Inspection. Examination during the study of endocrine patients is very important great importance, and often at the first glance at a patient one can recognize the disease or by general appearance patient, or according to individual signs of the disease (Graves' disease, myxedema, acromegaly, gigantism, pituitary dystrophy, Addison's disease).
When examining, you need to pay attention to the following signs.
1) Body growth, as well as the sizes and ratios of its individual parts: significant deviations in growth should direct the doctor’s thoughts to dysfunction of the cerebral appendage, thyroid, reproductive or thymus glands; maintaining or violating proportionality in separate parts bodies and the presence of others characteristic features allow us to clarify the pathogenesis of growth disorders; a disproportionate increase in the distal parts of the body (nose, lips, chin, hands, feet) will indicate hyperfunction of the anterior pituitary gland (acromegaly), etc.
2) Fatness of patients and features of fat deposition. Obesity is most often associated with decreased function of the thyroid, pituitary gland or gonads, emaciation with hyperthyroidism, damage to the cerebral appendage (Simmonds disease), and decreased function of the pancreas (diabetes). The distribution of fat in the subcutaneous tissue in typical cases often allows us to get closer to the pathogenetic diagnosis of endocrine obesity: preferential deposition of fat in the pelvic girdle ( Bottom part abdomen, buttocks, thighs) and on the chest is characteristic of pituitary and sexual obesity; a more or less uniform distribution of fat throughout the body will indicate thyroid obesity. Severe weight loss is observed with hyperthyroidism, with Addison's disease and especially with Simmonds' disease (pituitary cachexia).
3) Body hair. Due to the dependence of hair growth on hormonal influences, mainly the gonads, thyroid gland, adrenal cortex and medullary appendage, the condition and nature of the hairline are important diagnostic signs for disorders of internal secretion, such as: female type hair growth with eunuchoidism, increased hair growth with hyperthyroidism and acromegaly, hypertrichosis (hirsutism) with tumors of the adrenal cortex, hair loss with myxedema, etc.
4) Condition of the skin - tenderness and brightness in Graves' disease, roughness and pallor in myxedema, dark brown color in Addison's disease, etc.
5) Face, its expression and changes in the eyes.
From endocrine glands Only the thyroid gland and testicles are accessible to direct inspection: reduction and enlargement of these organs can be easily detected by inspection.
Palpation. By palpation, you can examine the same two endocrine glands - the thyroid and male reproductive organs, determining their size, density, uniformity or unevenness of consistency (nodularity), pain, etc. By means of a special gynecological examination Using bimanual palpation, you can also feel the female sex glands - the ovaries.
Big diagnostic value palpation of the skin in Graves' disease and myxedema: with the first, the skin is thin, soft, smooth, (velvety), moist and hot, with the second - thick, dense, rough, dry and cold.
Percussion. With the help of percussion, it is possible to determine the retrosternally (retrosternally) located struma (goiter), and this is, apparently, the only use of percussion in the study of endocrine glands.
Auscultation. Auscultation in the study of endocrine glands also finds only one application, namely in the study of an enlarged thyroid gland, when one can hear a systolic gurgling noise arising in its dilated arterial vessels.
Anthropometric measurements . Anthropometric measurements can serve to objectively confirm those noted during examination or to identify subtle endocrine-related differences in proportions and body structure. Thus, gender differences are reflected in women, compared to men, by relatively shorter limb lengths, smaller shoulder widths and large sizes pelvis Further, excessive leg length is characteristic of eunuchoidism, and relatively short legs are characteristic of early puberty. Determinations of height and weight also provide useful numerical data for the assessment of endocrine influences and endocrine pathology.
Determination of basal metabolism. Determination of basal metabolism is of great diagnostic importance for a number of diseases of the endocrine glands, especially the thyroid. By basal metabolism we mean the minimum amount of energy, expressed in calories, that the body needs to maintain its basic vital functions, i.e. blood circulation, respiration and constant temperature bodies. Therefore, the determination of the basal metabolic rate is carried out with complete physical rest on an empty stomach (no earlier than 12 hours after the last meal). The principle of determining the basal metabolic rate is that, using special equipment, the values of pulmonary ventilation are directly determined, i.e., the amount of exhaled air and its composition, over a known period of time (usually 10 minutes). Then, using special tables, the amount of absorbed oxygen and released carbon dioxide and their ratio (respiratory coefficient) are calculated, and then the required number of calories per hour per 1 kg of weight (normally about 1 calorie) or per 1 m2 of body surface (normally about 40 calories ). An increase in basal metabolism by more than 10-15% will indicate an undoubted pathological increase in it and is most often observed in hyperthyroidism or Graves' disease, in which an increase of 30-50-80-100% represents common occurrence. A decrease in basal metabolism by 15-30-50% against the norm is characteristic of hypothyroidism and myxedema, pituitary dystrophy and Simmonds' disease.
X-ray method . The X-ray method of examination easily makes it possible to determine changes in the bone skeleton and judge endocrine diseases from them. Thus, it is possible to recognize: 1) tumors of the pituitary gland by changes in the size and shape of the sella turcica (its widening and deepening, destruction of the edges); 2) acromegaly - by thickening of the bones and enlargement of the air cavities of the skull, by great development"exostosis in the circumference of the joints; 3) eunuchoidism - due to insufficient ossification of bone sutures and delayed ossification of the epiphyseal zones; 4) hypergenitalism - due to accelerated ossification of the epiphyses.
X-ray can also identify a retrosternally located enlarged thyroid gland(retrosternal goiter).
Laboratory research. From everyday laboratory research, used for diagnostic purposes in recognizing endocrine diseases, most often we have to deal with urine and blood tests.
Urine examination- her daily amount, specific gravity and sugar content in it - has essential when recognizing diabetes mellitus and diabetes insipidus.
Blood test can also play a known role in the recognition of certain endocrine diseases. For example, secondary anemia is often one of the symptoms of insufficiency of the thyroid gland (myxedema) or adrenal glands (Addison's disease). A certain degree of polyglobulia occurs in Graves' disease. Change leukocyte formula towards lymphocytosis is characteristic of dysfunction of the thyroid gland in one direction or another - irrespective (Graves' disease, myxedema). In other endocrine disorders, the blood picture also changes, but these changes have not yet been sufficiently studied.
Functional research methods. Functional diagnostics I have not acquired endocrine glands yet practical significance. Of those used for this purpose various methods(see specific guidelines on endocrinology) highest value have more complex: 1) determination of basal metabolic rate for assessment functional state thyroid gland; 2) determination of the specific dynamic effect of food - to identify the functional capacity of the pituitary gland and 3) study of glycemic blood curves - to judge the function of the pancreas, adrenal glands and thyroid gland.
Endocrinopathic syndromes
The main endocrinopathic syndromes are based mainly on the phenomena of hyperfunction or hypofunction of one or another endocrine gland.
I. Thyroid syndromes.
1. Hyperthyroid syndrome(hyperthyroidism, hyperthyroidism) is manifested by an increase in the volume of the thyroid gland, goiter (its hyperplasia), increased heart rate - tachycardia and protrusion eyeballs- bulging eyes (increased tone of the sympathetic nervous system).
This triad of symptoms is characteristic of severe cases of hyperthyroidism, the so-called Graves' disease. In addition to them, very important symptoms of hyperthyroidism are weight loss, depending on increased metabolism, trembling, diarrhea, sweating, vasomotor phenomena and phenomena of increased neuropsychic excitability associated with overexcitability of the autonomic sympathetic and parasympathetic nervous systems.
2. Hypothyroid syndrome(hypothyroidism, hypothyroidism) is often characterized by a decrease in the volume of the thyroid gland, a slowdown in heart rate and sunken eyeballs, then a tendency towards obesity, constipation, dry skin, a decrease in general nervous and mental excitability and, finally, a peculiar change in the skin and subcutaneous tissue, which appear infiltrated, doughy-dense consistency, as if swollen, but when pressure is applied to them, they do not leave pits; this is the so-called mucous swelling, hence the name of severe cases of this pathology - myxoedema.
II. Parathyroid syndromes.
1. Hyperparathyroid syndrome(hyperparathyroidism, hyperparathyroidism) is rare, accompanied by pstercalcemia and clinically, due to loss of skeletal significant quantities calcium salts, is expressed by atrophy and fibrous degeneration of bones with the formation of cavities in them, with their curvatures and fractures and subsequent skeletal deformation “(general fibrocystic osteitis - osteitis or osteodystrophia fibrosa cystica general is ata - Recklinghausen's disease).
2. Typoparathyroid syndrome(hypoparathyroidism, hypoparathyroidism) is observed much more often; a significant role in its pathogenesis is played by hypocalcemia (as well as a shift acid-base balance to the alkaline side - alkalosis and protein metabolism disorders). Clinical manifestation of this syndrome are increased excitability mainly musculoskeletal systems nervous system (when the calcium level in the blood decreases to 7 mg% and below) and a tendency to tetanic convulsions. These convulsions most often develop on upper limbs(the forearms are bent, the fingers are joined together in the “obstetrician’s hand” position), less often convulsions seize and lower limbs or extend also to the face, gastrointestinal tract or larynx. Seizures last from a few minutes to 1-2 hours and are easily repeated. In the clinic, this syndrome is called Spasmophilia or tetany.
