Cushing’s disease

• Hyperadrenocorticalism
• Hypercortisolsim

• 255.0 Cushing’s syndrome

• 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

• 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

• 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 inflammation
• 6B: Impaired aerobic capacity/endurance associated with deconditioning
• 7B: Impaired integumentary integrity associated with superficial skin involvement

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• 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

Demographics

• 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.

Signs and Symptoms

• 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
...