A 72-year-old lady presents to her GP with fatigue.
Her husband has noticed change in her character and her hair becoming thinner. She also complains of
constipation.
Her only medical history is type II diabetes mellitus which is diet controlled.
On examination she has a pale complexion and her skin is dry. Her pulse is 50 beats per minute, regular. The
rest of the examination is unremarkable.
The GP considers anaemia and requests a full blood count which shows:
Haemoglobin 9.1 g/dl 115-165
White cell count 7.2 x 109
/l 4-11
Platelets 147 x 109/l 150-400
Mean cell volume 105 fl 80-96
What is your diagnosis?
Chronic fatigue syndrome
Depression
Diabetes mellitus
GI malignancy
Hypothyroidism (Correct)
The presence of tender points is important to diagnose chronic fatigue syndrome.
Depression is a common cause of lethargy in the elderly; however other causes should be excluded.
Uncontrolled diabetes can cause lethargy and anaemia. However, other features in this scenario cannot be
explained.
Occult malignancy is another cause of anaemia. However, weight loss and gastrointestinal (GI) bleeding are
important features and change in character is rarely a feature.