III. Pituitary syndromes.
Violation complex functions pituitary gland entails the development of a number of pituitary or pituitary syndromes. We will present here only the more clinically important ones.
A. Hyperfunction of the pituitary gland, more precisely, its anterior lobe (hyperpituitarism) can lead to the development of three pituitary syndromes: the most famous and common acromegalic, the so-called Cushing syndrome, and diabetic.
1. Acromegaly is based on a tumor-like growth (adenoma) of eosinophilic cells of the anterior pituitary gland and overproduction of the growth hormone secreted by them. This syndrome is characterized by large sizes of the hands, feet and skull, brow ridges, cheekbones, nose and chin; At the same time, not only the bones, but also the soft parts, including the lips and tongue, increase.
If this hyperfunction of the pituitary gland appears in childhood, then there is a sharp increase overall growth, which ultimately goes more or less significantly beyond physiological norm- gigantism develops. Gigantism, therefore, is like acromegaly of childhood.
The opposite, rare syndrome associated with hypofunction of eosinophilic cells of the anterior pituitary gland is acromicria (micros - Greek - small), expressed in a decrease in the volume of the extremities, mainly the arms.
2. Cushing's syndrome is based on the proliferation (adenoma) of basophilic cells of the anterior lobe and the overproduction of endocrinotropic (stimulating the activity of other endocrine glands) pituitary hormones. The main symptoms of this syndrome are obesity of the face and trunk (but not limbs) with the formation of skin scars and hypertrichosis (stimulation of the adrenal cortex), arterial hypertension and hyperglycemia (stimulation of the adrenal medulla), bone loss - osteoporosis (stimulation of the parathyroid glands).
3. Pituitary diabetes associated with hyperproduction of a hormone that regulates carbohydrate metabolism and has an effect on it that is opposite to the action of insulin. This form of diabetes often accompanies acromegaly.
B. Hypofunction of the pituitary gland(hypopituitarism) underlies the following four syndromes:
1) pituitary obesity;
2) pituitary cachexia;
3) pituitary dwarf growth;
4) diabetes insipidus.
The described endocrinopathic syndromes are taken by us in their isolated form. But, as already stated above, individual glands are links of a single endocrine system. Therefore, in essence, there are no isolated dysfunctions of just one gland. Inevitably, a number of other glands more closely related to the first are also involved in the process. Therefore, almost every endocrine disease has the character of multiple lesions of the glands - pluriglandular in nature. However, pluriglandular syndromes in the strict sense of the word are also distinguished, and these include those intrasecretory disorders in the pathogenesis of which it is not possible to identify the leading role of damage to one or another gland, such as infantilism, premature aging, endocrine depletion.
Page 2 - 2 of 2
Most endocrine organs are inaccessible for direct examination, with the exception of the thyroid and gonads, therefore the state of the endocrine glands often has to be judged by clinical syndromes that are characteristic of hyper- or hypofunction of the affected gland, and homeostasis indicators.
Clinical examination of the endocrine system in children consists of studying complaints, medical history and life of the child, including genetic features family, conducting an objective examination of all organs and systems of the child, assessing data from additional research methods.
General examination of the patient
During an external examination of the child, attention is paid to the proportionality of the physique. Then an assessment is carried out physical development of the child, on the basis of which growth disorders can be identified. Grade physical development in children:
Considering the observed variation in various indicators of a child’s physical development, it is necessary to know the so-called normal, or Gaussian-Laplacian distribution. The characteristics of this distribution are the arithmetic mean value of the attribute or indicator (M) and the value of the standard deviation, or sigma (δ). Values beyond the M ± 2δ standard for healthy children, as a rule, indicate pathology.
In practice, indicative estimates retain their significance, in which the following empirical rule should be used: random variation of a trait that changes with age usually does not extend beyond one age interval; the value of a sign may be pathological in nature if its value is in the interval + 1-2 age intervals. The age intervals in the tables of standards are usually chosen as follows: from birth to one year the interval is equal to a month, from 1 year to 3 years - 3 months, from 3 to 7 years - 6 months, from 7 to 12 years - one year.
To accurately determine indicators of physical development, the pediatrician must use tables (or curves) of the age centile distribution. The practical use of these tables (graphs) is extremely simple and convenient. Columns of centile tables or curves graphically show the quantitative boundaries of a trait in a certain proportion or percentage (centile) of children of a given age and gender. In this case, the values characteristic of half of healthy children of a given age and gender - in the range from the 25th to the 75th centile - are taken as average or conditionally normal values.
Pituitary dwarfism is characterized by a slowdown in growth without changing body proportions. You can think about dwarfism if the child’s height lags behind what should be and goes beyond M-3δ (in the sigma series), below the boundaries of the 3rd centile (in centile tables) or SDS<-2. Рост взрослого мужчины-карлика не превышает 130 см, рост женщины - менее 120 см.
With hypothyroidism, there is a delay in growth with a violation of body proportions - short limbs. The face has a characteristic appearance: a wide flat bridge of the nose, widely spaced eyes (hypertelorism), a relative predominance of the facial skull, a large thick tongue, thick lips and other symptoms of hypothyroidism.
Acceleration of growth is characteristic of pituitary gigantism, in which growth exceeds the required height by more than 15% (above the 97th centile, SDS = +2), and thyrotoxicosis. Body proportions do not change with either disease.
If hyperfunction of the pituitary gland manifests itself after the closure of the growth plates, acromegaly develops - an enlargement of the nose, hands and feet, a massive lower jaw, and the brow ridges protrude strongly.
Inspection, palpation and assessment of skin condition. Pale skin with an icteric tint, grayish marbling, and dryness is noted in hypothyroidism. Waxy pallor is characteristic of pituitary tumors.
Purple-bluish coloration of the facial skin is observed with hyperfunction of the adrenal cortex (Cushing's syndrome and disease).
Hyperpigmentation of the skin (bronze tint) is observed with adrenal insufficiency.
Stretch marks (striae) are characteristic of Cushing's syndrome and hypothalamic obesity.
Dry skin is observed in diabetes mellitus and diabetes insipidus; In diabetes mellitus, in addition, there may be skin itching and furunculosis.
Increased skin moisture is observed in thyrotoxicosis, hypoglycemic conditions, and hyperinsulinism.
Hair condition. Dry, coarse, brittle hair is characteristic of hypothyroidism. Hirsutism (excessive hair growth in the male pattern in androgen-dependent areas) and hypertrichosis (excessive hair growth in androgen-independent areas) are associated with hyperfunction of the adrenal cortex.
Virilization- changes in the external female genitalia according to the male type - observed with congenital dysfunction of the adrenal cortex, with tumors of the adrenal glands or ovaries.
Inspection, palpation and assessment of the distribution of subcutaneous fat. An excess amount of subcutaneous tissue with its uniform distribution is characteristic of constitutional-exogenous, nutritional, and diencephalic obesity.
Excessive deposition of subcutaneous fat in the area of the shoulder girdle, 7th cervical vertebra, chest, and abdomen is observed in Itsenko-Cushing disease and syndrome.
Cerebral obesity is characterized by a bizarre distribution of subcutaneous tissue, for example, on the outer surface of the shoulder, inner thighs, etc.
There are 4 degrees of obesity:
I degree - excess body weight is 15-25% of the required amount,
II degree - -»- -»- from 25 to 50% -»-
III degree - -»- -»- 50-100% -»-
IV degree - -»- -»- more than 100%.
An important criterion for obesity is the body mass index (Quetelet) (BMI) - the ratio of weight in kg to height (in m 2). Obesity is defined as BMI exceeding the 95th centile for a given age and gender.
In the body, fat is located 1) in the subcutaneous fat (subcutaneous fat) and 2) around the internal organs (visceral fat). Excess subcutaneous fat in the abdominal area and visceral fat in the abdominal cavity form abdominal obesity. or "top" type. This type of fat distribution can be distinguished by measuring the circumferences of: the waist (WA) - under the lower edge of the ribs above the navel, the hips (HT) - at the level of the maximum protruding point of the buttocks, and calculating the WC/CV ratio. WC/BV values of more than 0.9 in men and more than 0.8 in women indicate the presence of abdominal obesity. On the contrary, when WC/TB values are equal to or less than 0.7, the “lower” or femorogluteal type of obesity is established.
A decrease in the development of subcutaneous fat is characteristic of Simmonds' disease (pituitary wasting), thyrotoxicosis, and diabetes mellitus before treatment.
Assessment of neuropsychic development and state of the nervous system
Hypothyroidism is characterized by a lag in mental development, while thyrotoxicosis is characterized by an acceleration of mental processes, short temper, irritability, tearfulness, fine tremor of the eyelids, fingers, instability of the autonomic nervous system.
With pituitary dwarfism and adiposis-genital dystrophy, mental infantilism is observed; with hypoparathyroidism, increased neuromuscular excitability (positive Trousseau and Chvostek symptoms).
