Adrenocortical carcinoma physical examination: Difference between revisions
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==Physical Examination== | ==Physical Examination== | ||
===Appearance of the patient=== | ===Appearance of the patient=== | ||
* [[Moon like face|Moon-like face]] | * [[Moon like face|Moon-like face]]<ref name="pmid26156970">{{cite journal| author=Nieman LK| title=Cushing's syndrome: update on signs, symptoms and biochemical screening. | journal=Eur J Endocrinol | year= 2015 | volume= 173 | issue= 4 | pages= M33-8 | pmid=26156970 | doi=10.1530/EJE-15-0464 | pmc=4553096 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26156970 }}</ref> | ||
* [[Buffalo hump]] | * [[Buffalo hump]] | ||
* Patients may appear [[Flushing|flushed]] due to the associated increase in [[erythropoietin]] secretion.< | * Patients may appear [[Flushing|flushed]] due to the associated increase in [[erythropoietin]] secretion.<ref name="pmid12923403">{{cite journal| author=La Batide-Alanore A, Chatellier G, Plouin PF| title=Diabetes as a marker of pheochromocytoma in hypertensive patients. | journal=J Hypertens | year= 2003 | volume= 21 | issue= 9 | pages= 1703-7 | pmid=12923403 | doi=10.1097/01.hjh.0000084729.53355.ce | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12923403 }}</ref> | ||
* Patients may appear [[obese]] due to associated type2 [[diabetes mellitus]] and [[Cushing's syndrome]].< | * Patients may appear [[obese]] due to associated type2 [[diabetes mellitus]] and [[Cushing's syndrome]].<ref name="pmid7567437">{{cite journal| author=Drénou B, Le Tulzo Y, Caulet-Maugendre S, Le Guerrier A, Leclercq C, Guilhem I et al.| title=Pheochromocytoma and secondary erythrocytosis: role of tumour erythropoietin secretion. | journal=Nouv Rev Fr Hematol | year= 1995 | volume= 37 | issue= 3 | pages= 197-9 | pmid=7567437 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7567437 }}</ref> | ||
===Vitals=== | ===Vitals=== | ||
* [[Hypotension]] occurs due to fluid contraction | * [[Hypotension]] occurs due to fluid contraction | ||
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===Chest=== | ===Chest=== | ||
* Gynecomastia | * [[Gynecomastia]] | ||
===Skin=== | ===Skin=== | ||
* Skin may be fragile and thin | * Skin may be fragile and thin | ||
* [[Jaundice]] secondary to deranged [[liver]] function in case of [[metastasis]] to the [[liver]] | * [[Jaundice]] secondary to deranged [[liver]] function in case of [[metastasis]] to the [[liver]] | ||
* [[Hyperpigmentation]] - this is due to | * [[Hyperpigmentation]] - this is due to [[melanocyte-stimulating hormone]] production as a byproduct of [[Adrenocorticotropic hormone|ACTH]] synthesis from [[Proopiomelanocortin|Proopiomelanocortin (POMC)]] | ||
* [[Telangiectasia]] (dilation of capillaries) | * [[Telangiectasia]] (dilation of [[capillaries]]) | ||
* Thinning of the skin (which causes [[easy bruising]]) | * Thinning of the [[skin]] (which causes [[easy bruising]]) | ||
* Purple or red [[striae]] (the weight gain in Cushing's stretches the skin, which is thin and weakened, causing it to hemorrhage) on the trunk, buttocks, arms, legs or breasts, proximal muscle weakness | * Purple or red [[striae]] (the weight gain in [[Cushing's syndrome|Cushing's]] stretches the skin, which is thin and weakened, causing it to [[hemorrhage]]) on the trunk, buttocks, arms, legs or breasts, and proximal [[muscle weakness]] | ||
* [[Hirsutism]] | * [[Hirsutism]] | ||
===Head=== | ===Head=== | ||
* [[Alopecia|Facial flushing]] | * [[Alopecia|Facial flushing]] | ||
* [[Icterus|Scleral icterus]] in case of [[metastasis]] to the [[liver]] | * [[Icterus|Scleral icterus]] in case of [[metastasis]] to the [[liver]] | ||
