Examine the head-focus on abnormalities such as: prominent jaw or forehead, round or puffy face, dull or flat expression, exophthalmos (protruding eyeballs and retracted upper lids) Observe skin color for areas of pigment loss or excess; slow wound healing, bruising, and petechiae (seen with adrenal hypofunction); increased pigmentation of the skin over joints due to increased levels of ACTH and MSH. Vitiligo - patchy areas of pigment loss (seen with primary hypofunction of the adrenal glands) Inspect fingernails for malformation, thickness or brittleness (may suggest thyroid gland problems) Check the truck for abnormalities in chest size and symmetry; truncal obesity and the presence of a “buffalo hump” between the shoulders may indicate adrenocortical excess Striae - reddish-purple stretch marks on the breasts, abdomen (adrenocortical excess) Assess hair distribution-hirsutism (excessive hair growth especially on the face, chest, center abd line on women); hair loss or change in texture Palpate the thyroid for size, symmetry, shape; stand either behind or in front of the patient, have the swallow to help you palpate the thyroid (easily felt when normal); have them turn their head to the right to palpate the right lobe and left to palpate the left lobe. Auscultate the chest to assess cardiac rate and rhythm (some endocrine problems cause dysrhythmias); check orthostatic vital signs
Ask the family about changes in the patient’s behaviors or personality Diagnostic Testing *Assays - measure the level of a specific hormone in the blood or other body fluid. *Stimulation Test - a stimulus is used to determine normal of abnormal function for example-pt with underactive endocrine gland-measured amounts of hormones are given to stimulate the target gland to maximize production; hormone levels are measured and compared with expected nml values; failure of the hormone level to rise with stimulation indicated hypofunction. *Suppression Test - used when hormone levels are high drugs or other substances known to normally suppress hormone production are administered; failure of suppression of the hormone production indicated hyperfunction Venous Sampling - blood is taken directly from veins that drain a specific endocrine gland and hormone levels are measured. Unexpected blood hormone levels may indicate the location of a mass, a dysfunctional gland, or a dysfunctional part of a gland. *do not draw labs from a double or triple lumen; venous stick only *Urine Test -24 hour urine collection ; remind patient that collection is timed exactly 24 hours; tell them to avoid taking any unnecessary drugs during testing because drugs can interfere with the test Test for Glucose -helps dx DM; A1C reveals the average blood glucose over 3 months Imaging - x-ray, MRI with contrast (most sensitive for pituitary gland); thyroid, parathyroid, ovaries, testes can be evaluated by Ultrasound; CT scan to evaluate adrenal glands, ovaries, pancreas
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- Winter '16
- Endocrine System, thyroid gland, endocrine glands