Weight Gain
Weight Gain: Excerpt from In a Page: Signs and Symptoms
Weight gain is a very common complaint in adult medicine and has a vast differential diagnosis. The key to diagnosis is often a good history and physical examination. It is important to quantify the degree and rapidity of weight gain by comparing old weights in the chart and questioning the patient.
Differential Diagnosis
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Primary obesity due to overeating and a sedentary lifestyle
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Medication side effects (e.g., oral contraceptives, corticosteroids, antidepressants, benzodiazepines, hypoglycemics, and anticonvulsants)
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Overeating secondary to nicotine withdrawal, depression, binge phase of bulimia nervosa
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Pregnancy
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Pre-eclampsia/eclampsia
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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)
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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)
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Congestive heart failure
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Hypothyroidism
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Diabetes mellitus
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Polycystic ovarian syndrome
–Associated with hirsutism, menstrual irregularities, insulin resistance, obesity
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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)
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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
Workup and Diagnosis
- Complete history and physical examination
–Baseline weight, rapidity of weight gain, food diary, medication list, tobacco and/or alcohol use, menstrual history, review of systems, and screen for depression
–Note body habitus (e.g., Cushing's often presents with moon facies, buffalo hump, and thin extremities)
–Note body hair distribution (scarce in hypothyroidism; hirsutism in PCOS and Cushing's syndrome)
–Note skin appearance (abdominal striae and easy bruising in Cushing's; acanthosis nigricans in diabetes)
–Check for peripheral edema and ascites (CHF, nephrotic syndrome, liver disease, pre-eclampsia)
- Initial labs include CBC (leukocytosis in Cushing's, thrombocytopenia in pre-eclampsia), fasting glucose (elevated in diabetes and Cushing's), BUN/creatinine (rule out renal failure), urinalysis (excessive proteinuria and lipiduria in nephrotic syndrome; proteinuria in pre-eclampsia and diabetes), TSH (hypothyroidism), lipid profile (hypercholesterolemia in nephrotic syndrome, Cushing's, diabetes), albumin (decreased in nephrotic syndrome and liver disease), and urine β-hCG
- Further studies may include 24-hour urine (if urinalysis reveals >3 g proteinuria), LFTs (elevated in liver disease and pre-eclampsia), dexamethasone suppression test (rule out Cushing's), chest X-ray and/or echocardiogram (rule out CHF if pulmonary edema suspected on exam), abdominal ultrasound and/or CT scan (rule out liver or renal disease), and/or pelvic ultrasound (rule out polycystic ovaries)
Treatment
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Weight loss by low-calorie diet and exercise
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Discontinue or change offending medications if possible
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Treat underlying medical disorders
–CHF: Diuretics, digoxin, ACE inhibitor, nitrates, salt
restriction
–Liver disease: Diuretics, paracentesis, salt restriction
–Nephrotic syndrome: Diuretics, anticoagulation,
nephrology referral
–Cushing's disease: Surgery to remove tumor
–Cushing's syndrome: Search for and treat the underlying
cause (e.g., resection of tumor); diet
–Depression: Antidepressants, counseling
–Hypothyroidism: Thyroid hormone replacement
–Diabetes: Oral medications, insulin, diet, exercise
–Polycystic ovarian syndrome: Diet, oral contraceptives
–Pregnancy: Prenatal care
–Pre-eclampsia: Bedrest, magnesium sulfate,
antihypertensive meds, deliver baby if necessary
–Bulimia: Psychiatry referral
Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
More About Bulimia nervosa
More Medical Textbooks Online about Bulimia nervosa
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Medical Books Excerpts
- Weight Loss
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Bulimia
- "The 5-Minute Pediatric Consult" (2008)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
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» Next page: Weight Loss (In A Page: Pediatric Signs and Symptoms)
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