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Diseases » Primary Hyperaldosteronism » Causes

Causes of Primary Hyperaldosteronism

Contents

Causes of Primary Hyperaldosteronism (Diseases Database):

The follow list shows some of the possible medical causes of Primary Hyperaldosteronism that are listed by the Diseases Database:

Source: Diseases Database

Primary Hyperaldosteronism Causes: Book Excerpts

Primary Hyperaldosteronism as a symptom:

Conditions listing Primary Hyperaldosteronism as a symptom may also be potential underlying causes of Primary Hyperaldosteronism. Our database lists the following as having Primary Hyperaldosteronism as a symptom of that condition:

Related information on causes of Primary Hyperaldosteronism:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Primary Hyperaldosteronism may be found in:

Hidden causes of Primary Hyperaldosteronism

Causes of Primary Hyperaldosteronism: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Primary Hyperaldosteronism.

Muscle Weakness – Proximal: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Duchenne and Becker muscular dystrophy
Spinal muscular atrophy
Spinal cord disorders
–Trauma
–Myelitis
–Neoplasm
–AVM
–Hemorrhage
–Tansverse myelitis
Limb-girdle myasthenia
Dermatomyositis
Congenital myopathies
–Central core disease
–Myotubular
–Nemaline (rod)
–Congenital fiber-type disproportion
Facioscapulohumeral syndrome
Limb-girdle muscular dystrophies
Glycogen storage myopathies
Endocrine myopathies
–Hypo- and hyperthyroidism
–Hyperparathyroidism
–Adrenalism
Polymyositis
GM2 gangliosidosis
Pompe disease
–Glycogen storage disease type II
–Acid maltase deficiency
McArdle disease
Carnitine deficiency
Fatty acid oxidation defects
Mitochondrial disorders
Steroid-induced myopathy
Slow channel syndrome
Toxins
–Organophosphates
–Aminoglycosides
–Tetrodotoxin (pufferfish)
Conversion reaction
Myasthenia gravis

» READ BOOK EXCERPT ONLINE »

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

Muscle Weakness – Distal: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Guillain-Barré syndrome (GBS)
–Acute, acquired, or monophasic
–Ascending weakness and parasthesias
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)

Compression neuropathy
–Trauma
–Neoplasm (e.g., plexiform neurofibroma in neurofibromatosis type 1)

Charcot-Marie-Tooth
–Defect in peripheral myelin protein
–Causes distal segmental demyelination
–Manifested by distal muscle atrophy and weakness

Drug-induced
–Phenytoin
–Isoniazid
–Nitrofurantoin
–Vincristine
–Zidovudine
Spinal muscular atrophy
Juvenile segmental spinal muscular atrophy

Miller-Fisher syndrome
–Clinical triad of ataxia, ophthalmoplegia, and areflexia

Tick paralysis
Juvenile amyotrophic lateral sclerosis
Giant axonal neuropathy
Vitamin B12 deficiency
Toxic neuropathy
–Arsenic
–Lead
–Mercury
–Thallium
–Glue sniffing
Uremic neuropathy
Idiopathic axonal neuropathy
Hereditary distal myopathy
Inclusion body myopathy
Rheumatoid arthritis
Refsum disease
Metachromatic leukodystrophy
Krabbe disease
Cockayne syndrome
Conversion reaction
–Usually fluctuating and unpredictable

» READ BOOK EXCERPT ONLINE »

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

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.

» READ BOOK EXCERPT ONLINE »

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

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

Amyotrophic lateral sclerosis (ALS)

ALS typically begins with muscle weakness and atrophy in one hand that rapidly spread to the arm and then to the other hand and arm. Eventually, these effects spread to the trunk, neck, tongue, larynx, pharynx, and legs; progressive respiratory muscle weakness leads to respiratory insufficiency.

Anemia

Varying degrees of muscle weakness and fatigue are exacerbated by exertion and temporarily relieved by rest. Other signs and symptoms include pallor, tachycardia, paresthesia, and bleeding tendencies.

Brain tumor

Signs and symptoms of muscle weakness vary with the location and size of the tumor. Associated findings include a headache, vomiting, diplopia, decreased visual acuity, a decreased level of consciousness (LOC), pupillary changes, decreased motor strength, hemiparesis, hemiplegia, diminished sensations, ataxia, seizures, and behavioral changes.

Guillain-Barré syndrome

Rapidly progressive, symmetrical weakness and pain ascends from the feet to the arms and facial nerves and may progress to total motor paralysis and respiratory failure. Associated findings include sensory loss or paresthesia, muscle flaccidity, loss of DTRs, tachycardia or bradycardia, fluctuating hypertension and orthostatic hypotension, diaphoresis, bowel and bladder incontinence, facial diplegia, dysphagia, dysarthria, and hypernasality.

Herniated disk

Pressure on nerve roots leads to muscle weakness, disuse and, ultimately, atrophy. The primary symptom is severe low back pain, possibly radiating to the buttocks, legs, and feet — usually on one side. Diminished reflexes and sensory changes may also occur.

Hypercortisolism

Hypercortisolism may cause limb weakness and eventually atrophy. Related cushingoid features include buffalo hump, moon face, truncal obesity, purple striae, thin skin, acne, elevated blood pressure, fatigue, hyperpigmentation, easy bruising, poor wound healing, and diaphoresis. The male patient may be impotent; the female patient may exhibit hirsutism and menstrual irregularities.

