What physical examination assessments should be completed for a 40-year-old female presenting with weight gain and hyperphagia (increased hunger), without fatigue or polydipsia (excessive thirst)?

Physical Examination Assessments for a 40-Year-Old Female with Weight Gain and Increased Hunger

A comprehensive physical examination for a 40-year-old female presenting with weight gain and increased hunger without fatigue or polydipsia should focus on evaluating for endocrine disorders, particularly hypothyroidism, Cushing's syndrome, and PCOS, as these are the most likely causes of her symptoms.

Initial Anthropometric Assessment

• Measure height, weight, and calculate BMI 1
• Measure waist circumference (target <35 inches or 88 cm for women) 1
• Document weight history and pattern of weight gain 1

Vital Signs Assessment

• Blood pressure with appropriately sized cuff (check for hypertension) 1
• Heart rate (check for tachycardia or bradycardia)
• Temperature
• Orthostatic pulse and blood pressure measurements 1

Endocrine-Focused Physical Examination

1. Thyroid examination:

   • Inspect and palpate for thyroid enlargement or nodules
   • Check for delayed ankle reflexes
   • Assess for periorbital puffiness, coarse skin, or cold skin 1

2. Cushing's syndrome assessment:

   • Look for central obesity, "moon face"
   • Check for dorsal and supraclavicular fat pads
   • Examine for wide (1-cm) violaceous striae
   • Assess for hirsutism 1
   • Evaluate for proximal muscle weakness 1

3. PCOS assessment:

   • Check for hirsutism, acne, or male-pattern hair loss
   • Assess for central obesity pattern 1

Cardiovascular Examination

• Auscultate heart for murmurs or abnormal rhythms
• Check for signs of heart failure (jugular venous distention, peripheral edema)
• Assess peripheral pulses 1

Abdominal Examination

• Assess for hepatomegaly or other abdominal masses
• Check for abdominal striae
• Evaluate for central adiposity pattern 1

Neurological Examination

• Assess muscle strength, particularly proximal muscles
• Check deep tendon reflexes, especially ankle reflexes 1

Skin Examination

• Evaluate for acanthosis nigricans (indicator of insulin resistance)
• Check for hirsutism or other signs of androgen excess
• Look for striae, bruising, or skin thinning (Cushing's) 1

Sleep Apnea Screening

• Assess Mallampati classification (class III-IV suggests higher risk)
• Evaluate neck circumference 1

Laboratory Tests to Consider

While not part of the physical examination itself, the following tests should be ordered based on physical exam findings:

• Thyroid-stimulating hormone and free thyroxine 1
• Comprehensive metabolic panel 1
• Fasting glucose and HbA1c
• Lipid profile 1
• Consider overnight dexamethasone suppression test if Cushing's suspected 1

Key Points to Remember

• Weight gain with increased hunger but without polydipsia or fatigue narrows the differential diagnosis
• Hypothyroidism is a common cause of weight gain in 40-year-old women but typically presents with fatigue
• Cushing's syndrome should be considered, especially with central obesity and striae
• PCOS can present with weight gain and is common in women of reproductive age
• Medications can cause weight gain and should be reviewed during history taking 1

The physical examination findings will guide further laboratory and diagnostic testing to determine the underlying cause of the patient's weight gain and increased hunger.