Document a thorough and focused physical assessment of endocrine function, including information

about genetics, aging, nutrition, environmental, and occupational issues

Gather patient history
 Get age and gender.
 Thyroid problems are more common for women.
 Aging changes the endocrine system: decreases ADH causes older adults to be prone for
dehydration; decreased estrogen causes decreased bone density, thinner, drier skin;
decreased glucose tolerance causes slow wound healing, polydipsia, polyuria; decreased
general metabolism cause less tolerance to cold, decreased appetite and decreased HR
and BP.
 Ask for any disorders and family history (DMII, decreased thyroid function, ovarian dysfunction,
infertility, growth and development disorders, obesity), any sexual effects from endocrine
disorders and current and history of drug usage.
 Ask for nutrition history:
 Any history of nausea, vomiting and abdominal pain.
 An increase or decrease of food/fluid intake.
 Any nutrition deficiency or inadequate intake of iodine or protein.
 Discuss any current problems: current S/S, onset, if ADL is affected, and energy levels.
 Ask patient about their sexual and reproductive functions:
 Women: ask age when menarche or menopause started, flow duration, and frequency.
 Men: any impotence S/S
 Both genders: change in libido and fertility issues.
 Ask for any GI disorders and bladder problems.
 Current and past pattern of elimination.
 Frequency and amount of urination.
 Discuss any physical feature changes: hair distribution and texture, eye protrusion, facial
contours, voice quality, body proportions, and secondary sexual characteristics.
 Ask for any changes in behavior and personality.
Physical Assessment
 Inspect any physical changes:
 Observe general appearance, check height, weight, fat distribution and muscle mass.
 Assess body hair growth and scalp.
 Examine face and head (look for prominent jaw or forehead, puffy or round face, flat
expression, exophthalmos)
 Check and palpate for any thyroid enlargement and JVD.
 Check skin color.
 Observe any areas of loss or excess pigmentation.
 Check for slow wound healing, bruising, petechiae, skin infections.
 Inspect fingernails (malformation, brittleness, or thickness)
 Check for edema (extremities or base of spine)
 Assess trunk for abnormalities: Chest size and symmetry, truncal obesity, “Buffalo hump”
 Check breast area for size, pigmentation, size, and symmetry. Look for any striae
 Inspect hair growth and distribution. It could be excessive body hair growth (hirsutism) or
excessive hair loss.
 Examine genitalia.
 Auscultate cardiac rate and rhythm.
Real life Example:
Most older adult patients I helped cared for have some form of endocrine disorders like DMII,
hypothyroidism, or Cushing’s. As an example, I cared for a patient who has Cushing’s. It took a while for
doctors to diagnose her with the disease. She mentioned that during her mid-40’s, she started to gain
weight, can’t sleep, became hypoglycemic, and was not feeling herself. The lab test showed that her
cortisol and urine were abnormal. Finally, she had to undergo surgery and replace her hormone every
two months right after.