Endocrine Myopathies Differential Diagnoses

1. Minetto MA, Lanfranco F, Motta G, Allasia S, Arvat E, D'Antona G. Steroid myopathy: some unresolved issues. J Endocrinol Invest. 2011 May. 34(5):370-5. [Medline].

2. Selcen D. Muscle diseases. Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26. Philadelphia, PA: Elsevier; 2020. 2: 2501-08.

3. Rushworth RL, Torpy DJ, Falhammar H. Adrenal Crisis. N Engl J Med. 2019 Aug 29. 381 (9):852-861. [Medline].

4. Nerup J. Addison's disease--clinical studies. A report of 108 cases. Acta Endocrinol (Copenh). 1974 May. 76 (1):127-41. [Medline].

5. Shapiro MS, Trebich C, Shilo L, Shenkman L. Myalgias and muscle contractures as the presenting signs of Addison's disease. Postgrad Med J. 1988 Mar. 64 (749):222-3. [Medline].

6. Harbuz V, Bihan H, Salama J, Reach G, Cohen R. Flexion contractures possibly reflect the existence of hypocortisolism: two case reports. J Neurol. 2010 Jul. 257 (7):1129-33. [Medline].

7. Ruff RL, Weissmann J. Endocrine Myopathies. Neurology Clinics. New York: McGraw Hill; August 1988. 6: 575-92.

8. Vegiopoulos A, Herzig S. Glucocorticoids, metabolism and metabolic diseases. Mol Cell Endocrinol. 2007 Sep 15. 275 (1-2):43-61. [Medline].

9. Kelly FJ, McGrath JA, Goldspink DF, Cullen MJ. A morphological/biochemical study on the actions of corticosteroids on rat skeletal muscle. Muscle Nerve. 1986 Jan. 9 (1):1-10. [Medline].

10. Smith OL, Wong CY, Gelfand RA. Influence of glucocorticoids on skeletal muscle proteolysis in normal and diabetic-adrenalectomized eviscerated rats. Metabolism. 1990 Jun. 39 (6):641-6. [Medline].

11. Relman AS. Diagnosis of primary aldosteronism. Am J Surg. 1964 Jan. 107:173-7. [Medline].

12. Conn JW, Knopf RF, Nesbit RM. Clinical characteristics of primary aldosteronism from an analysis of 145 cases. Am J Surg. 1964 Jan. 107:159-72. [Medline].

13. Atsumi T, Ishikawa S, Miyatake T, Yoshida M. Myopathy and primary aldosteronism: electronmicroscopic study. Neurology. 1979 Oct. 29 (10):1348-53. [Medline].

14. Jonklaas J, Cooper DS. Thyroid. Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26. Philadelphia, PA: Elsevier; 2020. 2: 1462-76.

15. Horak HA, Pourmand R. Endocrine myopathies. Neurol Clin. 2000 Feb. 18(1):203-13. [Medline].

16. Monzani F, Caraccio N, Siciliano G, Manca L, Murri L, Ferrannini E. Clinical and biochemical features of muscle dysfunction in subclinical hypothyroidism. J Clin Endocrinol Metab. 1997 Oct. 82 (10):3315-8. [Medline].

17. Argov Z, Arnold DL. MR spectroscopy and imaging in metabolic myopathies. Neurol Clin. 2000 Feb. 18 (1):35-52. [Medline].

18. Lin SH, Huang CL. Mechanism of thyrotoxic periodic paralysis. J Am Soc Nephrol. 2012 Jun. 23(6):985-8. [Medline]. [Full Text].

19. Thakker RV. The parathyroid glands, hypercalcemia, and hypocalcemia. Goldman L, Schafer AI. Goldman-Cecil Medicine. 26. Philadelphia, PA: Elsevier; 2020. 2: 1611-22.

20. Engel AG, Fransini-Armstrong C, eds. Endocrine myopathies. In: Myology. 2nd ed. McGraw-Hill. 1994.

21. Tran M, Elias AN. Severe myopathy and psychosis in a patient with Cushing's disease macroadenoma. Clin Neurol Neurosurg. 2003 Dec. 106 (1):1-4. [Medline].

22. Imrich R, Bosak V, Rovensky J. Polymyalgia rheumatica and temporal arteritis: the endocrine relations and the pathogenesis. Review. Endocr Regul. 2006 Sep. 40(3):83-9. [Medline].

