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