Fatigue

Differential diagnosis

• Infection
  • Tuberculosis
  • Human immunodeficiency virus
  • Infective endocarditis
  • Post-viral fatigue syndrome
• Neoplastic
  • Lung – cough, haemoptysis
  • Gastrointestinal – change in bowel habit, weight loss, PR bleeding
  • Breast – breast lumps, nipple discharge, skin changes
  • Prostate – dysuria, haematuria, terminal dribbling
  • Hepatocellular carcinoma – jaundice, itching, symptomatic ascites
• Symptomatic anaemia
  • Microcytic: chronic blood loss, iron deficiency, thalassaemia
  • Normocytic: anaemia of chronic disease, malabsorption, chronic haemolysis
  • Macrocytic: alcohol, pregnancy, thyroid dysfunction, myelodysplastic syndrome
• Inflammatory
  • Systemic lupus erythematosus
  • Rheumatoid arthritis
  • Polymyalgia rheumatica
  • Primary biliary cirrhosis
• Endocrine
  • Diabetes mellitus
  • Hypothyroidism
  • Adrenal insufficiency
    • Primary
    • Tuberculous
    • Bilateral adrenalectomy for Cushing’s
    • Exogenous steroid withdrawal, including TCM
• Drugs
  • β blockers
  • Benzodiazepines
  • Alcohol
  • Anti-histamines
• Metabolic
  • Obstructive sleep apnoea
  • Haemochromatosis
• Degenerative / neurological
  • Alzheimer’s dementia
  • Myasthenia gravis
• Failures
  • Congestive cardiac failure
  • Renal failure
  • Cirrhosis
• Psychological
  • Chronic fatigue syndrome