During the physical examination of a patient for the endocrine system, 'diminished axillary and pubic hair' may indicate a problem of?

Appeared in: NHM UP Staff Nurse - 2019

Explanation

Cortisol deficiency.
Diminished axillary and pubic hair is a sign of adrenal androgen deficiency.
In primary adrenal insufficiency (Addison's disease), damage to the adrenal cortex leads to a deficiency of both cortisol and adrenal androgens.
Since adrenal androgens are responsible for the growth of axillary and pubic hair (adrenarche), their deficiency results in the loss of this hair.
This sign is particularly noticeable in women, for whom the adrenal glands are a major source of androgens.

Why Other Options Were Wrong

Option B: Hypothyroidism is incorrect. While it can cause hair loss, it is typically characterized by coarse, dry, brittle hair and loss of the outer third of the eyebrows (madarosis), not specifically the loss of axillary and pubic hair.
Option C: Hyperthyroidism is incorrect. This condition is associated with fine, silky, and sometimes thinning scalp hair due to a shortened hair growth cycle. It does not cause a specific loss of axillary or pubic hair.
Option D: Hyperparathyroidism is incorrect. This disorder does not have specific hair-related symptoms. Its clinical manifestations are primarily due to hypercalcemia and include bone pain, kidney stones, and gastrointestinal or psychiatric issues.

Related Visual

Clinical Relevance

Nursing practice connection: Use the key finding related to Physical assessment findings in endocrine disorders to guide bedside assessment, documentation, and the next nursing action.
Observing diminished axillary and pubic hair is a key physical assessment finding that should prompt a nurse to consider adrenal insufficiency.
Nurses should follow up this observation by assessing for other signs of Addison's disease, such as orthostatic hypotension, hyperpigmentation, fatigue, muscle weakness, and unexplained weight loss.
Prompt reporting of this constellation of signs is critical, as an undiagnosed adrenal crisis can be life-threatening.

How to Approach the Question

First, identify the specific clinical sign presented in the question: 'diminished axillary and pubic hair'.
Recall the hormonal regulation of different types of body hair. Axillary and pubic hair growth (adrenarche) is primarily driven by adrenal androgens.
Evaluate each option by considering its effect on the adrenal glands and hair growth.
Connect 'Cortisol deficiency' to primary adrenal insufficiency (Addison's disease), where the adrenal cortex is damaged, affecting the production of both cortisol and androgens.
Systematically rule out the other options by recalling their characteristic hair changes: Hypothyroidism (coarse, brittle hair), Hyperthyroidism (fine, silky hair), and Hyperparathyroidism (no specific hair changes).
Select the option that directly aligns with the pathophysiology of losing adrenal androgen-dependent hair.

Concept Tested & Keywords

Concept Tested: Physical assessment findings in endocrine disorders
Stem keywords: physical examination, endocrine system, diminished axillary and pubic hair
Lead-in keywords: indicate a problem of

Question ID

QKdrkU7T4wgN21wCZqSSyy

Reference Book

E6 Gynecology Williams p. 344-415

E6 Medicine Macleod Clinical Examination 15e p. 225-227

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 2315-2317

Practise the full NHM UP Staff Nurse - 2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.

Attempt this paper Attempt in the NPrep app