Then the endocrine glands accessible to objective examination are examined.
Methods for studying the thyroid gland:
Inspection. The thyroid gland is normally not visible to the eye and cannot be palpated. Upon examination, you can determine the degree of enlargement of the thyroid gland. Starting from the second (with an increase in degree I, it is not visible to the eye). In addition, upon examination, symptoms characteristic of a decrease or increase in the function of the gland are revealed: the condition of the skin, subcutaneous tissue, physical development, eye symptoms (exophthalmos-bulging eyes, Dalrymple's symptoms - widening of the palpebral fissure, Jellinek - pigmentation of the eyelids, Kraus - rare blinking, Graefe - lag of the upper eyelid when looking down, Möbius - violation of convergence - when an object approaches the eyes, they first converge, and then one eye involuntarily moves to the side).
Palpation The thyroid gland is performed with the thumbs of both hands, which are located on the front surface, and the remaining fingers are placed on the back of the neck. In infants, palpating can be done with the thumb and index finger of one hand. When palpating the gland in older children, they are asked to make a swallowing movement, while the gland moves upward, and its sliding at this time along the surface of the fingers facilitates palpation examination.
The isthmus of the thyroid gland is examined by sliding movements of the thumb of one hand along the midline of the neck in a direction from top to bottom. The isthmus is located on the anterior surface of the trachea below the thyroid cartilage and reaches the 3rd tracheal ring. The lobes of the gland are located on both sides of the trachea and larynx, reaching the 5-6th tracheal ring.
When palpating the thyroid gland, it is necessary to note its size, surface features, the nature of the increase (diffuse, nodular, nodular), consistency (hard or soft elastic), pulsation, pain.
The term “goiter” is used when the thyroid gland is enlarged.
Currently in use WHO classification 2001, taking into account three clinical degrees of thyroid enlargement:
Grade 0 - the thyroid gland is not enlarged
1st degree - the thyroid gland is palpable
2nd degree - the goiter is palpable and visible to the eye
Auscultation examination of the thyroid gland is performed using a phonendoscope, which is applied to the gland. When the function of the gland increases, a vascular murmur is often heard over it. In older children, auscultation is performed while holding the breath.
Additional examination methods, used in the diagnosis of thyroid diseases in children:
Ultrasound examination – used to assess the size and structure of the gland;
Ultrasound examination with Dopplerography - blood flow in the gland is assessed;
Fine-needle puncture biopsy is a cytological examination of punctate, used in nodular forms of goiter to determine the cellular nature of the nodes;
Determination of the concentration of hormones in blood serum: thyroxine (T-4), triiodothyronine (T-3) and thyroid-stimulating hormone (TSH). T-4 and T-3 in the blood are in a free and protein-bound state. Hormonal activity is determined by the concentration of free fractions of thyroid hormones, therefore, to assess the functional state of the thyroid gland, it is necessary to examine the free fractions of T-3 and T-4;
5) Isotope scintigraphy - can be used to diagnose hormonally active and/or inactive formations, especially small ones in children over 12 years of age.
Enzyme immunoassay or radioimmunoassay
A) Antibodies to thyroid peroxidase (TPO) and microsomal antigen fractions (MAG) - used to diagnose the autoimmune process in chronic autoimmune thyroiditis;
B) Antibodies to TSH receptors - tested for suspected diffuse toxic goiter (Graves disease);
C) Antibodies to thyroglobulin are examined during observation of patients operated on for thyroid cancer (only in case of total resection).
7) X-ray method
Determination of bone age using radiographs of the hands.
To make this lecture easier to understand, let us recall some brief anatomical and physiological data on the endocrine system. To make this lecture easier to understand, let us recall some brief anatomical and physiological data on the endocrine system. The endocrine system is the system that releases hormones into the blood. “Hormones” are chemical substances secreted into the blood or lymphatic vessels and have various effects on target organs. The endocrine system is the system that releases hormones into the blood. “Hormones” are chemical substances secreted into the blood or lymphatic vessels and have various effects on target organs. Back in the middle of the twentieth century, it mainly included clearly organized morphological formations called glands. Back in the middle of the twentieth century, it mainly included clearly organized morphological formations called glands. By now this concept has become much broader. It turned out that many other organs and tissues have endocrine functions. By now this concept has become much broader. It turned out that many other organs and tissues have endocrine functions.
For example, one of these places turned out to be the hypothalamus. It turned out that the hypothalamus secretes: thyroliberin, luliberin, corticoliberin, prolactoliberin, folliculoliberin, somatoliberin, melanocytoliberin, luteostatin, melanocytostatin, which regulate the functioning of the pituitary gland. It turned out that the hypothalamus secretes: thyroliberin, luliberin, corticoliberin, prolactoliberin, in, somatoliberin, melanocytoliberin, luteostatin, melanocytostatin, which regulate the functioning of the pituitary gland
The liver secretes angiotensin. Kidneys - erythropotin and renin. Stomach – gastrin, somatostatin. The liver secretes angiotensin. Kidneys - erythropotin and renin. Stomach – gastrin, somatostatin. Duodenum and small intestine – motilin, secretin, cholecystokinin-pancreozymin, somatostatin. Cardiac atria and brain - atrial and brain natriuric peptides, respectively. Connective tissue and cells of mesenchymal origin are somatomedins. Duodenum and small intestine – motilin, secretin, cholecystokinin-pancreozymin, somatostatin. Cardiac atria and brain - atrial and brain natriuric peptides, respectively. Connective tissue and cells of mesenchymal origin are somatomedins. Adipose tissue – leptin, adiponectin, etc. Adipose tissue – leptin, adiponectin, etc.
In our subject it is not possible to analyze in detail all these hormones and their actions. But this information must be remembered once and for all: the endocrine system is not only the endocrine glands. However, here and today we are forced to talk specifically about the endocrine glands and their functions. In our subject it is not possible to analyze in detail all these hormones and their actions. But this information must be remembered once and for all: the endocrine system is not only the endocrine glands. However, here and today we are forced to talk specifically about the endocrine glands and their functions.
The system of endocrine glands is scattered throughout the body (Fig.) The system of endocrine glands is scattered throughout the body (Fig.) 1. Pituitary gland. 2. Thyroid gland. 3; 4 and 7. Adrenal glands. 5. Sex glands. 6. Pancreas. 8. Thymus (thymus gland) 9. Parathyroid glands. 10. Epiphysis. Let's briefly look at their morphology and functions.
The pineal gland secretes the hormone melatonin, which activates the division of pigment cells in the skin and has an antigonadotropic effect. The pineal gland secretes the hormone melatonin, which activates the division of pigment cells in the skin and has an antigonadotropic effect. The pituitary gland consists of an anterior - adenohypophysis and a posterior - neurohypophysis and intermediate parts (lobes). The pituitary gland consists of an anterior - adenohypophysis and a posterior - neurohypophysis and intermediate parts (lobes). The anterior lobe of the pituitary gland produces somatotropin - growth hormone; gonadotropic hormones that stimulate male and female reproductive glands; lactogenic hormone that supports the secretion of estrogen and progesterone by the ovaries; lactogenic hormone that supports the secretion of estrogen and progesterone by the ovaries; ACTH, which stimulates the production of adrenal hormones; TSH, which regulates the functioning of the thyroid gland. The posterior lobe of the pituitary gland contains two hormones: oxytocin, which regulates labor and secretion of the mammary glands and oxytocin, which regulates labor and secretion of the mammary glands, and vasopressin or antidiuretic hormone, which mainly regulates the reabsorption of water from the renal tubules, Intermediate part - intermedin hormone, which regulates pigment metabolism in the integumentary tissues.
THE THIROID GLAND produces thyroxine (T4) and triiodothyronine (T3), which regulate general metabolism in the body, influence the formation of the skeleton, accelerate bone growth and ossification of epiphyseal cartilage; calcitonin, which regulates the metabolism of calcium and phosphorus. Its functions are studied by determining these hormones.
The parathyroid glands regulate the metabolism of calcium and phosphorus. Removing the parathyroid glands causes seizures and can lead to death. The parathyroid glands regulate the metabolism of calcium and phosphorus. Removing the parathyroid glands causes seizures and can lead to death. The thymus (thymus gland is the most important organ of the body’s immunological defense. It ensures the differentiation and proliferation of bone marrow stem cells; produces the enzyme thymosin, which ensures the immunological competence of lymphocytes throughout the body. T-lymphocytes formed in the bone marrow enter the thymus and, under the influence of thymosin, become differentiated, immunologically competent and become the main mediators of cellular immunity Thymus (the thymus gland is the most important organ of the body’s immunological defense. It ensures differentiation and proliferation of bone marrow stem cells; produces the enzyme thymosin, which ensures the immunological competence of lymphocytes of the whole organism. T-lymphocytes formed in the bone marrow enter the thymus and under the influence thymosin become differentiated, immunologically competent and become the main mediators of cellular immunity
The adrenal glands consist of two layers - the cortex and the medulla. The adrenal glands consist of two layers - the cortex and the medulla. The medulla produces two hormones - mediators of the sympathetic nervous system - adrenaline and norepinephrine. They increase the contractility and excitability of the heart, constrict the blood vessels of the skin, and increase blood pressure. The medulla produces two hormones - mediators of the sympathetic nervous system - adrenaline and norepinephrine. They increase the contractility and excitability of the heart, constrict the blood vessels of the skin, and increase blood pressure. The cortex is an extremely important formation of the human body. It produces about 30 different hormones that regulate the concentration of sodium, potassium and chlorine in the blood and tissues, carbohydrate, protein and fat metabolism, as well as the production of sex hormones. The cortex is an extremely important formation of the human body. It produces about 30 different hormones that regulate the concentration of sodium, potassium and chlorine in the blood and tissues, carbohydrate, protein and fat metabolism, as well as the production of sex hormones
The pancreas is an organ that has both exocrine and endocrine functions. The exocrine function was discussed in the section on diseases of the digestive system. Endocrine function is provided by special cells collected in small islands (islets of Langerhans), which are embedded in the gland tissue throughout its entire volume. They produce the hormone insulin. Insulin mainly regulates carbohydrate metabolism - the consumption of glucose by various systems of the body, ensuring the transfer of glucose from the blood into the cell.
