Autoimmune polyendocrine syndrome physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Overview

The physical examination findings in autoimmune polyendocrine syndrome (APS) may include hypotension, bradycardia, tetany, dry skin, coarse hair, and muscle weakness depending upon the sub-type and the organ affected such as adrenals, thyroid or pancreatic islet cells. Patients of APS usually appear fatigued and dehydrated.

Physical Examination

Addisons's disease

The patient may be dehydrated and lethargic.[1]

Vitals

Skin

Neck

Extremities

Neurologic

Type 1 diabetes mellitus

Physical examination of type 1 DM include:[2][3][4][5]

Examination findings Classic new onset Diabetic ketoacidosis
Appearance of patient Patient is usually well appearing Patients are ill appearing, may be confused or in state of coma
Vital signs Pulse rate- Normal

Temperature- Normal

Blood pressure- Normal

Respiratory rate- Normal

Oxygen saturation- Normal

Blood glucose level- Elevated

Pulse rate- Tachycardia with regular rhythm, weak volume

Temperature- Normal or elevated or hypothermia

Blood pressure- Low blood pressure

Respiratory rate-

Oxygen saturation- usually normal but some cases may have low oxygen saturation

Blood glucose level- markedly elevated

Skin Skin examination is usually normal, but in some cases may reveal dry skin Poor skin turgor because of dehydration
HEENT HEENT examination is usually normal, in some cases eye examination may reveal opacity of lens (cataract) Dry mucous membrane, eyes may appear sunken because of dehydration
Neck Neck examination is normal Neck examination is normal
Lungs Lung examination is normal Lung examination is usually normal, but in some cases lung examination may reveal underlying triggering causes of diabetic ketoacidosis eg: pneumonia
Heart Heart examination is normal (S1 + S2 + 0) Heart examination is usually normal (S1 + S2 + 0)
Abdomen Abdominal examination is normal Abdominal tenderness may be elicited
Back Back examination is normal Back examination is usually normal
Genitourinary Genitourinary examination is usually normal Genitourinary examination is usually normal
Extremities Examination of extremities is usually normal, some cases may elicit finding of decreased sensation in the extremities Examination of extremities is usually normal
Neuromuscular Neuromuscular examination is usually normal Neuromuscular examination is usually normal

Hypoparthyroidism

Appearance of the Patient:

Vital Signs:

Skin:

Careful examination of skin around neck should be done for a possible surgical scar.

Common signs present are:

HEENT:

Some patients may have:


Lungs:

Some patients may have:

Heart:

Some patients may have:

Abdomen:

Some patients may have:

Neuromuscular:

Most common presentation is due to neuromuscular irritability. It present as:

Some patients may have extrapyramidal signs (due to calcification of basal ganglia):[13]

Psychiatric:

Some patients may have psychiatric manifestations:[14][15]

Extremities:

Some patients may have:

References

  1. Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S (2012). "Addison's disease". Contemp Clin Dent. 3 (4): 484–6. doi:10.4103/0976-237X.107450. PMC 3636818. PMID 23633816.
  2. http://www.aafp.org/afp/2005/0501/p1705.pdf
  3. Type 1 Diabetes mellitus "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on December 27th,2016
  4. http://spectrum.diabetesjournals.org/content/15/1/28
  5. "ADA".
  6. Abate EG, Clarke BL (2016). "Review of Hypoparathyroidism". Front Endocrinol (Lausanne). 7: 172. doi:10.3389/fendo.2016.00172. PMC 5237638. PMID 28138323.
  7. Cooper MS, Gittoes NJ (2008). "Diagnosis and management of hypocalcaemia". BMJ. 336 (7656): 1298–302. doi:10.1136/bmj.39582.589433.BE. PMC 2413335. PMID 18535072.
  8. Schafer, AL; Shoback, DM. De Groot, LJ; Chrousos, G; Dungan, K; et al., eds. Hypocalcemia: Diagnosis and Treatment. [Updated 2016 Jan 3]. Endotext [Internet].: South Dartmouth (MA): MDText.com, Inc.; 2000-.
  9. Shoback D (2008). "Clinical practice. Hypoparathyroidism". N. Engl. J. Med. 359 (4): 391–403. doi:10.1056/NEJMcp0803050. PMID 18650515.
  10. Sheldon RS, Becker WJ, Hanley DA, Culver RL (1987). "Hypoparathyroidism and pseudotumor cerebri: an infrequent clinical association". Can J Neurol Sci. 14 (4): 622–5. PMID 3690435.
  11. Levine SN, Rheams CN (1985). "Hypocalcemic heart failure". Am. J. Med. 78 (6 Pt 1): 1033–5. PMID 4014262.
  12. Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O (1992). "Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism". Intern. Med. 31 (4): 561–8. PMID 1633370.
  13. Basak RC (2009). "A case report of Basal Ganglia calcification - a rare finding of hypoparathyroidism". Oman Med J. 24 (3): 220–2. doi:10.5001/omj.2009.44. PMC 3251182. PMID 22224190.
  14. Arlt W, Fremerey C, Callies F, Reincke M, Schneider P, Timmermann W, Allolio B (2002). "Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D". Eur. J. Endocrinol. 146 (2): 215–22. PMID 11834431.
  15. Lin KF, Chen KH, Huang WL (2015). "Organic anxiety in a woman with breast cancer receiving denosumab". Gen Hosp Psychiatry. 37 (2): 192.e7–8. doi:10.1016/j.genhosppsych.2015.01.007. PMID 25772947.