436-035-0430 Endocrine System (1) The assessment of permanent impairment from disorders of the hypothalamic-pituitary axis requires evaluation of (1) primary abnormalities related to growth hormone, prolactin, or ADH; (2) secondary abnormalities in other endocrine glands, such as thyroid, adrenal, and gonads, and; (3) structural and functional disorders of the central nervous system caused by anatomic abnormalities of the pituitary. Each disorder must be evaluated separately, using the standards for rating the nervous system, visual system, and mental and behavioral disorders, and the impairments combined. Impairment of the hypothalamic-pituitary axis is determined under the following classes: (a) Class 1: 5% when controlled effectively with continuous treatment. (b) Class 2: 18% when inadequately controlled by treatment. (c) Class 3: 38% when there are severe symptoms and signs despite treatment. (2) Impairment of thyroid function results in either hyperthyroidism or hypothyroidism. Hyperthyroidism is not considered to be a cause of permanent impairment, because the hypermetabolic state in practically all patients can be corrected permanently by treatment. After remission of hyperthyroidism, there may be permanent impairment of the visual or cardiovascular systems, which should be evaluated using the appropriate standards for those systems. Hypothyroidism in most instances can be satisfactorily controlled by the administration of thyroid medication. Occasionally, because of associated disease in other organ systems, full hormone replacement may not be possible. Impairment of thyroid function is determined under the following classes: (a) Class 1: 5% when (a) continuous thyroid therapy is required for correction of the thyroid insufficiency or for maintenance of normal thyroid anatomy; AND (b) the replacement therapy appears adequate based on objective physical or laboratory evidence. (b) Class 2: 18% when (a) symptoms and signs of thyroid disease are present, or there is anatomic loss or alteration; AND (b) continuous thyroid hormone replacement therapy is required for correction of the confirmed thyroid insufficiency; BUT (c) the presence of a disease process in another body system or systems permits only partial replacement of the thyroid hormone. (3) Parathyroid: Impairment of parathyroid function results in either hyperparathyroidism or hypoparathyroidism. (a) In most cases of hyperparathyroidism, surgical treatment results in correction of the primary abnormality, although secondary symptoms and signs may persist, such as renal calculi or renal failure, which should be evaluated under the appropriate standards. If surgery fails, or cannot be done, the patient may require long-term therapy, in which case the permanent impairment may be classified under the following: (A) Class 1: 5% when symptoms and signs are controlled with medical therapy. (B) Class 2: 18% when there is persistent mild hypercalcemia, with mild nausea and polyuria. (C) Class 3: 78% when there is severe hypercalcemia, with nausea and lethargy. (b) Hypoparathyroidism is a chronic condition of variable severity that requires long-term medical therapy in most cases. The severity determines the degree of permanent impairment under the following: (A) Class 1: 3% when symptoms and signs controlled with medical therapy. (B) Class 2: 15% when intermittent hypercalcemia or hypocalcemia, and more frequent symptoms in spite of careful medical attention. (4) Adrenal cortex: Impairment of the adrenal cortex results in either hypoadrenalism or hyperadrenocorticism. (a) Hypoadrenalism is a lifelong condition that requires long-term replacement therapy with glucocorticoids or mineralocorticoids for proven hormonal deficiencies. Impairments are rated as follows: (A) Class 1: 5% when symptoms and signs are controlled with medical therapy. (B) Class 2: 33% when symptoms and signs are controlled inadequately, usually during the course of acute illnesses. (C) Class 3: 78% when severe symptoms of adrenal crisis during major illness, usually due to severe glucocortocoid deficiency or sodium depletion. (b) Hyperadrenocorticism due to the chronic side effects of nonphysiologic doses of glucocorticoids (iatrogenic Cushing’s syndrome) is related to dosage and duration of treatment and includes osteoporosis, hypertension, diabetes mellitus and the effects involving catabolism that result in protein myopathy, striae, and easy bruising. Permanent impairment ranges from 5% to 78%, depending on the severity and chronicity of the disease process for which the steroids are given. On the other hand, with diseases of the pituitary-adrenal axis, impairment may be classified based on severity: (A) Class 1: 5% when minimal, as with hyperadrenocorticism that is surgically correctable by removal of a pituitary or adrenal adenoma. (B) Class 2: 33% when moderate, as with bilateral hyperplasia that is treated with medical therapy or adrenalectomy. (C) Class 3: 78% when severe, as with aggressively metastasizing adrenal carcinoma. (5) Adrenal medulla: Impairment of the adrenal medulla results from pheochromocytoma and is classified as follows: (a) Class 1: 5% when the duration of hypertension has not led to cardiovascular disease and a benign tumor can be removed surgically. (b) Class 2: 33% when there is inoperable malignant pheochromocytomas, if signs and symptoms of catecholoamine excess can be controlled with blocking agents. (c) Class 3: 78% when there is wide metastatic malignant pheochromocytomas, in which symptoms of catecholamine excess cannot be controlled. (6) Pancreas: Impairment of the pancreas results in either diabetes mellitus or in hypoglycemia. (a) Diabetes mellitus is rated under the following classes: (A) Class 1: 3% when non-insulin dependent (Type II) diabetes mellitus can be controlled by diet; there may or may not be evidence of diabetic microangiopathy, as indicated by the presence of retinopathy or albuminuria greater than 30 mg/100 ml. (B) Class 2: 8% when non-insulin dependent (Type II) diabetes mellitus; and satisfactory control of the plasma glucose requires both a restricted diet and hypoglycemic medication, either an oral agent or insulin. Evidence of microangiopathy, as indicated by retinopathy or by albuminuria of greater than 30 mg/100 ml, may or may not be present. (C) Class 3: 18% when insulin dependent (Type I) diabetes mellitus is present with or without evidence of microangiopathy. (D) Class 4: 33% when insulin dependent (Type I) diabetes mellitus, and hyperglycemic or hypoglycemic episodes occur frequently in spite of conscientious efforts of both the patient and the attending physician. (b) Hypoglycemia is rated under the following classes: (A) Class 1: 0% when surgical removal of an islet-cell adenoma results in complete remission of the symptoms and signs of hypoglycemia, and there are no post-operative sequelae. (B) Class 2: 28% when signs and symptoms of hypoglycemia are present, with controlled diet and medications and with effects on the performance of activities of daily living. (7) Gonadal hormones: A patient with anatomic loss or alteration of the gonads that results in a loss or alteration in the ability to produce and regulate the gonadal hormones receives a value of 3% impairment for unilateral loss or alteration and 5% for bilateral loss or alteration. Loss of the cervix/uterus or penile sexual function is valued under OAR 436-035-0420. [ED. NOTE: Classes referenced are available from the agency.] Statutory/Other Authority: ORS 656.726 Statutes/Other Implemented: ORS 656.005, 656.214, 656.268 & 656.726 History: WCD 8-2012, f. 11-26-12, cert. ef. 1-1-13 WCD 8-2005, f. 12-6-05, cert. ef. 1-1-06 WCD 9-2004, f. 10-26-04, cert. ef. 1-1-05 WCD 2-2003, f. 1-15-03, cert. ef. 2-1-03 WCD 2-1991, f. 3-26-91, cert. ef. 4-1-91 Reverted to WCD 7-1988, f. 12-21-88, cert. ef. 1-1-89 WCD 18-1990(Temp), f. 9-14-90, cert. ef. 10-1-90 WCD 7-1988, f. 12-21-88, cert. ef. 1-1-89 WCD 2-1988, f. 6-3-88, cert. ef. 7-1-88