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History taking and clinical examination of endocrine system

Approaches for some commonly encountered endocrinological problems & their presentation

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History taking and clinical examination of endocrine system

  1. 1. Presenter-Tanmoy Mandal & Rajat Kar Chairperson- Prof S.P. Chowdhury
  2. 2.  WEIGHT GAIN-Hypothyroid PCOS Cushing syndrome Insulinoma Patients on insulin therapy  WEIGHT LOSS Hyperthyroid DM Adrenal failure Thyroiditis Zollinger Ellison Syndrome Pheochromocytoma
  3. 3.  INCREASED APPETITE-DM Frohlich syndrome Laurence moon biedl syndrome Insulinoma  DECREASED APPETITE-Adrenal failure Hypothyroid Drugs-dexamphetamine Cushing syndrome
  4. 4.  OBESITY-  Cushing syndrome  Syndrome X  Sleep apnea syndrome  Laurence moon biedl syndrome  Frohlich syndrome  Prader willi syndrome
  5. 5.  DIARRHEA Hyperthyroid Hyperparathyroid DM WDHA Syndrome Carcinoid syndrome Adrenal failure Zollinger ellison syndrome Kwashiorkor VIPOMA  CONSTIPATION  Hypothyroid  Hypokalemia  DM  Porphyria  Amyloidosis  Pheochromocytoma  Vit D excess  Hypercalcemia  Visceral myopathy
  6. 6.  VOMITING-  DKA  Adrenal failure  Hypercalcemia  Amyloidosis  Porphyria  Hyperparathyroid  DM  Vit A toxicity  Acute zinc toxicity  Galactosemia  DI  Congenital adrenal hyperplasia  Fructose intolerance  MELAS
  7. 7.  PAIN ABDOMEN-  Hypercalcemia  DKA  Adrenal crisis  Hyperparathyroid  Acute intermittent porphyria  Carcinoid  Zollinger Ellison Syndrome  Ovarian Hyperstimulation syndrome  C1 esterase deficiency  Myxedema
  8. 8.  POLYDIPSIA-  Central DI  Nephrogenic DI  Primary polydipsia  DM  Drugs  Hypercalcemia  POLYURIA-  Central DI  Nephrogenic DI  DM  Drugs  Cushing syndrome  Hypercalcemia  Alcohol  Caffeine
  9. 9.  HYPERHIDROSIS-  Hyperthyroid  Hypogonadism  Pheochromocytoma  Acromegaly  Mitochondrial diseases  Menopause  Obesity  HYPOHIDROSIS-  Hypothyroid  DM  Amyloidosis  Laron syndrome  Alcoholics  GH receptor deficiency  Fabry disease  Ectodermal dysplasia
  10. 10.  HEAT INTOLERANCE-  Hyperthyroid  Hypothalamic tumors  Drugs- atropine, belladona  Post menopausal syndrome  Graves disease  COLD INTOLERANCE-  Hypothyroid  Adrenal failure  Hypopituitarism  Anorexia nervosa  Hypothalamic tumors  Hashimoto thyroiditis
  11. 11.  HYPERSOMNIA-  Hypothyroid  Pickwickian syndrome  Prader willi syndrome  Narcolepsy  Niemann pick disease type C  Sleep deprivation syndrome  INSOMNIA-  Graves disease  Cushing syndrome  Alcohol  Caffeine
  12. 12.  PRECOCIOUS PUBERTY-  Congenital adrenal hyperplasia  Adrenal tumors  Hypothalamic hamartoma  Mc Cune Albright syndrome  Angelman syndrome  Exogenous hormones  DELAYED PUBERTY-  Hypothyroid  Constitutional  Hypopituitarism  Turner syndrome  Klinefelter syndrome  Prader willi syndrome  Kallmann syndrome  Cushing syndrome  Androgen insensitivity syndrome
  13. 13.  HIRSUITISM-  PCOS  Cushing syndrome  Congenital adrenal hyperplasia  Ovarian tumors  Acromegaly  Porphyria cutanea tarda  Drugs- Danazol, phenytoin, minoxidil  DECREASED BODY HAIR-  Hypogonadotrophic hypogonadism  Klinefelter syndrome  Panhypopituitarism  Kwashiorkor  Zinc deficiency  Iron deficiency
  14. 14.  GYNAECOMASTIA-  Klinefelter syndrome  Hypopituitarism  Drugs  Hypogonadism  Hyperthyroid  Aging  Adrenal tumors  Prolactinoma  BREAST ATROPHY-  Aging  PCOS  Menopause  HRT
  15. 15.  SHORT STATURE-  Growth hormone deficiency  Kwashiorkor  Turner’s syndrome  Achondroplasia  Hypothyroidism  Rickets  Osteogenesis imperfecta  Prader willi syndrome  Malnutrition  TALL STATURE-  Acromegaly  Marfan syndrome  Fragile X syndrome  Androgen insensitivity syndrome  Sotos syndrome  Mc-Cune Albright syndrome  Klinefelter syndrome  Homocystinuria  Hyperthyroid