Let us now consider the issues of the norm of hormones secreted by these glands. Here, unfortunately, we must immediately make a reservation that in various sources in Russia you can find significantly different normal values of these hormones, which depends on the lack of standardization of research methods and on the chaos that exists today place in this country. Even if there were uniform standards in Russia, no one is going to adhere to them - everyone uses the method that is easier for them to fulfill or that they like best. However, we must outline approximate standards for you, and you should know them. As mentioned above, the anterior lobe of the pituitary gland secretes a significant amount of a wide variety of hormones. As mentioned above, the anterior lobe of the pituitary gland secretes a significant amount of a wide variety of hormones.
The fasting GH level is 8 ng/ml. As you know, overproduction of this hormone can be observed with gigantism or acromegaly, and underproduction can be observed with pituitary dwarfism, which we discussed in the lecture “Questioning, examining...for endocrine diseases.” The level of fasting growth hormone is 8 ng/ml. As is known, overproduction of this hormone can be observed with gigantism or acromegaly, and underproduction can be observed with pituitary dwarfism, which we discussed in the lecture “Questioning, examining...for endocrine diseases” TSH is 0.45 - 6.2 µIU/ml. Thyroid-stimulating hormone regulates the function of the thyroid gland, and its overproduction can lead to hyperthyroidism, and decreased production can lead to myxedema. TSH is 0.45 - 6.2 µIU/ml. Thyroid-stimulating hormone regulates the function of the thyroid gland, and its overproduction can lead to hyperthyroidism, and decreased production can lead to myxedema
ACTH – (on an empty stomach, at 8 o’clock in the morning, in the supine position) - 
The delusion gets me everywhere - the nonsense of newspapers, television, radio. The shelling is nonsense: it's a short flight, but it always hits and wounds. It is impossible to interrupt this nonsense, It is impossible to interrupt this nonsense, You can’t protect yourself from it with earplugs... You can’t protect yourself from it with earplugs... Some people create troubles from victories, Some people create troubles from victories, And sells lost souls And sells lost souls And others, to block the op , And others, in order to block the shouting, So that they are finally heard, Show hysterical agility Even in church in prayers to the Almighty.
The PL level in men is 2–12 ng/ml, in women 2–20 ng/ml. The PL level in men is 2–12 ng/ml, in women 2–20 ng/ml. The level of ADH in the blood is 29 ng/ml. The level of ADH in the blood is 29 ng/ml. Targeted radiography of the sella turcica and especially nuclear magnetic resonance (NMR) studies and computed tomography are of great help in diagnosing diseases of the pituitary gland. Targeted radiography of the sella turcica and especially nuclear magnetic resonance (NMR) studies and computed tomography are of great help in diagnosing diseases of the pituitary gland. These methods make it possible to detect pituitary tumors up to 0.2 cm in diameter (microadenomas) with 97% confidence. These methods make it possible to detect pituitary tumors up to 0.2 cm in diameter (microadenomas) with 97% confidence.
Pancreas The main methods for studying the endocrine function of the pancreas are the direct determination of the level of insulin and glucagon in the blood. The main methods for studying the endocrine function of the pancreas are the direct determination of the levels of insulin and glucagon in the blood. However, these methods have not yet entered into widespread practice. The most widely used methods for indirectly studying the insulin-producing function of the pancreas are the determination of glucose in the blood and urine and the glucose tolerance test.
Blood glucose is determined on an empty stomach. The normal level is fluctuating from 3.33 to 5.5 (according to some methods up to 6.105) mmol/l. Blood glucose is determined on an empty stomach. The normal level is fluctuating from 3.33 to 5.5 (according to some methods up to 6.105) mmol/l. An increase in blood glucose levels is called hyperglycemia. An increase in blood glucose levels is called hyperglycemia. This indicator is an almost reliable sign of the presence of diabetes mellitus in a person (it should be remembered that hyperglycemia can also have other origins). This indicator is an almost reliable sign of the presence of diabetes mellitus in a person (it should be remembered that hyperglycemia can also have other origins). A decrease in blood glucose levels, which is called hypoglycemia, may also occur. This condition can occur both with diabetes mellitus and with a number of diseases, which may be based on tumors or damage to the endocrine glands of another order. A decrease in blood glucose levels, which is called hypoglycemia, may also occur. This condition can occur both with diabetes mellitus and with a number of diseases, which may be based on tumors or damage to the endocrine glands of another order.
Determination of glucose (sugar) in urine is usually carried out in a daily volume of urine. Normally, there is no glucose in the urine. Its appearance is called glycosuria and is a serious sign of diabetes mellitus, although sometimes it can occur after heavy consumption of sweet foods and a rare disease - renal diabetes. Determination of glucose (sugar) in urine is usually carried out in a daily volume of urine. Normally, there is no glucose in the urine. Its appearance is called glycosuria and is a serious sign of diabetes mellitus, although sometimes it can occur after heavy consumption of sweet foods and a rare disease - renal diabetes. Glucose tolerance test. In many people, diabetes occurs hidden, latently (the so-called impaired glucose tolerance). These people may have minor stigmata of diabetes that are not confirmed by routine urine and blood tests. To clarify the diagnosis in these cases, this test was developed. Glucose tolerance test. In many people, diabetes occurs hidden, latently (the so-called impaired glucose tolerance). These people may have minor stigmata of diabetes that are not confirmed by routine urine and blood tests. To clarify the diagnosis in these cases, this test was developed.
Typically, the test is performed as follows: the subject is taken for glucose on an empty stomach, then given 75 g (or, more precisely, 50 g per m2 of body area) of glucose dissolved in ml of water to drink, and the blood is tested for glucose every 30 minutes for the next 3 h. Usually the test is performed as follows: the subject is taken to test blood for glucose on an empty stomach, then given 75 g (or, more precisely, 50 g per m2 of body area) of glucose dissolved in ml of water to drink, and the blood is tested for glucose every 30 minutes for the next 3 hours. Interpretation of the results: in a healthy person, the rise in glucose level after 1 hour does not exceed 80% of the initial level, by 2 hours it drops to normal and by 2.5 hours it may fall below normal. Interpretation of the results: in a healthy person, the rise in glucose level after 1 hour does not exceed 80% of the initial level, by 2 hours it drops to normal and by 2.5 hours it may fall below normal. In patients, the maximum rise is observed after 1 hour, reaching figures above 80% of the initial value, and normalization is delayed for 3 hours or more. In patients, the maximum rise is observed after 1 hour, reaching figures above 80% of the initial value, and normalization is delayed for 3 hours or more.
Thyroid gland Thyroid gland Methods for studying the functions and clinical morphology of the thyroid gland include determination of protein-bound iodine, the level of thyroid hormones, the shape and size of the gland. Methods for studying the functions and clinical morphology of the thyroid gland include determining protein-bound iodine, the level of thyroid hormones, and the shape and size of the gland. Determination of protein-bound iodine (PBI) is one of the most important and accurate methods for studying gland function. 90-95% of SBI consists of thyroxine, a thyroid hormone. Determination of protein-bound iodine (PBI) is one of the most important and accurate methods for studying gland function. 90-95% of SBI consists of thyroxine, a thyroid hormone. Normally, the SBI is 315.37 nmol/l. Normally, the SBI is 315.37 nmol/l. With thyrotoxicosis, its level is higher than 630.37 nmol/l, with hypothyroidism - less than 315.18 nmol/l. With thyrotoxicosis, its level is higher than 630.37 nmol/l, with hypothyroidism - less than 315.18 nmol/l.
