Methods of studying the endocrine system

The manifestations of endocrine gland diseases are very diverse and can be detected already with the traditional clinical examination of the patient. Direct examination (examination, palpation) only the thyroid gland and testes are available. Laboratory studies currently allow determining the content of most hormonal substances in the blood, but the nature of metabolic disorders associated with changes in the content of these hormones can be established and using special methods. For example, in diabetes mellitus, the determination of blood glucose often more accurately reflects metabolic disturbances than the level of insulin controlling glucose metabolism.

In the diagnosis of endocrinopathies, it is important to focus primarily on the multiple symptoms of various organs and systems - skin, cardiovascular system, gastrointestinal tract, musculoskeletal and excretory systems, nervous system, eyes, comparing them with biochemical and other additional studies . It should be borne in mind that individual clinical manifestations of the disease may be due to differences and uneven distribution in the tissues of receptors with which hormones interact.

Anamnesis history

When a patient is interviewed, it is possible to identify a number of important data that indicate violations of the functions of these or other endocrine glands, the time and causes of their occurrence, the dynamics of development.

Already at the beginning of the conversation with the patient, you can clearly identify certain features: hasty confused speech, some fussiness in the movements, increased emotionality, characteristic for hyperthyroidism, and, conversely, lethargy, apathy, some inhibition in its hypofunction.

Complaints. Complaints of patients with endocrine disorders are often of a general nature (poor sleep, fast fatigue, mild irritability, weight loss), but may be more characteristic of the affected endocrine gland, including they may be associated with involvement in the process (in connection with the exchange hormonal disorders) of various organs and systems.

Patients may complain of skin itching (diabetes mellitus, hyperthyroidism), hair loss (thyroiditis), joint pain (acromegalia) and bones (hyperparathyroidism), bone fractures (hyperparathyroidism, Itenko-Cushing syndrome), muscle weakness (Itenko-Cushing syndrome, hyperaldosteronism), pain in the heart, palpitations with ciliary tachyarrhythmia (hyperthyroidism, pheochromocytoma). Often there are complaints of poor appetite, dyspepsia (hypothyroidism, adrenal insufficiency), impaired sexual function - amenorrhea (hyperthyroidism, hypogonadism, Itzenko-Cushing syndrome), menorrhagia (hypothyroidism), impotence (diabetes mellitus, hypogonadism).

Physical methods of endocrine system research

Examination and palpation

As already noted, only the thyroid and testes are available for examination and palpation. However, it is very important in these cases, and with the defeat of other endocrine glands (which can not be inspected and felt) to be guided by the results of physical examination of various organs and systems (skin, subcutaneous fatty tissue, cardiovascular system, etc.).

Already with a general examination, you can identify a number of significant signs of the pathology of the endocrine system: changes in growth (dwarf growth while maintaining proportionality of the body of the pituitary origin, giant growth with increasing pituitary function), disproportionate dimensions of individual body parts (acromegalia), hair follicles characteristic of many endocrinopathies , and a large number of other symptoms.

When examining the neck, an approximate idea of the size of the thyroid gland, a symmetrical or asymmetric increase in its various sections. When palpation of the lobes and thyroid isthmus, the magnitude, consistency, and also the character (diffuse or nodal) of the increase are evaluated. The mobility of the gland during swallowing, the presence or absence of soreness and pulsation in its area is assessed. For palpation of the nodes located behind the upper section of the sternum, it is necessary to immerse your fingers on the sternum and try to determine the pole of the node.

In the study of the skin, hirsutism (ovarian pathology, hypercorticosis), hyperhidrosis (hyperthyroidism), hyperpigmentation (hypercorticism), ecchymosis (hypercorticism), purple-cyanotic striae - peculiar sites (striae) of atrophy and stretching usually on the lateral areas of the abdomen (hypercorticism) are sometimes revealed.

The study of subcutaneous fat reveals both excessive development of subcutaneous fatty tissue - obesity (diabetes mellitus), and significant weight loss (hyperthyroidism, diabetes, insufficiency of the adrenal glands). With hypercorticism, excessive fat deposition on the face is observed, which gives it a lunate, rounded appearance (Itenko-Cushing syndrome). Peculiar dense edema of the legs, the so-called slimy edema, is observed with hypothyroidism (myxedema).

