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Examination of the endocrine system. Course work: methods of studying the endocrine system in normal and pathological conditions

Research methodology endocrine system consists of taking an anamnesis, examining the patient, palpation, auscultation, laboratory and instrumental research methods, both general and special.

For clinical examination an important condition is to comply with the sequence of examination endocrine organs: pituitary gland, thyroid gland, parathyroid glands, pancreas, adrenal glands, gonads.

When collecting anamnesis and examination, attention is paid to the presence or absence of the patient’s complaints and symptoms characteristic of the pathology of a particular endocrine gland. Complaints and symptoms indicating damage endocrine glands, are very diverse, since hormones have a great influence on metabolism, physical and mental development child, the functional state of various organs and systems of the child’s body.

Patients with pathology of the endocrine glands may have complaints about increased excitability, irritability, restless sleep, sweating, change in skin color, impaired hair and nail growth, thirst, etc.

Patients with hyperfunction of eosinophilic cells of the anterior pituitary gland may complain of gigantic (above 190-200 cm) height (gigantism), disproportionately large length of limbs, fingers and toes (acromegaly). One can also observe coarse facial features, prognathia, wide gaps between the teeth, and excessive kyphosis of the thoracic spine due to intensive growth of the vertebrae. There is also an increase brow ridges, well-defined muscles, but characteristic muscle weakness.

With hyperfunction of the basophilic cells of the pituitary gland, parents may complain of a significant increase in body weight, facial hair in girls (hirsutism), growth retardation, which is finally determined upon examination of the patient.

For pituitary insufficiency, typical complaints and symptoms are a decrease in height (by more than 25% compared to the norm), changes in facial expressions and “childish” facial features, poor muscle development, delayed or absent puberty, small size of the genital organs, marbling of the skin, cold limbs. The combination of these symptoms with adipose-sexual disorders (lower body) is possible with destructive damage to the hypothalamic-pituitary region.

With hyperthyroidism, there may be complaints of weight loss, irritability, excessive agitation and mobility, emotional instability, palpitations, increased moisture in the palms and general sweating, itching of the skin, a feeling of heat (fever), pain in the heart, tearfulness, and a feeling of pain in the eyes. Upon examination, you can detect trembling of the fingers, swelling of the eyelids, trembling of closed eyelids (Rosenbach's symptom), cutting blinking of the eyelids (Stellwag's symptom), one- or two-sided exophthalmos, impaired convergence of the eyes due to paresis of the internal rectus muscle of the eye (Mobius's symptom), white stripe sclera above the iris when looking down (Graefe's symptom), when looking up

(Kocher's sign), a white stripe of sclera around the iris with open eyes(Delrymple's symptom), "frightened", fixed gaze of shiny eyes.

When examining the neck of healthy children, especially during puberty, you can see the isthmus thyroid gland. If there is an asymmetry in the position of the thyroid gland, this indicates the presence of nodes. In a child with hyperthyroidism, one can observe an enlargement of the thyroid gland, degree I - enlargement of the isthmus, noticeable when swallowing; II degree - enlargement of the isthmus

and particles; III degree - “thick neck” (Fig. 44); IV degree - pronounced increase (goiter, sharply changes the configuration of the neck) (Fig. 45); V degree - a goiter of enormous size.

It should be noted that, unlike other formations in the neck, the thyroid gland mixes with the trachea during swallowing.

In patients with hypothyroidism, early lag in physical and mental development, late and incorrect teething, salivation, rough and hoarse voice, snoring when breathing, decreased interest in the environment, lethargy.

When examining a sick child, one can observe a delay in the development of facial bones, a saddle nose, Macroglossia, gray skin, puffy face, small eyes, thick lips, brittle nails, sparse hair on the head, short neck, limbs, fingers (bone growth in length is limited, but not in width).

Hyperfunction of the parathyroid glands leads to decreased appetite or even anorexia, nausea, vomiting, constipation, bone pain, muscle weakness, bone fractures, thirst, polydipsia, polyuria, depression, and memory impairment.

The history of patients with hypoparathyroidism includes high birth weight, slow loss of the umbilical cord remnant, chronic diarrhea, which often changes with constipation, developmental delay, photophobia, convulsions, excessive excitement, laryngospasm. During examination, optional symptoms may occur: eyelid spasm, conjunctivitis, cloudy lens of the eye, tooth decay, thin nails, hair pigmentation disorders.

If diabetes is suspected, it is necessary to find out whether the child has increased appetite(polyphagia), thirst (polydipsia) and increased urination (polyuria). At the same time, so-called minor symptoms may be observed diabetes mellitus- neurodermatitis, periodontal disease, furunculosis, itching in the genital area. On late stages Due to keto acidosis, appetite decreases, children get tired quickly, study worse, become lethargic and weak. Nocturnal and daytime enuresis, light-colored urine appears, after which starch stains remain on the underwear, paresthesia of the legs, visual acuity decreases, and xanthomas may appear on the palms.

In children infancy It is necessary to pay attention to low birth weight, weight loss (hypotrophy), pyoderma, and frequent inoculation.

Adrenogenital syndrome is a manifestation of congenital virilizing hyperplasia of the adrenal cortex. The history and examination of the patient reveals pseudohermaphroditism (enlargement of the clitoris, labia majora, abnormal development of the urethra, similar to hypospadias). Later, a male body type, hirsutism, low voice, and acne are observed. Boys may have macrogenitosomia (at 2-3 years), unnatural premature sexual development. Children of both sexes may experience tall, increased muscle strength, accelerated skeletal maturation. With more severe course signs of adrenogenital syndrome with loss of salts (Debreu-Fibiger syndrome) are noted. The above-mentioned manifestations of the disease include weight loss, slow weight gain and exicosis. Hyperthermia and hypertension are less common.

In patients with confirmed pituitary hyperplasia of the adrenal cortex, Itsenko-Cushing's disease is diagnosed. In Cushing's syndrome, the adrenal glands excessively produce cortisol (to a lesser extent aldosterone and androgens). Such patients complain, and upon examination there is stunted growth, “skinny” arms, changes in facial expressions and a moon-shaped face, with purplish-red skin. The skin of the torso and limbs is dry with numerous purplish-cyanotic stretch marks of atrophic origin. You can observe hypertrichosis, acne, pyoderma, mycosis. In girls, secondary sexual characteristics become reversed, and the cyclicity of menstruation is disrupted. In later stages, complaints of malnutrition or muscle atrophy, underdevelopment of the genital organs, and high blood pressure may appear.

