FATIGUE

Ask the Following Questions:

1. Is there weight loss? If there is weight loss, one must consider a neoplasm, endocrine disorders such as hyperthyroidism or diabetes mellitus, malnutrition or malabsorption, and chronic infectious diseases such as tuberculosis or subacute bacterial endocarditis.
2. Is there fever? If there is fever, one should consider an infectious disease such as tuberculosis, subacute bacterial endocarditis, toxoplasmosis, infectious mononucleosis, or brucellosis.
3. Is there pallor? If there is pallor, the most likely cause is a type of anemia such as that associated with malabsorption syndrome or iron deficiency anemia, pernicious anemia, or anemia blood loss.
4. Is the fatigue intermittent or constant? Intermittent fatigue would make one suspect myasthenia gravis. Constant fatigue would be related to any of the conditions we have already discussed. Constant fatigue, however, with no weight loss would make one consider a psychiatric disorder.
5. Is there a positive drug or alcohol history? Alcoholism, cocaine abuse, and chronic aspirin ingestion are just a few of the disorders that can be associated with chronic fatigue. Don't forget caffeine abuse!
6. Are there associated neurologic findings? Many neurologic disorders are associated with fatigue, and they include muscular dystrophy, amyotrophic lateral sclerosis, and Parkinson's disease.
7. Is there polyuria? Polyuria would make one think of hyperthyroidism, diabetes mellitus, hyperparathyroidism, and chronic renal failure.

DIAGNOSTIC WORKUP

All patients should have routine laboratory studies, including CBC, sedimentation rate, chemistry panel, VDRL test, and a urinalysis including analysis for myoglobin. CPK, LDH, AST, and urine creatine and creatinine should be done to rule out muscle disease. A thyroid profile should be done to rule out hyperthyroidism. Further endocrine workup including serum cortisol will help differentiate Addison's disease and hypopituitarism. Because fatigue is associated with aldosteronism, a 24-hr urine aldosterone determination should be done.

Tests for chronic infectious disease, such as febrile agglutinins, brucellin antibody titer, heterophile antibody titer or Monospot test, sputum for AFB, and various skin tests for tuberculosis and fungi, can be done. HIV testing may be appropriate if there is a history of high-risk sexual behavior. Serial blood cultures also would be of value if there is significant fever. Tests for chronic organ failure such as BUN, creatinine, serum electrolytes, and liver function tests should be done. A workup of anemia including a workup of malabsorption syndrome may be necessary. Consequently, stool analysis for fat content as well as d -xylose absorption testing may be done.

A search for neoplasm will include chest x-rays, x-rays of the skull and long bones, a bone scan, an upper GI series, and small bowel follow-through as well as a barium enema and intravenous pyelogram. A muscle biopsy will help differentiate certain collagen diseases, muscular dystrophy, and trichinosis. An ANA test and serum complement to screen for collagen disease should be done. A Tensilon test may be necessary to differentiate myasthenia gravis. If a neurologic disease is suspected, referral to a neurologist would be in order. Consider EMG also. If sleep apnea is a possibility, overnight polysomnography is indicated.

If all the tests prove negative, referral to a psychiatrist would be appropriate. On the other hand, it may be appropriate to refer the patient to a psychiatrist earlier in the course of the workup. The diagnosis of chronic fatigue syndrome is sometimes made when all the diagnostic tests are negative, but whether it is truly a disease is questionable.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

Other Book Chapters Related to Anemia

Read excerpts from these other book chapters related to Anemia:

Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

More About Causes of Anemia

• Back to symptom: Anemia: Introduction (review 810 causes)
• Next Book Extract About Anemia: ANEMIA (Algorithmic Diagnosis of Symptoms and Signs)
• All Book Extracts: All Online Book Extracts for Anemia

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

 » Next page: ANEMIA (Algorithmic Diagnosis of Symptoms and Signs)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• ANEMIA (Algorithmic Diagnosis of Symptoms and Signs)
• Fatigue (In a Page: Signs and Symptoms)
• Anemia (In a Page: Signs and Symptoms)
• Fatigue (In A Page: Pediatric Signs and Symptoms)
• Pallor (In A Page: Pediatric Signs and Symptoms)

Tools & Services:

• Bookmark this page
• Related medical articles for Anemia:
• Take a survey relating to Anemia
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City