Myasthenia gravis

Gradually progressive skeletal muscle weakness and fatigue are the cardinal symptoms of myasthenia gravis. Typically, weakness is mild upon awakening, but worsens during the day. Early signs include weak eye closure, ptosis, and diplopia; blank, masklike facies; difficulty chewing and swallowing; nasal regurgitation of fluid with hypernasality; and a hanging jaw and bobbing head. Respiratory muscle involvement may eventually lead to respiratory failure.

Osteoarthritis

Osteoarthritis is a chronic disorder that causes progressive muscle disuse and weakness that lead to atrophy.

Parkinson’s disease

Muscle weakness accompanies rigidity in Parkinson’s disease, a degenerative disorder. Related findings include a unilateral pill-rolling tremor, a propulsive gait, dysarthria, bradykinesia, drooling, dysphagia, masklike facies, and a high-pitched, monotone voice.

Peripheral nerve trauma

Prolonged pressure on or injury to a peripheral nerve causes muscle weakness and atrophy. Other findings include paresthesia or sensory loss, pain, and loss of reflexes supplied by the damaged nerve.

Potassium imbalance

With hypokalemia, temporary generalized muscle weakness may be accompanied by nausea, vomiting, diarrhea, decreased mentation, leg cramps, diminished reflexes, malaise, polyuria, dizziness, hypotension, and arrhythmias.

With hyperkalemia, weakness may progress to flaccid paralysis accompanied by irritability and confusion, hyperreflexia, paresthesia or anesthesia, oliguria, anorexia, nausea, diarrhea, abdominal cramps, tachycardia or bradycardia, and arrhythmias.

Rhabdomyolysis

Signs and symptoms include muscle weakness or pain, a fever, nausea, vomiting, malaise, and dark urine. Acute renal failure, due to renal structure obstruction and injury from the kidneys’attempt to filter myoglobin from the bloodstream, is a common complication.

Rheumatoid arthritis

With rheumatoid arthritis, symmetrical muscle weakness may accompany increased warmth, swelling, and tenderness in involved joints; pain; and stiffness, restricting motion.

Seizure disorder

Temporary generalized muscle weakness may occur after a generalized tonic-clonic seizure; other postictal findings include a headache, muscle soreness, and profound fatigue.

Spinal trauma and disease

Trauma can cause severe muscle weakness, leading to flaccidity or spasticity and, eventually, paralysis. Infection, tumor, and cervical spondylosis or stenosis can also cause muscle weakness.

Stroke

Depending on the site and extent of damage, a stroke may produce contralateral or bilateral weakness of the arms, legs, face, and tongue, possibly progressing to hemiplegia and atrophy. Associated effects include dysarthria, aphasia, ataxia, apraxia, agnosia, ipsilateral paresthesia or sensory loss, vision disturbances, an altered LOC, amnesia and poor judgment, personality changes, bowel and bladder dysfunction, a headache, vomiting, and seizures.

Other causes

Drugs

Generalized muscle weakness can result from prolonged corticosteroid use, digoxin, and excessive doses of dantrolene. Aminoglycoside antibiotics may worsen weakness in patients with myasthenia gravis.

Immobility

Immobilization in a cast, a splint, or traction can lead to muscle weakness in the involved extremity; prolonged bed rest or inactivity results in generalized muscle weakness.

» 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.

» READ BOOK EXCERPT ONLINE »

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

Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Guillain-Barré syndrome

Typically occurring after recovery from the acute stage of Guillain-Barré syndrome, steppage gait can be mild or severe and unilateral or bilateral; it’s invariably permanent. Muscle weakness usually begins in the legs, extends to the arms and face within 72 hours, and can progress to total motor paralysis and respiratory failure. Other effects include footdrop, transient paresthesia, hypernasality, dysphagia, diaphoresis, tachycardia, orthostatic hypotension, and incontinence.

Herniated lumbar disk

Unilateral steppage gait and footdrop commonly occur with late-stage weakness and atrophy of leg muscles. However, the most pronounced symptom is severe low back pain, which may radiate to the buttocks, legs, and feet, usually unilaterally. Sciatic pain follows, often accompanied by muscle spasms and sensorimotor loss. Paresthesia and fasciculations may occur.

Multiple sclerosis

Steppage gait and footdrop typically fluctuate in severity with multiple sclerosis’characteristic cycle of periodic exacerbation and remission. Muscle weakness, usually affecting the legs, can range from minor fatigability to paraparesis with urinary urgency and constipation. Related findings include facial pain, visual disturbances, paresthesia, incoordination, and sensory loss in the ankle and toes.

Peroneal muscle atrophy

Bilateral steppage gait and footdrop begin insidiously in peroneal muscle atrophy. Foot, peroneal, and ankle dorsiflexor muscles are affected first. Other early signs and symptoms include paresthesia, aching, and cramping in the feet and legs along with coldness, swelling, and cyanosis. As the disorder progresses, all leg muscles become weak and atrophic, with hypoactive or absent deep tendon reflexes (DTRs). Later, atrophy and sensory losses spread to the hands and arms.

Peroneal nerve trauma

Temporary ipsilateral steppage gait occurs suddenly but resolves with the release of peroneal nerve pressure. The gait is associated with footdrop and muscle weakness and sensory loss over the lateral surface of the calf and foot.

» READ BOOK EXCERPT ONLINE »

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

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

Hyperaldosteronism may be primary (uncommon) or secondary. In 70% of patients, hyperaldosteronism results from a benign aldosterone-producing adrenal adenoma. In 15% to 30% of patients, the cause is unknown; rarely, the cause is bilateral adrenocortical hyperplasia (in children) or carcinoma. Incidence is three times higher in females than in males and is highest between ages 30 and 50.

