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By: Irwan Subekti, Skep,Ners

Endocrine examination
General appearance
Characteristic
syndrome
appearance.
Stature.
Weight.
Ask pt. if any part
tender before
palpating.


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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.
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).

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Axillae
Acanthosis
nigricans
(acromegaly).
Axillary hair loss
(hypopituitary).
Skin tags
(acromegaly).
Endocrine examination
Face
Syndrome facies.
Acne, oily skin
(Cushing's).
Hirsutism
(panhypopituitary).
Chin enlargement
(acromegaly).

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Eyes
Exophthalmos
(hyperthryoid).
Eye fundus:
(DM).
(acromegaly).

Endocrine examination
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Pituitary Disorders
Pituitary gland is responsible for the hormonal
regulation of several body processes, including water
retention, breast milk synthesis and release, human
growth, and thyroid gland secretions.
A. Anterior pituitary various cells release the following
hormones:
1. Gonadotrophs release luteinizing hormone (LH) and
follicle-stimulating hormone (FSH).
2. Lactotrophs release prolactin (PRL).
3. Corticotrophs release adrenocorticotropic hormone
(ACTH).
4. Somatotrophs release growth hormone (GH).
5. Thyrotrophs release thyroid-stimulating hormone
(TSH).
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Pituitary Disorders (contd)
- Posterior pituitary releases oxytocin and antidiuretic
hormone (ADH, or vasopressin).
Common Disorders:
A. Hypopituitarism (pituitary dwarfism)
Clinical Manifestations:
1. Weight loss.
2. Atrophy of all endocrine glands and organs.
3. Hair loss.
4. Impotence.
5. Amenorrhea.
6. Hypoglycemia.
Treatment:
- Replacement of missing hormone (as GH)

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Pituitary Disorders (contd)
B. Hyperpituitarism (acromegaly)
Clinical Manifestations (excessive GH secretion)
1. Coarse features( e.g., broad skull, protruding
jaw/hands/feet)
2. Thickened heel pads.
3. Thick tongue.
4. Change in ring and shoe size.
Clinical Manifestations (excessive PRL secretion)
1. Decreased libido.
2. Amenorrhea.
3. Impotence.
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Pituitary Disorders (contd)
c. Diabetes insipidus.
caused by under secretion of ADH.
Clinical Manifestations:
1. Profound increased urine output.
2. Nocturia.
3. Extreme thirst.
4. Weight loss.
5. Tachycardia, hypotension.
Treatment:
- Administer ADH (vasopressin)
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Thyroid Glands Disorders
Thyroid gland secretes hormones that are involved in
human development, growth, and metabolism (T4 and T3)
It also secretes calcitonin when there is a high
concentration of calcium in the blood stream. The
function of calcitonin is to inhibit the amount of
reabsorption of calcium from the bone and to regulate the
amount of calcium in the blood stream.
Common Disorders
A. Iodine deficiency or excess
Dietary intake of iodine is necessary for the normal
synthesis of T3 and T4. A deficiency or excess
consumption of iodine can result in a deficiency in these
hormones (hypothyroidism) or an excess of these
hormones (hyperthyroidism). Disorders which lead to a
deficiency of iodide in the thyroid can also cause
hypothyroidism.
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Thyroid Glands Disorders (contd)
B. Hypothyroidism
Results in deficient production of
T4/T3 by the thyroid.
Clinical Manifestations:
1. Goiter.
2. Fatigue.
3. Constipation.
4. Weight gain.
5. Memory and mental impairment
and decreased
concentration.
6. Depression.
7. Menstrual irregularities and loss
of libido.
8. Coarseness or loss of hair.
9. Dry skin and cold intolerance.

10. Irregular or heavy menses.
11. Infertility.
12. Hoarseness.
13. Myalgias.
14. Hyperlipidemia.
15. Reflex delay.
16. Bradycardia, elevated
diastolic BP.
17. Hypothermia.
18. Ataxia.
19. Decreased serum T4,T3
levels.
Treatment:
- Hormones replacement
therapy.

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Thyroid Glands Disorders (contd)
C. Hyperthyroidism
Results from an excess amount of
T4 and T3 in the blood.
Clinical Manifestations:
1. Heat intolerance.
2. Palpitations, elevated systolic BP.
3. Weight changes.
4. Menstrual irregularities and
decreased libido.
5. Increased serum T4, T3.
6. Exophthalmos (bulging eyes)
7. Goiter.
8. Insomnia.
9. Muscle weakness.
10. Heat intolerance.
11. Diarrhea.
Treatment:
1. Administer medications
such as thionamides,
which inhibit synthesis
of T4 and T3, and beta
blockers which block the
action of thyroid
hormones on peripheral
cells.
2. Radioiodine destruction
of the thyroid .
3. Surgical removal of the
thyroid (thyroidectomy)
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Thyroid Glands Disorders (contd)
D. GRAVES' DISEASE.
It is the most common cause of
hyperthyroidism, an over production of
thyroid hormone, which causes enlargement
of the thyroid and other symptoms such as
Exophthalmos, heat intolerance and anxiety.