With insufficient adrenal function with chronic course(the production of cortisol, aldosterone, and androgens decreases) patients experience the classic triad of signs characteristic of Addison's disease - adynamia, pigmentation, hypotension. Patients complain of weakness, fatigue, decreased mobility, and decreased appetite. Characterized by intestinal obstruction. Weight loss, drowsiness, and muscle weakness develop. In some patients, the first manifestation of the disease is brown pigmentation of the skin and mucous membranes of the oral cavity (through excessive production of melanocyte-stimulating hormone by the pituitary gland). Pigmentation extends to the neck, elbow joints, white line abdomen, genitals, hard palate, inner surface of the cheeks. At acute defeat adrenal glands, patients complain of severe weakness, pain in abdominal cavity, vomiting, diarrhea.

Very important element examination is to assess the child’s sexual development. To do this, the mammary glands and pubic hair are carefully examined in girls; in boys, the development of the penis and testicles, as well as the degree of pubic hair. Identified secondary sexual characteristics and their development should be determined according to the classification proposed by JMTanner in 1962. For both girls and boys.

In children with premature sexual development (up to 8 years in girls and up to 10 years in boys), the symptom complex includes a significant acceleration of growth, early appearance foci of ossification in the bones, premature synostosis, as a result of which the body does not reach full development. Mental abilities meet age requirements. Spermatogenesis appears early in boys and menstruation in girls, enlargement and hair growth of the genital organs. Against the background of general apathy and lethargy, sexual excitability can be observed. Nystagmus, ptosis, and abnormal gait are not often observed.

In the anamnesis and upon examination of the patient, hypogonadism (delayed sexual development for 2 years or more) reveals true gynecomastia, eunuch-like body structure (narrow rib cage, no hair, disproportionate long legs, very little facial hair, gynecomastia, inverted nipples, insufficient development of secondary sexual characteristics). Such children grow up tall, they have high voice, insufficient development of the larynx, muscles, genital organs, and secondary sexual characteristics.

Palpation is important for diagnosing lesions of the endocrine glands. However, not all glands are accessible for palpation.

Palpation is carried out according to well-known rules (warm, clean hands, correct position doctor and patient, without unauthorized persons; without causing unnecessary suffering to the patient, they first probe superficially and then deeper).

Palpation of the isthmus of the thyroid gland is carried out with sliding movements of the thumb, index and middle fingers right hand up from the handle of the sternum.

To palpate the right and left lobes of the thyroid gland, it is necessary to place the II-V bent fingers of both hands behind the posterior edges, and thumb- behind the anterior edges of the sternocleidomastial muscle. After this, the child is asked to take a sip, during which the thyroid gland will move along with the larynx. At the same time, the surface, consistency, mobility, size, and pain of the organ are determined.

Right and left lobe The thyroid gland is palpated without pain in the form of soft, tender formations with a smooth surface.

With the help of palpation, the characteristics of sexual disorders are clarified, in particular, when palpating the external genitalia, their size, the degree of reduction (increase), the number of testicles in the scrotum, their density, and the location of the testicle in cryptorchidism are determined. The thickness of the subcutaneous fat layer, skin temperature on the extremities, muscle tone and strength, and their consistency are assessed. Often, in patients with pathology of the endocrine glands, an enlarged liver is palpated and its soreness is determined.

Percussion in children with diseases of the endocrine system can detect bone pain due to hyperparathyroidism, reduction in size relative stupidity heart with hypogonadism, enlarged liver with diabetes mellitus, as well as the thymus goiter, which is determined above the handle of the sternum.

Auscultation in patients with thyrotoxicosis can listen to a vascular murmur above the surface of the gland; weakened heart sounds and systolic murmur at its apex in case of adrenal insufficiency.

To diagnose diseases of the endocrine system, it is necessary to use special laboratory tests, namely, determining the content of hormones in various biological fluids.

Based on determining the level of these hormones, one can draw a conclusion about the nature of the dysfunction of the corresponding endocrine glands.

4.3.1. Methods for determining hormones

Currently most used in clinical practice methods for determining hormones are:

Radioimmune,

Immunoradiometric,

Radioreceptor,

Chemical methods and others.

Until the late 60s, the only method for determining hormone levels was biological, the basic principle of which was that in biological system(animal, organ, tissue) a sample is introduced containing an unknown amount of hormone and according to the degree of expression response The level of the hormone in it is determined in biological units of action. Thus, prolactin dose-dependently stimulates the growth of the crop epithelium of pigeons, testosterone stimulates the growth of the prostate gland in immature and castrated rats.

Radioimmunoassay(RIA) determination of hormones is based on the competitive binding of radiolabeled and unlabeled hormones with specific antibodies. The hormone acts as an antigen. The advantages of RIA are high sensitivity, high specificity, accuracy, reproducibility and ease of performance. The disadvantage is the use of radioactive isotopes, which determines the limited shelf life of the test kits.

Immunoradiometric analysis(IRMA) is a modification of RIA in which not an antigen (hormone), but specific antibodies are labeled with a radioactive label.

Radioreceptor analysis(PRA) - instead of antibodies to hormones, their own receptors are used.

In addition to radioactive labels, enzymes can be used as markers in hormonal analysis ( enzyme immunoassay ) and luminescent substances ( luminescence analysis).

By using chemical methods determine the metabolites of hormones and their precursors (for example, norepinephrine and adrenaline, dopamine, serotonin in the urine). Determining the content of hormones in the blood gives more reliable and accurate results.

Hormones are determined in biopsied or sectioned material.

4.3.2. Instrumental methods

Instrumental methods complete the diagnostic search for diseases of the endocrine glands. The most commonly used are: ultrasound (US), radiography, computed tomography (CT), magnetic resonance imaging (MRI). In addition, they apply special methods, such as angiography with selective sampling of blood flowing from the endocrine gland to determine hormones, scintigraphy (radioisotope study) of the thyroid gland, adrenal glands, bone densitometry.

Ultrasound examination most often used in endocrinology. The principle of the method is that a sensor with a piezocrystal sends ultrasonic waves into the human body, and then perceives the reflected impulses, converting them into electrical signals, which enter the video monitor through an amplifier. Ultrasound helps determine the size and echostructure of the organ, as well as performing a puncture biopsy of the organs.

Computed tomography is based on obtaining a “slice” of the body by computer processing of data on the absorption capacity of tissues when a collimated beam of X-rays passes through them. IN computer tomographs A narrow X-ray beam emitted by the tube, passing through the layer under study, is captured by detectors and processed. Each tissue absorbs radiation differently depending on its density. The minimum size of the pathological focus, determined using CT, ranges from 0.2 to 1 cm.

Magnetic resonance imaging(MRI) is based on the possibility of changing resonance and relaxation processes in hydrogen protons located in a static magnetic field in response to the use of a radio frequency pulse. After the pulse stops, the protons return to their original state, “dumping” excess energy, which is captured by the device. The image is constructed based on the difference in energies from different points. MRI scanners allow you to make sections with a thickness of 0.5 - 1 mm. The advantages of MRI are non-invasiveness, lack of radiation exposure, and “transparency” bone tissue, high differentiation of soft tissues.

