Weight Loss (In a Page: Signs and Symptoms)

• 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
• HIV infection
• Hypercalcemia
  –Usually occurs in patients with cancer
• Advanced cardiac and pulmonary disease
  –CHF (“cardiac cachexia”)
  –COPD
• Chronic drug use (e.g., alcohol, nicotine, lead, opiates, CNS stimulants)
• Hyperthyroidism
  –Increased appetite and increased energy expenditure
  –May present with tachycardia, hypertension, brisk reflexes, and ophthalmopathy
• Uncontrolled diabetes mellitus
• Hyperemesis gravidarum
  –Pathologic exaggeration of early-pregnancy nausea
  –Elevated β-hCG and estrogen levels
  • 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

Workup and Diagnosis

• Comprehensive history and physical examination, including assessment of diet and caloric intake
• In patients with adequate caloric intake, endocrine and malabsorptive disorders are more likely
• Initial tests may include CBC, serum chemistries, glucose (to rule out diabetes), thyroid function tests, ESR, and albumin and/or prealbumin
• HIV testing if risk factors are present
• Chest X-ray in smokers
• Age-appropriate cancer screening (e.g., mammography, fecal occult blood testing, flexible sigmoidoscopy or colonoscopy)
• Morning (AM) cortisol and ACTH stimulation test if suspect adrenal insufficiency
• Consider upper GI endoscopy, colonoscopy, and GI consult