* [[Moon face|Moon-face]] is a medical sign where the face swells up into a rounded shape. It is often associated with [[Cushing's syndrome]], which has led to it being known as Cushingoid facies ("Cushings-like face"), or [[steroid]] treatment | * [[Moon face|Moon-face]] is a medical sign where the face swells up into a rounded shape. It is often associated with [[Cushing's syndrome]], which has led to it being known as [[Cushingoid appearance|Cushingoid facies]] ("Cushings-like face"), or [[steroid]] treatment | ||
* [[Alopecia]] | * [[Alopecia]] | ||
Revision as of 14:41, 25 September 2017
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Adrenocortical carcinoma Microchapters |
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Differentiating Adrenocortical carcinoma from other Diseases |
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Diagnosis |
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Treatment |
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Case Study |
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Adrenocortical carcinoma physical examination On the Web |
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American Roentgen Ray Society Images of Adrenocortical carcinoma physical examination |
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Risk calculators and risk factors for Adrenocortical carcinoma physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] Ahmad Al Maradni, M.D. [3]
Overview
Common physical examination findings of Adrenocortical carcinoma include hypertension, weakness, gynecomastia, and acne.
Physical Examination
Appearance of the patient
- Moon-like face[1]
- Buffalo hump
- Patients may appear flushed due to the associated increase in erythropoietin secretion.[2]
- Patients may appear obese due to associated type2 diabetes mellitus and Cushing's syndrome.[3]
Vitals
- Hypotension occurs due to fluid contraction
- Hypertension due to cortisol's enhancement of epinephrine's vasoconstrictive effect
- Tachypnea if malignant secondaries are found in the lung. Dyspnea occurs in patients with complicated heart failure and cardiomyopathy
Chest
Skin
- Skin may be fragile and thin
- Jaundice secondary to deranged liver function in case of metastasis to the liver
- Hyperpigmentation - this is due to melanocyte-stimulating hormone production as a byproduct of ACTH synthesis from Proopiomelanocortin (POMC)
- Telangiectasia (dilation of capillaries)
- Thinning of the skin (which causes easy bruising)
- Purple or red striae (the weight gain in Cushing's stretches the skin, which is thin and weakened, causing it to hemorrhage) on the trunk, buttocks, arms, legs or breasts, and proximal muscle weakness
- Hirsutism
Head
- Facial flushing
- Scleral icterus in case of metastasis to the liver
- Moon-face is a medical sign where the face swells up into a rounded shape. It is often associated with Cushing's syndrome, which has led to it being known as Cushingoid facies ("Cushings-like face"), or steroid treatment
- Alopecia
Abdomen
- A palpable abdominal mass in the lower abdominal quadrant.
- Guarding may be present.
- Hepatomegaly if malignant secondaries found in liver.
- Diarrhea caused by gastrointestinal secretion of fluid and electrolytes, and flushing in medullary thyroid cancer patients.
Extremities
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity
Neurologic
Genitals
References
- ↑ Nieman LK (2015). "Cushing's syndrome: update on signs, symptoms and biochemical screening". Eur J Endocrinol. 173 (4): M33–8. doi:10.1530/EJE-15-0464. PMC 4553096. PMID 26156970.
- ↑ La Batide-Alanore A, Chatellier G, Plouin PF (2003). "Diabetes as a marker of pheochromocytoma in hypertensive patients". J Hypertens. 21 (9): 1703–7. doi:10.1097/01.hjh.0000084729.53355.ce. PMID 12923403.
- ↑ Drénou B, Le Tulzo Y, Caulet-Maugendre S, Le Guerrier A, Leclercq C, Guilhem I; et al. (1995). "Pheochromocytoma and secondary erythrocytosis: role of tumour erythropoietin secretion". Nouv Rev Fr Hematol. 37 (3): 197–9. PMID 7567437.