Chapter 57: Common Endocrine and Metabolic Complaints

Hypocalcemia, defined as serum calcium below 8.5 mg/dL, triggers compensatory parathyroid hormone release but can present acutely with neuromuscular hyperexcitability manifested through clinical signs like Trousseau's sign and Chvostek's sign, or chronically with integumentary and skeletal complications. Evaluation requires assessment of magnesium, phosphorus, albumin, and vitamin D status, with acute causes ranging from surgical trauma to medication effects and chronic causes stemming from hormonal deficiency or renal dysfunction. Gynecomastia, the proliferation of glandular breast tissue in male patients, results from androgen-estrogen imbalance or hyperprolactinemia and must be distinguished from adipose tissue accumulation; while pubertal onset frequently resolves spontaneously, persistent or prepubertal presentation warrants endocrinologic referral. Hirsutism encompasses excessive terminal hair growth in androgen-responsive body regions, with approximately ninety percent of cases attributable to idiopathic causes or polycystic ovary syndrome, requiring assessment for virilization features that might indicate neoplastic disease. Increased neck circumference commonly reflects thyroid enlargement but necessitates careful distinction between diffuse pathology and focal masses, with clinical examination techniques and consideration of malignancy risk guiding management decisions. The triad of polydipsia, polyphagia, and polyuria represents classic diabetes mellitus presentation, though differential diagnosis must include conditions such as diabetes insipidus, hyperthyroidism, and medication-induced effects. Diagnostic confirmation relies on standardized glycemic thresholds including hemoglobin A1c values and fasting or random glucose measurements, with comprehensive evaluation incorporating fluid balance assessment and metabolic investigation to identify underlying etiology and guide therapeutic intervention.