Genetic analysis

Molecular biological diagnostics is a highly informative method for diagnosing many endocrine diseases.

All hereditary diseases are divided into three main groups: chromosomal, genetic and diseases with hereditary predisposition.

To diagnose chromosomal endocrine diseases, the karyotyping method and the study of sex chromatin (Down, Shereshevsky-Turner, Klayfelter syndromes) are used. To find out gene mutations The method of compiling pedigrees (family trees) is widely used.

The development of diseases with hereditary predisposition is determined by the interaction of certain hereditary factors(mutations or combinations of alleles and factors external environment). Among the diseases of this group, the most studied are autoimmune diseases, such as diabetes mellitus, hypocortisolism, hypo- and hyperthyroidism.

In addition to predisposition to a disease, the genotype can determine its prognosis, the development of complications, as well as the prognosis of the effectiveness of the treatment methods used.

Most endocrine organs are inaccessible for direct examination, with the exception of the thyroid and gonads, therefore the state of the endocrine glands often has to be judged by clinical syndromes that are characteristic of hyper- or hypofunction of the affected gland, and homeostasis indicators.

Clinical examination of the endocrine system in children consists of studying complaints, medical history and life of the child, including genetic features family, conducting an objective examination of all organs and systems of the child, assessing data from additional research methods.

General examination of the patient

During an external examination of the child, attention is paid to the proportionality of the physique. Then an assessment is carried out physical development of the child, on the basis of which growth disorders can be identified. Grade physical development in children:

Considering the observed variation in various indicators of a child’s physical development, it is necessary to know the so-called normal, or Gaussian-Laplacian distribution. The characteristics of this distribution are the arithmetic mean value of the attribute or indicator (M) and the value of the standard deviation, or sigma (δ). Values beyond the M ± 2δ standard for healthy children, as a rule, indicate pathology.

In practice, indicative estimates retain their significance, in which the following empirical rule should be used: random variation of a trait that changes with age usually does not extend beyond one age interval; the value of a sign may be pathological in nature if its value is in the interval + 1-2 age intervals. The age intervals in the tables of standards are usually chosen as follows: from birth to one year the interval is equal to a month, from 1 year to 3 years - 3 months, from 3 to 7 years - 6 months, from 7 to 12 years - one year.

To accurately determine indicators of physical development, the pediatrician must use tables (or curves) of the age centile distribution. The practical use of these tables (graphs) is extremely simple and convenient. Columns of centile tables or curves graphically show the quantitative boundaries of a trait in a certain proportion or percentage (centile) of children of a given age and gender. In this case, the values characteristic of half of healthy children of a given age and gender - in the range from the 25th to the 75th centile - are taken as average or conditionally normal values.

With hypothyroidism, there is a delay in growth with a violation of body proportions - short limbs. The face has a characteristic appearance: a wide flat bridge of the nose, widely spaced eyes (hypertelorism), a relative predominance of the facial skull, a large thick tongue, thick lips and other symptoms of hypothyroidism.

Acceleration of growth is typical for pituitary gigantism, in which growth exceeds the required height by more than 15% (above the 97th centile, SDS = +2), and thyrotoxicosis. Body proportions do not change with either disease.

If the hyperfunction of the pituitary gland manifests itself after the closure of the growth plates, acromegaly develops - an enlargement of the nose, hands and feet, a massive lower jaw, and the brow ridges protrude strongly.

Inspection, palpation and assessment of skin condition. Pale skin with an icteric tint, grayish marbling, and dryness is noted in hypothyroidism. Waxy pallor is characteristic of pituitary tumors.

Purple-bluish coloration of the facial skin is observed with hyperfunction of the adrenal cortex (Cushing's syndrome and disease).

Hyperpigmentation of the skin (bronze tint) is observed with adrenal insufficiency.

Stretch marks (striae) are characteristic of Cushing's syndrome and hypothalamic obesity.

Dry skin is observed in diabetes mellitus and diabetes insipidus; In diabetes mellitus, in addition, there may be skin itching and furunculosis.

Increased skin moisture is observed in thyrotoxicosis, hypoglycemic conditions, and hyperinsulinism.

Hair condition. Dry, coarse, brittle hair is characteristic of hypothyroidism. Hirsutism (excessive hair growth in the male pattern in androgen-dependent areas) and hypertrichosis (excessive hair growth in androgen-independent areas) are associated with hyperfunction of the adrenal cortex.

Virilization- changes in the external female genitalia male type- observed with congenital dysfunction of the adrenal cortex, with tumors of the adrenal glands or ovaries.

Inspection, palpation and assessment of the distribution of subcutaneous fat. An excess amount of subcutaneous tissue with its uniform distribution is characteristic of constitutional-exogenous, nutritional, and diencephalic obesity.

Excessive deposits subcutaneous fat in the area of the shoulder girdle, 7th cervical vertebra, chest, abdomen is observed in diseases and Itsenko-Cushing syndrome.

Cerebral obesity is characterized by a bizarre distribution of subcutaneous tissue, for example on the outer surface of the shoulder, inner surface hips, etc.

There are 4 degrees of obesity:

I degree - excess body weight is 15-25% of the required amount,

II degree - -»- -»- from 25 to 50% -»-

III degree - -»- -»- 50-100% -»-

IV degree - -»- -»- more than 100%.

An important criterion for obesity is the body mass index (Quetelet) (BMI) - the ratio of weight in kg to height (in m 2). Obesity is defined as BMI exceeding the 95th centile for a given age and gender.

In the body, fat is located 1) in the subcutaneous fat (subcutaneous fat) and 2) around the internal organs (visceral fat). Excess subcutaneous fat in the abdominal area and visceral fat abdominal obesity forms in the abdominal cavity or "top" type. This type of fat distribution can be distinguished by measuring the circumferences of: the waist (WA) - under the lower edge of the ribs above the navel, the hips (HT) - at the level of the maximum protruding point of the buttocks, and calculating the WC/CV ratio. WC/BV values of more than 0.9 in men and more than 0.8 in women indicate the presence of abdominal obesity. On the contrary, when WC/TB values are equal to or less than 0.7, the “lower” or femorogluteal type of obesity is established.

A decrease in the development of subcutaneous fat is characteristic of Simmonds' disease (pituitary wasting), thyrotoxicosis, and diabetes mellitus before treatment.

Assessment of neuropsychic development and state of the nervous system

Hypothyroidism is characterized by a lag in mental development, while thyrotoxicosis is characterized by an acceleration of mental processes, short temper, irritability, tearfulness, fine tremor of the eyelids, fingers, instability of the autonomic nervous system.

With pituitary dwarfism and adipose-genital dystrophy, mental infantilism is observed; with hypoparathyroidism, increased neuromuscular excitability (positive Trousseau and Chvostek symptoms).

Then the endocrine glands accessible to objective examination are examined.

