Table 19. Local structural effects of endocrine diseases Endocrine symptoms and signs are rarely specific. This fact renders the art of recognizing an endocrine Structure affected Feature disorder in a patient more often one of suspecting rather than 'diagnosing' it. Unlike most other body Hypothalamus Headaches Pituitary Headaches, visual defect 'systems' the very nature of the endocrine system Thyroid Pressure symptoms, dysphagia, ensures that the effects of disordered function in a goitre gland affect the body as a whole and cause diffuse Gonads Testicular lumps, ovarian masses symptoms and signs. Most patients with a cardiac problem present with one or more specific symptoms such as chest pain, palpitations and oedema. The problem then becomes one of resolving whether a cardiac problem exists or not and, if so, what is the nature of the disease process. HISTORY Similarly, most patients with a gastro-enterological and neurological problem will present with a specific Present history symptom - diarrhoea, or tremor - which will direct attention to that organ system.