In primary hyperaldosteronism, chronic aldosterone excess is independent of the renin-angiotensin system and, in fact, suppresses plasma renin activity. This aldosterone excess enhances sodium reabsorption by the kidneys, which leads to mild hypernatremia and, simultaneously, hypokalemia and increased extracellular fluid (ECF) volume. Expansion of intravascular fluid volume also occurs and results in volume-dependent hypertension and increased cardiac output. Excessive ingestion of English black licorice or licorice-like substances can produce a syndrome similar to primary hyperaldosteronism due to the mineralocorticoid action of glycyrrhizic acid.

Secondary hyperaldosteronism results from an extra-adrenal abnormality that stimulates the adrenal gland to increase production of aldosterone. For example, conditions that reduce renal blood flow (renal artery stenosis) and ECF volume or produce a sodium deficit activate the renin-angiotensin system and, subsequently, increase aldosterone secretion. Thus, secondary hyperaldosteronism may result from conditions that induce hypertension through increased renin production (such as Wilms’tumor), ingestion of hormonal contraceptives, and pregnancy.

However, secondary hyperaldosteronism may also result from disorders unrelated to hypertension, which may or may not cause edema. For example, nephrotic syndrome, hepatic cirrhosis with ascites, and heart failure commonly induce edema, whereas Bartter’s syndrome and salt-losing nephritis don’t.

» READ BOOK EXCERPT ONLINE »

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

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)

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

» READ BOOK EXCERPT ONLINE »

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

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

Amyotrophic lateral sclerosis

This disorder typically begins with muscle weakness and atrophy in one hand that rapidly spread to the arm and then to the other hand and arm. Eventually, these effects spread to the trunk, neck, tongue, larynx, pharynx, and legs; progressive respiratory muscle weakness leads to respiratory insufficiency.

Anemia

Brain tumor

Signs and symptoms of muscle weakness vary with the location and size of the tumor. Associated findings include headache, vomiting, diplopia, decreased visual acuity, decreased level of consciousness, pupillary changes, decreased motor strength, hemiparesis, hemiplegia, diminished sensations, ataxia, seizures, and behavioral changes.

Guillain-Barré syndrome

Rapidly progressive, symmetrical weakness and pain ascends from the feet to the arms and facial nerves and may progress to total motor paralysis and respiratory failure. Associated findings include sensory loss or paresthesia, muscle flaccidity, loss of deep tendon reflexes, tachycardia or bradycardia, fluctuating hypertension and orthostatic hypotension, diaphoresis, bowel and bladder incontinence, facial diplegia, dysphagia, dysarthria, and hypernasality.

Head trauma

Severe head injury can cause varying degrees of muscle weakness. Other findings include decreased level of consciousness, otorrhea or rhinorrhea, raccoon eyes and Battle’s sign, sensory disturbances, and signs of increased intracranial pressure.

Herniated disk

Pressure on nerve roots leads to muscle weakness, disuse, and ultimately, atrophy. The primary symptom is severe low back pain, possibly radiating to the buttocks, legs, and feet—usually on one side. Diminished reflexes and sensory changes may also occur.

Hodgkin’s lymphoma

Muscle weakness may accompany the classic sign of painless, progressive lymphadenopathy. Other findings include paresthesia, fatigue, and weight loss.

Hypercortisolism

This disorder may cause limb weakness and eventually atrophy. Related cushingoid features include buffalo hump, moon face, truncal obesity, purple striae, thin skin, acne, elevated blood pressure, fatigue, hyperpigmentation, easy bruising, poor wound healing, and diaphoresis. The male patient may be impotent; the female patient may exhibit hirsutism and menstrual irregularities.

Hypothyroidism

Reversible weakness and atrophy of proximal limb muscles may occur in hypothyroidism. Accompanying findings commonly include muscle cramps; cold intolerance; weight gain despite anorexia; mental dullness; dry, pale, doughy skin; puffy face, hands, and feet; impaired hearing and balance; and bradycardia.

Multiple sclerosis

Muscle weakness in one or more limbs may progress to atrophy, spasticity, and contractures. Other findings typically wax and wane and may include diplopia and blurred vision, vision loss, nystagmus, hyperactive deep tendon reflexes, sensory loss or paresthesia, dysarthria, dysphagia, incoordination, ataxic gait, intention tremors, emotional lability, impotence, and urinary dysfunction.

Myasthenia gravis

Gradually progressive skeletal muscle weakness and fatigue are the cardinal symptoms of this disorder. Typically, weakness is mild upon awakening but worsens during the day. Early signs include weak eye closure, ptosis, and diplopia; a blank, masklike facies; difficulty chewing and swallowing; nasal regurgitation of fluid with hypernasality; and a hanging jaw and bobbing head. Respiratory muscle involvement may eventually lead to respiratory failure.

Osteoarthritis

This chronic disorder causes progressive muscle disuse and weakness that lead to atrophy.

Paget’s disease

As this disease progresses, muscle weakness or paralysis may develop, along with paresthesia and pain. The patient may also have bowed tibias, frequent fractures, and kyphosis.

Parkinson’s disease

Muscle weakness accompanies rigidity in this degenerative disorder. Related findings include a unilateral pill-rolling tremor, propulsive gait, dysarthria, bradykinesia, drooling, dysphagia, masklike facies, and a high-pitched, monotonic voice.

Peripheral nerve trauma

Prolonged pressure on or injury to a peripheral nerve causes muscle weakness and atrophy. Other findings include paresthesia or sensory loss, pain, and loss of reflexes supplied by the damaged nerve.

