Causes of Anorexia Nervosa

• Gastrointestinal and malabsorption disorders (e.g., celiac disease, Crohn's disease, cystic fibrosis, PUD)
  –Diarrhea is often present

• Depression
  –Weight loss is one diagnostic criterion
  –Most common cause of weight loss in outpatient populations

• Adrenal insufficiency
  –Anorexia, nausea, and fatigue are common
• Anorexia nervosa
  –May present with low albumin, parotid enlargement, lesions on knuckles and diminished tooth enamel from induced vomiting, and menstrual irregularities
• Failure to thrive (infants)
  –Parental neglect, emotional deprivation
  –Improper mixing of formula
  –Significant heart (shunts) or lung disease
  –Inborn errors of metabolism
• Intestinal parasites

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Source: In a Page: Signs and Symptoms, 2004

Weight Gain: Differential Diagnosis
(In a Page: Signs and Symptoms)

• Primary obesity due to overeating and a sedentary lifestyle
• Medication side effects (e.g., oral contraceptives, corticosteroids, antidepressants, benzodiazepines, hypoglycemics, and anticonvulsants)
• Overeating secondary to nicotine withdrawal, depression, binge phase of bulimia nervosa
• Pregnancy
• Pre-eclampsia/eclampsia
• Premenstrual syndrome
• Nephrotic syndrome
  –Renal loss of protein results in decreased intravascular oncotic pressure, leading to water “leakage” to extravascular compartments (e.g., edema, ascites)
  –Due to primary renal disease or secondary causes (e.g., diabetes mellitus)

• Acute or chronic liver disease
  –Decreased hepatic protein production results in decreased intravascular oncotic pressure, leading to water “leakage” to extravascular compartments (e.g., edema, ascites)
• Congestive heart failure
• Hypothyroidism
• Diabetes mellitus
• Polycystic ovarian syndrome
  –Associated with hirsutism, menstrual irregularities, insulin resistance, obesity
• Cushing's syndrome
  –Excess cortisol levels due to ACTH-secreting adrenal adenoma, adrenal hyperplasia, ACTH-secreting ectopic tumor, or ACTH-secreting pituitary adenoma (Cushing's disease)
• Less common etiologies (“zebras”) include hypothalamic lesions (e.g., tumor, infection), hyperphagia due to hyperthyroidism, acromegaly (growth hormone excess, usually due to a pituitary tumor), or growth hormone deficiency

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Source: In a Page: Signs and Symptoms, 2004

Anorexia: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Psychosocial/psychiatric
  –Unrealistic parental expectations of what child should eat leads to pressure and causes food refusal
  –Anorexia nervosa: Common among adolescents, particularly females
  –Depression

• Infectious
  –Gastroenteritis: Salmonella, Shigella, E. coli, Norwalk agent
  –HIV
  –Hepatitis A, B, C
  –Pyelonephritis
  –Mycobacterium tuberculosis

• GI disorders
  –Gastroesophageal reflux disease
  –Constipation
  –Appendicitis
  –Celiac disease
  –Pancreatitis
  –Crohn disease
  –Achalasia
  –Esophageal foreign body
  –Liver failure
• Metabolic/endocrine disorders
  –Hypothyroidism
  –Hypercalcemia
  –Panhypopituitarism
  –Addison disease
  –Diabetes insipidus
  –Lead poisoning
• Nutritional disorders
  –Zinc deficiency
  –B12 deficiency
  –Iron deficiency
  –Dietary chloride deficiency
  –Hypervitaminosis A
• Cardiopulmonary disease
  –Congestive heart failure
  –Cystic fibrosis
• Drug toxicity
  –Illicit drugs
  –Antihistamines
  –Methylphenidate
  –Ephedrine
  –Digitalis
• Rheumatic disorders
  –Systemic lupus erythematosus
  –Juvenile rheumatoid arthritis
• Pregnancy

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Source: In A Page: Pediatric Signs and Symptoms, 2007

Polyphagia: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Exogenous obesity
• Bulimia
• Depression
• Anxiety
• Diabetes mellitus
• Hypoglycemia
• Diabetes insipidus in infants
  –On breast milk or formula diet, excessive drinking is misinterpreted as excessive eating
• Hyperthyroidism or Graves disease
  –Increased metabolic rate, increased appetite, and increased oral intake as well as increased stool output
• Medications
  –Corticosteroids
  –Cyproheptadine
  –Tricyclic antidepressants
  –Valproic acid
  –Tetrahydrocannabinol
  –Neuroleptics
  • Hypothalamic lesions (hypothalamic –Tumors (e.g., craniopharyngioma)
    –Inflammation/autoimmune
    –Central nervous system infection
    –Head trauma
• Genetic syndromes
  –Prader-Willi syndrome
  –Laurence-Moon-Bardet-Biedl syndrome
  –Kleine-Levin syndrome
• Cystic fibrosis
  –Malabsorption results in chronic malnutrition, especially of fat

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Source: In A Page: Pediatric Signs and Symptoms, 2007

Weight Loss: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Infectious
  –The most common cause overall and can be divided into acute and chronic
  –Gastroenteritis most common infection
  –May be viral, bacterial, fungal, or parasitic
  –Estimated 21–37 million episodes a year in children under 5
  –Others include strep, osteomyelitis, EBV, TB

• Psychiatric/psychosocial
  –Anorexia nervosa
  –Bulimia
  –Depression
  –Rumination
  –Drugs: Cocaine, amphetamines, laxatives
• Gastrointestinal disorders
  –Gastroesophageal reflux disease
  –Inflammatory bowel disease
  –Hepatitis
  –Pancreatitis
  –Pancreatic insufficiency (e.g., CF, Shwachman syndrome)
  –Celiac disease
  –Sucrase-isomaltase deficiency
  –Fat malabsorption: Abetalipoproteinemia
  –Protein malabsorption: Hartnup disease
  –Superior mesenteric artery syndrome
• Nutritional
  –Dieting; inadequate caloric intake
  –Iron deficiency
  –Zinc deficiency
  –Neglect
• Metabolic/endocrine
  –Diabetes mellitus
  –Diabetes insipidus
  –Addison disease
  –Hyperthyroidism
  –Hypopituitarism
• Malignancy
• HIV
• Acute/chronic renal failure
• Inflammatory
  –Systemic lupus erythematosus
  –Juvenile rheumatoid arthritis
  –Sarcoidosis
• Neurologic
  –Increased ICP: Pseudotumor cerebri, mass
• Cardiopulmonary
  –Cystic fibrosis
  –Congenital heart disease
  –Congestive heart failure

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Source: In A Page: Pediatric Signs and Symptoms, 2007

Diarrhea – Chronic, No Blood or Weight Loss: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Osmotic: Presence of nonabsorbable solute, pH <5, volume <200 mL/day, normal electrolytes, stops with fasting
• Secretory: Mostly due to toxins, pH >6, volume >200 mL/day, no response to fasting, stool Na >70 mEq/L, negative reducing substances
• Toddler's diarrhea: Chronic nonspecific diarrhea, onset 3 months to 3 years of age, average 4–6 stools daily, due to excessive juice intake or low-fat diet
• Excessive intake of nonabsorbable solutes (lactulose, sorbitol, magnesium hydroxide)
• Congenital lactose deficiency: Very rare in infancy, but may occur in extremely premature infants; adult-onset type of hypolactasia may be seen in older children (over age 5), autosomal recessive, 15% white adults, 85% of black adults, 90% of Asian adults
• Secondary lactase deficiency: Follows a viral gastroenteritis, most commonly rotavirus, may persist for months
• Fructose intolerance
• Sucrase-isomaltase deficiency: Autosomal recessive, found in 0.2% of North Americans, symptoms commence on starting sucrose or glucose polymer-containing foods
• Glucose-galactose malabsorption: Rare, autosomal recessive disorder
• Infections
  –Giardiasis (most common infectious cause of chronic diarrhea in toddlers)
  –Cryptosporidium
  –Microsporidium
• Irritable bowel syndrome (IBS)
  –Abnormality of intestinal motility and pain perception with no organic basis
  –Abdominal pain associated with intermittent diarrhea or constipation
• Bacterial overgrowth: Enteric bacteria colonizes the upper small intestine
• Trehelase deficiency (trehelose is the sugar found in mushrooms)
• Zinc deficiency
  –Acrodermatitis enteropathica is typical rash
• Low-fat diet

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Source: In A Page: Pediatric Signs and Symptoms, 2007

Diarrhea – Chronic, with Weight Loss: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Allergic enteritis: Typically cow's milk or soy in infants
• Inflammatory bowel disease (IBD)
• Cystic fibrosis (CF)
  –Chronic diarrhea may be the only sign
  –90% have pancreatic insufficiency (PI)
• Celiac disease (CD): Gluten sensitivity, increased incidence in selective IgA deficiency, DM, and Down syndrome
• Immune deficiency (e.g., hypogammaglobulinemia)
• Sucrase-isomaltase deficiency: Autosomal recessive, symptoms with starting sucrose or glucose polymer-containing diet
• Microvillus inclusion disease: Most common cause of persistent diarrhea in the neonatal period
• Schwachman-Diamond syndrome
  –Pancreatic insufficiency, neutropenia, short stature, skeletal abnormalities
• Johannson-Blizzard syndrome
  –Pancreatic insufficiency, scalp defects, agenesis of nasal cartilage, deafness, imperforate anus
• Whipple disease:
  –Tropheryma whippelii (actinomycete)
  –Diagnosed mainly in adults
  –Weight loss, diarrhea, and arthropathy
• Tropical sprue: Common in developing countries; folate deficiency and diarrhea
• Neural crest tumors: Pheochromocytoma, VIPoma, Zollinger-Ellison syndrome, carcinoid tumors
• Mastocytoma
• Neuroblastoma
• Abetalipoproteinemia
• Giardiasis, Strongyloides, coccidia
• AIDS
• Acrodermatitis enteropathica: Zinc deficiency, acral perioral and perianal rashes, consider underlying cystic fibrosis
• Mutational defects in ion transport proteins
  –Chloride-losing diarrhea: Rare, ileal chloride transport defect, maternal polyhydramnios
  –Congenital sodium diarrhea
• Tufting enteropathy (epithelial dysplasia)
• Enterokinase deficiency

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Source: In A Page: Pediatric Signs and Symptoms, 2007

Anorexia: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

❑ Acquired immunodeficiency syndrome.An infection or Kaposi’s sarcoma affecting the GI or respiratory tract may lead to anorexia. Other findings include fatigue, afternoon fevers, night sweats, diarrhea, cough, lymphadenopathy, bleeding, oral thrush, gingivitis, and skin disorders, including persistent herpes zoster and recurrent herpes simplex, herpes labialis, or herpes genitalis.

