Tony Suharsono Pemeriksaan Fisik A variety of disorders can be found within the endocrine system. Usually involves either too little or too much hormone activity Health History Physical Assessment Physical assessment starts with height, weight, and vital signs Inspection Observe the patient for mood and affect Inspect the neck for thyroid enlargement Look for eyes that bulge (exophthalmos) Note posture, body fat, and presence of tremor Observe skin and hair texture and moisture. Note the presence of a moonlike face or “buffalo hump” on the upper back. Observe the lower extremities for skin and color changes that might indicate circulatory impairment Physical Assessment Palpation The thyroid gland Palpate all peripheral pulses. The posterior tibial and dorsalis pedis pulses may be diminished in patients with circulatory impairment. Palpate skin turgor Physical Assessment Diagnostic Testing Glucose Fasting Plasma Used to measure plasma glucose level after 12 to 14 hour fast Purpose : to screen for DM, to monitor diet or drug therapy Patient Preparation : explain to the patient about the test, explain that the test requires a blood sample, instruct the patient to fast for 12-14 hour before test, alert the patient to the symtoms of hypoglicemia Glucose Fasting Plasma Reference values : glucose value after fast at least 8 hours is 70-110 mg/dl atau 3.9-6.1 mmol/L Abnormal findings Elevated : DM (required confirmation), pancreatitis, recent acute ilness (miocard infark) Low plasma glucose : hyperinsulinism Glucose, 2 hour postprandial plasma Valuable screening tool for detecting DM The test is performed when the patient shows symtoms of diabetes or when the result of the fasting plasma glucose test suggest diabetes Purpose : to aid in the diagnosis of DM, to monitor drug or diet therapy in patient in DM Glucose, 2 hour postprandial plasma Patient Preparation Explain to the patient that this test is used to evaluate glucose metabolism and to detect diebetes Explain that the test requires a blood sample and tell the patient when and where it will be taken Tell the patient to eat a balance meal or one containing 100 g of carbohydrate before the test and then to fast for 2 hours. Instruct him to avoid exercise after the meal Glucose, 2 hour postprandial plasma Reference Value Less than 145 mg/dl or 8 mmol/L (in patients doesn’t have diabetes) Level slightly elevated in older than age 50 Abnormal findings Value 200mg/dl or above indicate DM Hiperglicemia may also occur with pancreatitis, sindroma cushing Low glucose level occur in hyperinsulinism Glucose tolerance test, oral The most sensitive method to evaluate borderline cases of diabetes Plasma and urine glucose level are monitored for 3 hours after the patient challenge dose of glucose Performed to assess insulin secretion and ability to metabolize glucose GTTO isn’t nosmally used in patient with fasting plasma glucose value >140mg/dl or post prandial plasma glucose value >200mg/dl Glucose tolerance test, oral Purpose To confirm diagnosis of DM To aid in the diagnosis of hypoglicemia and malabsorbtion syndrome Patient Preparation Explain to the patient that the test is used to evaluate glucose metabolism Instruct the patient to maintain a high carbohydrate diet for 3 days and then fast for 10-16 hours before test Tell the patient dont drink coffee or alcohol, or exercise 8 hours before an during test Tell the patient that this test requires five blood sample and usually five urine samples Alert the patient to the symtoms of hypoglicemia Glucose tolerance test, oral Reference values Normal plasma glucose level peak at 160-180 mg/dl within 30 minute to 1 hour Return to fasting level or lower within 2-3 hours Urine glucose test remain negative Abnormal findings Decrease glucose tolerance, may confirm diabetes melitus Increase glucose tolerance, may indicate insulinoma Hemoglobin glycosilated (HbA1c) Test is used to monitor doabetes therapy Provides information about the average blood glucose level during the preeceding 2-3 months It can be used to evaluate the long term effectiveness of diabetes therapy Hemoglobin glycosilated (HbA1c) Purpose : to assess control of diabetes mellitus Patient Preparation Explain to the patient that this test is used to evaluate diabetes therapy Explain that the test requires a blood sample, and then tell the patient when and where it will be taken Inform the patient that he need not restrict food or fluids Hemoglobin glycosilated (HbA1c) Reference value HbA1c values are reported as a percentage of the total Hb within RBC HbA1c account for 4 to 7% Abnormal findings Blood glucose good control regulation when the value <8% Value >10% indicates poor control C Peptide Proinsulin is split into C-peptide and insulin. The level of C-peptide is considered equal to the amount of insulin Indicating the amount of insulin made by the pancreas The C-peptide test measures the level of C-peptide in blood and Is used to differentiate between types 1 and 2 diabetes C Peptide Purpose : C-peptide level in blood and differentiate between types 1 and 2 diabetes Patient Preparation Why blood sample is taken That the patient should not eat or drink 8 hours before the test is administered That the healthcare provider may ask the patient to stop taking alcohol, insulin, sulfonylureas for 2 weeks prior to the test C Peptide Reference Values Normal C-peptide range: 0.78 to 1.89 ng/mL The blood glucose test is performed along with the C-peptide test and the results of both tests are compared. C Peptide Abnormal findings High C-peptide and high blood glucose values may indicate : type 2 diabetes, insulin resistance High C-peptide and low blood glucose values may indicate: insulinoma, sulfonylureas consumtion Low C-peptide and low blood glucose values may indicate: lever disease, taken insulin Low C-peptide and high blood glucose values may indicate: type 1 diabetes, pancreatectomy Others endocrin laboratory test Nuclear Scanning A thyroid scan may be done to determine the presence of tumors or nodules. For this test, a radioactive material is injected or radioactive iodine is taken orally. After a specified time, the thyroid gland is scanned with a scintillation camera. The scan will show “hot spots,” which are nodules that are not malignant, or “cold spots” (areas that do not take up the radioactivity), which indicate malignancy. Cold spots can then be biopsied to confirm a diagnosis. The patient should be aware that the test takes approximately 30 minutes to complete. Radiographic tests A computed tomographic (CT) scan or magnetic resonance imaging (MRI) may be done to locate a tumor or identify hypertrophy of a gland Ultrasound Ultrasound may be done of the thyroid or parathyroid glands to determine if they are enlarged or to find masses Biopsy Biopsy is done to obtain tissue to examine for possible cancerous cells. The thyroid gland can be biopsied either by needle aspiration under local anesthesia or using a surgical incision.