Practical session 1

Endocrinology semiology
1. Symptoms
• Neonates:
• hypotonia
• lethargia
• DSD
1. Symptoms
• Children:
• short stature, tall stature,
• weight gain, weight loss,
• dimorphic features,
• failure to thrive, developments
abnormalities,
• fractures, bone deformities
• precocious/delayed puberty,
• polyuria, bowel movements’
disturbances,
• exophtalmia, goiter.
 1. Symptoms
• Adults:
• headache,
• weight gain/loss,
• dysphonia, dysphagia,
• stretch marks, hirsutism,
• galactorrhea, menstrual
disturbances, infertility,
• asthenia,
• dimorphic features,
• polyuria, bowel movements’
disturbances,
• exophtalmia, goiter.
2. Familial history
• Obesity
• Diabetes mellitus
• Hypertension
• Genetic syndromes
• MEN
• Cancer
• Mothers: pregnancy
evolution, medication
 3. Personal history
• Children:
• birth length/weight;
• presentation position (ex.
Breech),
• APGAR score,
• breastfeeding duration,
• development milestones,
• vaccinations,
• school performance,
• age at puberty onset
 3. Personal history
• Females: • menstrual cycle characteristics;
• menarche age • Frequency
• Normal Tahi/poli/hypermenorrhoea
• Early Bradi/oligo/hypomenorrhoea
• Late • Amenorrhoea
• menopause age • Infertility
• early
• pregnancies,
• births,
• abortions
spontaneous/at request
3. Personal history
All:
• radiation exposure,
• tumors,
• surgery,
Chernobyl & Fukushima
• previous treatments
• Iodine
• Spironolactone
• Glucocorticoids
• smoking status,
• alcohol consumption,
• other drugs,
• exposure to toxic substances
 4. Current disease history
• Onset
• Evolution
• Intensity
• Response to treatment/intervention
• Current status
 5. Physical exam
• Attitude
• General status – emergencies
5. Physical exam

• Specific positions, walking

5. Physical exam - facies
5. Physical exam - facies
5. Physical exam - facies
5. Physical exam – facies
5. Physical exam – facies
5. Physical exam - skin
5. Physical exam - skin
5. Physical exam - skin
5. Physical exam - skin
5. Physical exam - skin
5. Physical exam – hair&nails
5. Physical exam – hair&nails Ferriman-Gallwey score
5. Physical exam – hair&nails
5. Physical exam – hair&nails
5. Physical exam – adipose tissue

• BMI
• Waist circumference
• Skin folds
• Waist to hip ratio
• Waist to height
5. Physical exam – adipose tissue
• BMI
5. Physical exam – adipose tissue
5. Physical exam – adipose tissue
• Waist circumference
 5. Physical exam – anthropometry
- Height
- Height velocity
- Arm span
- Sitting height
5. Physical exam – anthropometry
- Height
- Height velocity
- Arm span
- Sitting height
 5. Physical exam – anthropometry
- Height
- Height velocity
- Arm span
- Sitting height
 5. Physical exam – anthropometry
- Height
- Height velocity
- Arm span
- Sitting height
5. Physical exam – anthropometry 2
5. Physical exam – anthropometry 2
5. Physical exam – anthropometry 3
5. Physical exam – anthropometry 3
5. Physical exam – anthropometry 3
5. Physical exam - thyroid
5. Physical exam – calcium and bone
5. Physical exam – calcium and bone
5. Physical exam – puberty & external
genitalia
5. Physical exam – puberty & external genitalia
5. Physical exam – puberty &external genitalia
5. Physical exam – external genitalia
5. Physical exam – gonads & external genitalia
5. Physical exam – gonads & external genitalia
Examples from the literature :)
Examples from the literature :)
 Examples from art :)

Caravaggio

Quentin Matsys Watteau

Juan Carreño de Miranda

Da Vinci

Charles Bell
Famous people with endocrine diseases
Endocrine exam - summary
• Pituitary – pituitary tumor syndrome
• Headache, cranial nerve abnormalities
• Optochiasmatic syndrome
• Clinical signs of hormonal hyper/hyposecretion
• Polyuria, polidypsia
• Thyroid
• Palpation –goiter, nodules, compression, +/- auscultation,
• clinical signs of hyper/hypothyroidism
• Parathyroids
• Signs of hypocalcaemia - Chvostek, Trousseau, hyperventilation
• Signs of hypercalcaemia
• Adrenals
• CSR – obesity, striae, hyper/hypopigmentations, HTA, hirsutism
• MSR - HTA
• Gonads
• Virilization, feminization, menstrual irregularities, sexual dysfunction, infertily