23. Cutolo M, Foppiani L, Minuto F. Hypothalamic-pituitary-adrenal axis impairment in the pathogenesis of rheumatoid arthritis and polymyalgia rheumatica. J Endocrinol Invest. 2002. 25 (10 Suppl):19-23. [Medline].

24. Rocca PV, Alloway JA, Nashel DJ. Diabetic muscular infarction. Semin Arthritis Rheum. 1993 Feb. 22 (4):280-7. [Medline].

25. Horton WB, Taylor JS, Ragland TJ, Subauste AR. Diabetic muscle infarction: a systematic review. BMJ Open Diabetes Res Care. 2015. 3 (1):e000082. [Medline].

26. Rodolico C, Bonanno C, Pugliese A, Nicocia G, Benvenga S, Toscano A. Endocrine myopathies: clinical and histopathological features of the major forms. Acta Myol. 2020 Sep. 39 (3):130-135. [Medline].

27. Alshekhlee A, Kaminski HJ, Ruff RL. Neuromuscular manifestations of endocrine disorders. Neurol Clin. 2002 Feb. 20 (1):35-58, v-vi. [Medline].

28. Stewart PM. The Adrenal Cortex. Williams Textbook of Endocrinology. 12. Philadelphia: Elsevier Saunders; 12th May 2011.

29. Urbanic RC, George JM. Cushing's disease--18 years' experience. Medicine (Baltimore). 1981 Jan. 60 (1):14-24. [Medline].

30. Thorn GW, Dorrance S, Day E. Addison's disease: evaluation of synthetic desoxycorticosterone acetate therapy in 158 patients. Ann Intern Med. 1942. 16:1053-96. [Full Text].

31. Olson BR, Klein I, Benner R, Burdett R, Trzepacz P, Levey GS. Hyperthyroid myopathy and the response to treatment. Thyroid. 1991. 1 (2):137-41. [Medline].

32. Shane E, McClane KA, Olarte MR, Bilezikian JP. Hypoparathyroidism and elevated muscle enzymes. Neurology. 1980 Feb. 30 (2):192-5. [Medline].

33. Patten BM, Bilezikian JP, Mallette LE, Prince A, Engel WK, Aurbach GD. Neuromuscular disease in primary hyperparathyroidism. Ann Intern Med. 1974 Feb. 80 (2):182-93. [Medline].

34. Askari A, Vignos PJ Jr, Moskowitz RW. Steroid myopathy in connective tissue disease. Am J Med. 1976 Oct. 61 (4):485-92. [Medline].

35. Mishra AK, Agarwal A, Gupta S, Agarwal G, Verma AK, Mishra SK. Outcome of adrenalectomy for Cushing's syndrome: experience from a tertiary care center. World J Surg. 2007 Jul. 31 (7):1425-32. [Medline].

36. Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry. 2000 Jun. 68 (6):750-5. [Medline].

37. Patten BM, Pages M. Severe neurological disease associated with hyperparathyroidism. Ann Neurol. 1984 May. 15 (5):453-6. [Medline].

38. Frame B, Heinze EG Jr, Block MA, Manson GA. Myopathy in primary hyperparathyroidism. Observations in three patients. Ann Intern Med. 1968 May. 68 (5):1022-7. [Medline].

39. Mathew V, Misgar RA, Ghosh S, Mukhopadhyay P, Roychowdhury P, Pandit K, et al. Myxedema coma: a new look into an old crisis. J Thyroid Res. 2011. 2011:493462. [Medline]. [Full Text].

40. Salehi N, Agoston E, Munir I, Thompson GJ. Rhabdomyolysis in a Patient with Severe Hypothyroidism. Am J Case Rep. 2017 Aug 22. 18:912-918. [Medline].

41. Katipoglu B, Ates I, Acehan F, Meteris A, Yılmaz N. Rhabdomyolysis case based on hypothyroidism. Endocrinol Diabetes Metab Case Rep. 2016. 2016:[Medline].

42. Siafakas NM, Alexopoulou C, Bouros D. Respiratory muscle function in endocrine diseases. Monaldi Arch Chest Dis. 1999 Apr. 54(2):154-9. [Medline].

43. Abisi S, Yong YP, Beech A, Oluwole A, Tennant W. Spontaneous sequential compartment syndrome of the lower limbs. Vasc Endovascular Surg. 2013 Oct. 47 (7):566-8. [Medline].