Peripheral neuropathy

With this disorder, muscle weakness progresses slowly to flaccid paralysis, generally affecting distal extremities first. It may be accompanied by loss of vibration sense; paresthesia, hyperesthesia, or anesthesia in the hands and feet; hypoactive or absent deep tendon reflexes; mild-to-sharp burning pain; anhidrosis; and glossy red skin.

Poliomyelitis

Rapidly developing asymmetrical muscle weakness, progressing to flaccid paralysis, occurs with paralytic poliomyelitis. Associated signs and symptoms include moderate fever, headache, vomiting, lethargy, irritability, and widespread pain. As the disorder progresses, it may produce loss of superficial and deep reflexes, paresthesia, hyperalgesia, urine retention, constipation, abdominal distention, nuchal rigidity, and Hoyne’s, Kernig’s, and Brudzinski’s signs. Bulbar paralytic poliomyelitis produces symptoms of encephalitis, along with facial weakness, dysphasia, dysphagia, and respiratory abnormalities.

Polymyositis

This disorder produces insidious or acute onset of symmetrical limb and trunk muscle weakness and tenderness. Weakness may progress to facial, neck, pharyngeal, and laryngeal muscles. Associated findings include hypoactive deep tendon reflexes, dysphagia, and dysphonia.

Potassium imbalance

Protein deficiency

Prolonged protein deficiency may lead to muscle weakness and wasting, chronic fatigue, apathy, anorexia, lethargy, dry skin, and dull, sparse, dry hair.

Rhabdomyolysis

Signs and symptoms include muscle weakness or pain, fever, nausea, vomiting, malaise, and dark urine. Acute renal failure, due to renal structure obstruction and injury from the kidneys’attempt to filter the myoglobin from the bloodstream, is a common complication.

Rheumatoid arthritis

With this disease, symmetric muscle weakness may accompany increased warmth, swelling, and tenderness in involved joints; pain; and stiffness, restricting motion.

Seizure disorder

Temporary generalized muscle weakness may occur after a generalized tonic-clonic seizure; other postictal findings include headache, muscle soreness, and profound fatigue.

Spinal trauma and disease

Trauma can cause severe muscle weakness, leading to flaccidity or spasticity and, eventually, paralysis. Infection, tumor, and cervical spondylosis or stenosis can also cause muscle weakness.

Stroke

Depending on the site and extent of damage, a stroke may produce contralateral or bilateral weakness of the arms, legs, face, and tongue, possibly progressing to hemiplegia and atrophy. Associated effects include dysarthria, aphasia, ataxia, apraxia, agnosia, ipsilateral paresthesia or sensory loss, visual disturbance, altered level of consciousness, amnesia and poor judgment, personality changes, bowel and bladder dysfunction, headache, vomiting, and seizures.

Thyrotoxicosis

This disorder may produce insidious, generalized muscle weakness and atrophy. Other effects include anxiety, fatigue, heat intolerance, diaphoresis, tremors, tachycardia, palpitations, ventricular or atrial gallop, dyspnea, weight loss, an enlarged thyroid, and warm, flushed skin. Exophthalmos may be present.

Other causes

Drugs

Generalized muscle weakness can result from prolonged corticosteroid use, digoxin, and excessive doses of dantrolene sodium. Aminoglycoside antibiotics may worsen weakness in patients with myasthenia gravis.

Immobility

Immobilization in a cast, a splint, or traction can lead to muscle weakness in the involved extremity; prolonged bed rest or inactivity results in generalized muscle weakness.

» 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

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

Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Guillain-Barré syndrome

Typically occurring after recovery from the acute stage of this disorder, steppage gait can be mild or severe and unilateral or bilateral; it’s invariably permanent. Muscle weakness usually begins in the legs, extends to the arms and face within 72 hours, and can progress to total motor paralysis and respiratory failure. Other effects include footdrop, transient paresthesia, hypernasality, dysphagia, diaphoresis, tachycardia, orthostatic hypotension, and incontinence.

Herniated lumbar disk

Unilateral steppage gait and footdrop commonly occur with late-stage weakness and atrophy of leg muscles. However, the most pronounced symptom of a herniated lumbar disk is severe low back pain, which may radiate to the buttocks, legs, and feet, usually unilaterally. Sciatic pain follows, often accompanied by muscle spasms and sensorimotor loss. Paresthesia and fasciculations may also occur.

Multiple sclerosis (MS)

Like other signs and symptoms of MS, steppage gait and footdrop follow a characteristic cycle of periodic exacerbation and remission. Muscle weakness, usually affecting the legs, can range from minor fatigability to paraparesis with urinary urgency and constipation. Related findings include facial pain, visual disturbances, paresthesia, incoordination, and sensory loss in the ankle and toes.

Peroneal muscle atrophy

Bilateral steppage gait and footdrop begin insidiously in this disorder. Other early signs and symptoms include paresthesia, aching, cramping, coldness, swelling, and cyanosis in the feet and legs. Foot, peroneal, and ankle dorsiflexor muscles are affected first. As the disorder progresses, all leg muscles become weak and atrophic, with hypoactive or absent deep tendon reflexes (DTRs). Later, atrophy and sensory losses spread to the hands and arms.

Peroneal nerve trauma

Temporary ipsilateral steppage gait occurs suddenly but resolves with the release of peroneal nerve pressure. Steppage gait is associated with footdrop, muscle weakness, and sensory loss over the lateral surface of the calf and foot.

