A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin and mucous membranes [leading symptom: seizure-like flushing (erythema), especially in the head, neck region, and thorax]
- Auscultation (listening) of the heart.
- Auscultation of the lungs
- Palpation (palpation) of the abdomen (abdomen), etc.
- Inspection (viewing).
- Cancer screening [due todifferential diagnoses:
- Catecholamine-producing tumors – neoplasms such as pheochromocytoma (tumor of the adrenal gland) that produce catecholamines such as norepinephrine.
- Medullary thyroid carcinoma – form of thyroid cancer that produces calcitonin.
- Renal cell carcinoma (renal cell cancer).
- Serotonin-producing carcinoid (synonyms: diffuse neuroendocrine neoplasia (neoplasm); neuroendocrine tumors, NET; gastoenteropancreatic neuroendocrine neoplasia (GEP-NEN)) – localization: Depending on the localization, the following are distinguished: the bronchus carcinoid, thymus carcinoid, appendix carcinoid, ileum carcinoid, duodenal carcinoid, gastric carcinoid, rectal carcinoid (colon NET), pancreatic carcinoid (pancreatic NET); approx. 80 percent of tumors are located in the terminal ileum or appendix.Symptoms: The first sign is often persistent diarrhea. Typical for the carcinoids (GEP-NEN) is the “flush symptomatology” (flush syndrome); this is a sudden blue-red discoloration of the face, neck and under certain circumstances of the torso understood, furthermore hypoglycemias (hypoglycemia) or duodenal ulcers (ulcers of the duodenum).
- Systemic mastocytosis – disease characterized by excessive proliferation of mast cells.
- Vasoactive intestinal peptide (VIP)-producing tumors – neoplasms that produce hormones physiologically synthesized in the digestive tract]
- If necessary, gynecological examination in middle-aged women [due todifferential diagnosis: female climacteric disorders (menopausal symptoms)]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.