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
- Weight Loss
Loss and Lung Nodules 411 Case 65 A Woman with Difficulty Walking and Ataxia 415 Case 66 A Man with Progressive Neuropathy and Congestive Heart Failure 422 Case 67 An Elderly Woman with a Progressive Neuropathy 429 Case 68 A Young Woman with Difficulty [books.google.com]
Hyperthyroidism, or Graves disease, typically includes pretibial myxedema (a non-pitting edema with pink or light purple or blue nodules), Graves ophthalomopathy, proximal muscle weakness, adhesive capsulitis, muscle mass, weight loss, osteopenia, changes [the-rheumatologist.org]
Patients with myositic myopathy often exhibit fever, malaise, weight loss, and general fatigue. [mdedge.com]
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]
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]
- Asymptomatic
[…] patient is not recommended Baseline CK only in patients at increased risk of myopathy CK levels should be monitored in symptomatic patients If symptomatic, rule out other etioligies of muscle symptoms or asymptomatic CK elevations (increased physical [houstonendocrine.com]
The occurrence of asymptomatic muscle involvement has clouded the issue of whether a true sarcoid myopathy exists. Nonetheless, there are sarcoid patients with symptomatic muscle involvement. [78stepshealth.us]
[…] tendinopathy. 10–13 The failed healing response represents the pathophysiological mechanism thought to underlie (and not only in endocrine patients) the development of tendinopathies. 14 However, nothing is known about what really happens in tendons of asymptomatic [touchendocrinology.com]
Patients with subclinical hypothyroidism are generally asymptomatic or mildly symptomatic. [revespcardiol.org]
If CPK levels are between 5 and 10 times normal and the patient is asymptomatic or able to tolerate the symptoms, then the statin can still be continued. [clevelandclinicmeded.com]
- Epilepsy
[…] late responses, blink reflexes, neuromuscular transmission studies, identification of common and uncommon EMG waveforms, identification of normal EEG and evoked potential variants and age-related patterns, common EEG and evoked potential abnormalities, epilepsy [weillcornell.org]
Metabolic Myopathy Acid maltase or acid alpha-1,4-glucosidase deficiency (Pompe's disease) Glycogen storage disorders 3-11 Carnitine deficiency Fatty acid oxidation defects Carnitine palmitoyl transferase deficiency Mitochondrial Myopathy Myoclonic epilepsy [clevelandclinicmeded.com]
Patients suspected of these disorders should have a review of their history for hypertension, prior epilepsy, preeclampsia, head trauma, etc. [clinicalpainadvisor.com]
- Difficulty Walking
Walking and Ataxia 415 Case 66 A Man with Progressive Neuropathy and Congestive Heart Failure 422 Case 67 An Elderly Woman with a Progressive Neuropathy 429 Case 68 A Young Woman with Difficulty Swallowing 433 Case 69 A Young Woman with Intermittent [books.google.com]
Symptoms of myopathy usually include weakness, and may result in difficulty walking, standing, holding things, chewing, swallowing, or even talking. [weillcornell.org]
Affected muscle groups: Proximal muscle groups - difficulty rising from chair, climbing stairs, shaving, hair combing. Distal muscles - difficulty walking (flapping gait), grasping, handwriting. [patient.info]
- 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]
Gastrointestinal
- Muscle Rigidity
Malignant Hyperthermia Malignant hyperthermia is a severe reaction to anesthetic agents and depolarizing muscle-blocking agents that manifests as muscle rigidity, fever, muscle necrosis, myoglobinuria, metabolic acidosis, kidney failure, and cardiac arrhythmias [clevelandclinicmeded.com]
The excess calcium also causes the muscle fibres to contract and become rigid. Medications that prevent calcium release in the muscle appear to prevent the attack and are given at the first sign of attack. [britannica.com]
MNS typically presents with fever, autonomic instability, leukocytosis, tremor, muscle rigidity, encephalopathy, and an elevated CPK. [clinicalpainadvisor.com]
Cardiovascular
- Hypotension
It causes various symptoms, including hypotension and hyperpigmentation, and can lead to adrenal crisis with cardiovascular collapse. Diagnosis is clinical and by finding elevated plasma adrenocorticotropic hormone (ACTH) with low plasma cortisol. [msdmanuals.com]
[…] to thrive, growth retardation, ADHD Features in adults: goitre, thyrotoxic cardiac symptoms Myxedema coma The only emergent hypothyroid condition Precipitated by cold exposure infection analgesics drugs spontaneous Presentation stupor coma seizures hypotension [medbullets.com]
Sheehan syndrome Gestational enlargement of the pituitary combined with peripartum hypotension may lead to ischemia and necrosis of the pituitary. [clinicalpainadvisor.com]
telangiectasia; peripheral neuropathy Elevated 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 [aafp.org]
- Tachycardia
Beta-blockers should be used to control symptoms of hyperthyroidism (palpitations, shaking, anxiety, tachycardia). [clinicalpainadvisor.com]
sick sinus syndrome, bundle branch block, and ventricular tachycardia. [revespcardiol.org]
A severe type of TM is managed to be diagnosed when there are well-known signs of thyrotoxicosis increasing of thyroid gland, exophthalmos and tachycardia). [scirp.org]
