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19: ADDISON DISEASE

Debra F. Stern, DPT, DBA, MSM, PT; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Chronic renal insufficiency1

  • Hypocortisolism1

ICD-9-CM CODES2

  • 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

ICD-10-CM CODES3

  • E27.1 Primary adrenocortical insufficiency

  • E27.2 Addisonian crisis

  • E27.40 Unspecified adrenocortical insufficiency

PREFERRED PRACTICE PATTERNS4

  • 4B: Impaired Posture

  • 4C: Impaired Muscle Performance

PATIENT PRESENTATION

A 25-year-old female referred with significant sarcopenia and a BMI of 16. Her gait is unstable and she demonstrates coordination deficits. She is mildly short of breath on exertion. She describes little interest in food, but does have self-described craving for potato chips at times. Of late, she is too tired to exercise and she thinks it is because she is depressed. Her history reveals that she menstruates infrequently over the past year and that her skin tone has changed.

FIGURE 19-1

Clinical features of Addison disease. Note the hyperpigmentation in areas of increased friction including (A) palmar creases, (B) dorsal foot, (C) nipples and axillary region, and (D) patchy hyperpigmentation of the oral mucosa. (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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KEY FEATURES

Description

  • 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 women, involved in maintaining libido

Essentials of Diagnosis

  • May be insidious onset or sudden onset as in Addisonian crisis

  • 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

General Considerations

  • 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

FIGURE 19-2

Addison disease A. Hyperpigmentation ...

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