The physical examination should include a complete medical and mental status examination. Tachycardia or severe hypertension may indicate drug toxicity or thyrotoxicosis; fever may suggest encephalitis or porphyria. 18 Physical signs suggestive of underlying diagnoses include cushingoid appearance in certain endocrinopathies, arthritic deformities in autoimmune disorders, or movement and gait disturbances in conditions such as multiple sclerosis and Parkinson disease. 37 The neurologic examination should assess for focal signs, sensory deficits, myoclonus, or tremors. Tendon reflexes, cranial nerve testing, and ophthalmologic examination are important if a brain lesion, infection, or metabolic disease is suspected.
The suggested dosage for androgens varies depending on the age, and diagnosis of the individual patient. Dosage is adjusted according to the patient’s response and the appearance of adverse reactions. The dosage guideline for the testosterone pellets for replacement therapy in androgen-deficient males is 150mg to 450mg subcutaneously every 3 to 6 months. Various dosage regimens have been used to induce pubertal changes in hypogonadal males; some experts have advocated lower doses initially, gradually increasing the dose as puberty progresses, with or without a decrease in maintenance levels. Other experts emphasize that higher dosages are needed to induce pubertal changes and lower dosages can be used for maintenance after puberty. The chronological and skeletal ages must be taken into consideration, both in determining the initial dose and in adjusting the dose.
An alteration in mental status refers to general changes in brain function, such as confusion , amnesia ( memory loss ), loss of alertness, disorientation (not cognizant of self, time, or place), defects in judgment or thought, unusual or strange behavior, poor regulation of emotions, and disruptions in perception, psychomotor skills, and behavior. While an altered mental status is obviously characteristic of a number of psychiatric and emotional conditions, medical conditions and injuries that cause damage to the brain, including alcohol or drug overdose and withdrawal syndromes, can also cause mental status changes. Confusion, lethargy, delirium , dementia , encephalopathy , and organic brain syndrome are all terms that have been used to refer to conditions hallmarked by mental status changes.