Differential Diagnosis

The patient presents with a complex set of symptoms including temperature regulation issues, increased appetite, and decreased libido, alongside a history of prediabetes and hypercholesterolemia. The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Hypothyroidism: Despite the patient denying a history of endocrine problems or thyroid issues, hypothyroidism can sometimes present with non-specific symptoms such as feeling cold, increased appetite, and decreased libido. The progressive worsening of symptoms and the presence of night sweats (which could be related to the hot flashes experienced by some hypothyroid patients) make this a plausible diagnosis. Metformin, which the patient is taking, can also affect thyroid function tests, potentially masking hypothyroidism.

• Other Likely Diagnoses

  • Depression: The patient is on sertraline, indicating a history of depression. Depression can cause changes in appetite, libido, and can sometimes be associated with temperature dysregulation symptoms. The loss of sex drive and increased appetite could be related to the patient's mental health status.
  • Sleep Disorders: The patient reports feeling cold at night but hot internally, which could be indicative of sleep disorders such as sleep apnea. Sleep apnea can lead to decreased libido and increased appetite due to the lack of quality sleep.
  • Polycystic Ovary Syndrome (PCOS) in females or Late-Onset Hypogonadism in males: Although the patient's gender is not specified, these conditions can cause changes in libido, appetite, and could potentially affect temperature regulation. However, without more specific information on the patient's gender and other symptoms, this remains speculative.

• Do Not Miss Diagnoses

  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodes of feeling hot, sweating, and palpitations. Although less likely, it's a critical diagnosis not to miss due to its potential severity and impact on blood pressure.
  • Testicular Cancer: Can cause decreased libido and might be associated with other systemic symptoms such as weight loss or gain, and changes in appetite. Given the patient's reported loss of sex drive, this is an important consideration.
  • Hyperparathyroidism: Can lead to a variety of symptoms including increased appetite, and less commonly, temperature regulation issues. It's crucial due to its potential to cause significant morbidity if left untreated.

• Rare Diagnoses

  • Adrenal Insufficiency: A condition where the adrenal glands do not produce adequate amounts of hormones, potentially leading to changes in appetite, libido, and could affect temperature regulation.
  • Thyroid Storm: A life-threatening complication of untreated or undertreated hyperthyroidism, which could present with temperature dysregulation among other symptoms. However, the patient's symptoms do not fully align with a typical presentation of thyroid storm.
  • Craniopharyngioma: A rare type of brain tumor that can affect the hypothalamus, leading to a variety of symptoms including temperature dysregulation, changes in appetite, and libido issues. This diagnosis would be extremely rare and not initially considered without further diagnostic evidence.