Evaluation of Fatigue in a 17-Year-Old Male
A comprehensive diagnostic approach for fatigue in a 17-year-old male should begin with quantitative fatigue assessment, followed by focused history, physical examination, and targeted laboratory testing to identify treatable causes.
Initial Assessment
Fatigue Screening
- Use a numeric rating scale (0-10) to quantify fatigue severity:
- Mild: 1-3
- Moderate: 4-6
- Severe: 7-10 1
- For adolescents, a simplified 1-5 scale may be used 1
- If fatigue is mild (1-3), provide education on fatigue management and schedule follow-up
- If fatigue is moderate to severe (4-10), proceed with comprehensive evaluation 1
Focused History and Physical Examination
Key History Elements
- Onset, pattern, duration, and change over time
- Alleviating and exacerbating factors
- Impact on daily functioning and activities
- Associated symptoms
- Sleep patterns
- Emotional health assessment
- Medication review
- Substance use (including alcohol)
- Academic and social stressors
Physical Examination Focus
- Vital signs (including orthostatic measurements)
- Complete cardiopulmonary examination
- Neurological examination
- Lymph node examination
- Skin examination for pallor or rash
- Musculoskeletal examination
Evaluation of Treatable Contributing Factors
Essential Laboratory Testing
- Complete blood count with differential (to assess for anemia, infection) 2
- Comprehensive metabolic panel (to evaluate electrolytes, liver and kidney function) 2
- Thyroid-stimulating hormone (TSH) 2
- Urinalysis 2
- Fasting blood glucose or glycohemoglobin 2
Assessment of Common Contributing Factors
- Pain: Evaluate for chronic pain conditions
- Emotional distress: Screen for depression and anxiety
- Sleep disturbance: Assess sleep quality, duration, and potential sleep disorders
- Anemia: Evaluate CBC results
- Nutrition: Assess dietary habits and nutritional status
- Activity level: Determine current physical activity patterns
- Substance use: Screen for alcohol, caffeine, and drug use
- Medication side effects: Review all medications for fatigue as a side effect
- Comorbidities: Assess for underlying medical conditions 1
Management Approach
Non-pharmacological Interventions
- Structured physical activity plan: Include stretching and aerobic exercise like walking 3
- Sleep hygiene education:
- Regular sleep schedule
- Limit screen time before bed
- Create optimal sleep environment
- Stress management techniques:
- Relaxation exercises
- Mindfulness practices
- Time management strategies
- Nutrition counseling: Balanced diet with adequate hydration
Pharmacological Considerations
- Address any identified underlying causes
- Correct electrolyte abnormalities if present 2
- Consider selective serotonin reuptake inhibitors if depression is present 3
Follow-up and Monitoring
- Schedule regular follow-up visits rather than sporadic urgent appointments 3
- Reassess fatigue levels at each visit
- Monitor response to interventions
- Adjust management plan based on progress
Special Considerations
When to Consider Expanded Evaluation
- Fatigue persisting >1 month despite initial interventions
- Presence of concerning symptoms (unintentional weight loss, fever, night sweats)
- Severe fatigue (score 7-10) significantly impacting daily functioning
- Family history of autoimmune disorders or endocrine conditions
Common Pitfalls to Avoid
- Excessive laboratory testing: Initial laboratory studies affect management in only 5% of patients; if initial results are normal, repeat testing is generally not indicated 3
- Overlooking psychological factors: Emotional distress is a common contributor to fatigue in adolescents
- Ignoring lifestyle factors: Poor sleep habits, inadequate nutrition, and sedentary behavior are frequent causes of fatigue in teenagers
- Missing medication side effects: Review all medications, including over-the-counter drugs and supplements
Remember that fatigue is a common symptom with multiple potential causes, and a systematic approach to evaluation is essential for effective management in adolescent patients.