❑ Adrenocortical hypofunction. With adrenocortical hypofunction, anorexia may begin slowly and subtly, causing gradual weight loss. Other common signs and symptoms include nausea and vomiting, abdominal pain, diarrhea, weakness, fatigue, malaise, vitiligo, bronze-colored skin, and purple striae on the breasts, abdomen, shoulders, and hips.

❑ Alcoholism. Chronic anorexia commonly accompanies alcoholism, eventually leading to malnutrition. Other findings include signs of liver damage (jaundice, spider angiomas, ascites, edema), paresthesia, tremors, increased blood pressure, bruising, GI bleeding, and abdominal pain.

❑ Anorexia nervosa. Chronic anorexia begins insidiously and eventually leads to life-threatening malnutrition, as evidenced by skeletal muscle atrophy, loss of fatty tissue, constipation, amenorrhea, dry and blotchy or sallow skin, alopecia, sleep disturbances, distorted self-image, anhedonia, and decreased libido. Paradoxically, the patient typically exhibits extreme restlessness and vigor and may exercise avidly. He also may have complicated food preparation and eating rituals.

❑ Appendicitis. Anorexia closely follows the abrupt onset of generalized or localized epigastric pain, nausea, and vomiting. It can continue as pain localizes in the right lower quadrant (McBurney’s point), and other signs and symptoms appear: abdominal rigidity, rebound tenderness, constipation (or diarrhea), a slight fever, and tachycardia.

❑ Cancer. Chronic anorexia occurs along with possible weight loss, weakness, apathy, and cachexia.

❑ Chronic renal failure. Chronic anorexia is common and insidious. It’s accompanied by changes in all body systems, such as nausea, vomiting, mouth ulcers, ammonia breath odor, metallic taste in the mouth, GI bleeding, constipation or diarrhea, drowsiness, confusion, tremors, pallor, dry and scaly skin, pruritus, alopecia, purpuric lesions, and edema.

❑ Cirrhosis. Anorexia occurs early in cirrhosis and may be accompanied by weakness, nausea, vomiting, constipation or diarrhea, and dull abdominal pain. It continues after these early signs and symptoms subside and is accompanied by lethargy, slurred speech, bleeding tendencies, ascites, severe pruritus, dry skin, poor skin turgor, hepatomegaly, fetor hepaticus, jaundice, leg edema, gynecomastia, and right upper quadrant pain.

❑ Crohn’s disease. Chronic anorexia causes marked weight loss. Associated signs vary according to the site and extent of the lesion, but may include diarrhea, abdominal pain, fever, an abdominal mass, weakness, perianal or vaginal fistulas and, rarely, clubbing of the fingers. Acute inflammatory signs and symptoms — right lower quadrant pain, cramping, tenderness, flatulence, fever, nausea, diarrhea (including nocturnal), and bloody stools — mimic those of appendicitis.

❑ Gastritis. With acute gastritis, the onset of anorexia may be sudden. The patient may experience postprandial epigastric distress after a meal, accompanied by nausea, vomiting (commonly with hematemesis), fever, belching, hiccups, and malaise.

❑ Hepatitis. With viral hepatitis (hepatitis A, B, C, or D), anorexia begins in the preicteric phase, accompanied by fatigue, malaise, headache, arthralgia, myalgia, photophobia, nausea and vomiting, a mild fever, hepatomegaly, and lymphadenopathy. It may continue throughout the icteric phase, along with mild weight loss, dark urine, clay-colored stools, jaundice, right upper quadrant pain and, possibly, irritability and severe pruritus.

Signs and symptoms of nonviral hepatitis usually resemble those of viral hepatitis but may vary, depending on the cause and extent of liver damage.

❑ Hypothyroidism. Anorexia is common and usually insidious in patients with a thyroid hormone deficiency. Typically, vague early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent findings include decreased mental stability; dry, flaky, and inelastic skin; edema of the face, hands, and feet; ptosis; hoarseness; thick, brittle nails; coarse, broken hair; and signs of decreased cardiac output such as bradycardia. Other common findings include abdominal distention, menstrual irregularities, decreased libido, ataxia, intention tremor, nystagmus, a dull facial expression, and slow reflex relaxation time.

❑ Ketoacidosis. Anorexia usually arises gradually and is accompanied by dry, flushed skin; a fruity breath odor; polydipsia; polyuria and nocturia; hypotension; a weak, rapid pulse; a dry mouth; abdominal pain; and vomiting.

❑ Pernicious anemia. With pernicious anemia, insidious anorexia may cause considerable weight loss. Related findings include the classic triad of a burning tongue, general weakness, and numbness and tingling in the extremities; alternating constipation and diarrhea; abdominal pain; nausea and vomiting; bleeding gums; ataxia; positive Babinski’s and Romberg’s signs; diplopia and blurred vision; irritability; head-ache; malaise; and fatigue.

Other causes

❑ Drugs. Anorexia results from the use of amphetamines; chemotherapeutic agents; sympathomimetics, such as ephedrine; and some antibiotics. It also signals digoxin toxicity.

❑ Radiation therapy. Radiation treatments can cause anorexia, possibly as a result of metabolic disturbances.

❑ Total parenteral nutrition (TPN). Maintenance of blood glucose levels by I.V. therapy may cause anorexia.

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Source: Handbook of Signs & Symptoms (Third Edition), 2006

Weight gain, excessive: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Acromegaly

Acromegaly causes moderate weight gain. Other findings include coarsened facial features, prognathism, enlarged hands and feet, increased sweating, oily skin, deep voice, back and joint pain, lethargy, sleepiness, and heat intolerance. Occasionally, hirsutism may occur.

Diabetes mellitus

The increased appetite associated with diabetes mellitus may lead to weight gain, although weight loss sometimes occurs instead. Other findings include fatigue, polydipsia, polyuria, nocturia, weakness, polyphagia, and somnolence.

Hypercortisolism

Excessive weight gain, usually over the trunk and the back of the neck (buffalo hump), characteristically occurs in this disorder. Other cushingoid features include slender extremities, moon face, weakness, purple striae, emotional lability, and increased susceptibility to infection. Gynecomastia may occur in men; hirsutism, acne, and menstrual irregularities may occur in women.

Hyperinsulinism

Hyperinsulinism increases appetite, leading to weight gain. Emotional lability, indigestion, weakness, diaphoresis, tachycardia, visual disturbances, and syncope also occur.

Hypogonadism

Weight gain is common in hypogonadism. Prepubertal hypogonadism causes eunuchoid body proportions with relatively sparse facial and body hair and a high-pitched voice. Postpubertal hypogonadism causes loss of libido, impotence, and infertility.

Hypothalamic dysfunction

Conditions such as Laurence-Moon-Biedl syndrome cause a voracious appetite with subsequent weight gain, along with altered body temperature and sleep rhythms.

Hypothyroidism

With hypothyroidism, weight gain occurs despite anorexia. Related signs and symptoms include fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Myalgia, hoarseness, hypoactive deep tendon reflexes, bradycardia, and abdominal distention may occur. Eventually, the face assumes a dull expression with periorbital edema.

Nephrotic syndrome

With nephrotic syndrome, weight gain results from edema. In severe cases, anasarca develops — increasing body weight up to 50%. Related effects include abdominal distention, orthostatic hypotension, and lethargy.

Pancreatic islet cell tumor

Pancreatic islet cell tumor causes excessive hunger, which leads to weight gain. Other findings include emotional lability, weakness, malaise, fatigue, restlessness, diaphoresis, palpitations, tachycardia, visual disturbances, and syncope.

Preeclampsia

With preeclampsia, rapid weight gain (exceeding the normal weight gain of pregnancy) may accompany nausea and vomiting, epigastric pain, elevated blood pressure, and visual blurring or double vision.

Sheehan’s syndrome

Most common in women who experience severe obstetric hemorrhage, Sheeehan’s syndrome may cause weight gain.

Other causes

Drugs

Corticosteroids, phenothiazines, and tricyclic antidepressants cause weight gain from fluid retention and increased appetite. Other drugs that can lead to weight gain include hormonal contraceptives, which cause fluid retention; cyproheptadine, which increases appetite; and lithium, which can induce hypothyroidism.

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Source: Handbook of Signs & Symptoms (Third Edition), 2006

Low birth weight: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

This section lists some fetal and placental causes of low birth weight as well as the associated signs and symptoms pres-ent in the neonate at birth.

Chromosomal aberrations

Abnormalities in the number, size, or configuration of chromosomes can cause low birth weight and possibly multiple congenital anomalies in a premature or SGA neonate

For example, a neonate with trisomy 21 (Down syndrome) may be SGA and have prominent epicanthal folds, a flat-bridged nose, a protruding tongue, palmar simian creases, muscular hypotonia, and an umbilical hernia.

Cytomegalovirus infection

Although low birth weight in cytomegalovirus infection is usually associated with premature birth, the neonate may be SGA

Assessment at birth may reveal these classic signs: petechiae and ecchymoses, jaundice, and hepatosplenomegaly, which increases for several days. The neonate may also have a high fever, lymphadenopathy, tachypnea, and dyspnea, along with prolonged bleeding at puncture sites.

Placental dysfunction

Low birth weight and a wasted appearance occur in an SGA neonate

He may be symmetrically short or may appear relatively long for his low weight. Additional findings reflect the underlying cause. For example, if maternal hyperparathyroidism caused placental dysfunction, the neonate may exhibit muscle jerking and twitching, carpopedal spasm, ankle clonus, vomiting, tachycardia, and tachypnea.

Rubella (congenital)

Usually, the low-birth-weight neonate with this congenital rubellais born at term but is SGA

A characteristic “blueberry muffin” rash accompanies cataracts, purpuric lesions, hepatosplenomegaly, and a large anterior fontanel

Abnormal heart sounds, if present, vary with the type of associated congenital heart defect.

Varicella (congenital)

Low birth weight is accompanied by cataracts and skin vesicles.