44. Pivonello R, Isidori AM, De Martino MC, Newell-Price J, Biller BM, Colao A. Complications of Cushing's syndrome: state of the art. Lancet Diabetes Endocrinol. 2016 Jul. 4 (7):611-29. [Medline].

45. Gupta A, Gupta Y. Glucocorticoid-induced myopathy: Pathophysiology, diagnosis, and treatment. Indian J Endocrinol Metab. 2013 Sep. 17 (5):913-6. [Medline].

46. Panat SR, Jha PC, Chinnannavar SN, Chakarvarty A, Aggarwal A. Kocher debre semelaigne syndrome: a rare case report with orofacial manifestations. Oman Med J. 2013 Mar. 28 (2):128-30. [Medline].

47. Sindoni A, Rodolico C, Pappalardo MA, Portaro S, Benvenga S. Hypothyroid myopathy: A peculiar clinical presentation of thyroid failure. Review of the literature. Rev Endocr Metab Disord. 2016 Dec. 17 (4):499-519. [Medline].

48. Rodolico C, Toscano A, Benvenga S, et al. Myopathy as the persistently isolated symptomatology of primary autoimmune hypothyroidism. Thyroid. 1998 Nov. 8(11):1033-8. [Medline].

49. Achappa B, Madi D. Hoffmann's Syndrome- A Rare Form of Hypothyroid Myopathy. J Clin Diagn Res. 2017 May. 11 (5):OL01-OL02. [Medline].

50. Turken SA, Cafferty M, Silverberg SJ, De La Cruz L, Cimino C, Lange DJ, et al. Neuromuscular involvement in mild, asymptomatic primary hyperparathyroidism. Am J Med. 1989 Nov. 87 (5):553-7. [Medline].

51. Sorva A. Respiratory muscle weakness in primary hyperparathyroidism. J Am Geriatr Soc. 1996 Jan. 44 (1):104. [Medline].

52. Gentric A, Pennec YL. Fatal primary hyperparathyroidism with myopathy involving respiratory muscles in an old woman. J Am Geriatr Soc. 1994 Dec. 42 (12):1306. [Medline].

53. Costa RM, Dumitrascu OM, Gordon LK. Orbital myositis: diagnosis and management. Curr Allergy Asthma Rep. 2009 Jul. 9(4):316-23. [Medline].

54. Vignesh G, Balachandran K, Kamalanathan S, Hamide A. Myoedema: A clinical pointer to hypothyroid myopathy. Indian J Endocrinol Metab. 2013 Mar. 17 (2):352. [Medline].

55. Umpierrez GE, Stiles RG, Kleinbart J, Krendel DA, Watts NB. Diabetic muscle infarction. Am J Med. 1996 Sep. 101 (3):245-50. [Medline].

56. Giampietro O, Clerico A, Buzzigoli G, Del Chicca MG, Boni C, Carpi A. Detection of hypothyroid myopathy by measurement of various serum muscle markers--myoglobin, creatine kinase, lactate dehydrogenase and their isoenzymes. Correlations with thyroid hormone levels (free and total) and clinical usefulness. Horm Res. 1984. 19 (4):232-42. [Medline].

57. Doran GR. Serum enzyme disturbances in thyrotoxicosis and myxoedema. J R Soc Med. 1978 Mar. 71 (3):189-94. [Medline].

58. Minetto MA, Lanfranco F, Botter A, Motta G, Mengozzi G, Giordano R, et al. Do muscle fiber conduction slowing and decreased levels of circulating muscle proteins represent sensitive markers of steroid myopathy? A pilot study in Cushing's disease. Eur J Endocrinol. 2011 Jun. 164 (6):985-93. [Medline].

59. Romeo V. Myotonic Dystrophy Type 1 or Steinert's disease. Adv Exp Med Biol. 2012. 724:239-57. [Medline].

60. Li Cavoli G, Mulè G, Rotolo U. Renal involvement in psychological eating disorders. Nephron Clin Pract. 2011. 119(4):c338-41; discussion c341. [Medline].

61. Nilsson MI, Nissar AA, Al-Sajee D, Tarnopolsky MA, Parise G, Lach B, et al. Xin is a marker of skeletal muscle damage severity in myopathies. Am J Pathol. 2013 Dec. 183(6):1703-9. [Medline].

