The diagnosis of an endocrine disorder first requires a compatible clinical syndrome based on history and physical examination. In the absence of a compatible clinical syndrome, laboratory tests and other studies cannot be interpreted properly. Physical examination plays a fundamental role in the diagnosis of endocrinopathies.
Small muscle wasting
Muscle wasting can often be best seen in the small muscles of the dorsum of the hand and between the thumb and index finger.
Stiffness in joints preventing fingers from opposing each other in a prayer position.
Thickening of the palmar fascia. Seen in diabetic patients frequently.
Caused by loss of proprioception leading to constant trauma. Charcot described them in patients with syphilis. Patients present with warmth, redness, and edema, and over time the joints and bones of the feet are destroyed leaving a deformed foot that is prone to infection.
Hammer toes are so called as they resemble the hammers on a piano.
Atrophic, brownish patches usually found on the anterior lower legs. They are the most common skin lesions seen in diabetic patients and a marker of retinopathy, nephropathy, and neuropathy.
Necrobiosis lipoidica diabeticorum
Raised plaques that may ulcerate, found predominantly on the shins but are larger than diabetic dermopathy.
A skin disorder frequently described as “velvety” papillomatous hyperplasia with hyperpigmentation, found predominantly in the skin creases of the neck, axilla, inguinal, and inframammary folds. It is associated with a variety of endocrinopathies (acromegaly, Cushing’s, diabetes) as well as with neoplastic diseases.
Red/yellow papules that may be found in patients with extremely elevated triglycerides.
An autoimmune condition characterized by patches of hypopigmentation. May be seen in patients with type 1 DM as autoimmune diseases tend to coexist.
Red-colored hemorrhages and yellowish macular exudates. Proliferative diabetic retinopathy demonstrates new blood vessel growth.
Chvostek’s sign describes facial muscle contraction on tapping the parotid gland over the facial nerve.
Trousseau’s sign describes the development of carpal spasms after inflating a sphygmomanometer cuff over the brachial artery above systolic blood pressure. It is more specific for hypocalcemia than Chvostek’s sign.
Patients with pseudohypoparathyroidism (due to resistance to PTH) may have the classic shortening of the 4th and sometimes 5th MCP and MTP, known as Albright’s hereditary osteodystrophy.
Queen Anne’s sign
Soft tissue enlargement
Hyperpigmentation can be a sign of ACTH-independent (primary) adrenal insufficiency. High levels of ACTH found in these patients stimulate the melanocortin-1 receptor in the skin, resulting in hyperpigmentation. It tends to first occur in areas of the skin under pressure, including elbows, knuckles, palmar creases, lips, and buccal mucosa.
Red/yellow papules that occur around the eyes in patients with extremely elevated triglycerides.
Red/yellow papules that occur on extensor surfaces (eg, elbows, knees) in patients with extremely elevated triglycerides.
Sharp anterior bowing of the tibia.
Sources & further information:
- Cooper MS, Gittoes NJ. Diagnosis and management of hypocalcaemia. BMJ. 2008;336(7656):1298-1302.
- Loriaux DL. Diagnosis and differential diagnosis of Cushing’s syndrome. N Engl J Med. 2017;376(15):1451-1459.
- McGee S. Evidence Based Physical Diagnosis. Second ed. St. Louis, Missouri: Saunders Elsevier; 2007.