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CONDITION/DISORDER SYNONYMS

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  • Hyperadrenalism

  • Hyperadrenocorticism

  • Adrencorticalhyperfunction

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ICD-9-CM CODES

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  • 255.0 Cushing syndrome

  • 255.3 Other corticoadrenal overactivity

  • 255.6 Medulloadrenal hyperfunction

  • Associated physical therapy diagnoses

    • 315.4 Coordination disorder (clumsiness, dyspraxia and/or specific motor development disorder)

    • 718.45 Contracture of joint, pelvic region, and thigh

    • 719.70 Difficulty in walking

    • 728.2 Muscular wasting and disuse atrophy

    • 728.89 Disorders of muscle, ligament, and fascia

    • 729.9 Other disorders of soft tissue

    • 780.7 Malaise and fatigue

    • 781.2 Abnormality of gait: Ataxic, paralytic, spastic, staggering

    • 782.3 Edema

    • 786.0 Dyspnea and respiratory abnormalities

    • 786.05 Shortness of breath

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ICD-10-CM CODES

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  • E24.0 Pituitary-dependent Cushing disease

  • E24.2 Drug-induced Cushing syndrome

  • E24.3 Ectopic ACTH syndrome

  • E24.8 Other Cushing syndrome

  • E24.9 Cushing syndrome, unspecified

  • E27.5 Adrenomedullary hyperfunction

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PREFERRED PRACTICE PATTERNS

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  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction1

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation2

  • 6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning3

  • 7B: Impaired Integumentary Integrity Secondary to Superficial Skin Involvement4

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PATIENT PRESENTATION

A 60-year-old male is referred to PT for generalized muscle weakness, back pain, and complaints of fatigue. His history reveals type 2 diabetes, hypertension, and illegal drug use in his somewhat remote past. He complains of being sweaty most of the time, even without exertion, and is drinking a lot of water. The back pain is constant and he describes it as dull. His lower back is tender to touch, and the pain is not relieved with rest or change in activity. He states his wife is complaining about his decreased libido. Although he used to be an avid exerciser, he complains of being too tired and his legs are getting “skinny.”

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KEY FEATURES

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Description
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  • Excessive production and release of adrenal hormones, glucocorticoids (cortisol), androgens, mineralocorticoids from the adrenal glands

  • Adrenal glands are critical in regulating inflammation and cardiovascular function

  • Insidious or sudden onset

  • High cortisol levels

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Essentials of Diagnosis
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  • Fatigue

  • Weight gain

  • Decreased activity tolerance

  • Hypertension

  • Confirmation of suspected disease through blood testing

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FIGURE 20-1

Moon (round, full, puffy) facies and facial flushing in Cushing syndrome. (From Wolff K, Johnson RA. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 6th ed. New York, NY: McGraw-Hill; 2009.)

Graphic Jump Location
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FIGURE 20-2

Approach to the renal workup of hematuria. (Exclude UTI, lithiasis, trauma, bleeding disorders, sickle cell disease.) Complement is depressed in acute poststreptococcal type of glomerulonephritis (about 30 days), chronic glomerulonephritis (persistent), and lupus. ANA, antinuclear antibody; ASO, antistreptolysin antibody; BP, blood pressure; BUN, blood urea nitrogen; C3, complement; Ca, calcium; CBC, complete blood count; Cr, creatinine; IgA, immunoglobulin A; RBC, red blood cell; SLE, systemic lupus erythematosus; ...

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