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Atlas of Neuromuscular Diseases - part 10

Điều này có thể thay đổi và phụ thuộc vào sự rối loạn hệ thống cụ thể, cơ bắp tuy nhiên gần thường bị ảnh hưởng nhiều nhất. Đây là thay đổi phụ thuộc vào nguyên nhân cụ thể của bệnh cơ | 425 Myopathies associated with endocrine metabolic disorders and carcinoma Genetic testing NCV EMG Laboratory Imaging Biopsy Fig. 32. Muscle from a patient with diabetes mellitus showing myolysis with degenerating fibers arrow heads This is variable and depends on the specific systemic disorder however proximal muscles are most usually affected. This is variable depending on the specific cause of myopathy. Most of these myopathies progress slowly although rapid progression of symptoms may be observed with thyrotoxicosis. If treated most endocrine related myopathies are self limiting. Myopathies related to paraneoplastic disorders are usually not treatable. Distribution anatomy Time course Any age although most are observed in adults. Paraneoplastic related myopa- Onset age thies are more common in older patients. This disorder may be associated with a painful myopathy that can simulate polymyalgia or polymyositis. In severely hypothyroid children a syndrome characterized by weakness slow movements and striking muscle hypertrophy may be observed. Percussion myotonia and myoedema may be observed in patients with hypothyroidism. Clinical syndrome Hypothyroidism 426 Hyperthyroidism Thyrotoxicosis is associated with muscle atrophy and weakness. It may also be associated with a progressive extraocular muscle weakness ptosis periodic paralysis myasthenia gravis spastic paraparesis and bulbar palsy. Subjects may have brisk reflexes and fasciculations similar to amyotrophic lateral sclerosis. Hypoparathyroidism Hyperparathyroidism Affected patients may have tetany muscle spasm and occasionally weakness. Patients may have proximal weakness muscle atrophy hyperreflexia and fasciculations. Cushing syndrome and corticosteroid atrophy Acromegaly Occasionally muscle atrophy and weakness may be observed under conditions of hypercortisolemia. The muscles may appear enlarged however this disorder is usually associated with mild proximal upper or lower extremity muscle weakness. .