Musculoskeletal symptoms and neurological investigations in adrenocortical insufficiency: a case report and literature review.
OBJECTIVE
Various forms of adrenocortical insufficiency can cause musculoskeletal symptoms such as muscle pain, tautness of the limbs, arthralgia, and flexion contractures. However, the findings of neurological investigations are inconclusive and have not been well summarized.


METHODS
We report the case of a 61-year-old man with isolated adrenocorticotropic hormone deficiency who presented with musculoskeletal symptoms, including flexion contractures. We performed three neurological investigations: nerve conduction studies, electromyography, and muscle biopsy analysis. Further, we reviewed reports of 16 patients with various forms of adrenocortical insufficiency and musculoskeletal symptoms by considering the findings of these three investigations.


RESULTS
From the literature review, we found that (a) analysis of muscle biopsy is the most sensitive technique, followed by electromyography and then nerve conduction studies; and (b) the longer the duration of the musculoskeletal symptoms, the greater the incidence of abnormal findings with all three techniques.


CONCLUSIONS
Physicians may prioritize neurological investigations, depending on these findings.
Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan. hkinoshita-tky@umin.ac.jp
H
H
Kinoshita
S
S
Mizutani
K
K
Sei
M
M
Shimizu
M
M
Yasuda
T
T
Ohkubo
H
H
Tomimitsu
T
T
Kamata
F
F
Yakushiji
D000224:Addison Disease / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology / Q000503:physiopathology; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology