Symptoms

Does the patient complain of acne? 

If they have also developed oligomenorrhoea and hirsuitism, consider polycystic ovarian syndrome or late onset congenital adrenal hyperplasia.

If they have gained central weight, and developed thinned, bruised or red skin, consider Cushing’s syndrome.

If they have also developed hirsuitism, increased muscle bulk, increased libido or clitoromegaly consider Cushing’s syndrome or a virilising tumour.

Is the patient experiencing anxiety? 

If they have also developed heat intolerance, tremulousness, weight loss, diarrhoea or oligomenorrhoea consider thyrotoxicosis.

If they describe specific attacks of extreme anxiety, palpitations, abdominal pain or collapses, consider phaeochromocytoma.

Does the patient suffer from depression? 

If they also complain of tiredness and weight gain consider hypothyroidism.

If they are tired and nauseated, and describe polyuria or constipation consider hypercalcaemia.

If they have developed weight gain and thinned or red skin consider Cushing’s syndrome.

If they have also lost their libido, or developed erectile dysfunction consider hypogonadism, or hypopituitarism.

Does the patient complain of erectile dysfunction? 

If they have also lost their libido and their secondary sexual body hair, or complain of low energy consider all causes of hypogonadism.

If they have the symptoms of hypogonadism, but also describe abnormal breast development, galactorrhoea or visual loss, consider prolactinoma.

If they have also developed anxiety, tremulousness or weight loss, consider thyrotoxicosis.

Has the patient experienced faints? 

If the patient also describes specific attacks of extreme anxiety, palpitations, abdominal pain or collapses, consider phaeochromocytoma.

If they have also developed heat intolerance, palpitations, tremulousness, weight loss, diarrhoea or oligomenorrhoea consider thyrotoxicosis.

If they describe an association with fasting, extreme hunger, or the collapses are relieved by eating, or the patient has gained weight attempting to prevent attacks, consider insulinoma.

If the patient describes a feeling of dry warmth rather than sweating, flushing of the face or diarrhoea, consider carcinoid syndrome.

Is the patient suffering from fatigue? 

If they also complain of low energy, constipation, menorrhagia or weight gain consider hypothyroidism.

If they also complain of thirst, polyuria, nausea, constipation or indigestion, consider hypercalcaemia.

If they have developed muscle weakness, weight gain and thinned or red skin consider Cushing’s syndrome.

If they have developed increased skin pigmentation, lost weight, have a low serum sodium, or feel nauseated or dizzy consider Addison’s disease.

If they have also lost their libido, or developed erectile dysfunction consider hypogonadism, or hypopituitarism.

Does the patient experience fits? 

If they also describe specific attacks of extreme anxiety, palpitations, abdominal pain or collapses, consider phaeochromocytoma.

If they have also developed heat intolerance, palpitations, tremulousness, weight loss, diarrhoea or oligomenorrhoea consider thyrotoxicosis.

If they describe an association with fasting, extreme hunger, or the collapses are relieved by eating, or the patient has gained weight attempting to prevent attacks, consider insulinoma.

If the patient describes a feeling of dry warmth rather than sweating, flushing of the face or diarrhoea, consider carcinoid syndrome.

Does the patient describe flushing?

If the patient describes general heat intolerance, with weight loss, anxiety, tremulousness, palpitations, diarrhoea or oligomenorrhoea, consider thyrotoxicosis.

If the patient describes a feeling of dry warmth, flushing of the face, diarrhoea or episodic wheeze, consider carcinoid syndrome.

If the patient actually complains of a generalised increase in sweating, and has soft tissue swelling, consider acromegaly.

If the flushes tend to be worse at night, and are associated with profuse sweating, consider any cause of hypogonadism, the commonest being premature ovarian failure.

Has the patient experienced 'funny turns'?

If they also describe specific attacks of extreme anxiety, palpitations, abdominal pain or collapses, consider phaeochromocytoma.

If they have also developed heat intolerance, palpitations, tremulousness, weight loss, diarrhoea or oligomenorrhoea consider thyrotoxicosis.

If they describe an association with fasting, extreme hunger, or the collapses are relieved by eating, or the patient has gained weight attempting to prevent attacks, consider insulinoma.

If the patient describes a feeling of dry warmth rather than sweating, flushing of the face or diarrhoea, consider carcinoid syndrome.

Has the patient experienced hair loss? 

If they have lost eye brow hair and have diffuse thinning of scalp hair, or have developed weight gain, menorrhagia, constipation or tiredness, consider hypothyroidism.

If they have lost hair in a male baldness pattern, and developed hirsuitism, acne and oligomenorrhoea, consider polycystic ovarian syndrome, Cushing’s syndrome or a virilising tumour.

If they have lost secondary sexual body hair, and have a low libido or erectile dysfunction, consider hypogonadism or hypopituitarism.

If the hair loss is in well circumscribed patches, consider alopecia areata which may be associated with Addison’s disease, auto-immune thyroid disease and other organ specific auto-immune conditions.

Has the patient experienced hirsutism? 

If the patient has also developed oligomenorrhoea and acne, consider polycystic ovarian syndrome or late onset congenital adrenal hyperplasia.

If they have gained central weight, and developed thinned, bruised or red skin, consider Cushing’s syndrome.

If they have also developed increased muscle bulk, increased libido or clitoromegaly consider Cushing’s syndrome or a virilising tumour.