Thyroxine (T4) and triiodothyronine (T3) are determined from the thyroid hormones. Approximate norms: T nmol / l, and T3 - 1.2 - 2.8 nmol / l. Thyroxine (T4) and triiodothyronine (T3) are determined from the thyroid hormones. Approximate norms: T nmol / l, and T3 - 1.2 - 2.8 nmol / l. At the same time, as a rule, the TSH level is determined, which, according to the same methods, is normally 0.17 - 4.05 nmol/l. At the same time, as a rule, the TSH level is determined, which, according to the same methods, is normally 0.17 - 4.05 nmol/l. One of the objective methods of studying the morphology and function of the thyroid gland is scanning using radioactive isotopes. The scanograms can outline the size of the thyroid gland, areas of hypo- and hyperfunction. One of the objective methods of studying the morphology and function of the thyroid gland is scanning using radioactive isotopes. The scanograms can outline the size of the thyroid gland, areas of hypo- and hyperfunction.
In recent years, ultrasound examination (ultrasound) has been widely used to examine the thyroid gland. Ultrasound is currently the method of choice in determining the size of the thyroid gland and the presence of changes in its structure. In recent years, ultrasound examination (ultrasound) has been widely used to examine the thyroid gland. Ultrasound is currently the method of choice in determining the size of the thyroid gland and the presence of changes in its structure. A highly effective research method is CT, which allows you to study the size and structure, identify tumors or other changes in it. A highly effective research method is CT, which allows you to study the size and structure, identify tumors or other changes in it.
Adrenal glands (cortical layer) To study the function of the adrenal cortex, aldosterone is determined in the urine, 17-hydroxycorticosteroids (17-OX) in the blood and urine, and neutral 17-ketosteroids (17-KS) in the urine. To study the function of the adrenal cortex, aldosterone is determined in the urine, 17-hydroxycorticosteroids (17-OX) in the blood and urine, and neutral 17-ketosteroids (17-KS) in the urine. Determination of aldosterone. It is believed that there is a directly proportional relationship between the amount of aldosterone in the urine and the mineralocorticoid activity of the adrenal cortex. Determination of aldosterone. It is believed that there is a directly proportional relationship between the amount of aldosterone in the urine and the mineralocorticoid activity of the adrenal cortex. In healthy people, 8.34 to 41.7 nmol/day is excreted. aldosterone. In healthy people, 8.34 to 41.7 nmol/day is excreted. aldosterone. An increase in urinary aldosterone excretion can be observed with so-called primary and secondary hyperaldosteronism (adenoma or tumor or hyperfunction of the cortical layer). An increase in urinary aldosterone excretion can be observed with so-called primary and secondary hyperaldosteronism (adenoma or tumor or hyperfunction of the cortical layer).
The definition of 17-OX reflects the level of glucocorticosteroids in the blood. The definition of 17-OX reflects the level of glucocorticosteroids in the blood. Normally, 17-OX in the blood contains from 0.14 to 0.55 µmol/l. Normally, 17-OX in the blood contains from 0.14 to 0.55 µmol/l. A persistent increase in 17-ox levels is observed in adrenal tumors and in Itsenko-Cushing syndrome. A persistent increase in 17-ox levels is observed in adrenal tumors and in Itsenko-Cushing syndrome. A decrease in 17-OX is found with hypofunction of the adrenal cortex or insufficiency of the anterior pituitary gland. A decrease in 17-OX is found with hypofunction of the adrenal cortex or insufficiency of the anterior pituitary gland. Excretion of 17-OX in urine normally parallels changes in the blood. Excretion of 17-OX in urine normally parallels changes in the blood. Determination of cortisol in urine is considered even more specific for studying glucocorticosteroid function of the adrenal glands. Determination of cortisol in urine is considered even more specific for studying glucocorticosteroid function of the adrenal glands. Norm nmol/day. Norm nmol/day.
Definition 17-KS. Most of the 17-CS comes from androgens, so their determination allows us to make a judgment about the androgenic function of the adrenal cortex. Definition 17-KS. Most of the 17-CS comes from androgens, so their determination allows us to make a judgment about the androgenic function of the adrenal cortex. Normally, 27.7 - 79.7 µmol/day is excreted in men and 17.4 - 55.4 in women. Normally, 27.7 - 79.7 µmol/day is excreted in men and 17.4 - 55.4 in women. A decrease in the release of 17-KS is characteristic of adrenal insufficiency, an increase is characteristic of tumors. A decrease in the release of 17-KS is characteristic of adrenal insufficiency, an increase is characteristic of tumors. There are also methods for indirectly determining the functions of the adrenal cortex. These include the determination of sodium and potassium in blood and urine. There are also methods for indirectly determining the functions of the adrenal cortex. These include the determination of sodium and potassium in blood and urine.
It is known that in the regulation of electrolyte levels (especially sodium and potassium), the main role belongs to mineralocorticoids, in particular aldosterone, and to a lesser extent glucocorticoids. It is known that in the regulation of electrolyte levels (especially sodium and potassium), the main role belongs to mineralocorticoids, in particular aldosterone, and to a lesser extent glucocorticoids. In this regard, the level of sodium and potassium in the blood and their excretion in the urine will indirectly indicate the state of production of these hormones by the adrenal glands. In this regard, the level of sodium and potassium in the blood and their excretion in the urine will indirectly indicate the state of production of these hormones by the adrenal glands. Normally, sodium in the blood plasma contains mmol/l, and potassium - 3.8 - 4.6 mmol/l. Normally, sodium in the blood plasma contains mmol/l, and potassium - 3.8 - 4.6 mmol/l. Normally, mmol/day is excreted in urine. sodium and mmol/day. potassium Normally, mmol/day is excreted in urine. sodium and mmol/day. potassium In practice, determination in urine is carried out. In practice, determination in urine is rarely performed. rarely.
Adrenal glands (medulla) Studying the function of the adrenal medulla is most often resorted to when a tumor is suspected. To study the function of the adrenal medulla is most often resorted to when a tumor is suspected. Three hormones are studied - adrenaline, norepinephrine, dopamine in the blood or plasma. Three hormones are studied - adrenaline, norepinephrine, dopamine in the blood or plasma. Their level in plasma is equal to - adrenaline 
The endocrine system, or internal secretion system, consists of endocrine glands, so named because they secrete specific products of their activity - hormones - directly into the internal environment of the body, into the blood. There are eight of these glands in the body: thyroid, parathyroid or parathyroid, goiter (thymus), pituitary gland, pineal gland (or pineal gland), adrenal glands (adrenal glands), pancreas and gonads (Fig. 67).
The general function of the endocrine system comes down to the implementation of chemical regulation in the body, establishing connections between its organs and systems and maintaining their functions at a certain level.
Hormones of the endocrine glands are substances with very high biological activity, that is, they act in very small doses. Together with enzymes and vitamins, they belong to the so-called biocatalysts. In addition, hormones have a specific effect - some of them influence certain organs, others control certain processes in the tissues of the body.
The endocrine glands participate in the process of growth and development of the body, in the regulation of metabolic processes that ensure its vital activity, in the mobilization of the body’s forces, as well as in the restoration of energy resources and renewal of its cells and tissues. Thus, in addition to the nervous regulation of the body’s vital activity (including during sports), there is endocrine regulation and humoral regulation, which are closely interrelated and carried out through a “feedback” mechanism.
Since physical education and especially sports require more and more advanced regulation and correlation of the activities of various human systems and organs in difficult conditions of emotional and physical stress, the study of the function of the endocrine system, although not yet included in widespread practice, is gradually beginning to occupy an increasing place in the complex athlete research.
Correct assessment of the functional state of the endocrine system allows us to identify pathological changes in it in the case of irrational use of physical exercises. Under the influence of rational, systematic physical education and sports, this system is being improved.
Adaptation of the endocrine system to physical activity is characterized not simply by an increase in the activity of the endocrine glands, but mainly by a change in the relationships between individual glands. The development of fatigue during prolonged work is also accompanied by corresponding changes in the activity of the endocrine glands.
The human endocrine system, improving under the influence of rational training, helps to increase the body's adaptive capabilities, which leads to improved sports performance, in particular in the development of endurance.
Research of the endocrine system is complex and is usually performed in a hospital setting. But there are a number of simple research methods that allow, to a certain extent, to assess the functional state of individual endocrine glands - anamnesis, examination, palpation, functional tests.
Anamnesis. Information about the period of puberty is important. When questioning women, they find out the start time, regularity, duration, abundance of menstruation, the development of secondary sexual characteristics; when questioning men, the time of the onset of voice loss, facial hair, etc. For older people, the time of the onset of menopause, i.e., the time of cessation of menstruation in women, the state of sexual function in men.
Information about the emotional state is essential. For example, rapid changes in mood, increased excitability, anxiety, usually accompanied by sweating, tachycardia, weight loss, low-grade fever, and fatigue, may indicate increased thyroid function. When the function of the thyroid gland decreases, apathy is observed, which is accompanied by lethargy, slowness, bradycardia, etc.
Symptoms of increased thyroid function are sometimes almost identical to the symptoms that appear when an athlete overtrains. This aspect of the history should be given particular importance, since cases of increased thyroid function (hyperthyroidism) have been observed in athletes.
Determine the presence of complaints characteristic of patients with diabetes - increased thirst and appetite, etc.