Poliomyelitis

Steppage gait, usually permanent and unilateral, commonly develops after the acute stage of poliomyelitis. It’s typically preceded by fever, asymmetrical muscle weakness, coarse fasciculations, paresthesia, hypoactive or absent DTRs, and permanent muscle paralysis and atrophy. Dysphagia, urine retention, and respiratory difficulty may also occur.

Polyneuropathy

Diabetic polyneuropathy is a rare cause of bilateral steppage gait, which appears as a late but permanent effect. This sign is preceded by burning pain in the feet and is accompanied by leg weakness, sensory loss, and skin ulcers.

In polyarteritis nodosa with polyneuropathy, unilateral or bilateral steppage gait is a late finding. Related findings include vague leg pain, abdominal pain, hematuria, fever, and increased blood pressure.

In alcoholic polyneuropathy, steppage gait appears 2 to 3 months after the onset of vitamin B deficiency. The gait may be bilateral, and it resolves with treatment of the deficiency. Early findings include paresthesia in the feet, leg muscle weakness and, possibly, sensory ataxia.

Spinal cord trauma

In an ambulatory patient, spinal cord trauma may cause steppage gait. Its other effects vary with the severity of injury and may include unilateral or bilateral footdrop, neck and back pain, and vertebral tenderness and deformity. Paresthesia, sensory loss, asymmetrical or absent DTRs, and muscle weakness or paralysis may occur distal to the injury. The patient may also develop fecal and urinary incontinence.

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

Hyper-aldosteronism: Causes
(Handbook of Diseases)

Hyperaldosteronism may be primary or secondary. Most cases of primary hyperaldosteronism are due to benign aldosterone-producing adrenal adenomas. The remainder are due to bilateral adrenal hyperplasia. Rarely, adrenal carcinoma can cause primary hyperaldosteronism. The incidence is three times higher in women than in men and is highest between ages 30 and 50.

In primary hyperaldosteronism, chronic aldosterone excess is independent of the renin-angiotensin-aldosterone system and in fact suppresses plasma renin activity. This aldosterone excess enhances sodium reabsorption by the kidneys, which leads to mild hypernatremia and, simultaneously, hypokalemia and increased extracellular fluid volume. Expansion of intravascular fluid volume also occurs and results in volume-dependent hypertension and increased cardiac output.

Excessive ingestion of English black licorice or licorice-like substances can produce a syndrome similar to primary hyperaldosteronism due to the mineralocorticoid action of glycyrrhizic acid.

Secondary hyperaldosteronism results from an extra-adrenal abnormality that stimulates the adrenal gland to increase production of aldosterone. For example, conditions that reduce renal blood flow (renal artery stenosis) and extracellular fluid volume or produce a sodium deficit activate the renin-angiotensin-aldosterone system and, subsequently, increase aldosterone secretion. Thus, secondary hyperaldosteronism may result from conditions that induce hypertension through increased renin production (such as Wilms’tumor), ingestion of hormonal contraceptives, and pregnancy.

Secondary hyperaldosteronism may also result from disorders unrelated to hypertension. Such disorders may cause edema. For example, nephrotic syndrome, hepatic cirrhosis with ascites, and heart failure commonly induce edema; Bartter’s syndrome and salt-losing nephritis don’t.

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Source: Handbook of Diseases, 2003

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

Acromegaly

Diabetes mellitus

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

Hypothyroidism

Nephrotic syndrome

Pancreatic islet cell tumor

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

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

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

Amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) typically begins with muscle weakness and atrophy in one hand that rapidly spread to the arm and then to the other hand and arm. Eventually, these effects spread to the trunk, neck, tongue, larynx, pharynx, and legs; progressive respiratory muscle weakness leads to respiratory insufficiency.

Brain tumor

Signs and symptoms of muscle weakness vary with the tumor’s location and size. Associated findings include headache, vomiting, diplopia, decreased visual acuity, decreased level of consciousness (LOC), pupillary changes, decreased motor strength, hemiparesis, hemiplegia, diminished sensations, ataxia, seizures, and behavioral changes.

Guillain-Barré syndrome

With Guillain-Barré syndrome, rapidly progressive, symmetrical weakness and pain ascends from the feet to the arms and facial nerves and may progress to total motor paralysis and respiratory failure. Associated findings include sensory loss or paresthesia, muscle flaccidity, loss of DTRs, tachycardia or bradycardia, fluctuating hypertension and orthostatic hypotension, diaphoresis, bowel and bladder incontinence, facial diplegia, dysphagia, dysarthria, and hypernasality.

Head trauma

Severe head trauma can cause varying degrees of muscle weakness. Other findings include decreased LOC, otorrhea or rhinorrhea, raccoon eyes and Battle’s sign, sensory disturbances, and signs of increased intracranial pressure.

Herniated disk

Pressure on nerve roots from a herniated disk leads to muscle weakness, disuse and, ultimately, atrophy. The primary symptom is severe low back pain, possibly radiating to the buttocks, legs, and feet — usually on one side. Diminished reflexes and sensory changes may also occur.

Hodgkin’s lymphoma

With Hodgkin’s lymphoma, muscle weakness may accompany the classic sign of painless, progressive lymphadenopathy. Other findings include paresthesia, fatigue, persistent fever, night sweats, and weight loss.

Hypercortisolism

Hypercortisolism may cause limb weakness and, eventually, atrophy. Related cush-ingoid features include buffalo hump, moon face, truncal obesity, purple striae, thin skin, acne, elevated blood pressure, fatigue, hyperpigmentation, easy bruising, poor wound healing, and diaphoresis. The male patient may be impotent; the female patient may exhibit hirsutism and menstrual irregularities.

