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  • Chronic renal insufficiency1
  • Hypocortisolism1

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  • 255.41 Glucocorticoid deficiency
  • PT diagnoses/treatment diagnoses that may be secondary adrenal gland disorders
    • 315.4 Developmental coordination disorder
    • 719.70 Difficulty in walking involving joint site, unspecified
    • 728.2 Muscular wasting and disuse atrophy, not elsewhere
    • 728.89 Other disorders of muscle, ligament, and fascia
    • classified
    • 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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  • E27.1 Primary adrenocortical insufficiency
  • E27.2 Addisonian crisis
  • E27.40 Unspecified adrenocortical insufficiency

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Description

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  • Insufficient production or release of glucocorticoids (cortisol),1 androgens, and mineralocorticoids from the adrenal glands
  • These hormones play a role in
    • Conversion of food to energy
    • Inflammatory response
    • Response to stress
    • Maintaining sodium-potassium balance for blood pressure
    • Regulation and production of androgens in males and females, involved in maintaining libido
    • May be insidious onset or sudden onset, as in Addisonian crisis

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Essentials of Diagnosis

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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
  • Confirmation of suspected disease through blood testing

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General Considerations

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  • Clinic should have carbohydrates available if needed for drop in blood sugar
    • Orange juice, sugar packets, or similar
  • May result in secondary problems such as
    • Aerobic capacity and muscle endurance impairment
    • Sarcopenia
    • Weakness/impaired muscle performance
    • Musculoskeletal problems
    • Neuromuscular problems
    • Weight loss, indicating the need for PT intervention depending on severity

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Demographics

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  • Affects males and females equally
  • Can develop at any age
  • Maybe familial5

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Signs and Symptoms

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  • It is not the purview of a PT to medically diagnose hypothyroid, but rather to recognize the possibility in the differential diagnosis process, especially when the findings are not consistent with conditions commonly treated such as musculoskeletal, neuromuscular, integumentary, and cardiopulmonary
    • PTs may, however, treat conditions caused by adrenal disorders or treat patients with Addison’s disease for other pathologies that are unrelated
  • Hypotension
  • Fatigue
  • Weight loss,1 loss of appetite
  • Decreased activity tolerance
  • Fainting/loss of consciousness
  • Headaches
  • Sweating
  • Anorexia
  • Muscle weakness1
  • Darkening/hyperpigmentation of skin
  • Craving for salt
  • Hypoglycemia
  • Nausea
  • Diarrhea
  • Vomiting
  • Irritability
  • Depression
  • Pain
  • Joint pain
  • Low back pain
  • Abdominal pain
  • Leg pain
  • Hyperkalemia
  • Loss of libido
  • Oral lesions
  • Metabolic acidosis
  • Personality changes
  • Amenorrhea
  • Sparseness of hair in axilla

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Functional Implications

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  • Severe symptoms such as immediacy of need to defecate and diarrhea, which may be disabling and result in the inability to leave home
  • Decreasing weight with inability to exercise or move well
  • Sarcopenia, resulting in weakness, muscle mass loss, inability to ambulate or perform self-care, and aerobic capacity limitation secondary to inactivity
  • Decreased exercise tolerance
  • Limitations in ADLs or IADLs

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Possible Contributing Causes

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