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141222L - HISTORY TAKING FOR ADRENAL DISEASES

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Lecture by for 4th year medical students on December 22, 2014 by Prof Omar Hasan Kasule Sr.


Types of adrenal steroids
·        Glucocorticoids: act on carbohydrate metabolism
·        Mineralocorticoids: Na, K, and fluid balance in distal kidney tubules
·        Androgens: converted to testosterone

Addison disease (primary hypoadrenalism)
·        Causes: autoimmune, infiltration, TB, surgical removal, hemorrhage/infarction, infiltration
·        Effects: Impaired glucocorticoid, mineralocorticoid, and androgen production
·        Symptoms: weight loss, anorexia, malaise, fever, weakness, depression, impotence/amenorrhoea, nausea/vomiting, diarrhea, constipation, confusion, syncope, abdominal pain, myalgia, joint pain
·        Signs: pigmentation, postural hypotension, weight loss, muscle wasting, dehydration, loss of body hair

Cushing’s syndrome (increased circulating glucocorticoids)
·        Causes: (a)  increased ACTH from pituitary, ectopic tumors, or drug administration (b) adrenal adenoma / carcinoma (c) iatrogenic glucocorticoid administration
·        Symptoms: weight gain, changed appearance, depression, insomnia, amenorrhea/oligomenorhea, poor libido, thin skin easy to bruise, acne, muscle weakness, back pain, polyuria/polydipsia, psychosis
·        Signs: short stature, moon plethoric face, depression/psychosis, acne, hirsuitism, thin bruising skin, poor wound healing, pigmentation, skin infections, systemic hypertension, osteoporosis, pathological fractures, Kyphosis due to osteoporosis,  truncal / central obesity (buffalo hump), abdominal striae, rib fractures, proximal muscle weakness


HISTORY OF ADRENAL CONDITIONS (SCORING SHEET)


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1.0  DEMOGRAPHIC INFO




Name




Age and date of birth




Residential address




Occupation









2.0  HISTORY OF PRESENTING COMPLAINT(s)




Complaint #1: Onset, course, location (site), radiation, severity, time of day, duration, diurnal variation, character, aggravating factors (food, cough etc ), relieving factors, associated symptoms




Complaint #2:





Complaint #3:





Complaint #4:





What does the patient think is going on?




Treatments already given




Effect: work, daily life, sports,









3.0  PAST MEDICAL / SURGICAL HISTORY




Chronic illnesses like HT, DM, Cardiac




Hospitalizations




Surgeries









4.0 ALLERGY HISTORY




Reactions to medications: type and drug




Food allergies




Environmental allergies









5.0 MEDICATION HISTORY




List of current medications doses and why: prescribed or OTC?




List of chronic medications




Medicine stopped




Herbal or complimentary medications









6.0  FAMILY HISTORY




Parents: age, height, weight, health status, consanguinity, region of origin




Siblings: names, nicknames, age, height, weight, health status




Significant problems  maternal & paternal sides: arthritis, DM, HT, renal disease, anemia, headache, TB




Diseases that run in the family




Specific question about illnesses resembling presenting complaint: thyroid disease,









7.0 SOCIAL HISTORY




Type of housing, location (city vs rural), how many people in house




Education, occupation, income, religion and culture, smoking




Health insurance




Contact with animals









8.0 RISK FACTORS












































9.0 REVIEW OF SYSTEMS (If not covered in presenting complaints and PMH)




Skin: skin rash, pigmentation, bruising




CVS and RES: chest pain, cough (hemoptysis), dypnea (orthopnea, nocturnal dyspnea), cyanosis, palpitations, ankle swelling,




Hematological: pallor, jaundice, bone pain, bruises, epsitaxis




GIT: Vomiting, nausea, dyspepsia, dysphagia, abd pain, diarhoea / constipation, Bowel habits, feeding, weight loss / gain, rectal bleeding




Urinary tract: dysuria, enuresis, frequency., nocturia, hematuria, incontinence, urethral discharge




Genital: menstruation (regularity, length, volume), impotence,





CNS: irritability, drowsiness, collapse / blackout,  abnormal movements (seizures), headache, numbness, dizziness and loss of balance, vision, hearing, headache




Musculoskeletal: joint swelling, joint pain, skin rash, movement restrictions, muscle wasting, spasms,