness, and the presence of nodules. A diffusely enlarged thyroid may suggest Graves’ disease or Hashimoto’s thyroiditis, while nodularity may indicate multinodular goiter or thyroid neoplasia. Assess for tracheal deviation, which can occur in cases of large goiters. Note the consistency of the gland—soft suggests hyperthyroidism, firm suggests Hashimoto’s thyroiditis, and hard suggests malignancy.
  • Auscultation: If the thyroid gland is significantly enlarged, auscultate over the gland for a bruit, which may indicate increased vascularity, typical of Graves’ disease. This increased vascularity is due to hyperactive blood flow within the gland, often accompanying significant thyroid overactivity.

Gonadal Examination

The examination of the gonads is crucial in evaluating endocrine function, particularly for conditions involving hypogonadism or hormonal imbalances:

  • Males: Inspect and palpate the testes for size, consistency, and any masses. Small, soft testes may indicate hypogonadism or Klinefelter syndrome, whereas large or nodular testes may suggest a neoplasm. Assess for gynecomastia (breast tissue enlargement) in males, which may indicate hormonal imbalances such as decreased testosterone or increased estrogen.
  • Females: Evaluate for the presence of hirsutism (excess body or facial hair) and any menstrual irregularities, which can indicate conditions like polycystic ovary syndrome (PCOS). Note the distribution of body hair, which can provide clues about androgen excess or deficiency.

Examination of the Hands and Extremities

  • Palmar Features: Look for palmar erythema or sweaty palms, which may indicate hyperthyroidism. Assess for skin thickness and dryness, which are often associated with hypothyroidism. Additionally, inspect for pigmentation changes, particularly in Addison’s disease, where there may be increased pigmentation of the palmar creases.
  • Tremor: Ask the patient to stretch their arms out in front of them. A fine tremor of the hands may be indicative of thyrotoxicosis. This tremor is often accompanied by other signs such as tachycardia or hyperreflexia. Ensure you also assess for resting or intention tremor, which could indicate other underlying neurological conditions.
  • Nails: Look for onycholysis (Plummer’s nails), a condition where the nails lift off from the nail bed, which is sometimes seen in hyperthyroidism. Also assess for brittle nails in hypothyroidism, and pitting of the nails, which may indicate autoimmune thyroid conditions or other skin diseases.
  • Pretibial Myxedema: Inspect the shins for pretibial myxedema (localized thickening and swelling of the skin), a sign that can be associated with Graves’ disease. Palpate the area to determine if there is a waxy, non-pitting quality to the edema. Assess for non-pitting edema elsewhere on the body as well, which may occur in severe hypothyroidism.

Cardiovascular Examination

  • Pulse Rate and Rhythm: Measure the patient’s heart rate and rhythmTachycardia is often seen in hyperthyroidism, whereas bradycardia can indicate hypothyroidism. Look for signs of atrial fibrillation, which can occur as a complication of thyrotoxicosis. In addition, assess for bounding pulses or collapsing pulses, which are often present in hyperthyroidism due to increased cardiac output.
  • Blood Pressure: Measure blood pressure in both arms. Hypertension can be observed in Cushing’s syndrome, hyperaldosteronism (Conn’s syndrome), or pheochromocytoma. Postural hypotension may indicate Addison’s disease. Check for wide pulse pressure, which may also be seen in hyperthyroidism.
  • Cardiac Auscultation: Listen to the heart for murmurs or irregularities. A hyperdynamic precordium and increased heart sounds are consistent with hyperthyroidism. Look for evidence of heart failure, which can sometimes occur in untreated hypothyroidism or hyperthyroidism. Additionally, auscultate for extra heart sounds such as an S3, which may suggest congestive heart failure related to severe hypothyroidism.

Abdominal Examination

  • General Palpation: Palpate the abdomen for any organomegalyHepatomegaly can be seen in Cushing’s syndrome, while splenomegaly may suggest infiltrative diseases such as amyloidosis. Also assess for abdominal striae, which are characteristic of Cushing’s syndrome and are usually wide and purple in color.
  • Adrenal Glands: Although the adrenal glands are not directly palpable, symptoms such as abdominal tenderness and hyperpigmentation, along with systemic signs of hypotension or hypertension, can point toward adrenal insufficiency or excess (e.g., Addison’s disease or Cushing’s syndrome). Assess for signs of abdominal painradiating to the back, which may indicate an adrenal crisis or mass effect.

Neurological Examination

  • Reflexes: Assess the deep tendon reflexes (e.g., biceps, knee, ankle). Brisk reflexes with shortened relaxation phases are common in hyperthyroidism, while delayed reflex relaxation (often described as “hung-up reflexes”) is characteristic of hypothyroidism. In diabetic patients, diminished reflexes may indicate diabetic neuropathy.
  • Muscle Strength and Tone: Evaluate for proximal muscle weakness, which is often seen in hyperthyroidism and Cushing’s syndrome. Patients may have difficulty standing from a seated position without using their arms. In hypothyroidism, there may be muscle stiffness and crampingMuscle hypertrophy, particularly in children, may indicate long-standing hypothyroidism.
  • Sensory Examination: Assess the patient for signs of peripheral neuropathy, which can occur in diabetes mellitus. Look for decreased sensation in the feet, particularly to vibration and pinprick, which are classic findings in diabetic neuropathy. Also consider testing for temperature and proprioception to assess the extent of neuropathic damage.

Ophthalmic Examination

  • Eye Signs: Inspect for exophthalmos (protrusion of the eyeball) and lid retraction, both of which are commonly seen in Graves’ disease. Look for periorbital edema and ophthalmoplegia (weakness of the eye muscles). Test for lid lag by asking the patient to follow your finger in a downward motion; in hyperthyroidism, the upper eyelid may lag behind the movement of the eyeball. Assess the conjunctiva for dryness or redness, and note any signs of excessive tearing.
  • Visual Field Testing: Perform visual field testing to assess for any deficits, which may be suggestive of a pituitary tumor compressing the optic chiasm, often seen in pituitary adenomas. Check for bitemporal hemianopia, which is a common visual field defect associated with large pituitary masses.

Foot Examination

  • Inspection: Inspect the feet for skin changesulceration, or deformities. These are particularly important in patients with diabetes mellitus, as peripheral neuropathy and poor circulation can lead to foot ulcers and infections. Look for Charcot joints, which may be present in advanced neuropathy, leading to deformities in the foot architecture.
  • Pulses: Palpate the dorsalis pedis and posterior tibial pulses to assess peripheral circulation. Poorly palpable or absent pulses can indicate peripheral artery disease, which is common in diabetic patients. Assess capillary refill time to gauge peripheral perfusion, with prolonged refill suggesting circulatory compromise.
  • Neuropathy Testing: Use a 10g monofilament to test sensation in different areas of the feet to assess for peripheral neuropathy. Lack of sensation suggests advanced neuropathy, which increases the risk for foot ulcers. Supplement with vibration sense testing using a tuning fork and temperature discrimination to further evaluate sensory loss in diabetic neuropathy.

Mental Status and Cognitive Changes

  • Mental Status Examination: Evaluate the patient’s mental status for signs of depressionanxiety, or cognitive decline. Hypothyroidism is associated with slowed cognitive processingpoor concentration, and memory impairment, whereas hyperthyroidism can result in anxietyhyperactivity, and insomnia. Assessing mood and cognition provides additional clues to underlying endocrine dysfunction.