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Source: Handbook of Signs & Symptoms (Third Edition), 2006

Polyphagia [Hyperphagia]: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Anxiety

Polyphagia may result from mild to moderate anxiety or emotional stress. Mild anxiety typically produces restlessness, sleeplessness, irritability, repetitive questioning, and constant seeking of attention and reassurance. With moderate anxiety, selective inattention and difficulty concentrating may also occur. Other effects of anxiety may include muscle tension, diaphoresis, GI distress, palpitations, tachycardia, and urinary and sexual dysfunction.

Bulimia

Most common in women ages 18 to 29, bulimia causes polyphagia that alternates with self-induced vomiting, fasting, or diarrhea. The patient typically weighs less than normal, but has a morbid fear of obesity. She appears depressed, has low self-esteem, and conceals her overeating.

Diabetes mellitus

With diabetes mellitus, polyphagia occurs with weight loss, polydipsia, and polyuria. It’s accompanied by nocturia, weakness, fatigue, and signs of dehydration, such as dry mucous membranes and poor skin turgor.

Premenstrual syndrome (PMS)

Appetite changes, typified by food cravings and binges, are common with PMS. Abdominal bloating, the most common associated finding, may occur with behavioral changes, such as depression and insomnia. A headache, paresthesia, and other neurologic symptoms may also occur. Related findings include diarrhea or constipation, edema and temporary weight gain, palpitations, back pain, breast swelling and tenderness, oliguria, and easy bruising.

Other causes

Drugs

Corticosteroids, cyproheptadine, and some hormone supplements may increase appetite, causing weight gain.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Weight loss, excessive: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Adrenal insufficiency

Weight loss occurs with adrenal insufficiency, along with anorexia, weakness, fatigue, irritability, syncope, nausea, vomiting, abdominal pain, and diarrhea or constipation. Hyperpigmentation may occur at the joints, belt line, palmar creases, lips, gums, tongue, and buccal mucosa.

Anorexia nervosa

Anorexia nervosa is a psychogenic disorder, most common in young women, and is characterized by a severe, self-imposed weight loss ranging from 10% to 50% of premorbid weight, which typically was normal or not more than 5 lb (2.3 kg) over ideal weight. Related findings include skeletal muscle atrophy, loss of fatty tissue, hypotension, constipation, dental caries, susceptibility to infection, blotchy or sallow skin, cold intolerance, hairiness on the face and body, dryness or loss of scalp hair, and amenorrhea. The patient usually demonstrates restless activity and vigor and may also have a morbid fear of becoming fat. Self-induced vomiting or use of laxatives or diuretics may lead to dehydration or to metabolic alkalosis or acidosis.

Cancer

Weight loss is often a sign of cancer. Other findings reflect the type, location, and stage of the tumor and can include fatigue, pain, nausea, vomiting, anorexia, abnormal bleeding, and a palpable mass.

Crohn’s disease

Weight loss occurs with chronic cramping, abdominal pain, and anorexia. Other signs and symptoms include diarrhea, nausea, fever, tachycardia, abdominal tenderness and guarding, hyperactive bowel sounds, abdominal distention, and pain. Perianal lesions and a palpable mass in the right or left lower quadrant may also be present.

Cryptosporidiosis

Weight loss may occur with cryptosporidiosis, an opportunistic protozoan infection. Other findings include profuse watery diarrhea, abdominal cramping, flatulence, anorexia, malaise, fever, nausea, vomiting, and myalgia.

Depression

Weight loss or weight gain may occur with severe depression, along with insomnia or hypersomnia, anorexia, apathy, fatigue, and feelings of worthlessness. Indecisiveness, incoherence, and suicidal thoughts or behavior may also occur.

Diabetes mellitus

Weight loss may occur with diabetes mellitus, despite increased appetite. Other findings include polydipsia, weakness, fatigue, and polyuria with nocturia.

Esophagitis

Painful inflammation of the esophagus leads to temporary avoidance of eating and subsequent weight loss. Intense pain in the mouth and anterior chest occurs, along with hypersalivation, dysphagia, tachypnea, and hematemesis. If a stricture develops, dysphagia and weight loss will recur.

Gastroenteritis

Malabsorption and dehydration cause weight loss in gastroenteritis. The loss may be sudden in acute viral infections or reactions or gradual in parasitic infection. Other findings include poor skin turgor, dry mucous membranes, tachycardia, hypotension, diarrhea, abdominal pain and tenderness, hyperactive bowel sounds, nausea, vomiting, fever, and malaise.

Leukemia

Acute leukemia causes progressive weight loss accompanied by severe prostration; high fever; swollen, bleeding gums; and bleeding tendencies. Dyspnea, tachycardia, palpitations, and abdominal or bone pain may occur. As the disease progresses, neurologic symptoms may eventually develop.

Chronic leukemia, which occurs insidiously in adults, causes progressive weight loss with malaise, fatigue, pallor, enlarged spleen, bleeding tendencies, anemia, skin eruptions, anorexia, and fever.

Lymphoma

Hodgkin’s disease and non-Hodgkin’s lymphoma cause gradual weight loss. Associated findings include fever, fatigue, night sweats, malaise, hepatosplenomegaly, and lymphadenopathy. Scaly rashes and pruritus may develop.

Pulmonary tuberculosis

Pulmonary tuberculosis causes gradual weight loss, along with fatigue, weakness, anorexia, night sweats, and low-grade fever. Other clinical effects include a cough with bloody or mucopurulent sputum, dyspnea, and pleuritic chest pain. Examination may reveal dullness on percussion, crackles after coughing, increased tactile fremitus, and amphoric breath sounds.

Stomatitis

Inflammation of the oral mucosa (usually red, swollen, and ulcerated) in stomatitis causes weight loss due to decreased eating. Associated findings include fever, increased salivation, malaise, mouth pain, anorexia, and swollen, bleeding gums.

Thyrotoxicosis

With thyrotoxicosis, increased metabolism causes weight loss. Other characteristic signs and symptoms include nervousness, heat intolerance, diarrhea, increased appetite, palpitations, tachycardia, diaphoresis, fine tremor, and possibly an enlarged thyroid and exophthalmos. A ventricular or atrial gallop may be heard.

Other causes

Drugs

Amphetamines and inappropriate dosage of thyroid preparations commonly lead to weight loss. Laxative abuse may cause a malabsorptive state that leads to weight loss. Chemotherapeutic agents cause stomatitis or nausea and vomiting, which, when severe, causes weight loss.

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Source: Handbook of Signs & Symptoms (Third Edition), 2006

Anorexia nervosa: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

No causes of anorexia nervosa have been identified; however, genetic, social, and psychological factors have been implicated. Researchers in neuroendocrinology are seeking a physiologic cause, but have found nothing definite. Clearly, social attitudes that equate slimness with beauty play some role in provoking this disorder; family factors are also implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over one’s life. Anorexia nervosa has been associated with other psychiatric disorders, such as obsessive-compulsive disorder, depression, and anxiety.

Anorexia occurs in 5% to 10% of the population; about 95% of those affected are women. This disorder occurs primarily in adolescents and young adults but may also affect older women. The occurrence among males is rising. The prognosis varies but improves if the patient is diagnosed early or if she wants to overcome the disorder and seeks help voluntarily. Mortality ranges from 5% to 15% — the highest mortality associated with a psychiatric disturbance. One-third of these deaths can be attributed to suicide.

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Source: Professional Guide to Diseases (Eighth Edition), 2005

Anorexia: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Acquired immunodeficiency syndrome (AIDS)

An infection or Kaposi’s sarcoma affecting the GI or respiratory tract may lead to anorexia in a patient with AIDS. Other findings include fatigue, afternoon fevers, night sweats, diarrhea, cough, bleeding, lymphadenopathy, oral thrush, gingivitis, and skin disorders, including persistent herpes zoster and recurrent herpes simplex, herpes labialis, or herpes genitalis.

Adrenocortical hypofunction

In adrenocortical hypofunction, anorexia may begin slowly and subtly, causing gradual weight loss. Other common signs and symptoms include nausea and vomiting, abdominal pain, diarrhea, weakness, fatigue, malaise, vitiligo, bronze-colored skin, and purple striae on the breasts, abdomen, shoulders, and hips.

Alcoholism

Chronic anorexia commonly accompanies alcoholism, eventually leading to malnutrition. Other findings include signs of liver damage (jaundice, spider angiomas, ascites, edema), paresthesia, tremors, increased blood pressure, bruising, GI bleeding, and abdominal pain.

Anorexia nervosa

Chronic anorexia nervosa is an eating disorder that begins insidiously and eventually leads to life-threatening malnutrition, as evidenced by skeletal muscle atrophy, loss of fatty tissue, constipation, amenorrhea, dry and blotchy or sallow skin, alopecia, sleep disturbances, distorted self-image, anhedonia, and decreased libido. Paradoxically, many patients exhibit extreme restlessness and vigor and may exercise avidly; many also have complicated food preparation and eating rituals.

Appendicitis

Anorexia closely follows the abrupt onset of generalized or localized epigastric pain, nausea, and vomiting. It can continue as pain localizes in the right lower quadrant (McBurney’s point) and other signs and symptoms—abdominal rigidity, rebound tenderness, constipation or diarrhea, slight fever, and tachycardia—appear.

Cancer

Chronic anorexia may be accompanied by weight loss, weakness, apathy, and cachexia.

Chronic renal failure

Chronic anorexia is common and develops insidiously in chronic renal failure. It’s accompanied by changes in all body systems, such as nausea, vomiting, mouth ulcers, ammonia breath odor, metallic taste, GI bleeding, constipation or diarrhea, drowsiness, confusion, tremors, pallor, dry and scaly skin, pruritus, alopecia, purpuric lesions, and edema.

Cirrhosis

Anorexia occurs early in cirrhosis and may be accompanied by weakness, nausea, vomiting, constipation or diarrhea, and dull abdominal pain. It continues after these early signs and symptoms subside and is accompanied by lethargy, slurred speech, bleeding tendencies, ascites, severe pruritus, dry skin, poor skin turgor, hepatomegaly, fetor hepaticus, jaundice, edema of the legs, gynecomastia, and right-upper-quadrant pain.

