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Condition/Disorder Synonyms

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  • Hyperadrenocorticalism

  • Hypercortisolsim

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ICD-9-CM Code

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  • 255.0 Cushing's syndrome

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Associated Physical Therapy Diagnoses

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  • 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's disease

  • E24.2 Drug-induced Cushing's syndrome

  • E24.3 Ectopic ACTH syndrome

  • E24.8 Other Cushing's syndrome

  • E24.9 Cushing's syndrome, unspecified

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APTA Practice Patterns

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Key Features

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Description

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  • Pituitary gland releases excessive adrenocorticotropic hormone (ACTH)

  • The adrenals play a critical role in regulating inflammation and cardiovascular function

  • High cortisol levels

  • Tumor or increased growth of the pituitary gland

  • Can be drug induced

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Essentials of Diagnosis

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  • Noniatrogenic1

    • ACTH dependent

      • Cushing's disease (ACTH-secreting pituitary adenoma)

      • Ectopic ACTH syndrome

    • ACTH independent

      • Functional adrenocortical tumor

  • Iatrogenic1

    • Exogenous glucocortoid adminstration in high doses

  • Round, full face (moon face)1

  • 24-hour urine cortisol test

  • Confirmation of suspected disease through blood testing, blood ACTH level

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General Considerations

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  • May cause pathology in multiple organ systems or be caused by pathology in other organ systems

    • Cardiovascular: heart, peripheral circulation, blood pressure

    • Integumentary system

  • Mnemonic for each letter of CUSHING

  • May result in secondary problems such as aerobic capacity and muscle endurance impairment, weakness/impaired muscle performance, musculoskeletal problems, neuromuscular problems, weight gain; may indicate a need for physical therapy intervention depending on severity

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Demographics

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  • Cushing's disease (ACTH-secreting pituitary adenoma)1

    • More common in women (Female-Male ratio of approximately 8:1)

    • Age at diagnosis 20 to 40 years

  • Ectopic ACTH syndrome1

    • More common in men (Male-Female ratio of approximately 3:1)

    • Age at diagnosis 40 to 60 years

  • Functional adrenocortical tumor1

    • More common in women

    • Adrenal carcinoma occurs in about 2 per million population per year

    • Age at diagnosis usually 35 to 40 years.

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Clinical Findings

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Signs and Symptoms

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  • Growth retardation in children (85%)1

  • Psychiatric effects. Depression (50 to 80%)1

  • Round face; moon face (80%)1

  • Thick neck (80%)1

  • Thin extremities (80%)1

  • Atrophy of skin and dermal connective tissue (70%)1

  • Easy bruising (50%)1

  • Muscle wasting and weakness (70%)...

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