Methods for studying the thyroid gland:

Inspection. The thyroid gland is normally not visible to the eye and cannot be palpated. Upon examination, you can determine the degree of enlargement of the thyroid gland. Starting from the second (with an increase in degree I, it is not visible to the eye). In addition, upon examination, symptoms characteristic of a decrease or increase in the function of the gland are revealed: the condition of the skin, subcutaneous tissue, physical development, eye symptoms (exophthalmos-bulging eyes, Dalrymple's symptoms - widening of the palpebral fissure, Jellinek - pigmentation of the eyelids, Kraus - rare blinking, Graefe - lag upper eyelid when looking down, Möbius - convergence violation - when an object approaches the eyes, they first converge, and then one eye involuntarily moves to the side).

Palpation The thyroid gland is performed with the thumbs of both hands, which are located on the front surface, and the remaining fingers are placed on the back of the neck. In infants, palpation can be carried out with a large and index finger one hand. When palpating the gland in older children, they are asked to make a swallowing movement, while the gland moves upward, and its sliding at this time along the surface of the fingers facilitates palpation examination.

The isthmus of the thyroid gland is examined by sliding movements of the thumb of one hand along the midline of the neck in a direction from top to bottom. The isthmus is located on the anterior surface of the trachea below the thyroid cartilage and reaches the 3rd ring of the trachea. The lobes of the gland are located on both sides of the trachea and larynx, reaching the 5-6th tracheal ring.

When palpating the thyroid gland, it is necessary to note its size, surface features, the nature of the increase (diffuse, nodular, nodular), consistency (hard or soft elastic), pulsation, pain.

The term “goiter” is used when the thyroid gland is enlarged.

Currently in use WHO classification 2001, taking into account three clinical degrees of thyroid enlargement:

Grade 0 - the thyroid gland is not enlarged

1st degree - the thyroid gland is palpable

2nd degree - the goiter is palpable and visible to the eye

Auscultation examination of the thyroid gland is performed using a phonendoscope, which is applied to the gland. When the function of the gland increases, a vascular murmur is often heard over it. In older children, auscultation is performed while holding the breath.

Additional examination methods, used in the diagnosis of thyroid diseases in children:

Ultrasound examination – used to assess the size and structure of the gland;

Ultrasound examination with Dopplerography - blood flow in the gland is assessed;

Fine needle needle biopsy– cytological examination of punctate, used in nodular forms of goiter to determine the cellular nature of the nodes;

Determination of the concentration of hormones in blood serum: thyroxine (T-4), triiodothyronine (T-3) and thyroid-stimulating hormone (TSH). T-4 and T-3 in the blood are in a free and protein-bound state. Hormonal activity is determined by the concentration of free fractions of thyroid hormones, therefore, to assess the functional state of the thyroid gland, it is necessary to examine the free fractions of T-3 and T-4;

5) Isotope scintigraphy - can be used to diagnose hormonally active and/or inactive formations, especially small ones in children over 12 years of age.

Enzyme immunoassay or radioimmunoassay

A) Antibodies to thyroid peroxidase (TPO) and microsomal antigen fractions (MAG) - used to diagnose the autoimmune process in chronic autoimmune thyroiditis;

B) Antibodies to TSH receptors - examined if diffuse toxic goiter(Graves disease);

C) Antibodies to thyroglobulin are examined during observation of patients operated on for thyroid cancer (only in case of total resection).

7) X-ray method

Determination of bone age using radiographs of the hands.

The patient must be undressed.

I. Facial examination:

Pay attention to the harmony of features (with a disease of the pituitary gland, uneven bone growth is determined - an increase lower jaw, nose, brow ridges, zygomatic bones, etc.)

2.Skin color:

Pink color in diabetes mellitus, possible presence of xanthoma and xanthelasma;
Thin face with thin velvety skin, exophthalmos and pigmentation of the eyelids due to thyrotoxicosis;
A mask-like, expressionless face with slow facial expressions, a sleepy, waxy expression, puffy eyelids and narrowing palpebral fissures. The skin is dry, flaky – myxedema – a severe form of hypothyroidism;
Moon-shaped, purplish-red in color with the presence of pustules, stretch marks (striae), face - excessive production of adrenocorticotropic hormone (ACTH).

II. Hair condition:

Thin, brittle, slightly falling hair due to hyperthyroidism;
Thick, dull (without shine), brittle hair that falls out easily due to hypothyroidism;
Reduction or disappearance of hair in men on the chest, abdomen, pubis (secondary sexual characteristics) and male-type hair growth in women (appearance of a mustache, beard).

III. Skin examination:

Note the color, the presence of scratching (diabetes mellitus), pustular rashes, boils (diabetes mellitus, Ischeng-Cushing disease).
Pigmentation (meladerma) – chronic failure adrenal glands Pigmentation is especially pronounced on exposed parts of the body, in skin folds, in the area of the nipples and genitals, oral mucosa.
Determination of dryness and moisture of the skin is carried out visually (if the skin is dry, it becomes rough and thick; with high humidity, beads of sweat are noted) and always by palpation.

IV. Determining the patient's height

Place the patient in such a way that he touches the vertical board of the stadiometer with his heels, buttocks and shoulder blades.
Hold your head so that the upper edge of the outer ear canal and the outer corner of the eye on the same horizontal line.
Lower the horizontal bar onto your head and count the divisions.

V. Weighing the patient

Do it in the morning, on an empty stomach, after bowel movements. bladder and intestines, in underwear(with subsequent loss of laundry weight)

Weighing is carried out regularly, at certain intervals.

VI. Thickness of the subcutaneous fat layer

Gather the skin on the abdomen at the level of the navel into a fold.
In women, it should not normally exceed 4 cm, in men – 2 cm.

VII. Eye symptoms

Protruding eyes - exophthalmos
Wide opening of the palpebral fissures is Delrymple's symptom.
Glare in the eyes is a Kraus symptom.
Rare blinking is Stellwag's symptom.
Recession of the upper eyelid when looking down is Graefe's symptom.
Convergence disorder – Moebius sign (weakness of convergence)
Retraction of the upper eyelid with rapid changes of gaze - Kocher's sign

VIII. The presence of tremor is determined in the Romberg position:

The patient stands with his arms extended in front of his chest, fingers apart, not tense, heels together, eyes closed
Determine the presence of finger tremor
In case of pronounced tremor, it is necessary to carry out a finger-nose test, in which intention tremor can be detected - an increase in the amplitude of vibrations of the fingers when approaching the nose

IX. With disease of the endocrine glands, there may be swelling as a result of damage to the heart (diabetes mellitus, thyrotoxicosis), kidneys (diabetes mellitus), and a kind of tissue swelling ( mucous swelling) with hypothyroidism.

Large massive swellings are determined visually.

For slight swelling, palpation should be used:

Apply pressure with your fingers to the swollen skin, pressing it against the bone. Pits remain under the fingers, which are then smoothed out.