In the study of the eyes, characteristic exophthalmos (hyperthyroidism), as well as periorbital edema (hypothyroidism) can be detected. Perhaps the development of diplopia (hyperthyroidism, diabetes mellitus).

Important data can be obtained by examining the cardiovascular system. With prolonged course of some endocrine diseases, heart failure develops with typical signs of edematous syndrome (hyperthyroidism). One of the important causes of arterial hypertension is endocrine diseases (pheochromocytoma, Itenko-Cushing syndrome, hyperaldosteronism, hypothyroidism). Orthostatic hypotension (insufficiency of the adrenal glands) is less common. It is important to know that in most endocrine diseases such changes in the electrocardiogram are noted in connection with myocardial dystrophy, as a rhythm disorder, repolarization disorders - displacement of the ST segment, T wave. Echocardiography may occasionally reveal pericardial effusions (myxedema).

Sometimes a complete set of symptoms of impaired absorption with a typical diarrhea and the corresponding laboratory changes, such as anemia, electrolyte disorders, etc. (hyperthyroidism, adrenal insufficiency).

Disorders of urination with a characteristic for diabetes mellitus polyuria on the background of polydipsia are often overlooked by the patients themselves and by the doctors. Urolithiasis with the phenomena of renal colic occurs with hyperparathyroidism and Itenko-Cushing syndrome.

In the study of the nervous system, nervousness (thyrotoxicosis), rapid fatigue (adrenal insufficiency, hypoglycemia) are revealed. Possible violations of consciousness up to the development of coma (for example, hyperglycemic and hypoglycemic coma in diabetes mellitus). Theta with convulsions is characteristic of hypocalcemia.

Additional methods of studying the endocrine system

Visualization of the endocrine glands is achieved by various methods. Less informative is the usual X-ray study. Modern ultrasound is more informative. The most accurate picture is obtained by computed tomography, X-ray or based on magnetic resonance imaging. The latter study is especially valuable in the study of the pituitary gland, thymus, adrenal glands, parathyroid glands, pancreas. These studies are primarily used to identify tumors of the corresponding endocrine glands.

Radioisotope study of various endocrine glands has become widespread, which primarily relates to the thyroid gland. It allows us to clarify the structural features (magnitude), as well as functional violations. The most widely used are iodine-131 or pertechnetate, labeled with technetium-99. With the help of a gamma camera, gamma radiation is fixed on the photosensitive paper, and thus a scan is performed, which allows us to estimate the size, shape, regions of the gland actively accumulating isotopes (the so-called hot nodes). Radioisotope scanning is used in the study of the adrenal glands.

There are various methods for determining the content of hormones in the blood. Among them, radio-immune research (RIA-radioimmunoassay) deserves the greatest attention. The principle is as follows: Antibodies (antiserum) are prepared before the test substance which is an antigen, then the standard amount of the antiserum obtained is mixed with a standard amount of the initial antigen labeled with radioactive iodine-125 or iodine-131 (with up to 80% of the labeled antigen binds to antibodies, forming a radioactive precipitate with a certain radioactivity). To this mixture, the blood serum containing the test substance is added: the added antigen competes with the labeled antigen, displacing it from the complexes with the antibodies. The more detectable substance (hormone) is contained in the test sample, the more radioactive labels are displaced from the complex with the antibody. Next, the antigen-antibody complex is separated by precipitation or selective absorption from the free labeled hormone and its radioactivity (i.e., count) is measured on a gamma counter. The radioactivity of precipitate decreases. The larger the antigen in the test sample, the less radioactivity of the remaining precipitate. With the help of this method, a small amount of insulin, tropic pituitary hormones, thyroglobulin and other hormones can be detected with great accuracy in blood and urine. However, it should be borne in mind that the increase in the content of hormones in the blood can occur due to their fraction associated with proteins. In addition, the radioimmune method makes it possible to quantify chemically very close to hormones substances lacking hormonal activity, but having an antigenic structure in common with hormones. It is of some importance to determine the content of hormones after special stress tests, which make it possible to evaluate the reserve function of the gland.

Among the biochemical studies of blood, the most important is the determination of glucose in the blood and urine, which reflects the course of the pathological process in diabetes mellitus. Reducing or increasing the level of cholesterol in the blood is characteristic for thyroid dysfunction. The change in calcium metabolism is detected with parathyroid gland pathology.

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