Inspection. Pay attention to the following signs: the proportionality of the development of individual parts of the body in tall people (is there a disproportionate increase in the nose, chin, hands and feet, which may indicate hyperfunction of the anterior lobe of the pituitary gland - acromegaly), the presence of bulging eyes, pronounced shine in the eyes (observed with hyperthyroidism), puffiness of the face (noted with hypothyroidism), as well as signs such as an enlarged thyroid gland, sweating or dry skin, the presence of fat (predominant deposition of fat in the lower abdomen, buttocks, thighs and chest is characteristic of obesity associated with dysfunction of the pituitary gland and gonads), sudden weight loss (occurs with thyrotoxicosis, diseases of the pituitary gland - Simmonds disease and adrenal glands - Addison disease).
In addition, during examination, the hair on the body is determined, since hair growth depends to a large extent on the hormonal influences of the gonads, thyroid gland, adrenal gland and pituitary gland. The presence of hair in men, characteristic of women, may indicate insufficiency of the function of the gonads. The male type of hair in women can be a manifestation of hermaphroditism - the presence in one individual of characteristics characteristic of both sexes (such persons are not allowed to play sports).
Excessive hair growth on the body and limbs, and in women, on the face (mustache and beard) suggests a tumor of the adrenal cortex, hyperthyroidism, etc.
Palpation. Of all the endocrine glands, the thyroid gland and male reproductive glands can be directly palpated (as well as examined); during gynecological examination - female gonads (ovaries).
Functional tests. When studying the function of the endocrine glands, many such tests are used. Of greatest importance in sports medicine are functional tests used in the study of the thyroid gland and adrenal glands.
Functional tests when studying the function of the thyroid gland are based on the study of metabolic processes regulated by this gland. The thyroid hormone - thyroxine stimulates oxidative processes, participating in the regulation of various types of metabolism (carbohydrate, fat, iodine metabolism, etc.). Therefore, the main method of studying the functional state of the thyroid gland is to determine the basal metabolism (the amount of energy in kilocalories consumed by a person in a state of complete rest), which is directly dependent on the function of the thyroid gland and the amount of thyroxine secreted by it.
The value of basal metabolism in kilocalories is compared with the proper values calculated using the Harris-Benedict tables or nomograms, and is expressed as a percentage of the proper value. If the basal metabolism of the examined athlete exceeds the expected one by more than +10%, this suggests hyperfunction of the thyroid gland, if less than 10%, its hypofunction. The higher the percentage of excess, the more pronounced the hyperfunction of the thyroid gland. With significant hyperthyroidism, the basal metabolic rate may be greater than +100%. A decrease in basal metabolism by more than 10% compared to normal may indicate hypofunction of the thyroid gland.
Thyroid function can also be tested using radioactive iodine. This determines the ability of the thyroid gland to absorb it. If more than 25% of the administered iodine remains in the thyroid gland after 24 hours, this indicates an increase in its function.
Functional tests when studying adrenal function provide valuable data. The adrenal glands have a wide range of effects on the body. The adrenal medulla, secreting hormones - catecholamines (adrenaline and norepinephrine), communicates between the endocrine glands and the nervous system, participates in the regulation of carbohydrate metabolism, maintains vascular tone and heart muscles. The adrenal cortex secretes aldosterone, corticosteroids, and androgenic hormones, which play a vital role in the functioning of the body as a whole. All these hormones are involved in mineral, carbohydrate, protein metabolism and in the regulation of a number of processes in the body.
Tense muscle work enhances the function of the adrenal medulla. By the degree of this increase one can judge the effect of the load on the athlete’s body.
To determine the functional state of the adrenal glands, the chemical and morphological composition of the blood (the amount of potassium and sodium in the blood serum, the number of eosinophils in the blood) and urine (determination of 17-ketosteroids, etc.) is examined.
In trained athletes, after a load corresponding to their level of preparedness, there is a moderate increase in adrenal function. If the load exceeds the athlete’s functional capabilities, the hormonal function of the adrenal glands is suppressed. This is determined by a special biochemical test of blood and urine. With adrenal insufficiency, mineral and water metabolism changes: the level of sodium in the blood serum decreases and the amount of potassium increases.
Without a perfect, coordinated function of all endocrine glands, it is impossible to achieve high athletic performance. Apparently, various types of sports are associated with a predominant increase in the function of different endocrine glands, because the hormones of each gland have a specific effect.
When developing the quality of endurance, the main role is played by hormones that regulate all main types of metabolism; when developing the qualities of speed and strength, an increase in the level of adrenaline in the blood is important.
An urgent task of modern sports medicine is to study the functional state of the athlete’s endocrine system to clarify its role in increasing his performance and preventing the development of pathological changes both in the endocrine system itself and in other systems and organs (since dysfunction of the endocrine system affects the body as a whole ).
Chapter 15 CONCLUSION FROM THE RESULTS OF THE MEDICAL EXAMINATION
A medical examination of an athlete and an athlete, both primary and repeated and additional, must end with a medical report.
Based on the data obtained during the examination of anamnesis, physical development, health and functional status, as well as data from instrumental and laboratory studies and the conclusions of specialists in individual organs and systems (ophthalmologist, neurologist, etc.), the sports therapist must draw certain conclusions and give corresponding conclusion.
The primary medical examination necessarily includes all of the above elements. During repeated and additional examinations, instrumental, laboratory tests and consultations with specialists are carried out only if necessary and only those that the observing doctor-clinician finds necessary to prescribe. This determines the different nature of the medical opinion during the initial, repeated and additional examinations of an athlete or athlete. However, regardless of what kind of medical examination is carried out, the medical report must contain the following five sections: 1) assessment of health status, 2) assessment of physical development, 3) assessment of functional state, 4) recommendations to the athlete on daily routine, nutrition, etc. and 5) recommendations to the coach and teacher on individualization of the training process and training regimen.
Health assessment. The admission of a given person to sports or only to recreational physical education essentially depends on this assessment during the initial medical examination. In order to make a diagnosis of “healthy”, the doctor is obliged to exclude all possible pathological changes in the body that are a contraindication to playing sports. To confidently make such a diagnosis, he uses the entire arsenal of modern diagnostic tools.
If the diagnosis “healthy” is beyond doubt and is confirmed by all further studies, the person being examined receives permission to play sports and recommendations on which sports he should engage in. These recommendations are given on the basis of all the data obtained during the study, revealing the characteristics of the physique, constitution, functional state, etc., taking into account the specifics of the training process in a particular sport, which requires certain individual characteristics that the sports doctor should know well.
If the person being examined is not allowed to engage in sports, for which there must be absolute contraindications, the doctor is obliged to give recommendations regarding physical education, indicating their nature and permissible doses of physical activity.
Absolute contraindications to sports are various chronic diseases (heart disease, chronic diseases of the lungs, liver, stomach, intestines, kidneys, etc.), physical defects (for example, a removed lung or kidney) that cannot be cured. The doctor is guided by instructions defining contraindications to playing certain sports, as well as official instructions approved by the USSR Ministry of Health, defining the requirements that must be met by the health of an athlete entering a physical education institution of higher education.
In addition to absolute contraindications to sports, there are so-called relative contraindications - defects in health or physical development that prevent participation in only one sport. For example, perforation of the eardrum due to previous inflammation of the middle ear is a contraindication to water sports, but does not prevent participation in all other types; Flat feet serve as a relative contraindication only to weightlifting. For some postural disorders (for example, stoop, round back), it is not recommended to engage in sports in which these defects can worsen (for example, cycling, rowing, boxing), but sports are suggested, the nature of the training process in which helps to correct these defects .
For athletes, in addition to these contraindications, there are temporary contraindications to playing sports - during illness (until full recovery). These diseases include foci of chronic infection, which may not cause any complaints and may not bother the athlete for a certain period of time.
Foci of chronic infection are chronic diseases of individual organs (dental caries, chronic inflammation of the pharyngeal tonsils, gall bladder, paranasal cavities, ovaries, etc.), which do not actively manifest themselves (there are no pronounced complaints or clinical symptoms) while the body is able to suppress constant intoxication emanating from them. However, with the slightest decrease in the body's defenses, these lesions can cause complications in other organs. With timely treatment and removal of foci of chronic infection, the pathological changes they cause in other organs and systems disappear if irreversible changes have not yet developed in them.
The teacher and coach must ensure that the athlete follows all the doctor’s instructions and persists in treatment.
During repeated and additional medical examinations, a conclusion is given about the changes in health that have occurred under the influence of physical education and sports - both positive and possible negative (in the case of irrational use of physical activity).
Assessment of physical development. Based on data obtained using various methods of studying and assessing physical development, a general conclusion is given about physical development (average, high or low physical development), its existing defects are indicated, in particular, poor posture, lag in certain parameters of physical development, without taking into account which it is impossible to correctly construct the training process. Physical exercise should be aimed not only at increasing the functional state of the student, but also at eliminating identified defects in physical development, which can have an adverse effect on health if they are not eliminated. Thus, poor posture (stooping, scoliosis), worsening the functional state of the external respiratory system and the cardiovascular system, can contribute to the occurrence of diseases of these systems.
Repeated studies of physical development make it possible to evaluate the impact of systematic training on both morphological and functional indicators of physical development, to identify positive and negative (in cases where classes were carried out without taking into account the changes that the doctor pointed out in the conclusion during the initial examination) changes in the physical development.