Endocrine diseases are all kinds of hormonal disorders that most often arise due to dysfunction of the thyroid and pancreas, as well as as a result of systemic diseases. Exactly to endocrine diseases refers to type 2 diabetes mellitus, the number of cases of which is steadily increasing in recent years and becomes truly menacing. All diseases of the endocrine system cause complex disorders in the body, reducing the quality of life and destroying human health.

Routine examinations of the endocrine system:
Since the likelihood of developing diabetes increases over the years, the frequency and necessity of control tests depends on age.
Up to 45 years of age, a blood test for glucose is done if there is any suspicion of hormonal disorders (as directed by a doctor).
After 45 years of age, a blood glucose test should be done at least once every three years.
At any age, if you are at risk for diabetes, you need to do it regularly.

More information about diseases and risk factors of the endocrine system -.

Blood glucose test

Target. The level of glucose (sugar) in the blood shows how well it is happening in the body carbohydrate metabolism with the participation of the hormone insulin. Exceeding the normal glucose level indicates hyperglycemia (one of the indicators of type 2 diabetes), falling below normal indicates hypoglycemia (indicative of a lack of energy).

Way. In the classic case, blood is taken for glucose on an empty stomach: at least 8-10 hours must pass between the last (evening) meal and blood sampling. Also during this period you should not drink sweet drinks, alcohol, you can only drink water and weak unsweetened tea. Also, as prescribed by the doctor, blood is taken for glucose under load: in this case, a control blood sample is first taken on an empty stomach, then the person drinks a sweet solution, and his blood is taken again - several times over two hours. This allows you to track the dynamics of the increase and regulation of blood sugar levels.

Conclusions. Normal level blood sugar is 3.3 - 5.5 mmol/l. The closer your indicator is to the upper limit, the more alarming the result. Increased level glucose in the blood signals not only the possibility of developing diabetes mellitus, but also a number of other disorders, for example, pancreatitis, cystic fibrosis, pancreatic dysfunction. Even severe stress can cause blood glucose levels to rise.

Blood test for hormones

Target. Characteristic feature hormones produced by the thyroid, pancreas, reproductive system, adrenal glands, pituitary gland have a general effect on the body. Therefore, if any hormonal imbalance occurs, the consequences can be very diverse - from the development of diabetes mellitus to problems with reproductive function, leather, etc. Hormone analysis allows you to determine the level of various hormones in the blood, compare it with the norm and draw appropriate conclusions.

Way. Blood for hormones is donated on an empty stomach from a vein: 10 hours before blood collection you should not eat or drink, you should also refrain from physical activity and hectic activity at work. If you are taking any medications, especially hormonal ones, consult your doctor and decide on a temporary withdrawal regimen so as not to harm yourself and to obtain reliable test results.

Conclusions. The result of a blood test for hormones is a list of hormones (testosterone, estrogen, progesterone, prolactin, luteinizing hormone, thyroid hormones, etc.) and their levels in your blood. If one of the values does not fit into the norm, we can talk about a violation. But only a doctor can draw conclusions, because not only individual values are important, but also their combination.

Ultrasound of the thyroid gland and adrenal glands

Target. Ultrasound of the endocrine glands - the thyroid gland and adrenal glands - allows us to identify disorders in the health of the organs themselves, which led to hormonal imbalance. An ultrasound is performed to determine the causes hormonal disorders, as well as in cases where there are suspicions of changes in the glands (nodules in the thyroid gland).

Way. Ultrasound is performed using a machine ultrasound examination: a specialist places a sensor in the area of the thyroid gland or adrenal glands and, receiving a picture on the monitor, can visually assess the condition of the organ and the nature of the disorders. The shape, size of the glands, the presence of deviations and deformations, as well as neoplasms are assessed. Also considered lymph nodes and circulatory system.

Conclusions. The result of the analysis is an ultrasound image and its visual interpretation relative to the norm. As a rule, ultrasound of the endocrine glands allows high degree accurately detect the presence of neoplasms in organs and visible changes in their structure. The image analysis is carried out exclusively by a doctor.

Clinical examination of the endocrine system in children consists of studying complaints, medical history and life of the child, including genetic characteristics of the family, conducting an objective examination of all organs and systems of the child, and evaluating data from additional research methods.

General examination of the patient

Pituitary dwarfism is characterized by a slowdown in growth without changing body proportions. You can think about dwarfism if the child’s height lags behind what should be and goes beyond M-3δ (in the sigma series), below the boundaries of the 3rd centile (in centile tables) or SDS<-2. Рост взрослого мужчины-карлика не превышает 130 см, рост женщины - менее 120 см.

Inspection, palpation and assessment of skin condition. Pale skin with an icteric tint, grayish marbling, and dryness is noted in hypothyroidism. Waxy pallor is characteristic of pituitary tumors.

Purple-bluish coloration of the facial skin is observed with hyperfunction of the adrenal cortex (Cushing's syndrome and disease).

Hyperpigmentation of the skin (bronze tint) is observed with adrenal insufficiency.

Stretch marks (striae) are characteristic of Cushing's syndrome and hypothalamic obesity.

Dry skin is observed in diabetes mellitus and diabetes insipidus; In diabetes mellitus, in addition, there may be skin itching and furunculosis.

Increased skin moisture is observed in thyrotoxicosis, hypoglycemic conditions, and hyperinsulinism.

Virilization- changes in the external female genitalia according to the male type - observed with congenital dysfunction of the adrenal cortex, with tumors of the adrenal glands or ovaries.

Excessive deposition of subcutaneous fat in the area of the shoulder girdle, 7th cervical vertebra, chest, and abdomen is observed in Itsenko-Cushing disease and syndrome.

Cerebral obesity is characterized by a bizarre distribution of subcutaneous tissue, for example, on the outer surface of the shoulder, inner thighs, etc.

There are 4 degrees of obesity:

I degree - excess body weight is 15-25% of the required amount,

II degree - -»- -»- from 25 to 50% -»-

III degree - -»- -»- 50-100% -»-

IV degree - -»- -»- more than 100%.

In the body, fat is located 1) in the subcutaneous fat (subcutaneous fat) and 2) around the internal organs (visceral fat). Excess subcutaneous fat in the abdominal area and visceral fat in the abdominal cavity form abdominal obesity. or "top" type. This type of fat distribution can be distinguished by measuring the circumferences of: the waist (WA) - under the lower edge of the ribs above the navel, the hips (HT) - at the level of the maximum protruding point of the buttocks, and calculating the WC/CV ratio. WC/BV values of more than 0.9 in men and more than 0.8 in women indicate the presence of abdominal obesity. On the contrary, when WC/TB values are equal to or less than 0.7, the “lower” or femorogluteal type of obesity is established.

A decrease in the development of subcutaneous fat is characteristic of Simmonds' disease (pituitary wasting), thyrotoxicosis, and diabetes mellitus before treatment.