Crohn’s disease

Chronic anorexia causes marked weight loss in Crohn’s disease. Associated signs vary according to the site and extent of the lesion but may include diarrhea, abdominal pain, fever, abdominal mass, weakness, perianal or vaginal fistulas and, rarely, clubbing of the fingers. Acute inflammatory signs and symptoms—right-lower-quadrant pain, cramping, tenderness, flatulence, fever, nausea, diarrhea (including nocturnal), and bloody stools—mimic those of appendicitis.

Depressive syndrome

Anorexia reflects anhedonia in depressive syndrome. Accompanying signs and symptoms include poor concentration, indecisiveness, delusions, menstrual irregularities, decreased libido, insomnia or hypersomnia, fatigue, mood swings, poor self-image, and gradual social withdrawal.

Gastritis

In acute gastritis, anorexia may have a sudden onset. The patient may experience postprandial epigastric distress accompanied by nausea, vomiting (often with hematemesis), fever, belching, hiccups, and malaise.

Hepatitis

In viral hepatitis (hepatitis A, B, C, or D), anorexia begins in the preicteric phase and is accompanied by fatigue, malaise, headache, arthralgia, myalgia, photophobia, nausea and vomiting, mild fever, hepatomegaly, and lymphadenopathy. It may continue throughout the icteric phase along with mild weight loss, dark urine, clay-colored stools, jaundice, right-upper-quadrant pain and, possibly, irritability and severe pruritus.

Signs and symptoms of nonviral hepatitis usually resemble those of viral hepatitis but may vary, depending on the cause and the extent of liver damage.

Hypopituitarism

Anorexia usually develops slowly in hypopituitarism, which usually begins with hypergonadism. Accompanying signs and symptoms vary with the disorder’s severity and the number and type of deficient hormones. They may include amenorrhea; decreased libido; lethargy; cold intolerance; pale, thin, and dry skin; dry, brittle hair; and decreased temperature, blood pressure, and pulse rate.

Hypothyroidism

Anorexia is common and usually insidious in patients with thyroid hormone deficiency. Vague early findings typically include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent findings include decreased mental stability; dry, flaky, and inelastic skin; edema of the face, hands, and feet; ptosis; hoarseness; thick, brittle nails; coarse, broken hair; and signs of decreased cardiac output such as bradycardia. Other common findings include abdominal distention, menstrual
irregularities, decreased libido, ataxia, intention tremor, nystagmus, dull facial expression, and slow reflex relaxation time.

Ketoacidosis

Anorexia usually arises gradually in ketoacidosis and is accompanied by dry, flushed skin; fruity breath odor; polydipsia; polyuria and nocturia; hypotension; weak, rapid pulse; dry mouth; abdominal pain; and vomiting.

Pernicious anemia

In pernicious anemia, insidious anorexia may cause considerable weight loss. Related findings include the classic triad of burning tongue, general weakness, and numbness and tingling in the extremities; alternating constipation and diarrhea; abdominal pain; nausea and vomiting; bleeding gums; ataxia; positive Babinski’s and Romberg’s signs; diplopia and blurred vision; irritability, headache, malaise, and fatigue.

Other causes

Drugs

Anorexia may result from the use of amphetamines, chemotherapeutic agents, sympathomimetics such as ephedrine, and some antibiotics. It also may signal digoxin toxicity.

Radiation therapy

Radiation treatments can cause anorexia, possibly as the result of metabolic disturbances.

Total parenteral nutrition

Maintenance of blood glucose levels by I.V. therapy may cause anorexia.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Weight gain, excessive: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Acromegaly

This disorder causes moderate weight gain. Other findings include coarsened facial features, prognathism, enlarged hands and feet, increased sweating, oily skin, deep voice, back and joint pain, lethargy, sleepiness, heat intolerance and, occasionally, hirsutism.

Cushing’s syndrome (hypercortisolism)

Excessive weight gain, usually over the trunk and the back of the neck (buffalo hump), characteristically occurs in this disorder. Other cushingoid features include slender extremities, moon face, weakness, purple striae, emotional lability, and increased susceptibility to infection. Gynecomastia may occur in men; hirsutism, acne, and menstrual irregularities may occur in women.

Diabetes mellitus

The increased appetite associated with this disorder may lead to weight gain, although weight loss sometimes occurs instead. Other findings include fatigue, polydipsia, polyuria, nocturia, weakness, polyphagia, and somnolence.

Heart failure

Despite anorexia, weight gain may result from edema. Other typical findings include paroxysmal nocturnal dyspnea, orthopnea, and fatigue.

Hyperinsulinism

This disorder increases appetite, leading to weight gain. Emotional lability, indigestion, weakness, diaphoresis, tachycardia, visual disturbances, and syncope also occur.

Hypogonadism

Weight gain is common in this disorder. Prepubertal hypogonadism causes eunuchoid body proportions with relatively sparse facial and body hair and a high-pitched voice. Postpubertal hypogonadism causes loss of libido, impotence, and infertility.

Hypothalamic dysfunction

Conditions such as Laurence-Moon-Biedl syndrome cause a voracious appetite and subsequent weight gain along with altered body temperature and sleep rhythms.

Hypothyroidism

In this disorder, weight gain occurs despite anorexia. Related signs and symptoms include fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Myalgia, hoarseness, hypoactive deep tendon reflexes, bradycardia, and abdominal distention may occur. Eventually, the face assumes a dull expression with periorbital edema.

Metabolic syndrome

This syndrome, previously called syndrome X, consists of a group of disorders that affect metabolism, including excessive weight gain (usually in the central abdomen), hypertension (blood pressure greater than 135/85 mm Hg), abnormal cholesterol levels (high low-density lipoprotein and triglyceride levels, low high-density lipoprotein level), and high insulin levels. Inefficient use of insulin in the body is thought to be a major contributor to metabolic syndrome, as are physical inactivity, poor diet, and genetic factors. Individuals with metabolic syndrome are at a significantly increased risk for heart disease, stroke, and diabetes. Treatment typically involves exercising, following a heart-healthy diet, and refraining from smoking; medical therapy may be prescribed to treat the individual disorders.

Nephrotic syndrome

In this syndrome, weight gain results from edema. Severe edema (anasarca) can increase body weight by up to 50%. Related effects include abdominal distention, orthostatic hypotension, and lethargy.

Pancreatic islet cell tumor

This type of tumor causes excessive hunger, which leads to weight gain. Other findings include emotional lability, weakness, malaise, fatigue, restlessness, diaphoresis, palpitations, tachycardia, visual disturbances, and syncope.

Preeclampsia

In this disorder, rapid weight gain (exceeding the normal weight gain of pregnancy) may accompany nausea and vomiting, epigastric pain, elevated blood pressure, and blurred or double vision.

Sheehan’s syndrome

Most common in women who experience severe obstetric hemorrhage, this syndrome may cause weight gain caused by impaired pituitary gland function.

Other causes

Drugs

Corticosteroids, phenothiazines, and tricyclic antidepressants cause weight gain from fluid retention and increased appetite. Other drugs that can lead to weight gain include hormonal contraceptives, which cause fluid retention; cyproheptadine, which increases appetite; and lithium, which can induce hypothyroidism.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Low birth weight: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

This section lists some fetal and placental causes of low birth weight as well as the associated signs and symptoms present in the neonate at birth.

Chromosomal aberrations

Abnormalities in the number, size, or configuration of chromosomes can cause low birth weight and possibly multiple congenital anomalies in a premature or SGA neonate. For example, a neonate with trisomy 21 (Down syndrome) may be SGA and have prominent epicanthal folds, a flat-bridged nose, a protruding tongue, palmar simian creases, muscular hypotonia, and an umbilical hernia.

Cytomegalovirus infection

Although low birth weight in this disorder is usually associated with premature birth, some neonates may be SGA. Assessment at birth may reveal these classic signs: petechiae and ecchymoses, jaundice, and hepatosplenomegaly, which increases for several days. The neonate may also have a high fever, lymphadenopathy, tachypnea, and dyspnea, along with prolonged bleeding at puncture sites.

Placental dysfunction

Low birth weight and a wasted appearance occur in an SGA neonate. The neonate may be symmetrically short or may appear relatively long for his low weight. Additional findings reflect the underlying cause. For example, if maternal hyperparathyroidism caused placental dysfunction, the neonate may exhibit muscle jerking and twitching, carpopedal spasm, ankle clonus, vomiting, tachycardia, and tachypnea.

Rubella (congenital)

Usually, the low-birth-weight neonate with this disease is born at term but is SGA. A characteristic “blueberry muffin” rash accompanies cataracts, purpuric lesions, hepatosplenomegaly, and a large anterior fontanel. Abnormal heart sounds, if present, vary with the type of associated congenital heart defect.

Toxoplasmosis (congenital)

The low-birth-weight neonate may be either premature or SGA and may have hydrocephalus or microcephalus. Associated findings include fever, seizures, lymphadenopathy, hepatosplenomegaly, jaundice, and rash. Other defects, which may occur months or years later, include strabismus, blindness, epilepsy, and mental retardation.

Varicella (congenital)

Low birth weight is accompanied by cataracts and skin vesicles.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Polyphagia [Hyperphagia]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Anxiety

Polyphagia may result from mild to moderate anxiety or emotional stress. Mild anxiety typically produces restlessness, sleeplessness, irritability, repetitive questioning, and constant seeking of attention and reassurance. With moderate anxiety, selective inattention and difficulty concentrating may also occur. Other effects of anxiety may include muscle tension, diaphoresis, GI distress, palpitations, tachycardia, and urinary and sexual dysfunction.

Bulimia

Most common in women ages 18 to 29, bulimia causes polyphagia that alternates with self-induced vomiting, fasting, or diarrhea. The patient typically weighs less than normal but has a morbid fear of obesity. She appears depressed, has low self-esteem, and conceals her overeating.

Diabetes mellitus

With this disorder, polyphagia occurs with weight loss, polydipsia, and polyuria. It’s accompanied by nocturia, weakness, fatigue, and signs of dehydration, such as dry mucous membranes and poor skin turgor.

Migraine headache

Polyphagia sometimes precedes a migraine headache. The individual may experience changes in appetite or food cravings. Other prodromal signs and symptoms include fatigue, nausea, vomiting, and a visual aura. Light and noise sensitivity may also occur.

