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  • Hyperadrenocorticalism
  • Hypercortisolsim

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  • 255.0 Cushing’s syndrome

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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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  • 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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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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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%)1
  • Weight gain; increased body fat in trunk and thoracic back (80%)1
  • Pallor
  • Flushed face
  • Chest pain
  • Fatigue
  • Rapid breathing
  • Tachycardia
  • Palpitations
  • Hypertension
  • Skin changes, striae on the abdomen and chest
  • Darkening/hyperpigmentation of skin
  • Stretch marks
  • Acne
  • Excessive thirst
  • Sweating
  • Increased heat sensitivity
  • Decreased ...

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