Assessment of neuropsychic development and state of the nervous system

With pituitary dwarfism and adipose-genital dystrophy, mental infantilism is observed; with hypoparathyroidism, increased neuromuscular excitability (positive Trousseau and Chvostek symptoms).

Then the endocrine glands accessible to objective examination are examined.

Methods for studying the thyroid gland:

Inspection. The thyroid gland is normally not visible to the eye and cannot be palpated. Upon examination, you can determine the degree of enlargement of the thyroid gland. Starting from the second (with an increase in degree I, it is not visible to the eye). In addition, upon examination, symptoms characteristic of a decrease or increase in the function of the gland are revealed: the condition of the skin, subcutaneous tissue, physical development, eye symptoms (exophthalmos-bulging eyes, Dalrymple's symptoms - widening of the palpebral fissure, Jellinek - pigmentation of the eyelids, Kraus - rare blinking, Graefe - lag of the upper eyelid when looking down, Möbius - violation of convergence - when an object approaches the eyes, they first converge, and then one eye involuntarily moves to the side).

Palpation The thyroid gland is performed with the thumbs of both hands, which are located on the front surface, and the remaining fingers are placed on the back of the neck. In infants, palpating can be done with the thumb and index finger of one hand. When palpating the gland in older children, they are asked to make a swallowing movement, while the gland moves upward, and its sliding at this time along the surface of the fingers facilitates palpation examination.

When palpating the thyroid gland, it is necessary to note its size, surface features, the nature of the increase (diffuse, nodular, nodular), consistency (hard or soft elastic), pulsation, pain.

The term “goiter” is used when the thyroid gland is enlarged.

Currently in use WHO classification 2001, taking into account three clinical degrees of thyroid enlargement:

Grade 0 - the thyroid gland is not enlarged

1st degree - the thyroid gland is palpable

2nd degree - the goiter is palpable and visible to the eye

Additional examination methods, used in the diagnosis of thyroid diseases in children:

Ultrasound examination – used to assess the size and structure of the gland;

Ultrasound examination with Dopplerography - blood flow in the gland is assessed;

Fine-needle puncture biopsy is a cytological examination of punctate, used in nodular forms of goiter to determine the cellular nature of the nodes;

5) Isotope scintigraphy - can be used to diagnose hormonally active and/or inactive formations, especially small ones in children over 12 years of age.

Enzyme immunoassay or radioimmunoassay

A) Antibodies to thyroid peroxidase (TPO) and microsomal antigen fractions (MAG) - used to diagnose the autoimmune process in chronic autoimmune thyroiditis;

B) Antibodies to TSH receptors - tested for suspected diffuse toxic goiter (Graves disease);

C) Antibodies to thyroglobulin are examined during observation of patients operated on for thyroid cancer (only in case of total resection).

7) X-ray method

Determination of bone age using radiographs of the hands.

Complaints about fatigue, mood swings, sometimes tearfulness, emotional lability, palpitations that increase with physical activity -1-! these complaints are characteristic of thyrotoxicosis.
Some patients note a feeling of heat and decreased chilliness (patients sleep under a thin blanket or sheet). It is believed that the pathophysiological basis of this symptom is an increase in metabolism (due to increased activity of the thyroid gland).
Complaints of drowsiness, chilliness, apathy, lethargy, poor memory, sometimes in combination with constipation, can be manifestations of hypothyroidism.
Complaints of thirst (polydipsia), polyuria, dry mouth, increased appetite or, conversely, decreased appetite, and periodic itching of the skin are characteristic of diabetes mellitus. In most cases, the listed symptoms are observed during decompensation of the disease.
Complaints of attacks of unreasonable fear, accompanied by chills, headache, sometimes dizziness, nausea and vomiting, can be observed with pheochromocytoma, a hormonally active tumor of the adrenal glands.
Complaints about darkening of the skin, pigmentation of certain areas of the body, especially in places of natural pigmentation, combined with complaints of weakness, weight loss, muscle fatigue and muscle pain are characteristic of chronic adrenal insufficiency. Synonyms of this term are: hypocortisolism, bronze disease, Addison's disease.
Complaints of cramps, often in the flexor muscles of the upper limbs, the appearance of periodic trismus - convulsive clenching of the jaws and other forms of cramps of striated muscles are a sign of hypoparathyroidism.
Complaints of progressive weakness, severe fatigue, drowsiness in combination with rapid weight gain make it necessary to exclude the presence of adiposogenital dystrophy in the patient.
Complaints of severe thirst and corresponding polyuria, when daily diuresis reaches several liters, may be signs of diabetes insipidus.
Complaints of severe weakness, poor appetite, weight loss, polyuria combined with complaints of bone pain, a tendency to loose teeth and frequent bone fractures that heal poorly may be signs of hyperthyroidism.

The pathological course of menopause occupies a borderline position between therapy (endocrinology) and gynecology. Women's complaints about the sensation of hot flashes - short-term sensations of heat combined with increased sweating, irritability, and sometimes tearfulness - require a detailed collection of gynecological history and gynecological examination to exclude this disease. Male menopause occurs more smoothly, mainly with the development of symptoms of weakened sexual potency.
The examiner obtains a family and sexual history. The man is asked whether he is sexually active and at what age, and the number of children. The woman is asked if she has periods, their regularity and abundance (in particular, the number of days). In mature and elderly women, the time of menopause and the peculiarities of the menopausal period (presence of hot flashes and their frequency) are clarified. Next, you should find out the number of pregnancies and births; if there was no pregnancy, identify the cause.

Physical research methods

Examination of the patient

In some cases, examination of the patient is the triggering moment, forcing one to suspect endocrine pathology and direct the examination of the patient along this path.

First of all, the patient’s endocrine status is visually assessed. It is necessary to pay attention to the patient's weight and height. The average height of an adult man in Europe ranges from 170 to 190 cm, women - from 150 to 180 cm. In the second half of the 20th century. the height of the younger generation has increased by an average of 10-20 cm. Accordingly, the weight of a man should be in the range of 70-90 kg, and that of a woman - from 40 to 60 kg.
If these parameters are exceeded, they speak of a pathology that may be associated with the endocrine status. Height above 2.5 m in men and more than 2.1 m in women is called gigantism, below 1 m - dwarfism, which is also associated with pathology of the endocrine system. When growth is very low, it is customary to talk about nanism (nanos - dwarf).

To calculate the ideal ratio of height and weight, it is recommended to use the formula. The simplest method is to use the Broca index:
Ideal body weight = (height in cm - 100) ± 10% correction according to constitutional type.
With a Broca's index in the range of 90-100%, the indicators are considered satisfactory; an index above 110% indicates excess weight.
There are four degrees of obesity:

I degree: index 110-125%;
II degree: index 125-150%;
III degree: index 150-200%;
IV degree: index above 200%.

