Wednesday, April 15, 2009

Essentials of Endocrinology Part ii

Following symptom may suggest some of the common endocrinal/metabolic disorders.

NAUSEA:Most common manifestation of thyrotoxicosis is loose stool but occasionally it may be associated with nausea and vomitting.If a patient present with constant nausea and vomitting in the absence of significant structural diseases ,then we can consider the following endocrinal disorders as a differential diagnosis.They are adrenal insufficiency(nausea maximum in the morning associated with vomitting.)and hypercalcaemia.

CONSTIPATION/DIARRHOEA: Hypothyroidism or pan hypopitutarism may present with constipation and abdominal distension. Diarrhoea may occur as a part of autonomic neuropathy involving the gut in diabetes mellitus. Peptic ulceration may occur in zollinger Ellison syndrome.

SKIN CHANGES: In hyperthyroidism the skin is dry and hot, whereas in hypothyroidism skin appears pale sallow or slight yellow and thinning of scalp and lateral eye brow hair. Vitelligo, a common feature of autoimmune hyperthyroiditis and vitamin B12 deficiency. Excessive pigmentation is a feature of Cushing syndrome with increased sebum production causing greasy skin and acne on the face and shoulders. Violaceous cyanosis like skin discoloration may be a feature of carcinoid tumors of gut or lung (because of increased 5 hydroxy indole acetic acid 5HIAA). In hypoadrenalism, there is a pallor with pigmentation of conjunctival membrane beneath the lids, inside the mouth and axilla

MENSES :Regular menstration is a good indication against the androgen excess.,In such cases ,hirsuitism (Excess hair growth) can be considered as constitutional than Pathological.Pathological causes of excess hair growth include polycystic ovarian syndrome,late presentation of congenital adrenal hyperplasia,androgen secreting ovarian tumors.Moreover an increased libido suggests an increased androgen secretion

RENAL STONE: Renal stone may present due to primary hyperparathyroidism or it occur as a part of the syndrome multiple endocrine neoplasia.(MEN Type 1) or else it may run in families as an isolated disorder.

CRAMPS and paraesthesiae:If it is bilateral,it is due to hypoparathyroidism (decreased circulating ionized calcium level) or it may be associated with metabolic/respiratory alkalosis. Refractory cramping after correction of hypocalcaemia due to associated hypomagnesaemia.

Part 1

Source and links

Hutchison's clinical method and endocrineweb

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