Patient Presentations Related to the Endocrine System and Metabolism

The guide to clinical presentations in this category may include, but is not limited to, the following ways in which patients present for osteopathic medical care:

anesthesia-related complications • bariatric surgery • congenital neck masses (e.g., branchial cleft abnormalities) • diabetes mellitus, including diabetic ketoacidosis • dysmorphic features and genetic syndrome stigmata • endocrine disorders (e.g., Cushing syndrome, Addison disease, Hashimoto thyroiditis, Graves disease) • fever in immunocompromised host • fever of undetermined etiology • fluid and electrolyte management in hospitalized patient • gestational hyperglycemia • heat exhaustion, heat stroke • hyper/hypoglycemia • hyper/hypothermia from acute illness (viral, bacterial, parasitic) • hyperglycemic crisis, hyperosmolar (hyperglycemic) state • hypothermia from environmental exposure • masses – thyroid, adrenal, and pituitary (benign and malignant or metastatic tumors) • metabolic syndrome • multiple endocrine neoplasia • neck lymphadenitis • pre-diabetes • puberty, delayed or precocious • salivary gland neoplasms • sepsis • sialadenitis • stature abnormalities including unusual shortness (e.g., dwarfism due to achondroplasia or ateliosis) and excessive height (e.g., gigantism due to Marfan syndrome) • thyroglossal duct and/or dermoid cysts • weight abnormalities – involuntary weight loss, excessive weight gain, obesity

CONSTITUTIONAL SIGNS AND SYMPTOMS
fatigue • fever • generalized weakness • involuntary weight loss • malaise • night sweats • pallor

PHYSICAL EXAM FINDINGS
acromegaly • adipose distribution • Chvostek sign • exophthalmos • hyper/hyporeflexia • lid lag • lymphadenopathy, neck • macroglossia • monofilament testing • myxedema • retinopathy • striae • thyromegaly and goiter • tremors • Trousseau sign

LABORATORY TEST FINDINGS AND DIAGNOSTIC IMAGING
CT scanning • electrolyte levels (e.g., calcium, potassium, sodium, phosphorus, magnesium, chloride) • glucose testing • growth hormone levels • hemoglobin A1c testing • magnetic resonance imaging • nuclear medicine imaging • radiography • serum parathyroid hormone levels • thyroid function tests (e.g., TSH, free or total T4 or T3) • thyroid peroxidase antibodies • ultrasonography • urine microalbumin/creatinine levels