Assessment of functional status. In order to play sports, that is, to perform heavy physical activity, you must not only be absolutely healthy and well physically developed, you must also be well functionally prepared. Therefore, the third section of the medical report is the assessment of the functional state of the subject. It is given based on the results of a study using functional diagnostic methods conducted during the initial medical examination. During repeated and additional medical examinations, the doctor determines changes in the athlete’s functional state. Based on thorough research using functional diagnostic methods, a conclusion is made about the improvement or deterioration of the functional state. Its improvement usually indicates an increase in the level of training. In addition, the results of studies conducted during training and competitions (data from medical and pedagogical observations - see below) give the coach an idea of the state (improvement or deterioration) of special training.
With repeated examinations, the doctor can state a state of overtraining, which occurs as a result of overload of the central nervous system with excessive and monotonous physical activity, causing neurosis. It can determine if an athlete is overworked. A study of the recovery period after training and competitions reveals the lack of restoration of the functions of various body systems after previous loads. Insufficient accounting of this data can lead to overstressing those systems in which there were any deviations and which were subject to a particularly large load. This applies, in particular, to the heart: in an athlete, in the absence of any complaints and a decrease in performance, deviations are detected on the ECG, indicating a discrepancy between the level of his preparedness and the load being performed. If you do not pay attention to this, profound negative changes in the heart muscle can occur, causing disruption of its function.
Depending on the degree of functional readiness of the students, the teacher and trainer individualize their physical activity.
It must be borne in mind that the level of functional state is determined only by a comprehensive examination of the athlete. As already mentioned, no far-reaching conclusions should be made based on the study of just one indicator, even one that seems very informative. The nature of the set of indicators used when examining an athlete or physical athlete should not be standard. It is determined each time by the task facing the doctor.
A correct assessment by a doctor of the health status, physical development and functional state of the athlete’s body helps the coach and teacher correctly assess the state of fitness and, based on this, rationally build the training process.
An increase in the functional state of an athlete's body is characterized by economization of the activity of all systems at rest, a more economical adaptation to standard loads, and during maximum physical stress - the possibility of maximally enhancing the body's functions.
With the improvement of the functional state of the cardiovascular system, a slowdown in heart rate is noted; a slight decrease in blood pressure at rest, and according to ECG data, a moderate slowdown in atrioventricular conduction (PQ), raising teeth R And T, tooth reduction R, shortening of electrical systole (QT); increase in the amplitude of the X-ray kymogram waves; according to polycardiographic research - economization of contractile function.
Improvement in the functional state of the cardiovascular system, revealed in studies using standard tests, bicycle ergometry, etc., is expressed in a decrease in the response of pulse and blood pressure during endurance and strength loads and an increase in the response to speed loads, which indicates the mobilizing ability of the body. The response to functional tests is usually normotonic with a good quantitative relationship between pulse and blood pressure and their rapid recovery.
With an increase in the functional state of the external respiratory system, the respiratory rate decreases, the strength of the respiratory muscles increases, the actual vital capacity of the lungs significantly exceeds it should, the maximum pulmonary ventilation increases, the indicators of functional tests of the external respiratory system improve, the athlete becomes more resilient to a decrease in arterial blood oxygen saturation, the speed slows down blood flow (according to oximetry data).
With an increase in the functional state of the nervous and neuromuscular systems, the performance of coordination tests improves, as well as tests for studying the vestibular apparatus, the autonomic nervous system, the strength of various muscle groups increases, the amplitude between muscle tension and relaxation (according to myotonometry), the motor rheobase and chronaxia decrease , the indicators of antagonist muscles, etc., become closer.
After suffering injuries and illnesses, athletes and athletes are required to undergo an additional medical examination, which determines the exact timing of admission to sports training and physical education and their intensity in relation to a particular person. Past illnesses or injuries always reduce the level of functional state of an athlete and physical athlete. In these cases, even a small physical load for a particular athlete may not correspond to his functional capabilities at the moment and cause unfavorable changes in various organs and systems. Without an additional medical examination, the coach and teacher do not have the right to allow the athlete to participate in training. Otherwise, this can lead to relapse of the disease, and sometimes to serious complications.
When the functional state deteriorates under the influence of irrational, excessive physical activity, all these indicators change in the opposite direction.
Very important for the coach and teacher are those sections of the medical report in which the doctor gives recommendations to the athlete on the regimen, and to the coach and teacher on the individualization of training loads and the training regimen.
At the end of the report, the doctor must indicate the deadline for appearing for a second medical examination. The coach and teacher are responsible for ensuring that the athlete follows this instruction.
There is a division into medical groups of students of schools, technical schools and universities, members of primary physical education groups and those involved in health groups. This division is provided for by the state physical education program. For older people, the program is somewhat different, but not fundamentally different from the generally accepted one.
Coaches and teachers working with pupils or students in state physical education programs should know which medical group their students belong to.
Based on the state of health, physical development and functional readiness, those involved in the physical education program, as well as members of primary physical education groups, are divided into three medical groups - basic, preparatory and special.
The main medical group includes people with good functional condition and no deviations in health or physical development. In addition to taking full classes in the physical education program, they are allowed to prepare for passing and fulfilling the GTO standards. In addition, the doctor gives them recommendations regarding participation in any sports section and permission to participate in competitions in this sport, provided they are sufficiently prepared.
The preparatory group includes students who have slight deviations in health, insufficient functional state, and poor physical development. They master the same physical education program, but more gradually. The standards by which their performance is taken into account are developed taking into account the deviations that each of them has. They are prohibited from participating in additional sports sections. Those assigned to this group can engage in general physical training and gradually prepare to meet the standards of the GTO complex. With improvement in health, physical development and functional status, these students can be transferred from the preparatory group to the main group.
A special medical group includes persons with significant deviations (permanent or temporary) in their state of health and physical development. Classes with them are structured according to special programs, taking into account existing deviations and are conducted under constant medical supervision. If necessary, they are sent to physical therapy classes in medical institutions.
The coach and teacher receive a medical opinion on an athlete or physical educator in writing. If possible, and in national teams it is mandatory, medical opinions are discussed together with the teacher.
Based on the medical opinion, the trainer and teacher make the necessary adjustments to the training system. The recommendations specified in it are mandatory and require systematic monitoring. This does not relieve the doctor of the obligation to periodically check the implementation of his recommendations. The main provisions of the medical opinion that are directly related to the training process are included in the athlete’s individual training plan. During repeated medical examinations, the correctness of the training process and physical exercises is checked.
The doctor’s opinion helps to give a deep assessment of the work of the trainer and teacher. After all, its effectiveness is determined not only by such important criteria as increased sportsmanship, the number of highly qualified athletes trained, but also by the combination of achievements of high sportsmanship with an increase and strengthening of the athlete’s health, and the absence of negative changes. Only under this condition can we talk about the effectiveness and appropriateness of the training methodology used by the coach and teacher.
The need to carefully carry out a medical opinion has now become even more intensified due to the use of very intense physical activity in sports training. The use of such loads is necessary to achieve high results characteristic of modern sports. This requires careful compliance with all medical recommendations. Deviation from the conditions determined by the doctor when using intense loads makes them excessive, which can be harmful to the athlete’s health.
With high loads, it is necessary to carefully monitor their effects on the body in order to promptly prevent their possible negative effects. If an increase in sportsmanship and sports results is accompanied by a deterioration in health, the training method used is not rational.
The use of this kind of load requires absolute health, their clear individualization, regularity and gradual increase, sufficient rest between classes, strict adherence to the regime, etc. (you should not, for example, combine heavy physical activity with intense mental activity), careful systematic medical supervision.
Strict adherence to these requirements prevents possible overloading and ensures high efficiency of such loads.
The methodology for studying the endocrine system consists of taking an anamnesis, examining the patient, palpation, auscultation, laboratory and instrumental research methods, both general and special.
For a clinical examination, an important condition is to follow the sequence of examination of the endocrine organs: pituitary gland, thyroid gland, parathyroid glands, pancreas, adrenal glands, gonads.
When collecting anamnesis and examination, attention is paid to the presence or absence of the patient’s complaints and symptoms characteristic of the pathology of a particular endocrine gland. Complaints and symptoms indicating damage to the endocrine glands are very diverse, since hormones have a great influence on the metabolism, physical and mental development of the child, and the functional state of various organs and systems of the child’s body.
Patients with pathology of the endocrine glands may have complaints of increased excitability, irritability, restless sleep, sweating, changes in skin color, impaired hair and nail growth, thirst, etc.
Patients with hyperfunction of eosinophilic cells of the anterior pituitary gland may complain of gigantic (above 190-200 cm) height (gigantism), disproportionately large length of limbs, fingers and toes (acromegaly). One can also observe coarse facial features, prognathia, wide gaps between the teeth, and excessive kyphosis of the thoracic spine due to intensive growth of the vertebrae. There is also an increase in the superciliary arches, well-defined muscles, but muscle weakness is characteristic.