Does the patient have increased pigmentation? 

If they have also lost weight, have a low serum sodium, or feel nauseated or dizzy consider Addison’s disease.

If they have any alarm symptoms for malignancy, or have developed thin, bruised skin, and muscle weakness consider Cushing’s syndrome due to ectopic ACTH.

Is the patient more irritable than usual? 

If they have also developed heat intolerance, tremulousness, weight loss, diarrhoea or oligomenorrhoea consider thyrotoxicosis.

If they describe specific attacks of extreme anxiety, palpitations, abdominal pain or collapses, consider phaeochromocytoma.

Has the patient described a loss of libido? 

If they have also lost secondary sexual body hair, have erectile dysfunction, and low energy consider hypogonadism.

If they have the symptoms of hypogonadism, but are also dizzy, tired, and nauseated, consider hypopituitarism.

If they have the symptoms of hypogonadism, but also describe abnormal breast development, galactorrhoea or visual loss, consider prolactinoma.

Does the patient suffer from low energy levels? 

If the patient also complains of constipation and polyuria consider hypercalcaemia.

If they have developed constipation, menorrhagia, or gained weight consider hypothyroidism.

If they have developed a deep tan, lost weight and feel nauseated and dizzy consider Addison’s disease.

If they have lost weight, feel nauseated and dizzy, but have not developed a tan, and have also lost libido or stopped having periods consider hypopituitarism.

Has the patient experienced low moods? 

If they also complain of tiredness and weight gain consider hypothyroidism.

If they are tired and nauseated, and describe polyuria or constipation consider hypercalcaemia.

If they have developed weight gain and thinned or red skin consider Cushing’s syndrome.

If they have also lost their libido, or developed erectile dysfunction consider hypogonadism, or hypopituitarism.

Has the patient described nocturia? 

If the patient also complains of tiredness, constipation, indigestion, and polyuria consider hypercalcaemia.

If they describe extreme thirst, polyuria, skin infections, and sudden weight loss consider diabetes mellitus.

If they describe extreme thirst even at night, polyuria, and large volumes of nocturia consider diabetes insipidus.

Is the patient pale?

If they have also developed weight gain, menorrhagia, constipation or tiredness, consider hypothyroidism.

If they feel nauseated and dizzy, have a low serum sodium, and have also lost libido or stopped having periods consider hypopituitarism.

Is the patient describing polyuria? 

If the patient also complains of tiredness, constipation, indigestion, and polyuria consider hypercalcaemia.

If they describe extreme thirst, polyuria, skin infections, and sudden weight loss consider diabetes mellitus.

If they describe extreme thirst even at night, polyuria, and large volumes of nocturia consider diabetes insipidus.

Has the patient experienced soft tissue swelling? 

If they have also developed increased sweating, a change in facial appearance, or had an increase in shoe or ring size, consider acromegaly.

If they have generalised puffiness, or have developed weight gain, menorrhagia, constipation or tiredness, consider hypothyroidism.

Does the patient complain of profuse sweating? 

If they have also developed soft tissue swelling, a change in facial appearance, or had an increase in shoe or ring size, consider acromegaly.

If they have also developed anxiety, tremulousness, weight loss, or diarrhoea, consider thyrotoxicosis.

Does the patient have a 'permanent tan'? 

If they have also lost weight, have a low serum sodium, or feel nauseated or dizzy consider Addison’s disease.

If they have any alarm symptoms for malignancy, or have developed thin, bruised skin, and muscle weakness consider Cushing’s syndrome due to ectopic ACTH.

Is the patient often thirsty? 

If the patient also complains of tiredness, constipation, indigestion, and polyuria consider hypercalcaemia.

If they describe extreme thirst, polyuria, skin infections, and sudden weight loss consider diabetes mellitus.

If they describe extreme thirst even at night, polyuria, and large volumes of nocturia consider diabetes insipidus.

Does the patient suffer from tiredness? 

If the patient also complains of constipation and polyuria consider hypercalcaemia.

If they have developed constipation, menorrhagia, or gained weight consider hypothyroidism.

If they have developed a deep tan, lost weight and feel nauseated and dizzy consider Addison’s disease.

If they have lost weight, feel nauseated and dizzy, but have not developed a tan, and have also lost libido or stopped having periods consider hypopituitarism.

Has the patient experienced weight gain? 

If the patient has developed central weight gain as well as thinned, reddened skin, acne, hirsuitism, muscle weakness, diabetes, hypertension, hypokalaemia or osteoporosis, consider Cushing’s syndrome.

If the weight gain is long standing, onset has been very gradual, and weight fluctuates with life events and dieting, consider simple obesity.

If they have developed menorrhagia, constipation or tiredness, consider hypothyroidism.

If the weight gain was gradual, started in puberty, and is associated with hirsuitism, acne and oligomenorrhoea consider polycystic ovarian syndrome.

Has the patient experienced weight loss? 

If they have also developed anxiety, tremulousness, diarrhoea, or oligomenorrhoea consider thyrotoxicosis.

If they have developed a deep tan, have a low serum sodium, and feel nauseated and dizzy consider Addison’s disease.

If they feel nauseated and dizzy, have a low serum sodium, and have also lost libido or stopped having periods consider hypopituitarism.

If they have also developed thirst, polyuria and nocturia, consider diabetes mellitus.

If there are any other warning symptoms always consider malignancy.