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

Appeared in: HSSC Staff Nurse - 2015

Explanation

Cortisol deficiency because loss of axillary and pubic hair is a classic sign of adrenal insufficiency.
The growth of this type of hair is dependent on androgens produced by the adrenal glands (like DHEA).
In adrenal insufficiency (which includes cortisol deficiency), the production of adrenal androgens is reduced, leading to hair loss in these areas.
This sign is often more pronounced in women, as the adrenal glands are their main source of androgens.

Option B: Hypothyroidism is not the primary cause of isolated axillary and pubic hair loss.
Option C: Hyperthyroidism is associated with changes in hair texture (fine, silky) and diffuse thinning, not the specific loss of axillary and pubic hair.
Option D: Hyperparathyroidism does not typically cause hair loss. Its symptoms are related to high calcium levels.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical manifestations of adrenal insufficiency to guide bedside assessment, documentation, and the next nursing action.
A nurse observing diminished axillary and pubic hair during a physical assessment should recognize this as a potential sign of adrenal insufficiency and ensure this finding is documented and reported for further investigation.
This clinical sign should prompt the healthcare team to consider diagnostic tests such as serum cortisol levels, ACTH (adrenocorticotropic hormone) levels, and an ACTH stimulation test to confirm the diagnosis.
Patient safety is crucial, as undiagnosed adrenal insufficiency can lead to a life-threatening adrenal crisis, especially during times of stress, illness, or surgery.

How to Approach the Question

First, identify the key clinical finding presented in the question: 'diminished axillary and pubic hair'.
Next, recall the hormonal basis for this type of hair growth. Axillary and pubic hair are secondary sexual characteristics that are dependent on androgens.
Consider which endocrine glands produce androgens. The primary sources are the adrenal glands and the gonads.
Evaluate the given options in the context of androgen production.
Cortisol deficiency is a feature of adrenal insufficiency. In this condition, the adrenal gland's function is impaired, leading to decreased production of all its hormones, including androgens. This directly explains the hair loss.
Rule out the other options: Thyroid hormones (hypo/hyperthyroidism) primarily affect hair texture and scalp hair density. Parathyroid hormone regulates calcium and is not involved in hair growth.

Concept Tested & Keywords

Concept Tested: Clinical manifestations of adrenal insufficiency
Stem keywords: physical examination, endocrine system, diminished axillary and pubic hair
Lead-in keywords: indicate a problem of

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E6 Gynecology Williams pp. 407-409, 344-415

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