15
Delayed ankle reflex;
periorbital puffiness;
coarse skin; cold skin; slow
movement; goiter
yroid-stimulating
hormone; free thyroxine
None
Lid lag ; fine tremor of the
outstretched hands; warm,
moist skin
yroid-stimulating
hormone; free thyroxine
Radioactive iodine uptake
and scan
BP higher in upper
extremities than in lower
extremities; absent femoral
pulses; continuous murmur
over patient's back, chest,
or abdominal bruit;
le thoracotomy scar
(postoperative)
Echocardiogram oracic and abdominal
CT angiogram or MRA
Usually none Serum calcium Serum parathyroid
hormone
Signs of virilization
(11-beta-OH) or
incomplete masculinization
(17-alpha-OH)
Hypertension and
hypokalemia with low or
normal aldosterone and
renin
11-beta-OH: elevated
deoxycorticosterone
(DOC), 11-deoxycortisol,
and androgens17-alpha-
OH; decreased androgens
and estrogen; elevated
deoxycorticosterone and
corticosterone
Arrhythmias (with
hypokalemia)
Low aldosterone and renin Urinary cortisol
metabolites, genetic testing
Acral features; large hands
and feet; frontal bossing
Serum growth hormone
≥1 ng/mL during oral
glucose load
Elevated age- and sex-
matched IGF-1 level; MRI
scan of the pituitary
Physical Examination Screening Tests
Additional/
Confirmatory Tests
