By M Gurnell; John D Firth; Royal College of Physicians of London. Education Department
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Her BP is 145/85 mmHg. I have checked her electrolytes, FBC and fasting glucose and they are all within normal limits. I would be most grateful if you could see her to exclude an underlying cause for her weight gain. Yours sincerely, Introduction Weight gain of such magnitude and velocity always warrants thorough assessment and evaluation to exclude possible secondary causes (Table 10). History of the presenting problem Time course of weight gain Was there an event/trigger that started it off? She may have lost her END_C01 12/15/10 8:39 Page 25 ENDOCRINOLOGY: PACES STATIONS AND ACUTE SCENARIOS TABLE 10 CAUSES OF WEIGHT GAIN/OBESITY Cause Example/condition Lifestyle Habitual/social overeating (quantity or quality, eg energy-dense foods) Excessive alcohol consumption Lack of exercise (voluntary or inability) Psychological/psychiatric Anxiety/depression Eating disorders, eg binge/comfort eating Physiological Pregnancy, post pregnancy Ageing Genetic predisposition Simple forms of obesity: likely to reflect interaction between the individual’s genetic predisposition and his/her environment Severe monogenic obesity, eg congenital leptin deficiency Other syndromic disorders, eg Prader–Willi, Laurence– Moon–Biedl Other Endocrine disorders, eg hypothyroidism, polycystic ovarian syndrome (PCOS), Cushing’s syndrome, insulinoma Hypothalamic dysfunction, eg tumour, infiltration, surgery Fluid retention, eg cardiac failure, nephrotic syndrome, cirrhosis Iatrogenic, eg glucocorticoids, lithium, antidepressants job, contracted an illness, stopped smoking, suffered a personal/family stress or had a baby (as in this case).
Goitre: has there been any swelling or tenderness in the neck? Check for difficulty with swallowing/breathing. Type of disorder Example • Eye symptoms, eg prominence, dryness/itching, double vision. Hypermetabolic states Thyrotoxicosis DM Acute sepsis/trauma • Recent pregnancy: consider postpartum thyroiditis. Anorexia of chronic disorders Infections, eg gastrointestinal, HIV Systemic inflammatory disorders Malignancy, including lymphoma Addison’s disease Diabetes mellitus Anorexia nervosa or other eating disorder Upper gastrointestinal tract pathology, eg oesophageal stricture Neurological disorders, eg motor neuron disease Other relevant history Reduced calorie intake Malabsorption Coeliac disease Increased physical activity Female athletic triad DM, diabetes mellitus.
24 Station 2: History Taking Complications of acromegaly Further investigation will be determined by clinical findings and planned therapy, but formal polysomnography, or screening with overnight oximetry, will detect obstructive sleep apnoea in many patients with acromegaly and is of relevance to perioperative anaesthesia and airway management. Any clinical suspicion of colonic tumours should lead to formal examination of the large bowel endoscopically or radiologically. Do not forget to screen for other cardiovascular risk factors, eg dyslipidaemia.
