Differential Diagnosis for 70yo F with Gradual Worsening Fatigue, Malaise, and Hypotension
- Single most likely diagnosis
- Adrenal insufficiency: This condition is characterized by the inadequate production of adrenal hormones, leading to fatigue, malaise, and hypotension. The gradual worsening of symptoms and the absence of signs of infection or sepsis make this diagnosis a strong consideration.
- Other Likely diagnoses
- Dehydration (despite being reported as well-hydrated, this may need to be reassessed): Dehydration can cause hypotension and fatigue, even if the patient appears well-hydrated initially.
- Anemia: A gradual decline in hemoglobin levels can lead to fatigue, malaise, and hypotension due to decreased oxygen delivery to tissues.
- Heart failure: Decreased cardiac output can cause fatigue, malaise, and hypotension, especially in the elderly.
- Hypothyroidism: This condition can cause fatigue, malaise, and hypotension due to decreased metabolic rate.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Septic shock (despite no signs of infection or sepsis): It is crucial to consider and rule out septic shock, as it can be deadly if missed. The patient's hypotension and malaise could be early signs.
- Cardiac tamponade: This condition can cause hypotension and fatigue due to impaired cardiac filling and output.
- Massive pulmonary embolism: A large pulmonary embolism can cause hypotension, fatigue, and malaise due to decreased cardiac output and oxygenation.
- Hemorrhage (internal or external): Internal or external bleeding can cause hypotension and fatigue, even if the patient appears well initially.
- Rare diagnoses
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause hypotension, fatigue, and malaise due to excessive catecholamine production.
- Amyloidosis: A rare condition characterized by the deposition of abnormal proteins in tissues, leading to fatigue, malaise, and hypotension.
- Autonomic dysfunction: A rare condition affecting the autonomic nervous system, leading to hypotension, fatigue, and malaise due to impaired autonomic regulation.