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2.1
Myopathy, Endocrine
Endocrine Myopathies

Presentation

Presentations range anywhere from acute, painful, and necrotic myopathies, as can occur in statin myopathy, to more insidious presentations such as steroid myopathy. [ncbi.nlm.nih.gov]

Increased intracranial pressure is not a constant finding, but may be present. Hyperparathyroidism: Myopathy is a prominent finding. Both symmetric weakness of the proximal limbs and atrophy are present. [emedicine.medscape.com]

Fiber degeneration and necrosis are present. Serum muscle enzymes are characteristically elevated. By the end of the second week, a 15% to 50% eosinophilia is present. Serologic tests become positive by the end of the third week. 2. [78stepshealth.us]

A myopathy very often is present, and it rarely may be the presenting symptom. [forums.prohealth.com]

Entire Body System

  • Hodgkin Lymphoma

    The relationship of myositis to underlying malignancy remains controversial, and the frequency of this association is not well established. 2 types of cancer show a relationship with myositis: ovarian cancer and Non-Hodgkin lymphoma (shown on the left [radiologyassistant.nl]

    The more common tumors associated with dermatomyositis are ovarian cancer, breast cancer, melanoma, colon cancer, and non-Hodgkin’s lymphoma. [frontiersin.org]

  • Pathologist

    […] referred to neurologists, rheumatologists, orthopaedic surgeons, paediatricians or to general physicians, and their investigation, utilising electromyography (EM G) and muscle biopsy, often requires the help of the clinical neurophysiologist and of the pathologist [books.google.com]

Musculoskeletal

  • Myalgia

    Muscle side effects The most common side effect that patients will notice with taking statin medications for cholesterol include Myalgia muscle ache or weakness without creatine kinase (CK) elevation Myopathy myalgia plus elevation in serum CK more than [houstonendocrine.com]

    Acquired myopathies may have symptoms similar to those of genetic myopathies and also may include: Muscle weakness Muscle soreness (myalgias) Cramps Stiffness Muscle wasting around the shoulders and hips Causes and Risk Factors Patients who have a blood [cedars-sinai.edu]

    Related to high levels of ACTH produced by pituitary Adrenal insufficiency From Bramwell: Atlas of Clinical Medicine Addison's Disease Clinical Muscle Fatigue Weakness: Mild; Occasionally respiratory Cramps Myalgias Rhabdomyolysis Systemic Weight loss [neuromuscular.wustl.edu]

    Symptoms can range from mild cramps to more-severe myalgias, pain, and weakness. Rhabdomyolosis has also been reported in rare cases. [clevelandclinicmeded.com]

    […] muscle disorders with associated myalgias). [frontiersin.org]

  • Muscular Atrophy

    The muscular dystrophies The muscular dystrophies are a group of hereditary disorders characterized by progressive muscular atrophy and weakness. In most varieties the muscles of the limb girdles—the pelvic and shoulder muscles—are involved. [britannica.com]

    Spinal muscular atrophy. Congenital hypomyelinating neuropathies. It may be difficult to distinguish myopathy from peripheral neuropathy. [patient.info]

    Duchenne in 1855 first described a progressive muscular atrophy of childhood and was termed “hypertrophic paraplegia of infancy”. [slideplayer.com]

    Severe types with the expressed atrophy of muscles it is necessary to distinguish from muscular dystrophies, paraneoplastic myopathy, proximal spinal muscular atrophy and diabetic proximal amyotrophy (atrophy proximal muscles); when we mention bulbar [scirp.org]

    […] dystrophy: Duchenne muscular dystrophy, Becker muscular dystrophy Limb girdle muscular dystrophy LGMDs Fascioscapulohumeral muscular dystrophy FSH a.k.a. [learningneurology.com]

  • Fracture

    They affect at least 10 % of adults in the EU and significantly impair the state of health, especially in elderly subjects, being associated with postural instability, mobility disorders, increased risk of falls and fractures and impaired ability or disability [touchendocrinology.com]

    DOI] 18 Sexual dimorphism of frailty and cognitive impairment: Potential underlying mechanisms Qingwei Ruan,Grazia DæOnofrio,Tao Wu,Antonio Greco,Daniele Sancarlo,Zhuowei Yu Molecular Medicine Reports. 2017; 16(3): 3023 [Pubmed] | [DOI] 19 Minimising fracture [ijem.in]

    Muscles that are immobilized, as by a plaster cast following fracture of a long bone, tend to waste rapidly through shrinkage of the muscle fibres. A consistent finding is that the oxidative capacity of the muscle is reduced. [britannica.com]

