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Symptoms » Weight loss » Book Sections
 

Weight Loss

Unexplained, involuntary weight loss (defined as loss of 5% of baseline body weight over 6–12 months) is a common clinical presentation and is nearly always a sign of a serious medical or psychiatric illness. Numerous studies have independently associated unintentional weight loss with various adverse health outcomes, including decreased functional status and increased mortality.

Differential Diagnosis

  • Malignancy
    –Mediated by enhanced production of cytokines (e.g., TNF-α , interleukin-6)
    • 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

    Treatment

    • Identify and address the underlying cause
    • Appetite disturbance of depression may be reversed by antidepressant medications
    • Pancreatic enzymes for pancreatic malabsorption
    • Referral to nutritionist if necessary
    • Referral to social services if necessary
    • Anorexia of malignancy and AIDS can be treated with megestrol acetate or dronabinol
    • Aggressive treatment of anorexia nervosa, including evaluation for electrolyte and cardiac disorders and consultation with psychiatrist or psychologist

    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.

    Other Book Chapters Related to Weight loss

    Read excerpts from these other book chapters related to Weight loss:

    Medical Books Excerpts
    • ANOREXIA
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • WEIGHT LOSS
    • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
    • [ read ]
    • Anorexia
    • "In A Page: Pediatric Signs and Symptoms" (2007)
    • [ read ]
    • ANOREXIA
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
    • Anorexia
    • "Handbook of Signs & Symptoms (Third Edition)" (2006)
    • [ read ]
    • Anorexia
    • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
    • [ read ]
    • Anorexia
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Weight Loss
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Mediastinal Mass
    • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
    • [ read ]
    • Anorexia
    • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
    • [ read ]
    • Anorexia
    • "Nursing: Interpreting Signs and Symptoms" (2007)
    • [ read ]
    • ANOREXIA
    • "Differential Diagnosis in Primary Care" (2007)
    • [ read ]
     

    Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

    More About Causes of Weight loss



    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

     » Next page: Weight Gain (In a Page: Signs and Symptoms)

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