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  • 255.0 Cushing’s syndrome
  • 255.3 Other corticoadrenal overactivity
  • 255.6 Medulloadrenal hyperfunction

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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
  • E27.5 Adrenomedullary hyperfunction

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  • 315.4 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 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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Description

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  • Excessive production and release of adrenal hormones, glucocortcoids (cortisol), androgens, and mineralocorticoids from the adrenal glands
  • Adrenal glands 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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General Considerations

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  • Diagnosis for more occult problems may take time and require intensive diagnostic testing
  • May cause or be caused by pathology in multiple organ systems
    • Cardiovascular: heart, peripheral circulation, blood pressure
    • Integumentary
  • May result in secondary problems needing physical therapy intervention depending on severity such as: aerobic capacity/muscle endurance impairment, weakness/impaired muscle performance, musculoskeletal problems, neuromuscular problems, weight gain

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Demographics

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  • Males and females equally affected
  • Can develop at any age

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Signs and Symptoms

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  • Fatigue
  • Weight loss or gain
  • Libido changes
  • Pallor
  • Flushed face
  • Chest pain
  • Rapid breathing
  • Tachycardia
  • Palpitations
  • Hypertension
  • Excessive thirst
  • Sweating
  • Increased heat sensitivity
  • Headaches
  • Decreased gastrointestinal motility
  • Tingling
  • Increased or decreased muscle bulk
  • Muscle weakness
  • Paralysis
  • Increased frequency of urination
  • Increased bowel frequency
  • Darkening/hyperpigmentation of skin
  • Stretch marks
  • Acne
  • Hyperglycemia or diabetes
  • Inability to absorb calcium
  • Water retention, edema
  • Thinning of skin
  • Easy bruising
  • Poor wound healing
  • Abdominal pain
  • Diarrhea
  • Vomiting
  • Nausea
  • Depression, irritability, personality changes
  • Tremors
  • Low-back pain in area of kidneys
  • Hypokalemia
  • Increased sodium levels
  • Hallucinations
  • Amenorrhea, menstrual irregularities
  • Reduced uterus or breast size
  • Infertility
  • Increased body or facial hair
  • Deepened voice
  • Baldness
  • Growth deficiency, short stature
  • Round face, moon face
  • Increased excess body fat in trunk and thoracic back
  • Osteoporosis
  • Increased infection risk
  • Kidney stones
  • Goiter
  • Sleep disturbances
  • Cushing’s syndrome
  • Adrenal crisis
    • Coma
    • Shock
    • Seizures
    • Death

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Functional Implications

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  • Severe symptoms may be disabling, cause inability to leave home
  • Fatigue, weakness, muscle-mass loss
  • Inability to ambulate or perform self-care
  • Limited aerobic capacity or decreased exercise tolerance secondary to inactivity
  • Limited ADLs, IADLs
  • ...

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