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CONDITION/DISORDER SYNONYMS

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  • Hyperadrenocorticalism

  • Hypercortisolism

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ICD-9-CM CODES

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  • 255.0 Cushing syndrome

  • Associated physical therapy diagnoses

    • 315.4 Developmental coordination disorder

    • 718.45 Contracture of joint, pelvic region, and thigh

    • 719.70 Difficulty in walking involving joint site unspecified

    • 728.2 Muscular wasting and disuse atrophy, not elsewhere classified

    • 728.89 Other disorders of muscle, ligament, and fascia

    • 729.9 Other and unspecified disorders of soft tissue

    • 780.7 Malaise and fatigue

    • 781.2 Abnormality of gait

    • 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

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APTA 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 Inflammation

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

  • 7B: Impaired Integumentary Integrity Associated with Superficial Skin Involvement

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PREFERRED PRACTICE PATTERN

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  • 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury

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FIGURE 21-1

Typical findings in Cushing syndrome. (From McPhee SJ, Hammer GD. Pathophysiology of Disease: An Introduction to Clinical Medicine. 6th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 21-2

Clinical features of Cushing syndrome. A. Note central obesity and broad, purple stretch marks (B close-up). C. Note thin and brittle skin in an elderly patient with Cushing. D. Hyperpigmentation of the knuckles in a patient with ectopic ACTH excess. (From Longo DL, Fauci A, Kasper D, et al., eds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012.)

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PATIENT PRESENTATION

A 38-year-old female who works as a certified nurse assistant in a nursing home arrived complaining of upper and lower back pain which started 3 years ago after transferring a patient from wheelchair to bed. Patient reports that she has been suffering from back pain since then for which she has received all kinds of conservative treatment, including prior physical therapy for which she specifies hot packs and massage about 8 months ago. She reports having received multiple corticosteroids injections as well as oral corticosteroids for multiple periods of time prescribed by different physicians for pain control. The past medical history includes hypertension. Patient denies any history of osteoporosis and has never received a bone density test. In addition, patient reported that she feels very depressed because she has been unable to get pregnant. Upon observation, patient appears with central obesity and thin extremities (all four), kyphotic posture, thick neck, and round moon like face. During examination, patient presents ...

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