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1. SYMPTOMATOLOGY AND
INVESTIGATION OF ENDOCRINE
DISORDERS
DR RAIMI T.H.

2. Endocrine symptoms
• Polyuria
• Thirst
• Weight loss despite normal or increased appetite
• Weight gain
• Excessive hair growth (hirsuitism)
• Hair loss (alopecia)
• Increased pigmentation
• Irregular/ Abnormal menses
• Erectile dysfunction

3. Polyuria
Passage of large volume of urine.. ≥3L/24hrs
May be associated with nocturia
 increased osmotically active substances
 lack of or impaired action of vasopressin
Diabetes mellitus
Diabetes insipidus
Hypercalcaemia

4. Polydipsia (excessive thirst)
Increased water/ fluid intake
 decreased blood volume (hypovolaemia)
 increased serum osmolality
 Diabetes mellitus
Diabetes insipidus
Hypercalcaemia
Haemorrhage
Gastroenteritis

5. Weight loss
Loosening of clothes, belt line, wrist-watches etc
 Caloric loss exceeds caloric intake
 Thyrotoxicosis
Diabetes mellitus
Addison's disease
Malignancies

6. Weight loss

7. Weight gain
Tightening of clothing, foot-wares, etc
 Caloric intake exceeds caloric loss
 Hypothyroidism
 Cushing’s syndrome
 Simple obesity

8. Weight gain

9. Weight gain

10. Simple Obesity

11. Cushing’s syndrome

12. Cushing’s syndrome

13. Cushing’s syndrome

14. Erectile dysfunction
 Poor erection, retrograde ejaculation
 Neuropathies ( peripheral, autonomic)
 Vascular disease
 Psychogenic
 Hypogonadism
 Diabetes mellitus
 Spinal cord disease e.g. multiple sclerosis
 Hypopituitarism
 Depression
 Drugs e.g. beta blockers

15. Irregular/Abnormal menses
Amenorrhoea 1° and 2°
Oligomenorrhoea
Menorrhagia
 Pathophysiology

16. Endocrine Control of
the Ovarian Cycle

17. Irregular/Abnormal menses
Outflow tract : AIS
Mullerian agenesis
Asherman’s syndrome
 Disorders of ovulation
Turner’s syndrome
Ovarian failure
Pituitary disease e.g tumours
Hypothalamic amenorrhoea e.g
stress, exercise

18. Hirsuitism
Excessive male pattern hair growth in women
 Generally due to excess androgens
 Genetic and ethnic background
 Androgen secreting ovarian tumours
 Congenital adrenal hyperplasia
 Cushing’s syndrome
 Cushing’s disease

19. Hirsuitism

20. Hirsuitism

21. Hirsuitism

22. (Alopecia) hair loss
 May be eyebrow hair, male pattern baldness, secondary sexual
body hair, well circumscribed patches
 Reduced androgens
 Excess androgen (women)
 Autoimmune process
 Hypothyroidism (eyebrow)
 Male hypogonadism
 Addison’s disease (autoimmune)
 Cushing's syndrome and Cushing's disease (male pattern baldness)
 Androgen secreting (virilising) tumours (male pattern baldness)

23. (Alopecia) hair loss

24. Increased pigmentation
• Generalized
• May be prominent in some sites
 Increased melanin (stimulation of MSH receptor
on melanocytes)
 Increased melanocytes
 Addison’s disease
 Cushing’s syndrome
 Haemochromatosis

25. Addison’s disease

26. ??????????

27. Addison’s disease

28. INVESTIGATIONS
• Suspicion- hx and exam
• Screening tests - lab assay
• Specific or confirmatory- dynamic or adynamic
• Surgical and needle biopsy
• Scanning and neuroimaging- USS

29. Suspicion (clinical)- hx and exam
• Many endocrine glands sandwiched in other
systems
• Endocrinology interfaces with numerous
physiologic systems--- non- specific symptoms
• Classic symptoms in some (eg T1DM or T2DM)
• Gradual evolution or changes over months to
years----hypothyroidism, acromegaly
• Symptoms overlap a great range of normal
characteristics eg obese person vs Cushing’s
syndrome

30. Suspicion (clinical)- hx and exam contd.
• Seldom produces symptoms near gland of
origin (except thyroiditis, large pituitary
tumours)
• Hormones have more distant effect than local
(unlike pneumonia)
• Asymptomatic patients common (T2DM)
• Symptoms usually due to glandular hypo- or
hyper- function

31. T4
T3
Hypothalamic-Pituitary-Thyroid Axis
Physiology/Regulation
Pituitary
Thyroid Gland
Hypothalamus TRH
T4  T3
Liver
T4 T3
Heart
Liver
Bone
CNS
TR
Target Tissues
–
–
TSH

32. Screening tests – lab assay
• Sometimes confirm the disease
• Measure the hormones produced by the gland
e.g plasma T3 & T4, cortisol, testosterone (↓ or
↑)
• May be time-dependent e.g mid- night cortisol
(Cushing's syndrome), morning [8:00-9:00am]
cortisol (Addison’s disease) , 24hr urinary cortisol
(Cushing's syndrome) fasting plasma glucose
(diabetes mellitus)

33. Screening tests – lab assay contd.
• Hormones can be assayed in the urine or
saliva e.g cortisol
• Measure the effect of the hormone e.g plasma
glucose in diabetes mellitus (deficient insulin)
• Measure the trophic hormone alone e.g TSH,
or trophic hormone and gland product e.g TSH
and T4, ACTH and cortisol

34. Specific or confirmatory- dynamic or
adynamic
• Adynamic
o Measure the autoantibodies
-stimulating e.g TSH receptor antibodies
- blocking e.g TSH receptor antibodies
- destructive e.g islet cell, adrenal, thyroid
peroxidase

35. Specific or confirmatory- dynamic or
adynamic
• Dynamic- based on principle of feedback
mechanisms
o Stimulate the gland if there is hypofunction
(hormone deficiency) e.g ACTH stimulation in
Addison’s disease
o Suppress the gland if there is hyperfunction
(hormone excess) e.g dexamethasone
suppression in Cushing’s syndrome

36. Regulation of cortisol:
The HPA axis
+
+
-
-
Neural Stimuli
Hypothalamus
Anterior
Pituitary
Adrenal
CC:BY 3.0
BY: Regents of the University of
Michigan
ACTH
ACTH Plasma Cortisol
Concentration
CRF

37. Scanning and Radiological imaging
• Generally employed only after a hormonal
abnormality has been established by
biochemical testing
-Ultrasound e.g thyroid, testicular
-CT scan e.g adrenal, pituitary
-MRI e.g pituitary
-Radio-isotope scan e.g thyroid scan

38. THYROID ULTRASOUND SCAN

39. Surgical and Needle biopsy
• To diagnose cancers e.g FNAC of the thyroid
• All surgical specimens to be submitted for
pathological diagnosis