Endocrine System

• Author: David A. Morton III
• Pages: 907-990

9-1

Chapter 9

Endocrine System

NOTE: Effective June 7, 2011, the SSA will obsolete all endocrine listings with the exception of

child listing 109.08, which was re-worded. However, the listing discussions are being

retained because (1) although endocrine disorders per se are rarely disabling, there are

numerous possible complications that still need to be evaluated under other body systems;

(2) obsoleted listings can still be the basis for allowance in continuing disability review

(CDR) claims when relevant to the last favorable decision; (3) endocrine data appears fre-

quently in medical records; and (4) residual functional capacity (RFC) considerations are

still relevant to specific endocrine disorders and do not require association with any partic-

ular specific listing number. The explanatory material under 9.00 and 109.00 is current by

the SSA for endocrine disorders, explaining how complications are to be evaluated under

other body system listings as appropriate.

Part I – Adults

§9.00 Endocrine System

§9.01 Category of Impairments, Endocrine System

§9.02 Thyroid Disorders

§9.03 Hyperparathyroidism

§9.04 Hypoparathyroidism

§9.05 Neurohypophyseal Insufficiency (Diabetes Insipidus)

§9.06 Hyperfunction of the Adrenal Cortex

§9.07 (Reserved)

§9.08 Diabetes Mellitus

Part II – Children

§109.00 Endocrine System

§109.01 Category of Impairments, Endocrine System

§109.02 Thyroid Disorders

§109.03 Hyperparathyroidism

§109.04 Hypoparathyroidism or Pseudohypoparathyroidism

§109.05 Diabetes Insipidus

§109.06 Hyperfunction of the Adrenal Cortex

§109.07 Adrenal Cortical Insufficiency

MEDICAL ISSUES IN SOCIAL SECURITY DISABILITY 9-2

§109.08 Juvenile Diabetes Mellitus

§109.09 Iatrogenic Hypercorticoid State

§109.10 Pituitary Dwarfism

§109.11 Adrenogenital Syndrome

§109.12 Hypoglycemia

§109.13 Gonadal Dysgenesis (Turner’s Syndrome)

Part III – Forms

§9.02F Thyroid Disorders

§9.03F Parathyroid Disorders

§9.05F Neurohypophyseal Insufficiency

§9.06F Adrenal Disordrers

§9.08F Diabetes Mellitus

§109.09F Iatrogenic Hypercorticoid

§109.13F Gonadal Dysgenesis

9-3 ENDOCRINE SYSTEM §9.00

Form Reference:

See Forms 9.02, 9.03, 9.05, 9.06, 9.08, 109.13 to

solicit treating source medical information relevant to

the above adult and corresponding child listings.

Part I – Adults

§9.00 Endocrine System

A. What is an endocrine disorder? An endocrine

disorder is a medical condition that causes a hor-

monal imbalance. When an endocrine gland functions

abnormally, producing either too much of a specific

hormone (hyperfunction) or too little (hypofunction),

the hormonal imbalance can cause various complica-

tions in the body. The major glands of the endocrine

system are the pituitary, thyroid, parathyroid, adrenal,

and pancreas.

B. How do we evaluate the effects of endocrine

disorders? We evaluate impairments that result from

endocrine disorders under the listings for other body

systems. For example:

1. Pituitary gland disorders can disrupt hormone pro-

duction and normal functioning in other endocrine

glands and in many body systems. The effects of

pituitary gland disorders vary depending on which

hormones are involved. For example, when pituitary

hypofunction affects water and electrolyte balance

in the kidney and leads to diabetes insipidus, we

evaluate the effects of recurrent dehydration under

6.00.

2. Thyroid gland disorders affect the sympathetic

nervous system and normal metabolism. We evalu-

ate thyroid-related changes in blood pressure and

heart rate that cause arrhythmias or other cardiac

dysfunction under 4.00; thyroid-related weight loss

under 5.00; hypertensive cerebrovascular accidents

(strokes) under 11.00; and cognitive limitations,

mood disorders, and anxiety under 12.00.

3. Parathyroid gland disorders affect calcium levels

in bone, blood, nerves, muscle, and other body tis-

sues. We evaluate parathyroid-related osteoporosis

and fractures under 1.00; abnormally elevated cal-

cium levels in the blood (hypercalcemia) that lead

to cataracts under 2.00; kidney failure under 6.00;

and recurrent abnormally low blood calcium levels

(hypocalcemia) that lead to increased excitability

of nerves and muscles, such as tetany and muscle

spasms under 11.00.

4. Adrenal gland disorders affect bone calcium levels,

blood pressure, metabolism, and mental status. We

evaluate adrenal-related osteoporosis with fractures

that compromise the ability to walk or to use the

upper extremities under 1.00; adrenal-related hyper-

tension that worsens heart failure or causes recur-

rent arrhythmias under 4.00; adrenal-related weight

loss under 5.00; and mood disorders under 12.00.

5. Diabetes mellitus and other pancreatic gland dis-

orders disrupt the production of several hormones,

including insulin, that regulate metabolism and

digestion. Insulin is essential to the absorption of

glucose from the bloodstream into body cells for

conversion into cellular energy. The most common

pancreatic gland disorder is diabetes mellitus (DM).

There are two major types of DM: type 1 and type

2. Both type 1 and type 2 DM are chronic disorders

that can have serious disabling complications that

meet the duration requirement. Type 1 DM—pre-

viously known as “juvenile diabetes” or “insulin-

dependent diabetes mellitus” (IDDM)—is an abso-

lute deficiency of insulin production that commonly

begins in childhood and continues throughout adult-

hood. Treatment of type 1 DM always requires

lifelong daily insulin. With type 2 DM—previously

known as “adult-onset diabetes mellitus” or “non-

insulin-dependent diabetes mellitus” (NIDDM)—

the body’s cells resist the effects of insulin, impair-

ing glucose absorption and metabolism. Treatment

of type 2 DM generally requires lifestyle changes,

such as increased exercise and dietary modification,

and sometimes insulin in addition to other medica-

tions. While both type 1 and type 2 DM are usu-

ally controlled, some persons do not achieve good

control for a variety of reasons including, but not

limited to, hypoglycemia unawareness, other disor-

ders that can affect blood glucose levels, inability to

manage DM due to a mental disorder, or inadequate

treatment.

a. Hyperglycemia. Both types of DM cause hyper-

glycemia, which is an abnormally high level

of blood glucose that may produce acute and

long-term complications. Acute complications

of hyperglycemia include diabetic ketoacidosis.

Long-term complications of chronic hypergly-

cemia include many conditions affecting various

body systems.

(i) Diabetic ketoacidosis (DKA). DKA is an

acute, potentially life-threatening complica-

tion of DM in which the chemical balance of

the body becomes dangerously hyperglyce-