A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height [weight gain]; further:
- Inspection (viewing).
- Skin, mucous membranes and sclerae (white part of the eye) [enlargement of acra – body ends such as nose, chin, ears, hands (wedding ring no longer fits), feet (shoe size ↑), thickened facial/head skin, increased wrinkled (pronounced forehead wrinkles, deep folds around mouth) → coarsening of facial features; growth of upper and lower jaw (prognathism (protrusion of upper jaw), malocclusion (malocclusion), gaps between teeth); Enlargement of cartilaginous joint parts, thickened, hardened nails; macroglossia (enlargement of the tongue) → speech (cloggy speech); swallowing and occlusion disorders; water retention (water retention); alopecia (hair loss); hirsutism – increased terminal hair (long hair) in women, according to the male distribution pattern]
- Thyroid gland [goiter]
- Palpation (palpation) of the thyroid gland [goiter (thyroid enlargement)]
- Auscultation (listening) and percussion of the heart [cardiomegaly (enlargement of the heart)]
- Palpation of the mammae, both supraclavicular pits (upper clavicular pits), and axillae (axillae) [Normal: unremarkable; gynecomastia (enlargement of the male mammary gland); galactorrhea/diseased mammary discharge (in an adenoma that simultaneously secretes GH and prolactin)]
- Examination of the abdomen
- Percussion (tapping) of the abdomen [attenuation of tapping sound due to enlarged liver?]
- Palpation of the abdomen (abdomen) (tenderness?, palpation?, coughing pain?, guarding?, hernial orifices?, renal bearing palpation?) [Hepatomegaly (liver enlargement)]
- Inspection (viewing).
- Ophthalmological examination
- Suspected pituitary adenoma Examination of visual acuity (visual acuity) and oculomotor function (eye movements).
- Wg. visual disturbances/loss of visual acuity (compression of the optic chiasm); elevated intraocular pressure.
- ENT medical examination – due tosnoring and sleep apnea syndrome.
- Neurological examination
- Suspicion of pituitary adenoma: examination of visual acuity (visual acuity) and oculomotor function (eye movements).
- Wg. carpal tunnel syndrome – nerve compression syndrome affecting the median nerve at the wrist (causing paresthesias in the first three and a half fingers of the hand) [common]; tarsal tunnel syndrome – bottleneck syndrome with compression-related functional limitation of the tibial nerve (causing paresthesias of the feet) [common].
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.