141222L - HISTORY TAKING FOR ADRENAL DISEASES

Lecture by for 4^th 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)

	1	2	3	4
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,