62. Ferguson GT, Irvin CG, Cherniack RM. Effect of corticosteroids on respiratory muscle histopathology. Am Rev Respir Dis. 1990 Nov. 142 (5):1047-52. [Medline].

63. al-Lozi MT, Pestronk A, Lee WC, et al. Rapidly evolving myopathy with myosin-deficient muscle fibers. Ann Neurology. 1994 Mar. 35(3):257-9. [Medline].

64. Benvenga S, Toscano A, Rodolico C, et al. Endocrine evaluation for muscle pain. J R Soc Med. 2001 Aug. 94(8):405-7. [Medline].

65. Engel AG. Electron microscopic observations in primary hypokalemic and thyrotoxic periodic paralyses. Mayo Clin Proc. 1966 Nov. 41(11):797-808. [Medline].

66. McNab TL, Khandwala HM. Acromegaly as an endocrine form of myopathy: case report and review of literature. Endocr Pract. 2005 Jan-Feb. 11(1):18-22. [Medline].

67. Perrot S, Le Jeunne C. [Steroid-induced myopathy]. Presse Med. 2012 Apr. 41(4):422-6. [Medline].

68. Pourmand R. Metabolic myopathies. A diagnostic evaluation. Neurol Clin. 2000 Feb. 18(1):1-13. [Medline].

69. Saguil A. Evaluation of the patient with muscle weakness. Am Fam Physician. 2005 Apr 1. 71(7):1327-36. [Medline].

70. Soni M, Amato AA. Myopathic complications of medical disease. Semin Neurol. 2009 Apr. 29(2):163-80. [Medline].

71. Vantyghem MC, Dobbelaere D, Mention K, Wemeau JL, Saudubray JM, Douillard C. Endocrine manifestations related to inherited metabolic diseases in adults. Orphanet J Rare Dis. 2012 Jan 28. 7:11. [Medline]. [Full Text].

72. Horak HA, Pourmand R. Endocrine myopathies. Neurol Clin. 2000 Feb. 18 (1):203-13. [Medline].

Shireen R Chacko, MBBS Resident Physician, Department of Internal Medicine, Albert Einstein Medical Center

Disclosure: Nothing to disclose.

Catherine Anastasopoulou, MD, PhD, FACE Associate Professor of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University; The Steven, Daniel and Douglas Altman Chair of Endocrinology, Einstein Medical Center

Catherine Anastasopoulou, MD, PhD, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, American Society for Bone and Mineral Research, Endocrine Society, Philadelphia Endocrine Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Neil A Busis, MD Chief of Neurology and Director of Neurodiagnostic Laboratory, UPMC Shadyside; Clinical Professor of Neurology and Director of Community Neurology, Department of Neurology, University of Pittsburgh Physicians

Neil A Busis, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Academy of Neurology<br/>Serve(d) as a speaker or a member of a speakers bureau for: American Academy of Neurology<br/>Received income in an amount equal to or greater than $250 from: American Academy of Neurology.

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL Co-Founder and Former Chief Publishing Officer, eMedicine and eMedicine Health, Founding Editor-in-Chief, eMedicine Neurology; Founder and Former Chairman and CEO, Pearlsreview; Founder and CEO/CMO, PHLT Consultants; Former Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association for Physician Leadership

Disclosure: Nothing to disclose.

Dianna Quan, MD Professor of Neurology, Director of Electromyography Laboratory, University of Colorado School of Medicine

Dianna Quan, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Neurological Association

Disclosure: Received research grant from: Alnylam; Pfizer; Ionis; Cytokinetics; Apellis; Momenta; Alexion; Viela Bio; .

Wayne E Anderson, DO, FAHS, FAAN Assistant Professor of Internal Medicine/Neurology, College of Osteopathic Medicine of the Pacific Western University of Health Sciences; Clinical Faculty in Family Medicine, Touro University College of Osteopathic Medicine; Clinical Instructor, Departments of Neurology and Pain Management, California Pacific Medical Center

Wayne E Anderson, DO, FAHS, FAAN is a member of the following medical societies: American Academy of Neurology, American Headache Society, California Medical Association, California Neurology Society, International Headache Society, San Francisco Medical Society, San Francisco Neurological Society

Disclosure: Nothing to disclose.

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Ling Xu, MD to the development and writing of this article.

• Print this section
• Print the entire contents of
• Print the entire contents of article