Differential Diagnosis

The patient's symptoms of weight loss, abdominal pain, hyperpigmentation, hepatomegaly, polyarthritis, and hyperglycemia can be attributed to several possible diagnoses. Here's a categorized differential diagnosis:

• Single most likely diagnosis

  • Hemochromatosis: This genetic disorder leads to excessive iron absorption, resulting in iron overload. The symptoms presented, such as hyperpigmentation (bronze diabetes), hepatomegaly, polyarthritis, and hyperglycemia, are classic for hemochromatosis. Weight loss and abdominal pain can also occur due to liver dysfunction and other systemic effects of iron overload.

• Other Likely diagnoses

  • Hepatic carcinoma: While less likely than hemochromatosis given the combination of symptoms, liver cancer can cause weight loss, abdominal pain, and hepatomegaly. However, the presence of hyperpigmentation and polyarthritis is less commonly associated with liver cancer.
  • Type 2 diabetes mellitus: Hyperglycemia is a key feature, but type 2 diabetes alone does not account for hepatomegaly, hyperpigmentation, or polyarthritis, although these conditions can coexist.

• Do Not Miss diagnoses

  • Wilson disease: Although rare, Wilson disease is a genetic disorder leading to copper accumulation, primarily in the liver and brain. It can present with liver dysfunction (hepatomegaly), neurological symptoms, and sometimes diabetes or arthritis. Missing this diagnosis could be fatal due to the potential for severe liver disease and neurological deterioration.
  • Hepatic carcinoma with underlying liver disease: The presence of hepatomegaly and weight loss could indicate an underlying liver condition, such as cirrhosis, which significantly increases the risk of liver cancer. Early detection is crucial for treatment.

• Rare diagnoses

  • Porphyria cutanea tarda: This is a disorder of porphyrin metabolism that can cause skin hyperpigmentation, especially on sun-exposed areas, and sometimes liver disease. However, it less commonly presents with the full spectrum of symptoms described.
  • Other genetic metabolic disorders: There are several rare genetic disorders that affect metabolism and can lead to a combination of systemic symptoms, including liver disease, diabetes, and arthritis. Examples include certain lysosomal storage diseases, but these would be much less common and might present with additional, distinctive features.