Some Causes of a Presenting Symptom of Involuntary Weight Loss
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Endocrine disorders | ||
Increased appetite Heat intolerance, sweating, tremor, anxiety, tachycardia, diarrhea | Thyroid function tests | |
Diabetes mellitus, type 1 (new onset or poorly controlled) | Increased appetite Polydipsia, polyuria | Plasma glucose measurement |
Chronic primary adrenal insufficiency | Abdominal pain, fatigue, hyperpigmentation, orthostatic light-headedness | Serum electrolytes, cortisol, and adrenocorticotropic hormone levels |
Drugs | ||
History of excess consumption Vascular spiders, Dupuytren contractures, testicular atrophy, peripheral neuropathy Sometimes ascites, asterixis | Clinical evaluation Liver tests | |
Drugs
| History of use | Clinical evaluation When possible, trial of stopping drug |
Psychiatric disorders | ||
Inappropriate fear of weight gain in an emaciated young woman or adolescent female, amenorrhea | Clinical evaluation | |
Sadness, fatigue, loss of sexual desire and/or pleasure, sleep disturbance, psychomotor retardation | Clinical evaluation | |
Renal disorders* | ||
Edema, nausea, vomiting, stomatitis, dysgeusia, nocturia, fatigue, pruritus, decreased mental acuity, muscle twitches and cramps, peripheral neuropathy, seizures | ||
Edema, hypertension, proteinuria, fatigue, frothy urine | 24-hour urinary protein measurement Alternatively, spot urinary/serum protein ratio | |
Infections | ||
Fungal infections (usually primary fungal infections) | Fever, night sweats, fatigue, cough, dyspnea Often risk of exposure based on geography Sometimes other organ-specific manifestations | Usually cultures and stains Sometimes serologic tests Sometimes biopsy |
Fever, abdominal pain, bloating, flatulence, diarrhea, eosinophilia Usually residence or travel in developing countries | Disorder-specific tests (eg, microscopic examination of stool, culture, serology) | |
Fever, dyspnea, cough, lymphadenopathy, diarrhea, candidiasis | Blood antibody or antigen testing | |
Fever, night sweats, arthralgias, dyspnea, fatigue, Roth spots, Janeway lesions, Osler nodes, splinter hemorrhages, retinal artery emboli, stroke Often in patients with valvular heart disease or IV drug use | Blood cultures Echocardiography | |
Fever, night sweats, cough, hemoptysis Sometimes risk factors (eg, exposure, poor living conditions) | Chest x-ray Sputum culture and smear PPD and/or interferon-gamma release assay | |
Other systemic disorders | ||
Often night sweats, fatigue, fever Sometimes bone pain at night or other organ-specific symptoms | Organ-specific evaluation | |
Headache, muscle pains, jaw claudication, fever, and/or visual disturbances in an older adult | ESR and, if elevated, temporal artery biopsy | |
Cough, dyspnea, crackles Fever, fatigue, lymphadenopathy Sometimes symptoms of other organ involvement (eg, ocular, hepatic, gastrointestinal, bone) | Chest x-ray Sometimes chest CT Biopsy | |
Dental and taste disorders | ||
Dysgeusia (loss of taste) | Usually risk factors (eg, cranial nerve dysfunction, use of certain drugs, aging) | Clinical evaluation |
Poor dentition | Tooth or gum pain Halitosis, periodontitis, missing and/or decayed teeth | Clinical evaluation |
* Accumulation of edema may mask loss of lean body weight. ESR = erythrocyte sedimentation rate; PPD = purified protein derivative | ||