20: ADRENAL GLAND HYPERFUNCTION

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

CONDITION/DISORDER SYNONYMS

Hyperadrenalism
Hyperadrenocorticism
Adrencorticalhyperfunction

ICD-9-CM CODES

255.0 Cushing syndrome
255.3 Other corticoadrenal overactivity
255.6 Medulloadrenal hyperfunction
Associated physical therapy diagnoses
- 315.4 Coordination disorder (clumsiness, dyspraxia and/or specific motor development disorder)
- 718.45 Contracture of joint, pelvic region, and thigh
- 719.70 Difficulty in walking
- 728.2 Muscular wasting and disuse atrophy
- 728.89 Disorders of muscle, ligament, and fascia
- 729.9 Other disorders of soft tissue
- 780.7 Malaise and fatigue
- 781.2 Abnormality of gait: Ataxic, paralytic, spastic, staggering
- 782.3 Edema
- 786.0 Dyspnea and respiratory abnormalities
- 786.05 Shortness of breath

ICD-10-CM CODES

E24.0 Pituitary-dependent Cushing disease
E24.2 Drug-induced Cushing syndrome
E24.3 Ectopic ACTH syndrome
E24.8 Other Cushing syndrome
E24.9 Cushing syndrome, unspecified
E27.5 Adrenomedullary hyperfunction

PREFERRED PRACTICE PATTERNS

4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction¹
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation²
6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning³
7B: Impaired Integumentary Integrity Secondary to Superficial Skin Involvement⁴

PATIENT PRESENTATION

A 60-year-old male is referred to PT for generalized muscle weakness, back pain, and complaints of fatigue. His history reveals type 2 diabetes, hypertension, and illegal drug use in his somewhat remote past. He complains of being sweaty most of the time, even without exertion, and is drinking a lot of water. The back pain is constant and he describes it as dull. His lower back is tender to touch, and the pain is not relieved with rest or change in activity. He states his wife is complaining about his decreased libido. Although he used to be an avid exerciser, he complains of being too tired and his legs are getting “skinny.”

KEY FEATURES

Description

Excessive production and release of adrenal hormones, glucocorticoids (cortisol), androgens, mineralocorticoids from the adrenal glands
Adrenal glands are critical in regulating inflammation and cardiovascular function
Insidious or sudden onset
High cortisol levels

Essentials of Diagnosis

Fatigue
Weight gain
Decreased activity tolerance
Hypertension
Confirmation of suspected disease through blood testing

FIGURE 20-1

Moon (round, full, puffy) facies and facial flushing in Cushing syndrome. (From Wolff K, Johnson RA. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 6th ed. New York, NY: McGraw-Hill; 2009.)

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FIGURE 20-2

Approach to the renal workup of hematuria. (Exclude UTI, lithiasis, trauma, bleeding disorders, sickle cell disease.) Complement is depressed in acute poststreptococcal type of glomerulonephritis (about 30 days), chronic glomerulonephritis (persistent), and lupus. ANA, antinuclear antibody; ASO, antistreptolysin antibody; BP, blood pressure; BUN, blood urea nitrogen; C3, complement; Ca, calcium; CBC, complete blood count; Cr, creatinine; IgA, immunoglobulin A; RBC, red blood ...

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