Premenstrual syndrome

Appetite changes, typified by food cravings and binges, are common with this syndrome. Abdominal bloating, the most common associated finding, may occur with behavioral changes, such as depression and insomnia. Headache, paresthesia, and other neurologic symptoms may also occur. Related findings include diarrhea or constipation, edema and temporary weight gain, palpitations, back pain, breast swelling and tenderness, oliguria, and easy bruising.

Thyrotoxicosis

This disorder can produce weight loss, despite constant polyphagia. Other characteristics include weakness, nervousness, diarrhea, tremors, diaphoresis, and dyspnea. The patient’s hair and nails are thin and brittle, and his thyroid is enlarged. He may also exhibit palpitations, tachycardia, heat intolerance, exophthalmos, and an atrial or ventricular gallop.

Other causes

Drugs

Corticosteroids and cyproheptadine may increase appetite, causing weight gain.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Weight loss, excessive: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Adrenal insufficiency

Weight loss occurs in this disorder along with anorexia, weakness, fatigue, irritability, syncope, nausea, vomiting, abdominal pain, and diarrhea or constipation. Hyperpigmentation may occur at the joints, belt line, palmar creases, lips, gums, tongue, and buccal mucosa.

Anorexia nervosa

This psychogenic disorder, most common in young women, is characterized by a severe, self-imposed weight loss ranging from 10% to 50% of premorbid weight, which typically was normal or no more than 5 lb (2.3 kg) over ideal weight. Related findings include skeletal muscle atrophy, loss of fatty tissue, hypotension, constipation, dental caries, susceptibility to infection, blotchy or sallow skin, cold intolerance, hairiness on the face and body, dryness or loss of scalp hair, and amenorrhea. The patient usually demonstrates restless activity and vigor and may have a morbid fear of becoming fat. Self-induced vomiting or use of laxatives or diuretics may lead to dehydration or to metabolic alkalosis or acidosis.

Cancer

Weight loss can be a sign of many types of cancer. Other findings reflect the type, location, and stage of the tumor and can include fatigue, pain, nausea, vomiting, anorexia, abnormal bleeding, and a palpable mass.

Crohn’s disease

Weight loss occurs with chronic cramping, abdominal pain, and anorexia. Other signs and symptoms include diarrhea, nausea, fever, tachycardia, hyperactive bowel sounds, and abdominal distention, tenderness, and guarding. Perianal lesions and a palpable mass in the right or left lower quadrant may also be present.

Cryptosporidiosis

This opportunistic protozoan infection may cause weight loss, profuse watery diarrhea, abdominal cramping, flatulence, anorexia, nausea, vomiting, malaise, fever, and myalgia.

Depression

Severe depression may cause weight loss or weight gain along with insomnia or hypersomnia, anorexia, apathy, fatigue, and feelings of worthlessness. Indecisiveness, incoherence, and suicidal thoughts or behavior may also occur.

Diabetes mellitus

In this disorder, weight loss may occur despite increased appetite. Other findings include polydipsia, weakness, fatigue, and polyuria with nocturia.

Esophagitis

Painful inflammation of the esophagus leads to temporary avoidance of eating and subsequent weight loss. Intense pain in the mouth and anterior chest is accompanied by hypersalivation, dysphagia, tachypnea, and hematemesis. If a stricture develops, dysphagia and weight loss will recur.

Gastroenteritis

Malabsorption and dehydration cause weight loss in this disorder. The weight loss may be sudden in acute viral infections or reactions or gradual in parasitic infection. Other findings include poor skin turgor, dry mucous membranes, tachycardia, hypotension, diarrhea, abdominal pain and tenderness, hyperactive bowel sounds, nausea, vomiting, fever, and malaise.

Herpes simplex type 1

Painful fluid-filled blisters in and around the mouth make eating painful, causing decreased food intake and weight loss.

Leukemia

Acute leukemia causes progressive weight loss accompanied by severe prostration; high fever; swollen, bleeding gums; and other bleeding tendencies. Dyspnea, tachycardia, palpitations, and abdominal or bone pain may occur. As the disease progresses, neurologic symptoms may eventually develop.

Chronic leukemia, which occurs insidiously in adults, causes progressive weight loss with malaise, fatigue, pallor, enlarged spleen, bleeding tendencies, anemia, skin eruptions, anorexia, and fever.

Lymphomas

Hodgkin’s disease and malignant lymphoma cause gradual weight loss. Associated findings include fever, fatigue, night sweats, malaise, hepatosplenomegaly, and lymphadenopathy. Scaly rashes and pruritus may develop.

Pulmonary tuberculosis

This disorder causes gradual weight loss along with fatigue, weakness, anorexia, night sweats, and low-grade fever. Other clinical effects include a cough with bloody or mucopurulent sputum, dyspnea, and pleuritic chest pain. Examination may reveal dullness on percussion, crackles after coughing, increased tactile fremitus, and amphoric breath sounds.

Stomatitis

Inflammation of the oral mucosa (which are usually red, swollen, and ulcerated) in this disorder causes weight loss due to decreased eating. Associated findings include fever, increased salivation, malaise, mouth pain, anorexia, and swollen, bleeding gums.

Thyrotoxicosis

In this disorder, increased metabolism causes weight loss. Other characteristic signs and symptoms include nervousness, heat intolerance, diarrhea, increased appetite, palpitations, tachycardia, diaphoresis, a fine tremor, and possibly an enlarged thyroid gland and exophthalmos. A ventricular or atrial gallop may be heard.

Ulcerative colitis

Weight loss is a late sign of this disorder, which is initially characterized by bloody diarrhea with pus or mucus. Other findings include weakness, crampy lower abdominal pain, hyperactive bowel sounds, tenesmus, anorexia, low-grade fever and, occasionally, nausea and vomiting. Constipation may occur late. Fulminant colitis causes severe and steady abdominal pain and diarrhea, high fever, and tachycardia.

Whipple’s disease

This rare disease causes progressive weight loss along with abdominal pain, diarrhea, steatorrhea, arthralgia, fever, hyperpigmentation, lymphadenopathy, and splenomegaly.

Other causes

Drugs

Amphetamines and inappropriate dosage of thyroid preparations commonly lead to weight loss. Laxative abuse may cause a malabsorptive state that leads to weight loss. Chemotherapeutic agents may result in weight loss from severe stomatitis.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Involuntary Weight Loss: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Diabetes

❑ Depression

❑ Inadequate intake

❑ Drugs

❑ Hyperthyroidism

❑ Occult cancer

❑ Low cardiac output

❑ Anorexia nervosa

❑ Malabsorption

❑ Chronic infection

❑ Adrenal insufficiency

❑ Emphysema

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Source: Field Guide to Bedside Diagnosis, 2007

Anorexia nervosa: Causes
(Handbook of Diseases)

No one knows what causes anorexia nervosa. Researchers in neuroendocrinology are seeking a physiologic cause but have found nothing definite. Clearly, social attitudes that equate slimness with beauty play some role in provoking this disorder; family factors also are implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over one’s life.

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Source: Handbook of Diseases, 2003

Anorexia: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Acquired immunodeficiency syndrome

With acquired immunodeficiency syndrome (AIDS), an infection or Kaposi’s sarcoma affecting the GI or respiratory tract may lead to anorexia. Other findings include fatigue, afternoon fevers, night sweats, diarrhea, cough, bleeding, lymphadenopathy, oral thrush, gingivitis, and skin disorders, including persistent herpes zoster and recurrent herpes simplex, herpes labialis, or herpes genitalis.

Adrenocortical hypofunction

With adrenocortical hypofunction, anorexia may begin slowly and subtly, causing gradual weight loss. Other common signs and symptoms include nausea and vomiting, abdominal pain, diarrhea, weakness, fatigue, malaise, vitiligo, bronze-colored skin, and purple striae on the breasts, abdomen, shoulders, and hips.

Alcoholism

Chronic anorexia commonly accompanies alcoholism, eventually leading to malnutrition. Other findings include signs of liver damage (jaundice, spider angiomas, ascites, edema), paresthesia, tremors, increased blood pressure, bruising, GI bleeding, and abdominal pain.

Anorexia nervosa

With anorexia nervosa, chronic anorexia begins insidiously and eventually leads to life-threatening malnutrition, as evidenced by skeletal muscle atrophy, loss of fatty tissue, constipation, amenorrhea, dry and blotchy or sallow skin, alopecia, sleep disturbances, distorted self-image, anhedonia, and decreased libido. Paradoxically, the patient commonly exhibits extreme restlessness and vigor and may exercise avidly. Many patients also have complicated food preparation and eating rituals.

Appendicitis

With appendicitis, anorexia closely follows the abrupt onset of generalized or localized epigastric pain, nausea, and vomiting. It can continue as pain localizes in the right lower quadrant (McBurney’s point) and other signs and symptoms appear: abdominal rigidity, rebound tenderness, constipation (or diarrhea), slight fever, and tachycardia.

Cancer

With cancer, chronic anorexia occurs along with possible weight loss, weakness, apathy, and cachexia. Other findings may include nausea, vomiting, oral lesions, and changes in bowel habits.

Chronic renal failure

Chronic anorexia is common and insidious in chronic renal failure. It’s accompanied by changes in all body systems, such as nausea, vomiting, mouth ulcers, ammonia breath odor, metallic taste in the mouth, GI bleeding, constipation or diarrhea, drowsiness, confusion, tremors, pallor, dry and scaly skin, pruritus, alopecia, purpuric lesions, and edema.

Cirrhosis

With cirrhosis, anorexia occurs early and may be accompanied by weakness, nausea, vomiting, constipation or diarrhea, and dull abdominal pain. It continues after these early signs and symptoms subside and is accompanied by lethargy, slurred speech, bleeding tendencies, ascites, severe pruritus, dry skin, poor skin turgor, hepatomegaly, fetor hepaticus, jaundice, edema of the legs, gynecomastia, and right-upper-quadrant pain.

Crohn’s disease

With Crohn’s disease, chronic anorexia causes marked weight loss. Associated signs vary according to the site and extent of the lesion but may include diarrhea, abdominal pain, fever, abdominal mass, weakness, perianal or vaginal fistulas and, rarely, clubbing of the fingers. Acute inflammatory signs and symptoms — right-lower-quadrant pain, cramping, tenderness, flatulence, fever, nausea, diarrhea (including nocturnal), and bloody stools — mimic those of appendicitis.