Hypothyroidism

Multiple sclerosis

With multiple sclerosis, muscle weakness in one or more limbs may progress to atrophy, spasticity, and contractures. Other findings typically wax and wane and may include diplopia and blurred vision, vision loss, nystagmus, hyperactive deep tendon reflexes, sensory loss or paresthesia, dysarthria, dysphagia, incoordination, ataxic gait, intention tremors, emotional lability, impotence, and urinary dysfunction.

Myasthenia gravis

Gradually progressive skeletal muscle weakness and fatigue are the cardinal symptoms of myasthenia gravis. Typically, weakness is mild upon awakening but worsens during the day. Early signs include weak eye closure, ptosis, and diplopia; a blank, masklike facies; difficulty chewing and swallowing; nasal regurgitation of fluid with hypernasality; and a hanging jaw and bobbing head. Respiratory muscle involvement may eventually lead to respiratory failure.

Osteoarthritis

Osteoarthritis is a chronic disorder that causes progressive muscle disuse and weakness that lead to atrophy. Other findings include crepitation; enlarged edematous joints; Heberden’s nodes; increased pain in damp, cold weather; joint stiffness; limited range of motion; pain relieved by resting joints; and smooth, taunt, shiny skin.

Paget’s disease

As Paget’s disease progresses, muscle weakness or paralysis may develop, along with paresthesia and pain. The patient may also have bowed tibias, frequent fractures, and kyphosis.

Parkinson’s disease

Muscle weakness accompanies rigidity in patients with Parkinson’s disease. Related findings include a unilateral pill-rolling tremor, propulsive gait, dysarthria, bradykinesia, drooling, dysphagia, a masklike facies, and a high-pitched, monotonic voice.

Peripheral nerve trauma

Prolonged pressure on or injury to a peripheral nerve causes muscle weakness and atrophy. Other findings include paresthesia or sensory loss, pain, and loss of reflexes supplied by the damaged nerve.

Peripheral neuropathy

With peripheral neuropathy, muscle weakness progresses slowly to flaccid paralysis, generally affecting distal extremities first. It may be accompanied by loss of vibration sense; paresthesia, hyperesthesia, or anesthesia in the hands and feet; hypoactive or absent DTRs; mild to sharp burning pain; anhidrosis; and glossy red skin.

Potassium imbalance

Rhabdomyolysis

Signs and symptoms of rhabdomyolysis include muscle weakness or pain, fever, nausea, vomiting, malaise, and dark urine. Acute renal failure due to renal structure obstruction and injury from the kidneys’attempt to filter the myoglobin from the bloodstream is a common complication.

Rheumatoid arthritis

With rheumatoid arthritis, symmetric muscle weakness may accompany increased warmth, swelling, and tenderness in involved joints; pain; and stiffness that restrict motion. These findings typically occur bilaterally.

Seizure disorder

Temporary generalized muscle weakness may occur after a generalized tonic-clonic seizure; other postictal findings include headache, muscle soreness, and profound fatigue. The patient may experience an aura before the seizure.

Spinal trauma and disease

Spinal trauma can cause severe muscle weakness, leading to flaccidity or spasticity and, eventually, paralysis. Infection, tumor, and cervical spondylosis or stenosis can also cause muscle weakness.

Stroke

Depending on the site and extent of damage, a stroke may produce contralateral or bilateral weakness of the arms, legs, face, and tongue, possibly progressing to hemiplegia and atrophy. Associated effects include dysarthria, aphasia, ataxia, apraxia, agnosia, ipsilateral paresthesia or sensory loss, visual disturbance, altered level of consciousness, amnesia and poor judgment, personality changes, bowel and bladder dysfunction, headache, vomiting, and seizures.

Thyrotoxicosis

Thyrotoxicosis may produce insidious, generalized muscle weakness and atrophy. Other effects include anxiety, fatigue, heat intolerance, diaphoresis, tremors, tachycardia, palpitations, ventricular or atrial gallop, dyspnea, weight loss, an enlarged thyroid, and warm, flushed skin. Exophthalmos may be present.

Other causes

Drugs

Immobility

Immobilization in a cast, a splint, or traction can lead to muscle weakness in the involved extremity; prolonged bed rest or inactivity results in generalized muscle weakness.

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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

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

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

Depression

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

Gastroenteritis

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

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

Pulmonary tuberculosis

Stomatitis

Thyrotoxicosis

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

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

Hypotonia and Weakness: Principal Causes of Hypotonia and Weakness
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