    Cushing disease is associated with osteoporosis that may lead to vertebral compression fractures. Integumentary system Thyrotoxicosis leads to hair loss, pretibial myxedema, onycholysis and acropachy. [clinicalpainadvisor.com]

Neurologic

  • Tremor

    Examples are plentiful and include such signs as distinctive tremors in a Parkinson’s disease patient and red hands on a patient with liver disease. [books.google.com]

    Associated hyperthyroid features like enlarged thyroid gland, tremor, bulging eyes, and a fast heart rate may be seen. Blood tests show an elevated thyroxine level. In Graves disease, antibodies against the thyroid gland are present. [encyclopedia.com]

    Muscle fatigue, stiffness, myalgias, or cramps may be the main or only presenting symptoms of hypothyroidism. [8] Hyperthyroidism : General symptoms include weight loss, sweating, tremor, muscle wasting, and painless weakness. [emedicine.medscape.com]

    Hyperthyroidism: General symptoms include weight loss, sweating, tremor, muscle wasting, and painless weakness. Occasional patients have myalgia, cramps, and bulbar and ocular muscle weakness. [forums.prohealth.com]

    No tremors or fasciculations were elicited. Pupillary reaction and pupil size were normal bilaterally. Click here to download Figure 1 Figure 1a. Showing ptosis in patient on day 4 of admission. Figure 1b. [asean-endocrinejournal.org]

  • Insomnia

    Other common side effects of corticosteroids include weight gain, thinning of the skin, easy bruising, cataracts, glaucoma, insomnia, mood change, difficulty concentrating, and muscle cramping. [rheumatologyadvisor.com]

Workup

This innovative one-page format provides the definition, differential diagnosis, workup and diagnosis, and treatment options for nearly 170 diseases and disorders. [books.google.com]

[…] incidence 40-60 years Hyperthyroid myopathy - Peak incidence 20-60 years Hypothyroid myopathy - Incidence increases after 40 years Cushing myopathy - Peak incidence 20-40 years CLINICAL Section 3 of 10 Author Information Introduction Clinical Differentials Workup [forums.prohealth.com]

A neurologic examination that shows deficits in a single nerve or radicular distribution indicates a possible mononeuritis, entrapment neuropathy, or radiculopathy, and calls for a different workup than that required for a limb paresis in a patient with [aafp.org]

Serum

  • Hyponatremia

    […] face, eyelids, and hands (myxedema) skin thinning of lateral eye brows bradycardia delayed relaxation of the deep tendon reflexes Evaluation Labs elevated TSH is most sensitive measure decreased serum and free T4 may have megaloblastic anemia may have hyponatremia [medbullets.com]

    Hyperkalemia, hyponatremia and hypoglycemia may occur with adrenal insufficiency (Addison's disease). [clinicalpainadvisor.com]

    […] transaminase and GGT levels; anemia; decreased vitamin B 12 Normal to elevated Normal Myopathic changes*; selected atrophy of type II muscle fibers Endocrine Adrenal insufficiency Generalized Variable Hypotension; hypoglycemia; bronzing of the skin Hyponatremia [aafp.org]

    Cramps are usually benign and can occur with multiple conditions like dehydration, hyponatremia, azotemia, myxedema, etc. [frontiersin.org]

  • Hyperprolactinemia

    The prevalence of hyperprolactinemia ranges from 0.4% in the general adult population to 9% in women with reproductive disorders. 1 Although hyperprolactinemia itself does not have clear effects on the cardiovascular system, there is a possible association [revespcardiol.org]

Treatment

200 9 Ankylosing Spondylitis C Treatment and Assessment 209 10 Reactive and Enteropathic Arthritis 217 11 Osteoarthritis A Clinical Features 224 11 Osteoarthritis B Pathology and Pathogenesis 229 11 Osteoarthritis C Treatment 235 12 Gout A Clinical Features [books.google.com]

Treatments of steroid myopathy are as follows: Lower the dose of steroid, use a nonfluorinated glucocorticoid, and exercise or physical therapy. [ncbi.nlm.nih.gov]

Parathyroidectomy, subtotal Other Vitamin D deficiency Teriparatid treatment 8 Recombinant human 1–34 amino acid sequence of parathyroid hormone Osteoporosis treatment Clinical Cramps Muscle tenderness Time course: Hours after treatment Other features [neuromuscular.wustl.edu]

Treatment of hypothyroidism is thyroid hormone replacement. With proper therapy, serum CK levels return to normal over several months. B. Thyrotoxic myopathy. [78stepshealth.us]

Prognosis

Prognosis Prognosis is also very dependent of aetiology. E.g. congenital myopathies are chronic and progress over years, whereas other myopathies are more acute and can quickly lead to respiratory failure and other complications. [teesneuro.org]