[…] cardiovascular disease, diabetes) Hypocalcemia; uremia Normal Myopathic MUAPs‡ Atrophy of type II muscle fibers; increased lipofuscin beneath cell membrane; calcium deposits in muscle Thyroid hormone (hyperthyroidism) Proximal, bulbar 40 to 49 years Weight loss; tachycardia [aafp.org]
Eyes
- Diplopia
An Older Woman with Progressive Muscle Weakness 572 Case 92 An HIVInfected Man with Muscle Weakness and Spasms 577 Case 93 A Woman with Limb Swelling and Pain 581 Case 94 A Man with a Bent Spine 584 Case 95 A Man with Muscle Stiffness and Later with Diplopia [books.google.com]
Ocular symptoms (diplopia, reduced blinking, lid droop) and skin disease may be present, especially in the case of Graves disease. Parathyroid dysfunction Hypoparathyroidism : Tetany with or without carpopedal spasm is seen. [emedicine.medscape.com]
Ocular symptoms (diplopia, reduced blinking, lid droop) and skin disease may be present, especially in the case of Graves disease. Parathyroid dysfunction Hypoparathyroidism: Tetany with or without carpopedal spasm is seen. [forums.prohealth.com]
The characteristic features of myasthenia are ptosis, diplopia and restricted movements of eyes balls upwards and outwards, dysarthria, dysphagia, dysphonia and amimiya (the same-absent facial expression). [scirp.org]
Intermittent weakness may suggest a disease of the neuromuscular junction such as myasthenia gravis – especially if the patient has facial involvement such as ptosis, diplopia or dysarthria. [rheumatologyadvisor.com]
Skin
- Hyperpigmentation
It causes various symptoms, including hypotension and hyperpigmentation, and can lead to adrenal crisis with cardiovascular collapse. Diagnosis is clinical and by finding elevated plasma adrenocorticotropic hormone (ACTH) with low plasma cortisol. [msdmanuals.com]
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 Anorexia Depression Skin: Hyperpigmentation [neuromuscular.wustl.edu]
Another important signs of Addison’s disease are skin hyperpigmentation, painful spasms of the belly muscles, painful flexor muscular contractures, provoked by the affection of tendons and ligaments. [scirp.org]
Other endocrine diseases Evaluation of HEENT is particularly important in acromegaly (headache, difficult intubation, visual field defects), carcinoid syndrome (facial flushing, hyperpigmentation, headache), hypoparathyroidism (hypocalcemia will lead [clinicalpainadvisor.com]
Musculoskeletal
- 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]
Neurologic
- Polyneuropathy
The diagnosis of the patient with polyneuropathy is discussed in Chapter 21 although most of the potential causes are listed in table 21-4. [dartmouth.edu]
A number of studies have shown it to be equal in prevalence to critical illness polyneuropathy, which affects up to 58% of patients with prolonged ICU stays and nearly 80% of patients with multiorgan failure or septic shock. [clevelandclinicmeded.com]
[…] occasional patient; Muscle swellling & pain Course Progression of weakness: Slow over months Resolution of weakness after treatment: Slow over months Neuropathy Carpal tunnel syndrome (25%) Cranial nerves : Deafness; Hoarse voice (Local vocal cord lesion) Polyneuropathy [neuromuscular.wustl.edu]
[…] myopathy Myopathy with tubular aggregates Myotonia: Myotonic dystrophy DM1, Proximal myotonic myopathy (Myotonic dystrophy DM2), Myotonia Congenita (Thomsen’s disease) Dermatomyositis, polymyositis Drug toxicity Denervation: Motor neuron diseases, but not polyneuropathies [learningneurology.com]
Muscle biopsy is occasionally required to differentiate CIM from other myopathies or from critical illness polyneuropathy. [frontiersin.org]
- Headache
General symptoms include infertility, impotence, headaches, and mass effects of the pituitary tumor. [emedicine.medscape.com]
Beware of symptoms of nocturnal hypoxia (poor sleep, nightmares, headaches). Physiotherapy. May require tracheostomy and permanent ventilation. Specific medication: may be useful in particular situations for particular myopathies. [patient.info]
General symptoms include infertility, impotence, headaches, and mass effects of the pituitary tumor. Physical: Physical examination should focus on the entire body, as the endocrine diseases usually present with multiple system findings. [forums.prohealth.com]
Other endocrine diseases Evaluation of HEENT is particularly important in acromegaly (headache, difficult intubation, visual field defects), carcinoid syndrome (facial flushing, hyperpigmentation, headache), hypoparathyroidism (hypocalcemia will lead [clinicalpainadvisor.com]
- Motor Disturbances
Neurofibrillary tangles, amyotrophy and progressive motor disturbance in mice expressing mutant (P301L) tau protein. Nat Genet, 25, 402-405. [books.google.es]
disturbances, but in TM patients predominate of the “thyrotoxic complaints” (the classical complaints which characteristic for thyrotoxicosis). [scirp.org]
- Paresis
Autoimmune Target autoantigens Association with myasthenia gravis Frequency of MG when DO present: 1% clinical MG; 8% with anti-AChR antibodies Especially when Exotropia present Non-restrictive ophthalmoplegia New EOM paresis after period of stability [neuromuscular.wustl.edu]
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]
- Vertigo
Complaints of “numbness” or tingling, vision disturbance or vertigo suggest broader damage to the nervous system. [dartmouth.edu]
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]
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]