Braindisorders
1. Cerebralmalformations
2. Chromosomal abnormalities
3. Hypoxic-ischemic encephalopathy
4. Hypotonic cerebral palsy
5. Intracranial infection
6. Trauma
7. Metabolic disorders
8. Neurodegenerative disorders
9. Nonspecific mental retardation
Spinal cord disorders
1. Trauma
2. Spinal dysraphism
3. Neoplasm
Anterior horn cell (or cranial motornuclei) disorders
1. Spinal muscular atrophies
2. Enteroviral infection
Peripheral (or cranial) nerve disorders
1. Acuteinflammatory demyelinating polyradiculopathy (Guillain-Barré syndrome)
2. Chronic inflammatory demyelinatingpolyneuropathy
3. Chronic motor-sensory polyneuropathy
4. Sensory neuropathies
Neuromuscular junction disorders
1. Myasthenia
  1. Neonataltransient myasthenia gravis
  2. Congenital myasthenic syndromes
  3. Juvenile myasthenia gravis
2. Botulism
3. Tick paralysis
Muscle disorders
1. Congenitalmyopathies
  1. Centralcore disease
  2. Nemaline rod myopathy
  3. Myotubular myopathy
  4. Congenital myopathy with fiber-typedisproportion
  5. Other
2. Metabolic myopathies
  1. Glycogenoses
    1. Glycogenstorage disease II
    2. Glycogen storage disease III
  2. Carnitine deficiency
    1. Medium-chainacyl-CoA dehydrogenase deficiency
    2. Primary carnitine deficiency (carnitinetransporter deficiency)
    3. Muscle carnitine deficiency
3. Respiratory chain disorders
  1. Periodicparalysis
  2. Endocrine myopathies
4. Dystrophies
  1. Congenital muscular dystrophy
  2. Duchenne muscular dystrophy
  3. Becker muscular dystrophy
  4. Emery-Dreifuss muscular dystrophy
  5. Limb-girdle muscular dystrophy
  6. Facioscapulohumeral muscular dystrophy
5. Myotonic syndromes: myotonic dystrophy
6. Inflammatory myopathies
  1. Dermatomyositis
  2. Polymyositis
Connective tissue disorders
1. Congenitallaxity of ligaments
2. Ehlers-Danlos syndrome
3. Marfan syndrome
Metabolic disorders
1. Hypopituitarism
2. Renal tubular acidosis
3. Rickets
4. Hypercalcemia

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

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

Muscle weakness: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Amyotrophic lateral sclerosis (ALS).ALS typically begins with muscle weakness and atrophy in one hand that rapidly spread to the arm and then to the other hand and arm. Eventually, these effects spread to the trunk, neck, tongue, larynx, pharynx, and legs; progressive respiratory muscle weakness leads to respiratory insufficiency.

Anemia.With anemia, varying degrees of muscle weakness and fatigue are exacerbated by exertion and temporarily relieved by rest. Other signs and symptoms include pallor, tachycardia, paresthesia, and bleeding tendencies.

Brain tumor.Signs and symptoms of muscle weakness vary with a brain tumor's location and size. Associated findings include headache, vomiting, diplopia, decreased visual acuity, decreased level of consciousness (LOC), pupillary changes, decreased motor strength, hemiparesis, hemiplegia, diminished sensations, ataxia, seizures, and behavioral changes.

Guillain-Barré syndrome.Rapidly progressive, symmetrical weakness and pain ascends from the feet to the arms and facial nerves and may progress to total motor paralysis and respiratory failure. With Guillain-Barré syndrome, associated findings include sensory loss or paresthesia, muscle flaccidity, loss of DTRs, tachycardia or bradycardia, fluctuating hypertension and orthostatic hypotension, diaphoresis, bowel and bladder incontinence, facial diplegia, dysphagia, dysarthria, and hypernasality.

Herniated disk.Pressure on nerve roots of herniated disk leads to muscle weakness, disuse and, ultimately, atrophy. The primary symptom is severe low back pain, possibly radiating to the buttocks, legs, and feet—usually on one side. Diminished reflexes and sensory changes may also occur.

Hypercortisolism.Hypercortisolism may cause limb weakness and eventually atrophy. Related cushingoid features include buffalo hump, moon face, truncal obesity, purple striae, thin skin, acne, elevated blood pressure, fatigue, hyperpigmentation, easy bruising, poor wound healing, and diaphoresis. The male patient may be impotent; the female patient may exhibit hirsutism and menstrual irregularities.

Myasthenia gravis.Gradually progressive skeletal muscle weakness and fatigue are the cardinal symptoms of myasthenia gravis. Typically, weakness is mild upon awakening, but worsens during the day. Early signs include weak eye closure, ptosis, and diplopia; blank, masklike facies; difficulty chewing and swallowing; nasal regurgitation of fluid with hypernasality; and a hanging jaw and bobbing head. Respiratory muscle involvement may eventually lead to respiratory failure.

Osteoarthritis.Osteoarthritis is a chronic disorder that causes progressive muscle disuse and weakness that lead to atrophy.

Parkinson's disease.Muscle weakness accompanies rigidity in Parkinson's disease. Related findings include a unilateral pill-rolling tremor, a propulsive gait, dysarthria, bradykinesia, drooling, dysphagia, masklike facies, and a high-pitched, monotone voice.

Peripheral nerve trauma.Prolonged pressure on or injury to a peripheral nerve causes muscle weakness and atrophy. Other findings include paresthesia or sensory loss, pain, and loss of reflexes supplied by the damaged nerve.

Potassium imbalance.With hypokalemia,temporary generalized muscle weakness may be accompanied by nausea, vomiting, diarrhea, decreased mentation, leg cramps, diminished reflexes, malaise, polyuria, dizziness, hypotension, and arrhythmias.

Rhabdomyolysis.Signs and symptoms of rhabdomyolysis include muscle weakness or pain, fever, nausea, vomiting, malaise, and dark urine. Acute renal failure, due to renal structure obstruction and injury from the kidneys'attempt to filter myoglobin from the bloodstream, is a common complication.

Rheumatoid arthritis.With rheumatoid arthritis, symmetrical muscle weakness may accompany increased warmth, swelling, and tenderness in involved joints; pain; and stiffness, restricting motion.

Seizure disorder.Temporary generalized muscle weakness may occur after a generalized tonic-clonic seizure; other postictal findings include headache, muscle soreness, and profound fatigue.

