What is the diagnosis for a 49-year-old male presenting with progressive fatigue and weakness?

From the Guidelines

The workup for progressive fatigue and weakness in a 49-year-old male should begin with a comprehensive history and physical examination, focusing on the onset, pattern, duration, and associated or alleviating factors of fatigue, as well as an evaluation of disease status and treatable contributing factors, such as comorbidities, medications, and nutritional issues, as recommended by the American Society of Clinical Oncology 1. The initial evaluation should include a thorough review of systems to determine if other symptoms substantiate suspicion for recurrence or other underlying conditions.

• A focused fatigue history should be performed, including the onset, pattern, duration, and change over time of fatigue, as well as associated or alleviating factors.
• The patient's disease status should be evaluated by assessing the risk of recurrence based on stage, pathologic factors, and treatment history.
• Treatable contributing factors, such as comorbidities (e.g., cardiac dysfunction, endocrine dysfunction, pulmonary dysfunction, renal dysfunction, anemia, arthritis, neuromuscular complications, sleep disturbances, pain, emotional distress), medications (e.g., persistent use of sleep aids, pain medications, or antiemetics), alcohol/substance abuse, nutritional issues, weight/caloric intake changes, and deconditioning, should be assessed. Additional testing, such as laboratory tests and imaging studies, may be necessary based on the patient's symptoms and medical history, as suggested by the NCCN clinical practice guidelines on cancer-related fatigue 1.
• Laboratory tests may include complete blood count, comprehensive metabolic panel, thyroid function tests, vitamin B12, folate, and vitamin D levels.
• Imaging studies, such as chest X-ray and MRI of the brain or spine, may be considered if symptoms suggest specific organ involvement or malignancy. It is essential to consider the patient's overall health and well-being, including their activity level, sleep patterns, and nutritional status, when formulating a treatment plan, as emphasized by the American Society of Clinical Oncology 1.
• The patient's activity level, including changes in exercise or activity patterns and the influence of deconditioning, should be assessed.
• Sleep studies should be considered if sleep disorders are suspected.
• Nutritional assessment should be performed to evaluate weight gain and loss, caloric intake changes, impediments to nutritional intake, and fluid and electrolyte imbalances. By taking a comprehensive and systematic approach to evaluating progressive fatigue and weakness, healthcare providers can identify underlying causes and develop effective treatment plans to improve patient outcomes, as recommended by the NCCN clinical practice guidelines on cancer-related fatigue 1.

From the Research

Progressive Fatigue and Weakness in a 49-Year-Old Male Workup

• The patient's symptoms of progressive fatigue and weakness can be evaluated using a comprehensive history and physical examination, including cardiopulmonary, neurologic, and skin examinations 2.
• Fatigue can be classified as physiologic, secondary, or chronic, and the underlying cause should be identified and treated accordingly 2.
• In some cases, fatigue can be a symptom of a underlying condition such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is a chronic and potentially debilitating disorder 2.
• A 49-year-old man with progressive numbness, gait instability, and tremors was found to have a chronic demyelinating sensorimotor polyradiculoneuropathy and a monoclonal immunoglobulin (Ig) M kappa gammopathy, highlighting the importance of a thorough workup to arrive at the correct diagnosis 3.
• Laboratory evaluations, such as renal function tests and electrolyte analysis, may also be necessary to rule out other potential causes of fatigue and weakness, such as thyroid dysfunction or acid maltase deficiency 4, 5.
• A step-by-step approach to diagnosis, considering specific etiologies and red flag features, is necessary to arrive at the correct diagnosis and develop an effective treatment plan 3.