Misdiagnosis of Lethargy
Misdiagnosis and Lethargy
Cluster of diseases with difficult diagnosis issues: There is a well-known list of
medical conditions that are all somewhat difficult to diagnose, and all can present
in a variety of different severities.
Diseases in this group include multiple sclerosis, lupus, Lyme disease, fibromyalgia,
thyroid disorders (hypothyroidism or hyperthyroidism),
chronic fatigue syndrome, diabetes - all of these can have vague symptoms in their early presentations.
Also, depression can have some symptoms similar to these conditions, and also the reverse,
that many of these conditions can mimic depression and be misdiagnosed as depression.
RLS sleep disorder causing night-time leg sensations often misdiagnosed: A common but relatively unknown
sleep-related disorder called Restless Leg Syndrome (RLS) is often misdiagnosed.
The typical symptoms are night-time tingling, crawling, or burning sensations in the legs,
with the irresistable urge to move the legs.
This need for leg movement leads to tossing and turning, or getting up out of bed,
all of which interferes with the ability to fall asleep.
The sufferer then has the typical symptoms of sleep deprivation during the day: fatigue, tiredness,
morning headaches, irritability, poor concentration and so on.
This condition is sometimes misdiagnosed as other conditions
such as ADHD, sleep disorders, other causes of insomnia, or other causes of leg tingling.
Many patients also suffer from a related disorder called
Periodic limb movement disorder (PLMD), which causes leg spasms
or other jerky movements.
See introduction to RLS or introduction to PLMD.
Pituitary conditions often undiagnosed cause of symptoms: There are a variety of symptoms
that can be caused by a pituitary disorder (see symptoms of pituitary disorders).
For example, fatigue, headache, weight gain, diabetes-like symptoms, and various other symptoms.
Pituitary tumors and other similar conditions are not as rare as physicians tend to believe.
See introduction to pituitary conditions.
Carcinoma right colon: Carcinoma of the right colon is not clinically apparent to the physician as that of the carcinoma of left colon as the symptoms the patient presents with maybe as vague as pallor,tiredness and lethargy with dull abdominal pain which are all due to occult blood loss which occurs due to the growing tumour within.Evidence of low blood counts in an elderly patient with mild symptoms must not be overlooked as more cases of carcinoma right colon are emerging in the western world than in comparison to the carcinoma left colon which is more easier to diagnose.
Bronze diabetes due to hemochromatosis: Hereditary hemochromatosis is a single gene disorder
commonly seen. It occurs due to an increase in the iron storage in the
body. The excess iron gets stored in various organs in the body such as
liver, pancreas, skin, joints and pituitary and hence the symptomatology varies
according to the organs affected. It may include lethargy, polyuria,
polydipsia, loss of libido, bronze diabetes, bronzy appearance of skin etc. The
condition may be confused and misdiagnosed as hepatitis, thalassaemia and other
conditions associated with iron overload. Serum ferritin levels helps in
determining the diagnosis. As the condition is a hereditary disorder all first
degree relatives must be screened.
Commmon case of iron deficeincy anaemia: Iron deficiency anaemia is a common cause of anaemia
worldwide. It is the largest cause of microcytic hypochromic anaemia with its
main differential diagnosis being thalassaemia and anaemia of chronic disease. It
is differentiated from the other two conditions based on blood tests. It is
very important to differentiate between iron deficiency anaemia and thalassaemia
as the treatment in both the conditions are exactly opposite. In iron
deficiency anaemia iron has to be supplemented but in case of thalassaemia the
iron stores are normal and iron supplementation is contraindicated. Iron deficiency
anaemia must be spotted early on in children as in the long run it affects
their cognitive and psychomotor performance and late diagnosis in thalassaemia
can cause lethargy, failure to thrive and jaundice.
Addison's disease has a good prognosis: Addison’s disease when treated
with adequate replacement therapy has a good prognosis and life expectancy
approximates normal. Lifelong medical supervision is required for signs of
continued adequate therapy and avoidance of overdose and avoidance of
complications such as hyperpyrexia, Addisonian crisis, psychotic reactions and
hyperkalemic paralysis. It must be differentiated from conditions such as
pituitary stalk resection, withdrawal from long term use of steroids, Sheehan’s
syndrome and trauma.
More about Misdiagnosis
» Next page: DEPRESSION (Algorithmic Diagnosis of Symptoms and Signs)
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