  16. 16.  ERECTILE DYSFUNCTION-  Hyperthyroid  Hypothyroid  Hypogonadism  Hemochromatosis  DM  Obesity  Hypercholesterolemia  Syndrome X  LOSS OF LIBIDO-  Hypothyroid  DM  Menopause  Hyperprolactinemia  Adrenal insufficiency  Drugs-SSRI
  17. 17.  LACTATIONAL FAILURE-  Sheehan syndrome  Drugs-metoclopramide  GALACTORRHEA-  Hypothyroid  Hyperprolactinemia  Pituitary adenoma  Drugs-antipsychotics, antidepressants  Male hypogonadism  CKD
  18. 18.  RECURRENT FRACTURE-  Cushing syndrome  Osteoporosis  Hypogonadism  Hyperthyroid  RTA-2  Rickets  Osteogenesis imperfecta  Hyperparathyroid  Osteopetrosis  BONE PAIN-  Hypercalcemia  Rickets  Hyperparathyroid  Paget disease of bone  Osteomalacia  Gaucher’s disease  Acromegaly
  19. 19.  POOR SCHOLASTIC PERFORMANCE-  Hypothyroid  Type 1 DM  Lead poisoning  Down’s syndrome  Fragile X syndrome  Klinefelter syndrome  FAILURE TO THRIVE-  Down’s syndrome  Inborn errors of metabolism  Cystic fibrosis  Hyperthyroid  Juvenile DM
  20. 20.  HYPERPIGMENTATI ON-  Adrenal failure  Hemochromatosis  Drugs- minocycline  Cushing disease  Porphyria  Nelson syndrome  Graves disease  Mercury poisoning  VITILIGO-  Hyperthyroid  Pernicious anemia  PGA syndrome  Drugs  Adrenal failure
  21. 21.  AMBIGUOUS GENITALIA-  21 alpha hydroxylase def  3 beta hydroxylase def  5 alpha reductase def  11 beta hydroxylase def  Androgen receptor defect  Drug induced  DECREASED TESTICULAR VOLUME-  Klinefelter syndrome  Hemochromatosis  Congenital adrenal hyperplasia  Cushing syndrome  Hyperprolactinemia  Kallman syndrome  Laurence moon biedl syndrome  Alcohol
  22. 22.  FLUSHING-  Carcinoid  Pheochromocytoma  Post menopausal  Hyperthyroid  Mastocytosis  Alcohol  Vit B3 excess  POSTURAL DIZZINESS-  Adrenal failure  DM  Hypoglycemia  Hyperthyroid  Hypothyroid  Hyperventilation syndrome
  23. 23.  HOARSENESS OF VOICE-  Hypothyroid  Goitre  Hashimoto thyroiditis  Acromegaly  Adrenocortical carcinoma  PROPTOSIS-  Graves disease  Cushing syndrome  Pheochromocytoma  Hypothyroidism  Acromegaly
  24. 24.  TREMORS-  Hyperthyroid  Hypercalcemia  Hyperparathyroid  FAHR Syndrome  Hypomagnesemia  Thiamine def  Hypoglycemia  Alcohol withdrawal  DEAFNESS-  Hypothyroid  Pendred syndrome  Alport syndrome  Usher syndrome  Drugs-aminoglycosides
  25. 25.  SEIZURES-  Hypoglycemia  Hypercalcemia  Hypocalcemia  Hypomagnesemia  VISUAL DISTURBANCE-  DM  Pituitary adenoma  Prolactinoma  Galactosemia  Hypothyroid  Zinc def.  Vit A def.  Storage diseases
  26. 26.  HEADACHE-  Pituitary adenoma  Nelson syndrome  Hypothyroid  Hypercalcemia  PARAESTHESIA-  DM  Cushing syndrome  Hypothyroid  Carcinoid syndrome  Myxedema  GH excess  Vit B 12 def
  27. 27.  Lithium  Amiodarone  Iodine supplements  Diuretics  Steroid  Vitamin A, D  Heparin  Anticonvulsant
  28. 28.  Onset of menses  Cycle  Duration  Flow  Dysmenorrhea  Menopause
  29. 29.  AMENORRHEA-  Hypothyroid  Hyperthyroid  Sheehan syndrome  Hyperprolactinemia  Hemochromatosis  PCOS  Turner syndrome  Congenital adrenal hyperplasia  Androgen insensitivity syndrome  OLIGOMENORRHEA-  PCOS  Hyperprolactinemia  Anorexia nervosa  Bulimia nervosa  Drugs- antipsychotics  Thyrotoxicosis  Prader willi syndrome
  30. 30.  PRIMARY-  Mullerian agenesis  Turner syndrome  Septo optic dysplasia  Kallmann syndrome  Swyer james syndrome  SECONDARY-  Hypothyroid  Hyperthyroid  Cushing syndrome  DM  PCOS
  31. 31.  Number of children  Last child birth  Vaginal delivery/ LSCS  Emergency / planned delivery  Prolonged third stage of labour  Gestational diabetes  History of large baby  Postpartum complication  History of severe blood loss postpartum  Lactational failure  History of infertility  Use of drugs for pregnancy

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