History, examination and investigation
The presentations of endocrine disease are diverse, and the findings in the history and on examination of the patient reflect this. Although multiple endocrine disorders may occur in the same patient, most have abnormalities of a single hormonal system, and the symptoms, signs and necessary investigations relate closely to those abnormalities.
A full history and examination is essential in any patient with a suspected endocrine disorder. Common presentations that should raise the possibility of endocrine disease are listed in Table 87, Table 88.
The diagnosis of endocrine diseases has been advanced by techniques that can measure low concen-
Table 87. Common presenting complaints in endocrine disease
Body size and shape
• Short stature
• Tall stature
• Excessive weight or weight gain
• Loss of weight
Metabolic effects
• Tiredness
• Weakness
• Increased appetite
• Decreased appetite
• Polydipsia or thirst
• Polyuria or nocturia
• Tremor
• Palpitation
• Anxiety
Local effects
• Swelling in the neck
• Carpal tunnel syndrome
• Bone or muscle pain
• Protrusion of eyes
• Visual loss (acuity or fields, or both)
• Headache
Reproduction or sex
• Loss or absence of libido
• Impotence
• Oligomenorrhoea or amenorrhoea
• Subfertility
• Galactorrhoea
• Gynaecomastia
• Delayed puberty
• Precocious puberty
Skin
• Hirsutes
• Hair thinning
• Pigmentation
• Dry skin
• Excess sweating
Table 88. Endocrine disease - past and family histories
Previous medical history
• Previous pregnancies (ease of conception, postpartum haemorrhage)