Endocrine: Examination
  1. Environment, general appearance
  2. Nails, hands, arms, axillae
  3. Face, eyes, mouth
  4. Neck, thyroid
  5. Chest, abdomen
  6. Genitalia, legs
Environment
  • N/A
General appearance
  • Characteristic syndrome appearance.
  • See Common Syndrome Exams Reference.
  • Stature.
  • Weight.
  • Ask pt. if any part tender before palpating.
Nails
Hands
  • Oversized hands (acromegaly).
  • Heat (hyperthyroid).
  • Tremor (hyperthyroid).
  • Palmar erythema (hyperthyroid).
  • Pigmentation of palmar crease (Addison's, but normal in asians, blacks).
  • 3rd, 5th metacarpals shortened (pseudohypoparathryoid).
  • Pulse: rate (hyper-, hypothyroid), rhythm, character. See Pulse Reference.
Arms
  • Blood pressure for hypertension (Cushing'), hypotension (Addison's).
  • Trousseau's sign (hypercalcemia):
    Occlude brachial artery for 3 min using BP cuff.
    See if carpal spasm is induced.
  • Muscle weakness (hypothyroid, Cushing's).
Axillae
  • Acanthosis nigricans (acromegaly).
  • Axillary hair loss (hypopituitary).
  • Skin tags (acromegaly).
Face
  • Syndrome facies.
  • Acne, oily skin (Cushing's).
  • Hirsutism (panhypopituitary).
  • Chin enlargement (acromegaly).
Eyes
Mouth
  • Buccal pigmentation (Addison's).
  • Tongue enlargement (acromegaly).
Neck
  • Inspect buffalo hump (Cushing's).
  • Palpate supraclavicular fat pads (Cushing's).
  • Inspect webbed neck (Turner's).
Thyroid
  • Inspect for goiter.
  • Dr. palpates pt's thyroid from behind.
Chest
  • Pigmented nipple (Addison's).
  • Loss, gain of chest hair.
  • Male gynecomastia (Cushing's).
  • Reduced female breast size (panhypopituitary).
Abdomen
  • Pt. lies down, one pillow under head.
  • Purple striae (Cushing's).
  • Disproportionate abdominal fat (Cushing's).
Genitalia
  • Atrophy.
  • Virilisation.
Legs
  • Peripheral neuropathy (DM).
  • Toenails and foot showing same symptoms as Fingernails and Hands.