What are the causes of hypotension, fatigue, and sensitivity to cold?

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Last updated: May 11, 2025View editorial policy

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Differential Diagnosis for Low Blood Pressure, Tiredness, and Sensitivity to Cold

  • Single Most Likely Diagnosis
    • Hypothyroidism: This condition is characterized by a decrease in thyroid hormone production, which can lead to symptoms such as fatigue, cold intolerance, and hypotension. The combination of these symptoms makes hypothyroidism a strong candidate for the single most likely diagnosis.
  • Other Likely Diagnoses
    • Anemia: A decrease in red blood cells or hemoglobin can cause fatigue, weakness, and shortness of breath, which may contribute to feelings of cold intolerance. Additionally, anemia can lead to a decrease in blood pressure.
    • Adrenal Insufficiency: This condition occurs when the adrenal glands do not produce enough cortisol and aldosterone, leading to symptoms such as fatigue, hypotension, and decreased tolerance to cold.
    • Dehydration: Severe dehydration can cause a drop in blood pressure, leading to fatigue, weakness, and dizziness. While dehydration itself may not directly cause sensitivity to cold, it can exacerbate underlying conditions that do.
  • Do Not Miss Diagnoses
    • Myxedema Coma: A life-threatening complication of untreated hypothyroidism, characterized by severe hypothermia, hypotension, and altered mental status. Early recognition and treatment are crucial to prevent mortality.
    • Addisonian Crisis: A life-threatening complication of adrenal insufficiency, marked by severe hypotension, dehydration, and electrolyte imbalances. Prompt recognition and treatment with corticosteroids are essential to prevent death.
    • Sepsis: A severe infection that can cause hypotension, fatigue, and altered mental status. While sensitivity to cold may not be a primary symptom, sepsis can lead to a systemic inflammatory response that affects multiple organ systems.
  • Rare Diagnoses
    • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, but in some cases, may present with hypotension, fatigue, and cold intolerance due to intermittent catecholamine release.
    • Mitochondrial Myopathies: A group of rare genetic disorders that affect the mitochondria, leading to muscle weakness, fatigue, and exercise intolerance. Some patients may experience cold intolerance and hypotension due to impaired energy production.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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