Endocrine Abstracts

Background: Stress-related illness is commonly referred to the endocrine clinic, and often becomes a diagnosis of exclusion after extensive investigation. We provide evidence that a positive clinical diagnosis can be made without risk of missing organic illness.

Methods: 101 consecutive and unselected referrals for ‘fatigue ?endocrine’ between 1/4/95 and 30/3/99 were identified from an endocrine clinic database (81 female, 20 male; mean age 41 y, range 15-86 y). A positive diagnosis of mood dysphoria had been made in all of them on the basis of functionality, cognitive state, weight behaviour and autonomic symptoms. Outcome 5y later was assessed by postal questionnaire to patient and GP.

Results: 89% of patients presented with fatigue, 61% sleep upset, 60% low mood, 50% anxiety and 50% weight gain. Fewer than 4% had experienced weight loss. Autonomic symptoms such as headaches, myalgia, thermolability, flushing, palpitations, tremulousness and cognitive disturbance were reported by 57% of the patients. 72% experienced 'good days and bad'. 37% of patients had a pre-existing endocrine diagnosis, mostly hypothyroidism. A previous history of depression was present in 16%, and panic attacks in 6%.

Outcomes: Follow up data was available for 74/101 cases, of whom 72 were known to be alive at 5y. The two deaths resulted from metastatic ovarian cancer and motor neurone disease. Of the surviving 72 patients, 76% continued to experience problems with fatigue, motivation and/or mood disturbance, but no significant or life-threatening disorder had been missed at the original consultation.

Conclusions: The clinical diagnosis of fatigue, based on history and tests to exclude anaemia, hypothyroidism and diabetes is safe: these patients do not demonstrate excess morbidity and mortality, nor are their presenting symptoms early features of significant physical illness. The diagnosis of mood dysphoria might arguably be made in primary care, although time is needed to do so.