Spinal trauma and disease.Trauma to the spine can cause severe muscle weakness, leading to flaccidity or spasticity and, eventually, paralysis. Infection, tumor, and cervical spondylosis or stenosis can also cause muscle weakness.

Stroke.Depending on the site and extent of damage, a stroke may produce contralateral or bilateral weakness of the arms, legs, face, and tongue, possibly progressing to hemiplegia and atrophy. Associated effects include dysarthria, aphasia, ataxia, apraxia, agnosia, ipsilateral paresthesia or sensory loss, vision disturbances, altered LOC, amnesia and poor judgment, personality changes, bowel and bladder dysfunction, headache, vomiting, and seizures.

Other causes

Drugs.Generalized muscle weakness can result from prolonged corticosteroid use, digoxin, and excessive doses of dantrolene. Aminoglycoside antibiotics may worsen muscle weakness in patients with myasthenia gravis.

Immobility.Immobilization in a cast, a splint, or traction can lead to muscle weakness in the involved extremity; prolonged bed rest or inactivity results in generalized muscle weakness.

» READ BOOK EXCERPT ONLINE »

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

Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Guillain-Barré syndrome.Typically occurring after recovery from the acute stage of Guillain-Barré syndrome, steppage gait can be mild or severe and unilateral or bilateral; it's invariably permanent. Muscle weakness usually begins in the legs, extends to the arms and face within 72 hours, and can progress to total motor paralysis and respiratory failure. Other effects include footdrop, transient paresthesia, hypernasality, dysphagia, diaphoresis, tachycardia, orthostatic hypotension, and incontinence.

Herniated lumbar disk.Unilateral steppage gait and footdrop commonly occur with late-stage weakness and atrophy of leg muscles that occur with a herniated lumbar disk. However, the most pronounced symptom is severe low back pain, which may radiate to the buttocks, legs, and feet, usually unilaterally. Sciatic pain follows, commonly accompanied by muscle spasms and sensorimotor loss. Paresthesia and fasciculations may occur.

Multiple sclerosis.Steppage gait and footdrop typically fluctuate in severity with multiple sclerosis'characteristic cycle of periodic exacerbation and remission. Muscle weakness, usually affecting the legs, can range from minor fatigability to paraparesis with urinary urgency and constipation. Related findings include facial pain, vision disturbances, paresthesia, incoordination, and sensory loss in the ankle and toes.

Peroneal muscle atrophy.Bilateral steppage gait and footdrop begin insidiously in peroneal muscle atrophy. Foot, peroneal, and ankle dorsiflexor muscles are affected first. Other early signs and symptoms include paresthesia, aching, and cramping in the feet and legs along with coldness, swelling, and cyanosis. As the disorder progresses, all leg muscles become weak and atrophic, with hypoactive or absent deep tendon reflexes. Later, atrophy and sensory losses spread to the hands and arms.

Peroneal nerve trauma.Temporary ipsilateral steppage gait occurs suddenly but resolves with the release of peroneal nerve pressure. The gait is associated with footdrop and muscle weakness and sensory loss over the lateral surface of the calf and foot.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

» Next page: Symptoms of Primary Hyperaldosteronism

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Causes of Primary Hyperaldosteronism

Causes of Primary Hyperaldosteronism (Diseases Database):

Primary Hyperaldosteronism Causes: Book Excerpts

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Causes of Primary Hyperaldosteronism: Online Medical Books

Muscle Weakness – Proximal: Differential Diagnosis (In A Page: Pediatric Signs and Symptoms)

Muscle Weakness – Distal: Differential Diagnosis (In A Page: Pediatric Signs and Symptoms)

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

Acromegaly

Diabetes mellitus

Hypercortisolism

Hyperinsulinism

Hypogonadism

Hypothalamic dysfunction

Hypothyroidism

Nephrotic syndrome

Pancreatic islet cell tumor

Preeclampsia

Sheehan’s syndrome

Other causes

Drugs

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

Amyotrophic lateral sclerosis (ALS)

Anemia

Brain tumor

Guillain-Barré syndrome

Herniated disk

Hypercortisolism

Myasthenia gravis

Osteoarthritis

Parkinson’s disease

Peripheral nerve trauma

Potassium imbalance

Rhabdomyolysis

Rheumatoid arthritis

Seizure disorder

Spinal trauma and disease

Stroke

Other causes

Drugs

Immobility

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

Adrenal insufficiency

Anorexia nervosa

Cancer

Crohn’s disease

Cryptosporidiosis

Depression

Diabetes mellitus

Esophagitis

Gastroenteritis

Leukemia

Lymphoma

Pulmonary tuberculosis

Stomatitis

Thyrotoxicosis

Other causes

Drugs

Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]: Medical causes (Handbook of Signs & Symptoms (Third Edition))

Guillain-Barré syndrome

Herniated lumbar disk

Multiple sclerosis

Peroneal muscle atrophy

Peroneal nerve trauma

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

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

Acromegaly

Cushing’s syndrome (hypercortisolism)

Diabetes mellitus

Heart failure

Hyperinsulinism

Hypogonadism

Hypothalamic dysfunction

Hypothyroidism

Metabolic syndrome

Nephrotic syndrome

Pancreatic islet cell tumor

TREATMENTS &
RESEARCH

Dr. Huntley's
Diagnosis
Checklist

Muscle Weakness – Proximal: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Muscle Weakness – Distal: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

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

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

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

Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

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

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

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

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

Gait, steppage [Equine gait, paretic gait, prancing gait, weak gait]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Hyper-aldosteronism: Causes
(Handbook of Diseases)

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