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Diabetes Mellitus
DM is a chronic disease that
results from a deficiency of
insulin or a resistance to the
effects of insulin.
Predisposing Factors:
1. Heredity.
2. Obesity.
3. Age.
4. Diet.
5. Lack of exercise.
Types of DM:
1. IDDM (type 1)
2. NIDDM (type 2)

- IDDM:
Clinical Manifestations:
1. Polyuria.
2. Polydipsia.
3. Polyphagia.
4. Glucosuria.
- NIDDM:
Clinical Manifestations:
1. Easy fatigue.
2. Skin infections, slow
healing, Itching.
3. Vision changes.
4. burning on urination.
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Diabetes Mellitus (contd)
Nursing Care of DM:
1. Encourage eat healthful well balanced diet.
2. Encourage exercise.
3. Check the blood sugar regularly.
4. Use insulin or oral antidiabetic agents correctly if
ordered
by the physician.
Complications:
1. Vision problems.
2. Cardiovascular diseases.
3. Renal diseases.
4. Poor healing.
5. Diabetic coma.
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Hyperglycaemia (diabetic coma)
Clinical Manifestations:
1. Early headache, drowsiness, or
confusion.
2. Sweat, fruity odor to the breath.
3. Deep breathing, labored
respirations.
4. Full, bounding pulse, low BP.
5. Nausea, vomiting.
6. Flushed, dry hot skin.
7. Weakness.
8. Glucosuria, hyperglycaemia.
9. Unconsciousness.
Treatment:
- Administer
insulin, as well as
fluids and
electrolytes.

Occurs slowly.

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Hypoglycemia
Clinical Manifestations:
1. Complaints of hunger, weakness, dizziness.
2. Skin cold, moist clammy pale.
3. Rapid shallow respirations.
4. Nervousness.
5. Rapid pulse.
6. Unconsciousness.
7. No sugar in urine.
8. Low serum glucose level.
Occurs rapidly
Terms Definitions
basal metabolic rate (BMR)
Somewhat outdated test to measure the energy used when the body is in a state of
rest.
blood serum test
blood test to measure the level of substances such as calcium, electrolytes,
testosterone, insulin, and glucose.
fasting blood sugar (FBS)
Blood test to measure the amount of sugar circulating throughout the body after a
12 hour fast
glucose tolerance test (GTT)
Test to determine the blood sugar level. A measured dose of glucose is given to the
patient either orally or intravenously. Blood samples are taked at certain intervals to
determine the ability of the patient to use glucose.
protein-bound iodine test (PBI)
Blood test to measure the concentration of thyroxine circulating in the bloodstream.
The iodine becomes bound to the protein in the blood and can be measured. Useful
in establishing thyroid function.
radioactive iodine uptake test (RAIU)
Test in which radioactive iodine is taken orally or intravenously. The amount that is
eventually taken into the thyroid gland is measured to assist in determining thyroid
function.
radioimmunoassay (RIA) Test used to measure the levels of hormones in the plasma of the blood.
serum glucose tests
Blood test performed to assist in determining insulin levels and useful for adjusting
medication dosage.
thyroid echogram
Ultrasound examination of the thyroid that can assist in distingushing a thyroid
nodule from a cyst.
thyroid function test(TFT)
Blood test used to measure the levels of T3 and T4 and TSH in the bloodstream to
assist in determining thyroid function.
thyroid scan
Test in which a radioactive iodine is administered that localizes in the thyroid gland.
The gland can then be vusualized with a scanning device to detect pathology such
as tomors.
total calcium
Blood test to measure the total amount of calcuum to assist in detecting parathyroid
and bone disorders.
two-hour postprandial glucose
tolerance test
blood test to assist in evaluation glucose metabolism. The patient eats a high
carbohydrate diet and fasts overnight before the test. A blood sample is then taken 2
hours after a meal.
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Pengkajian Diagnostik

Foto Tengkorak (kranium)
Melihat kondisi silla tursika :
tumor atau atrofi
Foto Tulang (osteo)
Untuk melihat kondisi tulang :
- Pada orang gigantisme dijumpi
tulang yg bertambah besar dari
ukuran maupun panjang
- Pada orang akromegali akan
dijumpai tulang perifer yg
bertambah ukurannya
kesamping
CT-Scan Otak
Melihat kemungkinan adanya
tumor pada hipofise atau
hipothalamus




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* Pemeriksaan Darah :
Untuk mengukur :
- Kadar GH
- Kadar TSH
* Pemeriksaan Urine + Darah :
Kadar ACTH * Pemeriksaan
Darah :
Untuk mengukur :
- Kadar GH
- Kadar TSH
* Pemeriksaan Urine + Darah :
Kadar ACTH
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