Assessment of Patients With Endocrine Disorders

Assessment

HEALTH HISTORY AND CLINICAL MANIFESTATIONS

Because of the widespread effects of the endocrine system on the body, a wide variety of signs and symptoms may occur with endocrine disorders. Although specific endocrine disorders are often accompanied by specific clinical symptoms, more general manifestations may occur with a number of endocrine disorders. Changes in energy level and fatigue are common to many en-docrine imbalances. During the health history, the nurse asks the patient about fatigue and changes in usual energy levels and about how the changes affect the patient’s ability to carry out activities of daily life. The nurse also asks about changes in heat and cold tolerance as well as recent changes in weight: increases or decreases may occur with changes in adrenal and thyroid disorders and may be a result of changes in fat distribution or fluid loss or retention.

Changes in sexual function and secondary sex characteristics may occur with any number of endocrine disorders and are assessed by obtaining a sexual history. Asking the patient or family about changes in mood, memory, and ability to concentrate and altered sleep patterns is important because these changes are common in endocrine disorders. Other specific symptoms that occur with spe-cific endocrine disorders are discussed with each of those disorders.

PHYSICAL ASSESSMENT

The patient is observed for obvious changes in appearance that may indicate endocrine dysfunction. Changes in the skin texture are common with both hypofunction and hyperfunction of the thyroid gland. Eye changes, such as exophthalmos, may occur with hyperthyroidism and Graves’ disease. Changes in physical appearance (eg, appearance of facial hair in women, “moon face,” “buffalo hump,” thinning of the skin, obesity of the trunk and thinness of the extremities, increased size of the feet and hands, edema) may signify disorders of the thyroid, adrenal cortex, or pi-tuitary gland.

Vital signs are measured and compared with previous values if known. Elevated blood pressure may occur with hyperfunction of the adrenal cortex or tumor of the adrenal medulla. Decreased blood pressure may occur with hypofunction of the adrenal cor-tex. Other specific physical assessment findings are discussed with each endocrine disorder.