Depressive syndrome

Anorexia reflects anhedonia in depressive syndrome. Accompanying signs and symptoms include poor concentration, indecisiveness, delusions, menstrual irregularities, decreased libido, insomnia or hypersomnia, fatigue, mood swings, poor self-image, and gradual social withdrawal.

Gastritis

With acute gastritis, the onset of anorexia may be sudden. The patient may experience postprandial epigastric distress, accompanied by nausea, vomiting (commonly hematemesis), fever, belching, hiccups, and malaise.

Hepatitis

With viral hepatitis (hepatitis A, B, C, or D), anorexia begins in the preicteric phase, accompanied by fatigue, malaise, headache, arthralgia, myalgia, photophobia, nausea and vomiting, mild fever, hepatomegaly, and lymphadenopathy. It may continue through the icteric phase, along with mild weight loss, dark urine, clay-colored stools, jaundice, right-upper-quadrant pain and, possibly, irritability and severe pruritus.

Signs and symptoms of nonviral hepatitis usually resemble those of viral hepatitis but may vary, depending on the cause and extent of liver damage.

Hypopituitarism

Anorexia usually develops slowly in hypopituitarism, which usually begins with hypergonadism. Accompanying signs and symptoms vary with the disorder’s severity and the number and type of deficient hormones. Such signs and symptoms include amenorrhea; decreased libido; lethargy; cold intolerance; pale, thin, and dry skin; dry, brittle hair; and decreased temperature, blood pressure, and pulse rate.

Hypothyroidism

Anorexia is common and usually insidious in patients with hypothyroidism (thyroid hormone deficiency). Typically, vague early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent findings include decreased mental stability; dry, flaky, and inelastic skin; edema of the face, hands, and feet; ptosis; hoarseness; thick, brittle nails; coarse, broken hair; and signs of decreased cardiac output such as bradycardia. Other common findings include abdominal distention, menstrual irregularities, decreased libido, ataxia, intention tremor, nystagmus, dull facial expression, and slow reflex relaxation time.

Pernicious anemia

With pernicious anemia, insidious anorexia may cause considerable weight loss. Related findings include the classic triad of burning tongue, general weakness, and numbness and tingling in the extremities; alternating constipation and diarrhea; abdominal pain; nausea and vomiting; bleeding gums; ataxia; positive Babinski’s and Romberg’s signs; diplopia and blurred vision; irritability, headache, malaise, and fatigue.

Other causes

Drugs

Anorexia results from the use of amphetamines, chemotherapeutic agents, sympathomimetics such as ephedrine, and some antibiotics. It also signals digoxin toxicity.

Radiation therapy

Radiation treatments can cause anorexia, possibly as the result of metabolic disturbances.

Total parenteral nutrition

Maintenance of blood glucose levels by I.V. therapy may cause anorexia.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Polyphagia: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Anxiety

Polyphagia may result from mild to moderate anxiety or emotional stress. Mild anxiety typically produces restlessness, sleeplessness, irritability, repetitive questioning, and constant seeking of attention and reassurance. With moderate anxiety, selective inattention and difficulty concentrating may also occur. Other effects of anxiety may include muscle tension, diaphoresis, GI distress, palpitations, tachycardia, and urinary and sexual dysfunction.

Bulimia

Most common in women ages 18 to 29, bulimia causes polyphagia that alternates with self-induced vomiting, fasting, or diarrhea. The patient typically weighs less than normal but has a morbid fear of obesity. She appears depressed, has low self-esteem, and conceals her overeating.

Diabetes mellitus

With diabetes mellitus, polyphagia occurs with weight loss, polydipsia, and polyuria. It’s accompanied by nocturia, weakness, fatigue, and such signs of dehydration as dry mucous membranes and poor skin turgor.

Migraine headache

Polyphagia sometimes precedes a migraine headache. The individual may experience changes in appetite or food cravings. Other prodromal signs and symptoms include fatigue, nausea, vomiting, and a visual aura. Light and noise sensitivity may also occur.

Premenstrual syndrome

Appetite changes, typified by food cravings and binges, are common with premenstrual syndrome. Abdominal bloating, the most common associated finding, may occur with behavioral changes, such as depression and insomnia. Headache, paresthesia, and other neurologic symptoms may also occur. Related findings include diarrhea or constipation, edema and temporary weight gain, palpitations, back pain, breast swelling and tenderness, oliguria, and easy bruising.

Thyrotoxicosis

Thyrotoxicosis can produce weight loss despite constant polyphagia. Other characteristics include weakness, nervousness, diarrhea, tremors, diaphoresis, and dyspnea. The patient’s hair and nails are thin and brittle, and his thyroid is enlarged. He may also exhibit palpitations, tachycardia, heat intolerance, exophthalmos, and an atrial or ventricular gallop.

Other causes

Drugs

Corticosteroids and cyproheptadine may increase appetite, causing weight gain.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Weight gain, excessive: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Acromegaly

Acromegaly causes moderate weight gain. Other findings include coarsened facial features, prognathism, enlarged hands and feet, increased sweating, oily skin, deep voice, back and joint pain, lethargy, sleepiness, and heat intolerance. Occasionally, hirsutism may occur.

Diabetes mellitus

The increased appetite associated with diabetes mellitus may lead to weight gain, although weight loss sometimes occurs instead. Other findings include fatigue, polydipsia, polyuria, nocturia, weakness, polyphagia, and somnolence.

Heart failure

Despite anorexia, weight gain may result from edema. Other typical findings in heart failure include paroxysmal nocturnal dyspnea, tachypnea, tachycardia, nausea, orthopnea, and fatigue.

Hypercortisolism

Excessive weight gain, usually over the trunk and the back of the neck (buffalo hump), characteristically occurs in hypercortisolism. Other cushingoid features include slender extremities, moon face, weakness, purple striae, emotional lability, and increased susceptibility to infection. Gynecomastia may occur in men; hirsutism, acne, and menstrual irregularities may occur in women.

Hyperinsulinism

Hyperinsulinism increases appetite, leading to weight gain. Emotional lability, indigestion, weakness, diaphoresis, tachycardia, vision disturbances, and syncope also occur.

Hypogonadism

Weight gain is common in hypogonadism. Prepubertal hypogonadism causes eunuchoid body proportions with relatively sparse facial and body hair and a high-pitched voice. Postpubertal hypogonadism causes loss of libido, impotence, and infertility.

Hypothyroidism

With hypothyroidism, weight gain occurs despite anorexia. Related signs and symptoms include fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Myalgia, hoarseness, hypoactive deep tendon reflexes, bradycardia, and abdominal distention may occur. Eventually, the face assumes a dull expression with periorbital edema.

Nephrotic syndrome

With nephrotic syndrome, weight gain results from edema. In severe cases, anasarca develops — increasing body weight up to 50%. Related effects include abdominal distention, orthostatic hypotension, and lethargy.

Pancreatic islet cell tumor

Pancreatic islet cell tumor causes excessive hunger, which leads to weight gain. Other findings include emotional lability, weakness, malaise, fatigue, restlessness, diaphoresis, palpitations, tachycardia, vision disturbances, and syncope.

Preeclampsia

With preeclampsia, rapid weight gain (exceeding the normal weight gain of pregnancy) may accompany nausea and vomiting, epigastric pain, elevated blood pressure, and visual blurring or double vision.

Other causes

Drugs

Corticosteroids, phenothiazines, and tricyclic antidepressants cause weight gain from fluid retention and increased appetite. Other drugs that can lead to weight gain include hormonal contraceptives, which cause fluid retention; cyproheptadine, which increases appetite; and lithium, which can induce hypothyroidism.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Weight loss, excessive: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Adrenal insufficiency

Weight loss occurs with adrenal insufficiency, along with anorexia, weakness, fatigue, irritability, syncope, nausea, vomiting, abdominal pain, and diarrhea or constipation. Hyperpigmentation may occur at the joints, belt line, palmar creases, lips, gums, tongue, and buccal mucosa.

Anorexia nervosa

Anorexia nervosa, a psychogenic disorder that’s most common in young women, is characterized by a severe, self-imposed weight loss ranging from 10% to 50% of premorbid weight, which typically was normal or not more than 5 lb (2.3 kg) over ideal weight. Related findings include skeletal muscle atrophy, loss of fatty tissue, hypotension, constipation, dental caries, susceptibility to infection, blotchy or sallow skin, cold intolerance, hairiness on the face and body, dryness or loss of scalp hair, and amenorrhea. The patient usually demonstrates restless activity and vigor and may also have a morbid fear of becoming fat. Self-induced vomiting or use of laxatives or diuretics may lead to dehydration or to metabolic alkalosis or acidosis.

Cancer

Weight loss is often a sign of cancer. Other findings reflect the type, location, and stage of the tumor and can include fatigue, pain, nausea, vomiting, anorexia, abnormal bleeding, and a palpable mass.

Crohn’s disease

With Crohn’s disease, weight loss occurs with chronic cramping, abdominal pain, and anorexia. Other signs and symptoms include diarrhea, nausea, fever, tachycardia, abdominal tenderness and guarding, hyperactive bowel sounds, abdominal distention, and pain. Perianal lesions and a palpable mass in the right or left lower quadrant may also be present.

Cryptosporidiosis

Weight loss may occur with cryptosporidiosis, an opportunistic protozoan infection. Other findings include profuse watery diarrhea, abdominal cramping, flatulence, anorexia, malaise, fever, nausea, vomiting, and myalgia.

Depression

Weight loss or weight gain may occur with severe depression, along with insomnia or hypersomnia, anorexia, apathy, fatigue, and feelings of worthlessness. Indecisiveness, incoherence, and suicidal thoughts or behavior may also occur.

Diabetes mellitus

Weight loss may occur with diabetes mellitus, despite increased appetite. Other findings include polydipsia, weakness, fatigue, blurred vision, and polyuria with nocturia.

Esophagitis

Painful inflammation of the esophagus leads to temporary avoidance of eating and subsequent weight loss. Intense pain in the mouth and anterior chest occurs, along with hypersalivation, dysphagia, tachypnea, and hematemesis. If a stricture develops, dysphagia and weight loss will recur.

Gastroenteritis

Malabsorption and dehydration cause weight loss in gastroenteritis. The loss may be sudden in acute viral infections or reactions or gradual in parasitic infection. Other findings include poor skin turgor, dry mucous membranes, tachycardia, hypotension, diarrhea, abdominal pain and tenderness, hyperactive bowel sounds, nausea, vomiting, fever, and malaise.

