WEIGHT LOSS:
One of the most sinister symptom is weight loss which should never be ignored. Patients often try to justify.
Weight = Water+ fat+muscles.
Water loss or water gain can be quick,whereas fat and muscles loss or gain is a slow process. So weight loss in days or hours means Water loss. Weight loss over weeks/months means muscle and/or fat loss.
ENDOCRINE CAUSES:
Endocrinal causes of weight changes are usually associated with other features of the disease and BP will also change with weight. Most common Endo cause is Diabetes especially type I or even poorly controlled or undiagnosed type II. Other endo causes are;
1): Hyperthyroidism ( sweating, tremors, eye changes etc).
2): Acromegaly ( increase finger and toe size, face and nose features, high BP etc)
3): Pheochromocytoma ( panic episodes, HTN etc).
4): Addisonian ( dehydration, low BP, low glucose, pigmentation etc).
5): Hypopituitarism will have hypotension, dehydration, smooth atrophic hairless facial skin etc ). 6): Hyper parathyroid can cause weight loss due to hypercalcemia affecting GIT.
CHRONIC INFLAMMATORY CAUSES;
1): Chronic infections have inflammatory symptoms like fever, sweating etc with raised ESR. (CRP isn’t as useful in chronic infections). Localising symptoms like cough, sputum, diarrhoea , malabsorption etc can help locate infection. TB, Subacute Endocarditis, Abscess, Whipple’s disease, Nocardia etc are a few examples.Workup is needed based on clinical suspicion.
2): Autoimmune diseases, being a chronic inflammatory conditions, cause weight loss and fever etc as well. Associated clinical features, when present are useful. However fever weight loss etc can be the sole initial presentation and unless we keep high degree of suspicion, diagnosis gets delayed or missed. SLE, Stills Disease & Vasculitides are more notorious to present non specifically to begin with. Other autoimmune diseases usually present fairly typically.
CANCERS;
1): Malignancy related weight loss is usually a feature of metastatic cancer and usually not accompanied with inflammatory clues.However a few cancers are notorious to produce lot of chemical mediators and can cause fever with weight loss and raised inflammatory markers. Renal cell CA, hepatocellular CA , Lymphoma , Leukemias or Brain malignancies involving hypothalamic temperature centre are a few example.
2): Pancreatic and Upper GI Malignancies are more notorious to cause weight loss as presentation is often delayed or missed initially.
3):?Atrial Myxoma is a BENIGN tumour with weight loss and fever ( usually benign rumours don’t cause weight loss or fever). Thorough examination followed by resting should be helpful.
PSYCHIATRIC CAUSES;
Depression, stress and psychiatric illnesses can cause weight loss, usually due to poor food intake/care. Masked depression should always be thought of no other reason found.
CHRONIC METABOLIC / NUTRITIONAL DEPRIVATIONS;
1): Chronic hypoxia States like Emphysema, severe chronic anaemia , Heart failure etc also cause weight loss due to muscle atrophy. This is usually masked my edema. When they start diuretics, weight loss become apparent.
2): Coeliac disease can present just with weight loss in any age group and without any other GI symptom. Keep a high degree of suspicion even if there is no other GI symptoms.
3): Chronic organ failure of any kind like CRF, cirrhosis etc also cause cachexia, which needs to be kept in mind and looked into. Cirrhosis especially is a common to present this way.
4): Malnutrition or Malabsorption are very common, easily over looked and missed causes. Proper history should be taken about dietary habits & GI symptoms