If you are overweight or obese, you should pay attention to the distribution of adipose tissue. This is now given great importance, since obesity has become a global problem, and with high weight, mortality increases by 4-6 times.

According to modern concepts, there are two types of obesity:

android;
gynoid.

With the android type of obesity, there is a predominant deposition of fat in the upper half of the body and on the abdomen. With the gynoid type of obesity, deposits are more noticeable on the hips and buttocks.

Thus, the characteristic signs of endocrine pathology are the following external manifestations:

acromegaly (Greek asgop - limb) - disproportionate enlargement of the limbs, face and other parts of the skeleton;
gigantism - unusually high (more than 2.5 m) height of the patient;
nanism - dwarfism, when the height of an adult patient is less than 140 cm;
Itsenko-Cushing syndrome - morbid obesity with the presence of purple scars on the skin (striae, which are often located in the lower abdomen and thighs), often combined with pathological baldness. A sign of chronic elevated serum cortisol concentrations;
morbid obesity;
bronze coloration of the skin and mucous membranes due to adrenal insufficiency, Addison's disease;
The hair type may not correspond to the patient's gender, which requires genetic analysis. When examining a patient, the presence of severe obesity of the female type with fat deposition on the hips, buttocks, and breasts in combination with hypoplasia of the genital organs requires the exclusion of adiposogenital dystrophy;

1. Complaints from the central nervous system

2. From the SSS side

3. From the genital area

4. Complaints due to metabolic disorders

1 – irritability, increased nervous excitability, causeless anxiety, insomnia, neurovegetative disorders, tremors, sweating, feeling hot, etc. (diffuse toxic goiter, thyroid disease); hypothyroidism – lethargy, indifference, indifference, drowsiness, memory impairment.

2 – shortness of breath, palpitations, pain in the heart area, interruptions in heart function, changes in pulse, blood pressure.

3 – decreased sexual function. Irregular menstruation, impotence, decreased libido lead to infertility.

4 – loss of appetite. Change in body weight. Polyuria, thirst, dry mouth. Pain in muscles, bones, joints.

They may complain of slow growth (with diseases of the pituitary gland); changes in appearance. They may complain of hoarseness, rough voice, and difficulty speaking. Changes in skin, hair, nails.

Objective examination.

Changes in the patient's appearance and characteristics of his behavior. With diffuse toxic goiter - mobility, fussiness, animated gestures, frightened facial expression, exophthalmos.

Hypothyroidism - slowness, low mobility, swollen sleepy face, poor facial expressions, ballroom withdrawn, indifferent, etc.

Changes in the patient's height, changes in size and ratio of body parts - gigantic growth (above 195 cm), with diseases of the pituitary gland, as well as the gonads, develop according to the female type. Dwarf height - less than 130 cm - children's body proportions. Acromegaly - a disease of the pituitary gland - an increase in the size of the limbs - a large head with large facial features.

Changes in body hair – with pathology of the gonads – thinning of hair growth. Premature graying and hair loss.

Accelerated hair growth.

Features of fat deposition and nutritional pattern – weight loss up to cachexia (DTC), with hypothyroidism – weight gain, obesity. Predominantly fat deposition in the pelvic girdle. Pituitary gland diseases.

Changes in the skin – the skin is thin, tender, hot, moist – DTS. With hypothyroidism, the skin is dry, flaky, rough, and pale.

Palpation. Thyroid gland. Size, consistency, mobility.

1. 4 bent fingers of both hands are placed on the back surface of the neck, and the thumb is placed on the front surface.

2. The patient is offered swallowing movements during which the thyroid gland moves along with the larynx and moves between the fingers.

3. The thyroid isthmus is examined by sliding fingers along its surface from top to bottom.

4. For ease of palpation of each of the lateral lobes of the gland, press on the thyroid cartilage from the opposite side. Normally, the thyroid gland is not visible and usually not palpable.

Sometimes the isthmus can be palpated. In the form of a transversely lying smooth painless roll of elastic consistency no wider than the middle finger of the hand. During swallowing movements, the fluid will move up and down by 1-3 cm.

There are three degrees of thyroid enlargement:

0 - no goiter.

I. The thyroid gland is not visible, but is palpable. Moreover, its size is larger than the distal phalanx of the patient’s thumb.

II. The thyroid gland is visible and palpable. "thick neck"

Palpation results:

1. The thyroid gland is uniformly enlarged, of normal consistency, painless, and displaced.

2. The thyroid gland is enlarged, with nodes, painless, displaced - endemic goiter.

3. Thyroid with dense nodular or tuberous formations, fused to the skin, growing into the surrounding tissues and not dislodging when swallowing - thyroid cancer

Laboratory methods.

Biochemical blood test.

Blood test for hormones - TSH, T3 - triiodotyranine, T4 - triiodotyraxine.

Determination of glucose in blood. OTTG – oral glucose tolerance test.

Urine examination. General urine analysis. Daily amount of urine for sugar. 2 cans are given - one is 3 liters, the second is 200 ml. before the study, the usual drinking regimen. No night urine. Stirred. Pour into a small jar. We attach the direction, with the inscription of the amount of urine.

Instrumental research. X-ray. Ultrasound.

Clinical syndromes:

1. Hyperglycemia syndrome

2. Hypoglycemia syndrome

3. Hyperthyroidism syndrome

4. Hypothyroidism syndrome

5. Hypercortisolism syndrome

6. Hypocortisolism syndrome

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"Kovrov Medical College"

Abstract on the topic:

“Methods for studying patients with diseases of the endocrine system”

Completed:

Student of group 33-L

Sirotkina Olga

Supervisor:

Chuprova N.K.

Kovrov, 2009

The procedure for studying patients with diseases of the endocrine system


Weakness Sexual dysfunction Irritability, insomnia Lethargy, chilliness, memory loss Change in body weight Change in appearance Change in appetite Palpitations, heart pain, headache Thirst, polyuria Changes in skin, hair, nails Diarrhea or constipation Itchy skin
Medical history
Risk factors Dynamics Survey data Treatment given Complications
Life history
Growth and development Skull injuries Past diseases Use of hormonal drugs Sexual disorders Heredity Neuropsychic stress Gynecological history Working and living conditions
Objective research
	Palpation
Facial expression, behavioral characteristics Skin change Changes in hair, nails, hair type, alopecia Obesity, features of fat deposition Thyroid enlargement "Eye" symptoms Hand tremors	Skin condition (humidity, temperature, turgor, elasticity) Thyroid gland
Laboratory and instrumental research methods
Thyroid gland	Pancreas	Pituitary gland, adrenal glands
Level of thyroid hormones in the blood Scanning BX Level of protein-bound iodine in the blood Thermometry	Fasting blood sugar level Blood sugar profile Daily glycosuria Acetonuria Alkaline blood reserve	Anthropometry X-ray, tomography of the skull Ultrasound, tomography, pneumo-retroperitoneum, adrenal scintigraphy Levels of pituitary and adrenal hormones in the blood and urine

The endocrine glands produce hormones that perform various functions, and when their activity is disrupted, a wide variety of disorders occur in the body. Therefore, it is almost impossible to identify a small number of complaints characteristic only of endocrine pathology. Most often, complaints are identified due to malfunction of the following systems:

Central nervous system

Cardiovascular system

Genital area

Metabolism

CNS disorders are detected in all patients with VVS diseases. It appears as:

Irritability;

Increased nervous excitability;

Unreasonable anxiety;

Insomnia.

