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Chapter VII. Investigation of patients with diseases of endocrine system

History, examination and investigation

The presentations of endocrine disease are diverse, and the findings in the history and on examination of the patient reflect this. Although multiple endocrine disorders may occur in the same patient, most have abnormalities of a single hormonal system, and the symptoms, signs and necessary investigations relate closely to those abnormalities.

A full history and examination is essential in any patient with a suspected endocrine disorder. Common presentations that should raise the possibility of endocrine disease are listed in Table 87, Table 88.

Table 87. Common presenting complaints in endocrine disease

Body size and shape

•  Short stature

•  Tall stature

•  Excessive weight or weight gain

•  Loss of weight

Metabolic effects

•  Tiredness

•  Weakness

•  Increased appetite

•  Decreased appetite

•  Polydipsia or thirst

•  Polyuria or nocturia

•  Tremor

•  Palpitation

•  Anxiety

Local effects

•  Swelling in the neck

•  Carpal tunnel syndrome

•  Bone or muscle pain

•  Protrusion of eyes

•  Visual loss (acuity or fields, or both)

•  Headache

Reproduction or sex

•  Loss or absence of libido

•  Impotence

•  Oligomenorrhoea or amenorrhoea

•  Subfertility

•  Galactorrhoea

•  Gynaecomastia

•  Delayed puberty

•  Precocious puberty

Skin

•  Hirsutes

•  Hair thinning

•  Pigmentation

•  Dry skin

•  Excess sweating

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