Weight loss

• Hyperthyroidism: Weight loss despite increased appetite, heat intolerance, tremor, tachycardia, goitre.
• Diabetes Mellitus (Type 1 and Type 2): Polyuria, polydipsia, fatigue, weight loss despite normal or increased appetite.
• Adrenal Insufficiency (Addison’s Disease): Weight loss, hyperpigmentation, hypotension, fatigue, hyponatraemia, hyperkalaemia.
• Pheochromocytoma: Episodic weight loss, hypertension, palpitations, sweating, headache.
• Hypercalcaemia: Weight loss, polyuria, polydipsia, constipation, abdominal pain, mental confusion.
• Malignancy (e.g., pancreatic, lung, gastric): Unexplained weight loss, fatigue, anorexia, night sweats, masses on examination.

• Malabsorption (e.g., Coeliac Disease, Crohn’s Disease): Chronic diarrhoea, steatorrhoea, abdominal pain, bloating, weight loss.
• Peptic Ulcer Disease: Epigastric pain relieved by eating, nausea, early satiety, possible weight loss.
• Gastroesophageal Reflux Disease (GORD): Heartburn, regurgitation, dysphagia, weight loss if severe.
• Chronic Pancreatitis: Epigastric pain radiating to the back, steatorrhoea, weight loss, history of alcohol use.
• Inflammatory Bowel Disease (IBD): Chronic diarrhoea, abdominal pain, blood in stool, weight loss, extraintestinal manifestations.
• Gastrointestinal Malignancies (e.g., gastric, colorectal cancer): Unexplained weight loss, anorexia, change in bowel habits, rectal bleeding.
• Chronic Infections (e.g., tuberculosis): Chronic cough, night sweats, fever, weight loss, history of travel to endemic areas.

• Depression: Weight loss due to decreased appetite, low mood, anhedonia, sleep disturbances, fatigue.
• Anxiety Disorders: Weight loss due to increased energy expenditure, decreased appetite, restlessness, insomnia.
• Eating Disorders (e.g., Anorexia Nervosa, Bulimia Nervosa): Marked weight loss, body image distortion, restrictive eating habits, possible purging behaviours.
• Substance Abuse (e.g., alcohol, stimulants): Weight loss due to poor nutrition, decreased appetite, social isolation.
• Chronic Stress: Weight loss due to increased cortisol levels, decreased appetite, gastrointestinal symptoms.
• Medication-Related: Weight loss associated with certain medications such as metformin, antidepressants, stimulants, chemotherapy.
• Increased Physical Activity: Weight loss due to high energy expenditure without compensatory increase in caloric intake.

Assess the specific symptoms presented by the patient:

• Onset and Duration: Gradual vs. sudden weight loss, amount of weight lost, and over what time period.
• Appetite and Dietary Intake: Changes in appetite, dietary habits, food intolerances, or avoidance.
• Gastrointestinal Symptoms: Presence of nausea, vomiting, diarrhoea, abdominal pain, changes in bowel habits.
• Systemic Symptoms: Fever, night sweats, fatigue, palpitations, tremors, polyuria, polydipsia, hyperpigmentation.
• Psychiatric Symptoms: Screening for depression, anxiety, stress, or eating disorders, including changes in mood or behaviour.
• Physical Activity: Recent changes in physical activity levels, including exercise habits.
• Social Factors: Recent stressors, social isolation, financial difficulties, or substance misuse.

Gather a detailed background including:

• Past Medical History: Previous weight issues, chronic illnesses, gastrointestinal diseases, endocrine disorders, or malignancies.
• Drug History: Detailed history of medication use, including over-the-counter and herbal supplements that may contribute to weight loss.
• Family History: Family history of autoimmune diseases, gastrointestinal conditions, malignancies, or psychiatric disorders.
• Social History: Lifestyle factors including occupation, stress, diet, physical activity, alcohol consumption, smoking, and drug use.
• Travel History: Recent travel to areas with high prevalence of chronic infections like tuberculosis.
• Reproductive History (in females): Changes in menstrual cycle, pregnancy, or menopause that might affect weight.

• Full Blood Count (FBC): To assess for anaemia, infection, or haematological malignancies.
• Thyroid Function Tests (TFTs): To rule out hyperthyroidism as a cause of weight loss.
• Fasting Blood Glucose and HbA1c: To assess for diabetes mellitus, particularly type 1 diabetes.
• Liver Function Tests (LFTs): To evaluate for chronic liver disease or malignancy.
• Renal Function Tests: To assess for chronic kidney disease or dehydration.
• Inflammatory Markers (CRP, ESR): To detect chronic inflammatory or infectious processes.
• Calcium Levels: To assess for hypercalcaemia, particularly in the context of malignancy or hyperparathyroidism.
• Coeliac Serology: To screen for coeliac disease in patients with gastrointestinal symptoms and weight loss.
• HIV Test: To rule out HIV as a cause of chronic weight loss with associated immunosuppression.
• Cortisol Levels (including Synacthen Test): To assess for adrenal insufficiency.
• Tumour Markers: If malignancy is suspected based on clinical features or family history.
• Tuberculosis (TB) Testing: If there is a history of exposure, travel, or symptoms suggestive of TB.

• Chest X-ray: To assess for tuberculosis, lung malignancy, or other chronic pulmonary conditions.
• Abdominal Ultrasound: To evaluate for abdominal malignancies, chronic pancreatitis, or liver disease.
• Endoscopy (Upper and Lower): To assess for gastrointestinal causes of weight loss such as peptic ulcer disease, coeliac disease, or malignancies.
• CT/MRI Scan: For detailed imaging if malignancy, chronic infection, or other significant pathology is suspected.
• PET Scan: If malignancy is suspected and there is a need for metabolic imaging to detect metastasis or recurrent disease.
• DEXA Scan: To assess for osteoporosis in patients with significant weight loss and suspected bone density issues.
• Echocardiogram: If cardiac cachexia is suspected due to underlying heart failure.