With hyperfunction of the basophilic cells of the pituitary gland, parents may complain of a significant increase in body weight, facial hair in girls (hirsutism), growth retardation, which is finally determined upon examination of the patient.
For pituitary insufficiency, typical complaints and symptoms are a decrease in height (by more than 25% compared to the norm), changes in facial expressions and “childish” facial features, poor muscle development, delayed or absent puberty, small size of the genitals, marbling of the skin, cold limbs. The combination of these symptoms with adipose-sexual disorders (lower body) is possible with destructive damage to the hypothalamic-pituitary region.
With hyperthyroidism, there may be complaints of weight loss, irritability, excessive agitation and mobility, emotional instability, palpitations, increased moisture in the palms and general sweating, itching of the skin, a feeling of heat (fever), pain in the heart, tearfulness, and a feeling of pain in the eyes. Upon examination, you can detect trembling of the fingers, swelling of the eyelids, trembling of closed eyelids (Rosenbach's symptom), cutting blinking of the eyelids (Stellwag's symptom), one- or two-sided exophthalmos, impaired convergence of the eyes due to paresis of the internal rectus muscle of the eye (Mobius's sign), white stripe of the sclera above the iris when looking down (Graefe's symptom), when looking up
(Kocher's sign), a white stripe of sclera around the iris when the eyes are open (Delrymple's sign), "frightened", fixed gaze of shiny eyes.
When examining the neck of healthy children, especially during puberty, you can see the isthmus of the thyroid gland. If there is an asymmetry in the position of the thyroid gland, this indicates the presence of nodes. In a child with hyperthyroidism, one can observe an enlargement of the thyroid gland, degree I - enlargement of the isthmus, noticeable when swallowing; II degree - enlargement of the isthmus
and particles; III degree - “thick neck” (Fig. 44); IV degree - pronounced increase (goiter, sharply changes the configuration of the neck) (Fig. 45); V degree - a goiter of enormous size.
It should be noted that, unlike other formations in the neck, the thyroid gland mixes with the trachea during swallowing.
Patients with hypothyroidism may experience early retardation in physical and mental development, late and incorrect teething, salivation, a rough and hoarse voice, snoring when breathing, decreased interest in the environment, and lethargy.
When examining a sick child, you can observe a delay in the development of facial bones, a saddle nose, Macroglossia, gray skin color, puffy face, small eyes, thick lips, brittle nails, sparse hair on the head, short neck, limbs, fingers (bone growth in length is limited , no width).
Hyperfunction of the parathyroid glands leads to decreased appetite or even anorexia, nausea, vomiting, constipation, bone pain, muscle weakness, bone fractures, thirst, polydipsia, polyuria, depression, and memory impairment.
The history of patients with hypoparathyroidism includes high birth weight, slow loss of the umbilical cord remnant, chronic diarrhea, which often changes with constipation, developmental delay, photophobia, convulsions, excessive agitation, and laryngospasm. During examination, optional symptoms may occur: eyelid spasm, conjunctivitis, cloudy lens of the eye, tooth decay, thin nails, hair pigmentation disorders.
If diabetes mellitus is suspected, it is necessary to find out if the child has increased appetite (polyphagia), thirst (polydipsia) and increased urination (polyuria). At the same time, so-called minor symptoms of diabetes mellitus can be observed - neurodermatitis, periodontal disease, furunculosis, itching in the genital area. In the later stages, due to keto acidosis, appetite decreases, children quickly get tired, study worse, and become lethargic and weak. Nocturnal and daytime enuresis, light-colored urine appears, after which starch stains remain on the underwear, paresthesia of the legs, visual acuity decreases, and xanthomas may appear on the palms.
In infants, attention should be paid to low birth weight, weight loss (hypotrophy), pyoderma, and frequent napping.
Adrenogenital syndrome is a manifestation of congenital virilizing hyperplasia of the adrenal cortex. The history and examination of the patient reveals pseudohermaphroditism (enlargement of the clitoris, labia majora, abnormal development of the urethra, similar to hypospadias). Later, a male body type, hirsutism, low voice, and acne are observed. Boys may have macrogenitosomia (at 2-3 years), an unnatural precocious sexual development. Children of both sexes can experience high growth, increased muscle strength, and accelerated skeletal maturation. In more severe cases, signs of adrenogenital syndrome with loss of salts (Debreu-Fibiger syndrome) are noted. The above-mentioned manifestations of the disease include weight loss, slow weight gain and exicosis. Hyperthermia and hypertension are less common.
In patients with confirmed pituitary glandular hyperplasia of the adrenal cortex, Itsenko-Cushing's disease is diagnosed. In Cushing's syndrome, the adrenal glands excessively produce cortisol (to a lesser extent aldosterone and androgens). Such patients complain, and upon examination there is stunted growth, “skinny” arms, changes in facial expressions and a moon-shaped face, with purplish-red skin. The skin of the trunk and limbs is dry with numerous purplish-cyanotic stretch marks of atrophic origin. You can observe hypertrichosis, acne, pyoderma, mycosis. In girls, secondary sexual characteristics become reversed, and the cyclicity of menstruation is disrupted. In later stages, complaints of malnutrition or muscle atrophy, underdevelopment of the genital organs, and high blood pressure may appear.
With insufficient adrenal function with a chronic course (the production of cortisol, aldosterone, and androgens decreases), patients experience the classic triad of signs characteristic of Addison's disease - adynamia, pigmentation, hypotension. Patients complain of weakness, fatigue, decreased mobility, and decreased appetite. Characterized by intestinal obstruction. Weight loss, drowsiness, and muscle weakness develop. In some patients, the first manifestation of the disease is brown pigmentation of the skin and mucous membranes of the oral cavity (through excessive production of melanocyte-stimulating hormone by the pituitary gland). Pigmentation extends to the neck, elbow joints, linea alba, genitals, hard palate, and inner surface of the cheeks. With acute damage to the adrenal glands, patients complain of severe weakness, abdominal pain, vomiting, and diarrhea.
A very important element of the examination is the assessment of the child’s sexual development. To do this, the mammary glands and pubic hair are carefully examined in girls; in boys, the development of the penis and testicles, as well as the degree of pubic hair. Identified secondary sexual characteristics and their development should be determined according to the classification proposed by JMTanner in 1962. For both girls and boys.
In children with premature sexual development (up to 8 years in girls and up to 10 years in boys), the symptom complex includes a significant acceleration of growth, early appearance of foci of ossification in the bones, premature synostosis, as a result of which the body does not reach full development. Mental abilities meet age requirements. Spermatogenesis appears early in boys and menstruation in girls, enlargement and hair growth of the genital organs. Against the background of general apathy and lethargy, sexual excitability can be observed. Nystagmus, ptosis, and abnormal gait are not often observed.
In the anamnesis and upon examination of the patient, hypogonadism (delayed sexual development for 2 years or more) reveals true gynecomastia, eunuch-like body structure (narrow chest, no hair, disproportionately long legs, very little facial hair, gynecomastia, inverted nipples, insufficient development of secondary sexual characteristics). Such children grow up tall, they have a high-pitched voice, insufficient development of the larynx, muscles, genitals, and secondary sexual characteristics.
Palpation is important for diagnosing lesions of the endocrine glands. However, not all glands are accessible for palpation.
Palpation is carried out according to well-known rules (warm, clean hands, correct position of the doctor and the patient, without strangers; without causing unnecessary suffering to the patient, they first palpate superficially and then deeper).
Palpation of the isthmus of the thyroid gland is carried out by sliding movements of the thumb, index and middle fingers of the right hand upward from the handle of the sternum.
To palpate the right and left lobes of the thyroid gland, it is necessary to place the II-V bent fingers of both hands behind the posterior edges, and the thumb behind the anterior edges of the sternocleidomastyl muscle. After this, the child is asked to take a sip, during which the thyroid gland will move along with the larynx. At the same time, the surface, consistency, mobility, size, and pain of the organ are determined.
The right and left lobes of the thyroid gland are palpated without pain in the form of soft, tender formations with a smooth surface.
With the help of palpation, the characteristics of sexual disorders are clarified, in particular, when palpating the external genitalia, their size, the degree of reduction (increase), the number of testicles in the scrotum, their density, and the location of the testicle in cryptorchidism are determined. The thickness of the subcutaneous fat layer, skin temperature on the extremities, muscle tone and strength, and their consistency are assessed. Often, in patients with pathology of the endocrine glands, an enlarged liver is palpated and its soreness is determined.
Percussion in children with diseases of the endocrine system can detect pain in the bones with hyperparathyroidism, a decrease in the size of the relative dullness of the heart with hypogonadism, an enlarged liver with diabetes mellitus, as well as a goiter located in the thymus, which is determined above the handle of the sternum.
Auscultation in patients with thyrotoxicosis can listen to a vascular murmur above the surface of the gland; weakened heart sounds and systolic murmur at its apex with adrenal insufficiency.
To diagnose diseases of the endocrine system, it is necessary to use special laboratory tests, namely, determining the content of hormones in various biological fluids.
Based on determining the level of these hormones, one can draw a conclusion about the nature of the dysfunction of the corresponding endocrine glands.