(6) Endocrine System Assessment

ENDOCRINE SYSTEM

what 2 main topics we talk about?

1. Diabetes

2. Thyroid

3. PA

Diabetes - topics

1. Basics

2. Symptoms

3. Numbers

4. Continuous Glucose Monitoring (CGM)

5. Complications

Diabetes Basics

1. BG levels

   • Alpha cells → Glucagon → ↑ blood glucose (BG).

   • Beta cells → Insulin → ↓ BG.

2. Insulin types

   • Basal insulin = Constant release throughout day.

   • Bolus insulin = Extra insulin released with meals.

3. DM types

   • Type 1 DM = Autoimmune beta-cell destruction → Little/no insulin.

   • Type 2 DM = Insulin resistance + impaired insulin secretion.

     • T2DM risks:

       • Obesity, inactivity, family history,

       • PCOS, gestational diabetes, HTN.

Diabetes Symptoms

1. Hyperglycemia = HIGH blood sugar

   • Remember the 3 P's:

     • Polyuria = Peeing a lot.

     • Polydipsia = Thirsty/drinking a lot.

     • Polyphagia = Hungry/eating a lot.

   • Other symptoms: Weight loss, blurry vision, fatigue, slow-healing wounds.

2. Hypoglycemia = LOW blood sugar

   • Sweating, shaking, hunger, palpitations.

   • Confusion, behavior changes.

   • Severe → Seizures, loss of consciousness, death.

Diabetes Symptoms

What more dangerous?

Hypoglycemia is more immediately dangerous than hyperglycemia.

Diabetes Symptoms

Causes:

• High BG →

• Low BG →

• High BG →

  • Missed medications, ↑ carbs, inactivity,

  • stress, illness, corticosteroids. (3S, stress, sick, sterioids)

• Low BG →

  • Too much medication, skipped meals, increased exercise/weight loss.

Diabetes Numbers

Measurement	Diabetes if…
Fasting BG — diagnosis	≥126 mg/dL
Random BG + symptoms — diagnosis	≥200 mg/dL
2-hour OGTT — diagnosis	≥200 mg/dL
Normal A1c	<5.7%
Prediabetes A1c	5.7–6.4%
Diabetes A1c	≥6.5%
A1c goal — most patients	<7%
A1c goal — some older/comorbid patients	<8%
Fasting/premeal BG goal	80–130 mg/dL
2-hour postmeal BG goal	<180 mg/dL

• goal (PATIENT already has diabetes)

Diabetes Numbers

Diagnosis usually needs confirmation with a…

second abnormal result, unless there is unequivocal symptomatic hyperglycemia.

Diabetes Numbers

A1c — remember:

• Measures average BG over approximately 3 months.

• Controlled → Check every 6 months.

• Uncontrolled → Check every 3 months.

• Anemia → May make A1c inaccurate.

• Nonfasting test.

Continuous Glucose Monitoring (CGM)

• Measures sugar in interstitial fluid (fluid between cells), NOT directly in blood.

• 5–15 minute lag = CGM readings may be behind actual blood sugar.

A1c vs. CGM

• A1c = Average blood sugar over 3 months.

• CGM = Shows when sugar is HIGH, LOW, or NORMAL throughout the day.

What to address first?

• Address hypoglycemia FIRST, even if patient also has high glucose.

BG Logs

• Look for trends before/after meals, not one isolated reading.

Continuous Glucose Monitoring (CGM) - numbers

CGM Range	Goal
Target: 70–180 mg/dL	>70%
Low: <70	<4%
Very low: <54	<1%
High: >180	<25%
Very high: >250	<5%

Diabetes Complications

1. Short-term:

DKA	HHS
More common T1DM	More common T2DM
Ketones present	Little/no significant ketosis
Insulin deficiency → fat breakdown	Severe hyperglycemia/dehydration

⭐ BOTH = Medical emergencies.

2. Long-term:

• Microvascular = Eyes, Kidneys, Nerves → Retinopathy, nephropathy, neuropathy.

  • Small vessels → Glucose control clearly reduces complications.

• Macrovascular = Heart, Brain, Peripheral arteries → MI, stroke, PAD.

  • Large vessels → Glucose control alone isn't enough.

Thyroid

Easy trick:

• Graves RAVES 💃🔥

  • FAST 🔥

• Hashimoto HIBERNATES 🐻❄

  • SLOW 🥶

Thyroid - CHART

	Hyperthyroidism	Hypothyroidism
T3/T4	↑	↓
TSH	↓	↑
Cause	Graves'	Hashimoto's
Weight	Loss	Gain
Temperature	Hot/sweaty	Cold
Heart	Tachycardia	Bradycardia
GI	↑ Bowel movements	Constipation
Mood	Anxious/irritable	Depressed/tired
Skin	smooth, moist	rough, dry
Hair	Fine, silky	Coarse, thinning
Eyes/face	Exophthalmos (Bulging eyes)	Facial/Periorbital puffiness
Reflexes	Can be brisk	Diminished
Emergency	Thyroid storm	Myxedema coma

Thyroid

Extra physical signs:

1. Hyperthyroidism:

   • Onycholysis = Nail separates from nail bed

   • Pretibial myxedema = Waxy swelling of shin → Classically Graves

Thyroid negative feedback

1. How it works normally

• Hypothalamus (TRH) → Pituitary (TSH) → Thyroid (T3/T4).

Physical Assessment

Diabetes

• BP goal = <130/80.

• Foot inspection = Every visit.

  • Patients should inspect feet daily and avoid walking barefoot.

• Monofilament = Tests protective sensation → Neuropathy.

• Tuning fork = Tests vibration sensation.

• Dorsalis pedis + posterior tibial = Foot pulses.

Physical Assessment

Thyroid

• Check neck while patient swallows → Look for enlargement/nodules.

  • Goiter = Enlarged thyroid (can occur with hyper or hypo).