Scapular winging Fasciculations Rhabdomyolysis : With thyroid storm Bulbar syndrome: Dysphagia Tendon reflexes : Brisk Lab High T 3 or T 4 CK: Normal or low EMG: Myopathic; ± Fasciculations or fibrillations Muscle pathology: Normal or type 2 atrophy Prognosis [neuromuscular.wustl.edu]

Prognosis This depends on the specific diagnosis. The primary disorders are incurable conditions with varied prognosis. Secondary myopathy may be corrected by treating the underlying cause. [patient.info]

Prognosis Prognosis is quite good. In two to four months after euthryoid state is achieved, muscle weakness improves. But it may take up to a year for muscle bulk to return. Respiratory failure is very rare. [encyclopedia.com]

Etiology

Myopathy is a common term for a muscle disease that is unrelated to any disorder of innervation or neuromuscular junction, with a wide range of possible etiologies. [news-medical.net]

The etiologies of hyperadrenalism include pituitary or ectopic overproduction of adrenocorticotropic hormone (ACTH), adrenal tumors, or exogenous corticosteroid administration. [emedicine.medscape.com]

Rhabdomyolysis may also be seen with infectious etiologies, alcohol, and toxic exposures. [clevelandclinicmeded.com]

Adrenal dysfunction The etiologies of hypoadrenalism are many, including infection, inflammatory disease, and tumor. Notably, adrenal failure may follow pituitary failure. [forums.prohealth.com]

Epidemiology

Pathology and Pathogenesis 319 15 Systemic Lupus Erythematosus C Treatment and Assessment 327 16 Antiphospholipid Syndrome 339 17 Systemic Sclerosis A Clinical Features 343 17 Systemic Sclerosis B Epidemiology Pathology and Pathogenesis 351 17 Systemic [books.google.com]

Friedman, CR, Neimann, J., Wegener, HC, and Tauxe, RV Epidemiology of Campylobacter jejuni infections in the United States and other industrialized nations. [books.google.es]

Sensory-Motor neuropathy SPG 22 Ataxia May increase risk of: Statin myopathy External links eMedicine Hyperthyroidism Epidemiology Female > Male Onset: Average 5th decade Myopathy (80%) Onset Slowly progressive; More common with increasing age Acute onset [neuromuscular.wustl.edu]

Epidemiology These are all relatively uncommon diseases: Duchenne muscular dystrophy is easily the most common childhood-onset muscular dystrophy and affects 1 in 3,300 boys. [ 6 ] The prevalence of Duchenne muscular dystrophy is 63 cases per million. [patient.info]

Polymyalgia rheumatica (PMR) and temporal arteritis (TA): Although research is just beginning, Imrich and colleagues note that age-related changes in the neuroendocrine system could represent a pathogenic factor for PMR and/or TA in genetically disposed. [5] Epidemiology [emedicine.medscape.com]

Pathophysiology

This article discusses the clinical features, pathophysiology, and management of toxic and endocrine myopathies. [ncbi.nlm.nih.gov]

Sarcopenia is their pathophysiological common denominator. Recent reports have shown that endocrine disorders, even when subclinical, may also be associated with tendinopathies. [touchendocrinology.com]

Get a quick and memorable overview of anatomy, pathophysiology, and clinical presentation from the precision and beauty of Netter and Netter-style plates that highlight key neuroanatomical and neurologic concepts. [books.google.com]

Steroid myopathy is the most common endocrine myopathy. [1] Pathophysiology Although abnormal endocrine states usually present with muscle weakness—most often proximal weakness—the exact pathophysiology remains incompletely understood. [emedicine.medscape.com]

Prevention

Early detection and expeditious correction of metabolic disturbances in endocrinopathies such as Cushing syndrome, thyroid and parathyroid diseases, and acromegaly can minimize and prevent neurologic complications including myopathy. [ncbi.nlm.nih.gov]

Recent Findings: Early detection and expeditious correction of metabolic disturbances in endocrinopathies such as Cushing syndrome, thyroid and parathyroid diseases, and acromegaly can minimize and prevent neurologic complications including myopathy. [journals.lww.com]

Physical therapists can help in devising muscle strengthening exercises and in preventing muscle contractures. Protective eye glasses and eye patches are used to prevent corneal exposure and ulceration. [encyclopedia.com]

Prevention Genetic counselling is, in some of the most common myopathies such as Duchenne muscular dystrophy, the only intervention that can prevent disease. In general: Give genetic counselling early. [patient.info]

Preventive treatment for permanent contraction of a muscle ( contractures ) includes physical therapy and bracing. There are currently no drugs available to prevent or treat contractures. [consultantsinneurology.com]

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