These complaints are characteristic of hyperthyroidism—increased thyroid function.

With hypothyroidism, a decrease in thyroid function, the following are observed:

Drowsiness;

Memory impairment;

Chilliness

Patients are also characterized by neurovegetative disorders:

Sweating;

Feeling hot;

Cardiovascular disorders occur in many types of endocrine pathologies, but are most typical for diseases of the thyroid gland, adrenal glands and pituitary gland.

Patients complain of:

Tingling in the region of the heart;

Heartbeat;

Shortness of breath on exertion.

Sexual disorders.

Decreased sexual function (cessation of menstruation, impotence, decreased libido) occurs primarily in diseases of the gonads, but is often observed in cases of dysfunction of the pituitary gland, adrenal glands, and thyroid gland.

Complaints related to changes in metabolism.

Appetite disturbances are possible both in the direction of increasing it (polyphagia, bulimia) and decreasing it up to the point of aversion to food (anorexia).

Changes in the patient's body weight are not always adequate to changes in appetite.

With hypothyroidism (myxedema), patients gain weight with decreased appetite.

People with hyperthyroidism and diabetes mellitus lose weight, despite a good appetite.

Polyuria, thirst, dry mouth are observed in diabetes mellitus and diabetes insipidus and are associated with impaired water and carbohydrate metabolism.

Pain in muscles, bones, and joints is constantly observed with dysfunction of the adrenal glands and pituitary gland and is explained by osteoporosis (loss of bone tissue), which sometimes leads to pathological bone fractures with minor injuries. These phenomena are a consequence of disturbances in mineral metabolism.

Other complaints.

Slow growth - with pathology of the hypothalamus, pituitary gland;

Changes in appearance - with Itsenko-Cushing's disease and syndrome, diseases of the thyroid gland, pituitary gland;

Changes in skin, hair, nails:

Dry skin - with hypothyroidism, diabetes mellitus and diabetes insipidus;

Swelling - with hypothyroidism;

Skin itching - with diabetes mellitus and diabetes insipidus;

Fragility, hair loss on the head, loss of eyebrows, eyelashes, brittle nails - with hypothyroidism;

Hair loss on the head, excess hair on the face and body - in case of Itsenko-Cushing's disease and syndrome;

Constipation - with hypothyroidism;

Diarrhea - with thyrotoxicosis;

Vomiting, abdominal pain - with untreated diabetes mellitus, adrenal insufficiency (Addison's disease).

Medical history

Determining the history of the development of the present disease is carried out according to the general scheme:

Risk factors;

Onset of the disease;

Development of the disease;

The treatment carried out, its duration, effectiveness.

Life history

From the life history for the diagnosis of endocrine diseases, the following information is of particular importance:

Place of birth and residence of the patient.

Geographic location is essential for identifying possible endemic goiter caused by a lack of iodine in the soil and water of some areas.

Features of the individual development of the patient:

Birth injuries;

Growth pattern;

Data on sexual disorders.

Particular attention is paid to the onset of puberty and the appearance of secondary sexual characteristics.

Delay in sexual development may be a manifestation of a disorder of the gonads, adrenal glands, or thyroid gland;

Early development of sexual characteristics is a consequence of increased function of the gonads.

Gynecological history in women.

The time of appearance and nature of menstruation, as well as the appearance of signs of menopause, are determined. How did pregnancy and childbirth proceed?

Often endocrine diseases occur during puberty, after childbirth or during menopause.

Working and living conditions:

Conflict situations;

Occupational hazards and accidents.

The use of hormonal and antihormonal drugs (treatment with insulin, Mercazolil, steroid hormones of the adrenal cortex, the use of anabolic steroids to build muscle mass).

Hereditary predisposition.

General inspection

Examination is a valuable method in diagnosing endocrine disorders. Often the diagnosis can be assumed at the first glance at the patient based on some characteristic signs.

In many diseases of the endocrine glands, the appearance and behavioral characteristics of patients attract attention:

Mobility, fussiness, animated gestures and a tense-frightened facial expression, which is caused by exophthalmos, rare blinking, increased shine of the eyes;

Slowness, low mobility, sleepy, swollen face, almost without facial expressions;

Closedness of patients, indifference to the environment;

"Moon Face";

Changing the shape of the neck.

The patient’s height, size and ratio of parts of his body:

Gigantic growth

Dwarf stature

Increased size of limbs, large head with large facial features

Changes in body hair:

Hair thinning;

Accelerated hair growth in children;

Change in hair type.

Nutritional pattern and fat deposition characteristics:

Emaciation;

Increase in body weight;

Predominant fat deposition in the pelvic girdle;

Even distribution of fat throughout the body;

Excessive fat deposition on the face and torso.

Skin changes:

Tender, moist, with hyperemia, hot to the touch;

Rough, pale;

Thin, atrophic, flabby, with numerous fine wrinkles;

Rough, thickened, compacted;

Oily, acne-prone, with stretch marks;

Bronze color.

Palpation

Palpation as a method of studying endocrinological patients is used to evaluate the thyroid gland and male reproductive glands - the testicles.

Rules for palpation of the thyroid gland.

Four bent fingers of both hands are placed on the back surface of the neck behind the anterior edges of the sternocleidomastoid muscles, and the thumb is placed on the front surface.

The patient is asked to make swallowing movements, during which the thyroid gland moves along with the larynx and moves between the fingers of the examiner.

The isthmus of the thyroid gland is examined by sliding fingers along its surface from top to bottom.

For ease of palpation of each of the lateral lobes of the gland, pressure is applied to the thyroid cartilage from the opposite side.

Percussion, auscultation

These methods occupy a secondary place in the diagnosis of endocrinological disorders:

Percussion above the manubrium of the sternum reveals a substernal goiter;

Auscultation allows you to listen to noise over the thyroid gland in cases of its hyperfunction, the appearance of which is explained by increased vascularization of the gland and is combined with its pulsation determined by palpation.

Additional research methods.

Determination of hormones in the blood;

Glucose tolerance test;

Scintigraphy;

Test with the absorption of radioactive I131 by the thyroid gland;

X-ray methods;

Thermography;

Thermometry.

References

1. Great medical encyclopedia.

2. Propaedeutics in therapy.

3. Basics of nursing in therapy.