Herpes simplex 1

With herpes simplex 1, painful fluid-filled blisters in and around the mouth, especially the tongue, gums, and cheeks, make eating painful causing decreased food intake and weight loss. Fever and pharyngitis may also occur.

Leukemia

Acute leukemia causes progressive weight loss accompanied by severe prostration; high fever; swollen, bleeding gums; and bleeding tendencies. Dyspnea, tachycardia, palpitations, and abdominal or bone pain may occur. As the disease progresses, neurologic symptoms may eventually develop.

Chronic leukemia, which occurs insidiously in adults, causes progressive weight loss with malaise, fatigue, pallor, enlarged spleen, bleeding tendencies, anemia, skin eruptions, anorexia, and fever.

Lymphoma

Hodgkin’s disease and non-Hodgkin’s lymphoma cause gradual weight loss. Associated findings include fever, fatigue, night sweats, malaise, hepatosplenomegaly, and lymphadenopathy. Scaly rashes and pruritus may develop.

Pulmonary tuberculosis

Pulmonary tuberculosis causes gradual weight loss, along with fatigue, weakness, anorexia, night sweats, and low-grade fever. Other clinical effects include a cough with bloody or mucopurulent sputum, dyspnea, and pleuritic chest pain. Examination may reveal dullness on percussion, crackles after coughing, increased tactile fremitus, and amphoric breath sounds.

Stomatitis

Inflammation of the oral mucosa (usually red, swollen, and ulcerated) in stomatitis causes weight loss due to decreased eating. Associated findings include fever, increased salivation, malaise, mouth pain, anorexia, and swollen, bleeding gums.

Thyrotoxicosis

With thyrotoxicosis, increased metabolism causes weight loss. Other characteristic signs and symptoms include nervousness, heat intolerance, diarrhea, increased appetite, palpitations, tachycardia, diaphoresis, fine tremor, and possibly an enlarged thyroid and exophthalmos. A ventricular or atrial gallop may be heard.

Ulcerative colitis

Weight loss is a late sign of ulcerative colitis, which is initially characterized by bloody diarrhea with pus or mucus. Weakness, crampy lower abdominal pain, tenesmus, anorexia, low-grade fever, and occasional nausea and vomiting may also occur. Bowel sounds are hyperactive, and constipation may occur late. With fulminant colitis, severe and steady abdominal pain and diarrhea, high fever, and tachycardia occur.

Other causes

Drugs

Amphetamines and inappropriate dosage of thyroid preparations commonly lead to weight loss. Laxative abuse may cause a malabsorptive state that leads to weight loss. Chemotherapeutic agents cause stomatitis, which, when severe, causes weight loss.

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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Growth Deficiency: Weight and Height: Principal Causes of Growth Deficiency: Weight and Height
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

1. Normalvariations
   1. Constitutionaldelay of growth and maturation
   2. Genetic (familial) short stature
2. Disorders primarily affecting weight
   1. Intrauterinegrowth disturbance
   2. Undernutrition
   3. Excessive calorie wasting (vomiting,diarrhea, polyuria)
   4. Chronic disease
   5. Psychologic disorders
      1. Psychosocialdeprivation
      2. Anorexia nervosa
      3. Depression
      4. Psychosis
3. Disorders primarily affecting skeletalgrowth (height)
   1. Chromosomal abnormalities
   2. Dysmorphic syndromes
   3. Bone and cartilage disorders (osteochondrodysplasias)
   4. Endocrine disorders
      1. Hypothyroidism
      2. Glucocorticoid excess
      3. Growth hormone deficiency/insensitivity

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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Anorexia: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Acquired immunodeficiency syndrome.An infection or Kaposi's sarcoma affecting the GI or respiratory tract may lead to anorexia. Other findings include fatigue, afternoon fevers, night sweats, diarrhea, cough, lymphadenopathy, bleeding, oral thrush, gingivitis, and skin disorders, including persistent herpes zoster and recurrent herpes simplex, herpes labialis, or herpes genitalis.

Adrenocortical hypofunction.With adrenocortical hypofunction, anorexia may begin slowly and subtly, causing gradual weight loss. Other common signs and symptoms include nausea and vomiting, abdominal pain, diarrhea, weakness, fatigue, malaise, vitiligo, bronze-colored skin, and purple striae on the breasts, abdomen, shoulders, and hips.

Alcoholism.Chronic anorexia commonly accompanies alcoholism, eventually leading to malnutrition. Other findings include signs of liver damage (jaundice, spider angiomas, ascites, edema), paresthesia, tremors, increased blood pressure, bruising, GI bleeding, and abdominal pain.

Anorexia nervosa.Chronic anorexia begins insidiously and eventually leads to life-threatening malnutrition and electrolyte disorders, as evidenced by skeletal muscle atrophy, loss of fatty tissue, constipation, amenorrhea, dry and blotchy or sallow skin, alopecia, sleep disturbances, distorted self-image, anhedonia, decreased libido, and cardiac arrhythmias. Paradoxically, the patient typically exhibits extreme restlessness and vigor and may exercise compulsively. He may have complicated food preparation and eating rituals.

Appendicitis.Anorexia closely follows the abrupt onset of generalized or localized epigastric pain, nausea, and vomiting cause by appendicitis. It can continue as pain localizes in the right lower quadrant (McBurney's point), and other signs and symptoms appear, such as abdominal rigidity, rebound tenderness, constipation (or diarrhea), a slight fever, and tachycardia.

Cancer.Chronic anorexia occurs along with possible weight loss, weakness, apathy, and cachexia.

Chronic renal failure.With chronic rental failure,chronic anorexia is common and insidious. It's accompanied by changes in all body systems, such as nausea, vomiting, mouth ulcers, ammonia breath odor, metallic taste in the mouth, GI bleeding, constipation or diarrhea, drowsiness, confusion, tremors, pallor, dry and scaly skin, pruritus, alopecia, purpuric lesions, and edema.

Cirrhosis.Anorexia occurs early in cirrhosis and may be accompanied by weakness, nausea, vomiting, constipation or diarrhea, and dull abdominal pain. It continues after these early signs and symptoms subside and is accompanied by lethargy, slurred speech, bleeding tendencies, ascites, severe pruritus, dry skin, poor skin turgor, hepatomegaly, fetor hepaticus, jaundice, leg edema, gynecomastia, and right upper quadrant pain.

Crohn's disease.With Crohn's disease, chronic anorexia causes marked weight loss. Associated signs vary according to the site and extent of the lesion, but may include diarrhea, abdominal pain, fever, an abdominal mass, weakness, perianal or vaginal fistulas and, rarely, clubbing of the fingers. Acute inflammatory signs and symptoms—right lower quadrant pain, cramping, tenderness, flatulence, fever, nausea, diarrhea (including nocturnal), and bloody stools—mimic those of appendicitis.

Gastritis.With acute gastritis, the onset of anorexia may be sudden. The patient may experience postprandial epigastric distress after a meal, accompanied by nausea, vomiting (commonly with hematemesis), fever, belching, hiccups, and malaise.

Hepatitis.With viral hepatitis (hepatitis A, B, C, or D), anorexia begins in the preicteric phase, accompanied by fatigue, malaise, headache, arthralgia, myalgia, photophobia, nausea and vomiting, a mild fever, hepatomegaly, and lymphadenopathy. It may continue throughout the icteric phase, along with mild weight loss, dark urine, clay-colored stools, jaundice, right upper quadrant pain and, possibly, irritability and severe pruritus.

Signs and symptoms of nonviral hepatitis usually resemble those of viral hepatitis but may vary, depending on the cause and extent of liver damage.

Hypothyroidism.Anorexia is common and usually insidious in patients with a thyroid hormone deficiency. Typically, vague early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent findings include decreased mental stability; dry, flaky, and inelastic skin; edema of the face, hands, and feet; ptosis; hoarseness; thick, brittle nails; coarse, broken hair; and signs of decreased cardiac output such as bradycardia. Other common findings include abdominal distention, menstrual irregularities, decreased libido, ataxia, intention tremor, nystagmus, a dull facial expression, and slow reflex relaxation time.

Ketoacidosis.Anorexia usually arises gradually and is accompanied by dry, flushed skin; a fruity breath odor; polydipsia; polyuria and nocturia; hypotension; a weak, rapid pulse; a dry mouth; abdominal pain; vomiting, and altered level of consciousness.

Pernicious anemia.With pernicious anemia, insidious anorexia may cause considerable weight loss. Related findings include the classic triad of a burning tongue, general weakness, and numbness and tingling in the extremities; alternating constipation and diarrhea; abdominal pain; nausea and vomiting; bleeding gums; ataxia; positive Babinski's and Romberg's signs; diplopia and blurred vision; irritability; head-ache; malaise; and fatigue.

Other causes

Drugs.Anorexia results from the use of amphetamines, chemotherapeutic agents, sympathomimetics such as ephedrine, and some antibiotics. It also signals digoxin toxicity.

Radiation therapy.Radiationtreatments can cause anorexia, possibly as a result of metabolic disturbances.

Total parenteral nutrition (TPN).Maintenance of blood glucose levels by I.V. therapy may cause anorexia.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

Weight gain, excessive: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Acromegaly.Acromegaly causes moderate weight gain. Other findings include coarsened facial features, prognathism, enlarged hands and feet, increased sweating, oily skin, deep voice, back and joint pain, lethargy, sleepiness, and heat intolerance. Occasionally, hirsutism may occur.

Diabetes mellitus.The increased appetite associated with diabetes mellitus may lead to weight gain, although weight loss sometimes occurs initially. Other findings include fatigue, polydipsia, polyuria, nocturia, weakness, polyphagia, and somnolence.

Hypercortisolism.Excessive weight gain, usually over the trunk and the back of the neck (buffalo hump), characteristically occurs in hypercortisolism. Other cushingoid features include slender extremities, moon face, weakness, purple striae, emotional lability, and increased susceptibility to infection. Gynecomastia may occur in men; hirsutism, acne, and menstrual irregularities may occur in women.

Hyperinsulinism.Hyperinsulinism increases appetite, leading to weight gain. Emotional lability, indigestion, weakness, diaphoresis, tachycardia, vision disturbances, and syncope also occur.

