--- module: 026-01 language: en chapter: 26 title: "Endocrine and Reproductive Examination and Investigation" module_title: "Foundations" source_sha256: ac0e49f310d62821ecef03570dfb40be4867939478ed7c34c143f83b9502c7db --- # Endocrine and reproductive examination and investigation ## Orientation and endocrine history ### Slow, multisystem disorders #### Separate gland disease from drugs, illness, pregnancy #### Binding proteins and assay interference ### Reproduction adds privacy, consent, trauma-informed care ### Time course and function first #### Weight: fat, fluid, muscle, intake, catabolism #### Pigmentation, salt craving, stones, ring or shoe size ### Weak symptoms gain meaning in coherent clusters ### Record every route of medicine and supplement #### Steroids, amiodarone, lithium, opioids, biotin #### Can create or conceal endocrine syndromes ## General endocrine examination ### Habitus, fat and muscle distribution, voice ### Lying and standing pressure when appropriate ### Skin: striae, bruises, pigmentation, hirsutism ### Proximal weakness: chair rise, arms against resistance ### Tremor, reflex relaxation, fields, gait ### No single feature proves a diagnosis #### Rounded face, obesity, sparse hair are common #### Weigh discriminatory combinations instead ## Thyroid and pituitary examination ### Inspect neck at rest and during swallowing ### Palpate size, consistency, nodules, nodes #### Bruit only when increased flow suspected #### Retrosternal extension compresses despite small neck ### Thyroid effects beyond the neck ### Graves orbitopathy: acuity, fields, colour, cornea #### Optic neuropathy needs urgent review ### Pituitary: confrontation fields, pupils, cranial nerves ### Apoplexy: headache with sudden visual change #### Vomiting, hypotension, altered consciousness ### Acromegaly: acral, facial, jaw, sleep apnoea ## Diabetes and foot assessment ### Glucose patterns, hypoglycaemia, ketosis risk ### Foot inspection: callus, deformity, ulcer, footwear ### Pulses, temperature, capillary return, ischaemia ### Calibrated monofilament for protective sensation ### Risk category must lead to action #### Education, footwear, podiatry, vascular review ## Reproductive and sexual history ### Neutral language, patient's own terms ### Do not infer anatomy or risk from identity ### Cycle, bleeding, discharge, contraception, safety ### Obstetric history: every pregnancy and outcome ### Current pregnancy: bleeding, headache, movements ### Male history: testes, torsion, androgen use #### Semen varies, repeat abnormal results ## Intimate examination ### Indication, explicit consent, privacy, chaperone #### Patient may pause or stop at any time ### Speculum visualises vagina, cervix, allows sampling ### Bimanual: limited sensitivity for many disorders ### Testis: hard intratesticular mass needs urgent ultrasound ### Sudden pain with high testis suggests torsion #### Immediate surgical assessment, no low-value tests ## Laboratory reasoning ### Define the suspected axis first ### Pair target hormone with regulator #### Free thyroxine with thyroid-stimulating hormone #### Calcium with parathyroid hormone #### Normal regulator may be inappropriate ### Confirm unexpected abnormalities #### Timing, fasting, cycle, pregnancy, binding proteins #### Biotin, heterophile antibodies, hook effect #### Contact laboratory when phenotype conflicts ### Dynamic tests assess reserve or suppressibility #### Need pretest probability and validated thresholds ## Reproductive and pregnancy investigations ### Pregnancy test detects chorionic gonadotropin #### Never read one number without gestation #### Pain, instability, peritonism: ectopic urgency ### Amenorrhoea: exclude pregnancy first ### Ultrasound shows anatomy, hysteroscopy other questions ### Infertility: ovulation, semen, tubes in parallel #### Reserve tests predict stimulation response ### Screening estimates risk, diagnosis defines it ## Imaging and tissue diagnosis ### Image after biochemical formulation ### Ultrasound, resonance, tomography, nuclear roles #### Radiation and nuclear limits in pregnancy ### Incidental lesion may be unrelated #### Secretes, compresses, malignant, growing ### Pituitary, adrenal: no biopsy without specialist biochemistry ## Emergency recognition ### Adrenal crisis, thyroid storm, ketoacidosis ### Apoplexy, torsion, ruptured ectopic, haemorrhage ### Stabilise and treat before confirmation #### Take critical samples without meaningful delay