Hypogonadism.Weight gain is common in hypogonadism. Prepubertal hypogonadism causes eunuchoid body proportions with relatively sparse facial and body hair and a high-pitched voice. Postpubertal hypogonadism causes loss of libido, impotence, and infertility.

Hypothalamic dysfunction.Conditions such as Laurence-Moon-Biedl syndrome cause a voracious appetite with subsequent weight gain, along with altered body temperature and sleep rhythms.

Hypothyroidism.With hypothyroidism, weight gain occurs despite anorexia. Related signs and symptoms include fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Myalgia, hoarseness, hypoactive deep tendon reflexes, bradycardia, and abdominal distention may occur. Eventually, the face assumes a dull expression with periorbital edema.

Metabolic syndrome.Metabolic syndrome, previously called syndrome X, consists of a group of disorders that affect metabolism, including excessive weight gain (usually in the central abdomen), hypertension (blood pressure greater than 135/85 mm Hg), abnormal cholesterol levels (high low-density lipoprotein and triglyceride levels, low high-density lipoprotein level), and high insulin levels.

Nephrotic syndrome.With nephrotic syndrome, weight gain results from edema. In severe cases, anasarca develops—increasing body weight up to 50%. Related effects include abdominal distention, orthostatic hypotension, and lethargy.

Pancreatic islet cell tumor.Pancreatic islet cell tumor causes excessive hunger, which leads to weight gain. Other findings include emotional lability, weakness, malaise, fatigue, restlessness, diaphoresis, palpitations, tachycardia, vision disturbances, and syncope.

Preeclampsia.With preeclampsia, rapid weight gain (exceeding the normal weight gain of pregnancy) may accompany nausea and vomiting, epigastric pain, elevated blood pressure, and blurred or double vision.

Sheehan's syndrome.Most common in women who experience severe obstetric hemorrhage, Sheehan's syndrome may cause weight gain.

Other causes

Drugs.Corticosteroids, phenothiazines, and tricyclic antidepressants cause weight gain from fluid retention and increased appetite. Other drugs that can lead to weight gain include hormonal contraceptives, which cause fluid retention; cyproheptadine, which increases appetite; and lithium, which can induce hypothyroidism.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

Low birth weight: Medical causes
(Nursing: Interpreting Signs and Symptoms)

This section lists some fetal and placental causes of low birth weight as well as the associated signs and symptoms present in the neonate at birth.

Chromosomal aberrations.Abnormalities in the number, size, or configuration of chromosomes can cause low birth weight and possibly multiple congenital anomalies in a premature or SGA neonate. For example, a neonate with trisomy 21 (Down syndrome) may be SGA and have prominent epicanthal folds, a flat-bridged nose, a protruding tongue, palmar simian creases, muscular hypotonia, and an umbilical hernia.

Cytomegalovirus infection.Although low birth weight in cytomegalovirus infection is usually associated with premature birth, the neonate may be SGA. Assessment at birth may reveal these classic signs: petechiae and ecchymoses, jaundice, and hepatosplenomegaly, which increases for several days. The neonate may also have a high fever, lymphadenopathy, tachypnea, and dyspnea, along with prolonged bleeding at puncture sites.

Placental dysfunction.With placental dysfunction, low birth weight and a wasted appearance occur in an SGA neonate. He may be symmetrically short or may appear relatively long for his low weight. Additional findings reflect the underlying cause. For example, if maternal hyperparathyroidism caused placental dysfunction, the neonate may exhibit muscle jerking and twitching, carpopedal spasm, ankle clonus, vomiting, tachycardia, and tachypnea.

Rubella (congenital).Usually, the low-birth-weight neonate with congenital rubella is born at term but is SGA. A characteristic “blueberry muffin” rash accompanies cataracts, purpuric lesions, hepatosplenomegaly, and a large anterior fontanel. Abnormal heart sounds, if present, vary with the type of associated congenital heart defect.

Varicella (congenital).With congenital varicella, low birth weight is accompanied by cataracts and skin vesicles.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

Polyphagia [Hyperphagia]: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Anxiety.Polyphagia may result from mild to moderate anxiety or emotional stress. Mild anxiety typically produces restlessness, sleeplessness, irritability, repetitive questioning, and constant seeking of attention and reassurance. With moderate anxiety, selective inattention and difficulty concentrating may also occur. Other effects of anxiety may include muscle tension, diaphoresis, GI distress, palpitations, tachycardia, and urinary and sexual dysfunction.

Bulimia.Bulimia causes polyphagia that alternates with self-induced vomiting, fasting, or diarrhea. The patient typically weighs less than normal, but has a morbid fear of obesity. She appears depressed, has low self-esteem, and conceals her overeating.

Diabetes mellitus.With diabetes mellitus, polyphagia occurs with weight loss, polydipsia, and polyuria. It's accompanied by nocturia, weakness, fatigue, and signs of dehydration, such as dry mucous membranes and poor skin turgor.

Premenstrual syndrome (PMS).Appetite changes, typified by food cravings and binges, are common with PMS. Abdominal bloating, the most common associated finding, may occur with behavioral changes, such as depression and insomnia. Headache, paresthesia, and other neurologic symptoms may also occur. Related findings include diarrhea or constipation, edema and temporary weight gain, palpitations, back pain, breast swelling and tenderness, oliguria, and easy bruising.

Other causes

Drugs.Corticosteroids, cyproheptadine, and some hormone supplements may increase appetite, causing weight gain.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

Weight loss, excessive: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Adrenal insufficiency.Weight loss occurs with adrenal insufficiency, along with anorexia, weakness, fatigue, irritability, syncope, nausea, vomiting, abdominal pain, and diarrhea or constipation. Hyperpigmentation may occur at the joints, belt line, palmar creases, lips, gums, tongue, and buccal mucosa.

Anorexia nervosa.Anorexia nervosa is characterized by a severe, self-imposed weight loss ranging from 10% to 50% of premorbid weight, which typically was normal or not more than 5 lb (2.3 kg) over ideal weight. Related findings include skeletal muscle atrophy, loss of fatty tissue, hypotension, constipation, dental caries, susceptibility to infection, blotchy or sallow skin, cold intolerance, hairiness on the face and body, dryness or loss of scalp hair, and amenorrhea. The patient usually demonstrates restless activity and vigor and may also have a morbid fear of becoming fat. Self-induced vomiting or use of laxatives or diuretics may lead to dehydration or to metabolic alkalosis or acidosis.

Cancer.Weight loss is often a sign of cancer. Other findings reflect the type, location, and stage of the tumor and can include fatigue, pain, nausea, vomiting, anorexia, abnormal bleeding, and a palpable mass.

Crohn's disease.With Crohn's disease, weight loss occurs with chronic cramping, abdominal pain, and anorexia. Other signs and symptoms include diarrhea, nausea, fever, tachycardia, abdominal tenderness and guarding, hyperactive bowel sounds, abdominal distention, and pain. Perianal lesions and a palpable mass in the right or left lower quadrant may also be present.

Cryptosporidiosis.Weight loss may occur with cryptosporidiosis. Other findings include profuse watery diarrhea, abdominal cramping, flatulence, anorexia, malaise, fever, nausea, vomiting, and myalgia.

Depression.Weight loss or weight gain may occur with severe depression, along with insomnia or hypersomnia, anorexia, apathy, fatigue, and feelings of worthlessness. Indecisiveness, incoherence, and suicidal thoughts or behavior may also occur.

Diabetes mellitus.Weight loss may occur with diabetes mellitus, despite increased appetite. Other findings include polydipsia, weakness, fatigue, and polyuria with nocturia.

Esophagitis.Painful inflammation of the esophagus leads to temporary avoidance of eating and subsequent weight loss. Intense pain in the mouth and anterior chest occurs, along with hypersalivation, dysphagia, tachypnea, and hematemesis. If a stricture develops, dysphagia and weight loss will recur.

Gastroenteritis.Malabsorption and dehydration cause weight loss in gastroenteritis. The loss may be sudden in acute viral infections or reactions or gradual in parasitic infection. Other findings include poor skin turgor, dry mucous membranes, tachycardia, hypotension, diarrhea, abdominal pain and tenderness, hyperactive bowel sounds, nausea, vomiting, fever, and malaise.

Leukemia.Acute leukemia causes progressive weight loss accompanied by severe prostration; high fever; swollen, bleeding gums; and bleeding tendencies. Dyspnea, tachycardia, palpitations, and abdominal or bone pain may occur. As the disease progresses, neurologic symptoms may eventually develop.

Chronic leukemia causes progressive weight loss with malaise, fatigue, pallor, enlarged spleen, bleeding tendencies, anemia, skin eruptions, anorexia, and fever.

Lymphoma.Hodgkin's disease and non-Hodgkin's lymphoma cause gradual weight loss. Associated findings include fever, fatigue, night sweats, malaise, hepatosplenomegaly, and lymphadenopathy. Scaly rashes and pruritus may develop.

Pulmonary tuberculosis.Pulmonary tuberculosis causes gradual weight loss, along with fatigue, weakness, anorexia, night sweats, and low-grade fever. Other clinical effects include a cough with bloody or mucopurulent sputum, dyspnea, and pleuritic chest pain. Examination may reveal dullness on percussion, crackles after coughing, increased tactile fremitus, and amphoric breath sounds.

Stomatitis.Inflammation of the oral mucosa (usually red, swollen, and ulcerated) in stomatitis causes weight loss due to decreased eating. Associated findings include fever, increased salivation, malaise, mouth pain, anorexia, and swollen, bleeding gums.

Thyrotoxicosis.With thyrotoxicosis, increased metabolism causes weight loss. Other characteristic signs and symptoms include nervousness, heat intolerance, diarrhea, increased appetite, palpitations, tachycardia, diaphoresis, fine tremor and, possibly, an enlarged thyroid and exophthalmos. A ventricular or atrial gallop may be heard.

Other causes

Drugs.Amphetamines and inappropriate dosage of thyroid preparations commonly lead to weight loss. Laxative abuse may cause a malabsorptive state that leads to weight loss. Chemotherapeutic agents cause stomatitis or nausea and vomiting, which, when severe, causes weight loss.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Anorexia Nervosa: Anorexia Nervosa - risk factors
(The 5-Minute Pediatric Consult)

More prevalent in industrialized societies; occurs in all US household income levels and major ethnic groups

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Source: The 5-Minute Pediatric Consult, 2008