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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Vitamin B12 deficiency develops over a slowly progressive continuum. Early manifestations may be generalized weakness or fatigue, indigestion, diarrhea, or depression. Pernicious anemia is considered the classic cause, but others include malabsorption because of achlorhydria or other gastric dysfunction, fish tapeworm infection, and strict vegetarianism. Iron deficiency often coexists. Because presentation is often atypical, vitamin B12 deficiency is a diagnostic consideration whenever neuropsychiatric signs or symptoms are unexplained.
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PMID:Vitamin B12 deficiency. Important new concepts in recognition. 220 95

Exertional dyspnea and fatigue dominated the clinical picture of pernicious anemia in a 78 year old man. A disturbed gait indicated concomitant neurologic disorders. A reduced Vitamin B12 level, an abnormal Schillingtest, atrophy of gastric mucosa as well as maturation disturbance of erythrocytes and neutrophils were present as typical signs of the disease. Administration of Cyanocobalamine led to correction of blood values within three weeks.
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PMID:[Fatigue, exertional dyspnea, unsteady gait]. 281 13

One hundred consecutive patients, 74 women and 26 men, aged between 18 and 83 years (mean = 54.8 years), referred with complaints related to oral galvanism were investigated and treated and the treatment results were evaluated after 2-3 years. Forty of the patients reported facial pain, pain from the teeth, temporomandibular joints (TMJ) and masticatory muscles and TMJ clicking and locking and 26 reported headache. Smarting in the oral mucosa, smarting of the tongue and xerostomia were reported by 26, 21 and 24 patients, respectively, and 30 patients reported an unpleasant taste, a metallic taste or a battery taste. The same patient often reported several symptoms. The patients also reported various general symptoms, above all joint symptoms, pain in the back, neck and shoulders and general muscular pain but also tiredness, weakness, difficulty in concentrating, depression and insomnia. After clinical and radiological examination, salivary tests, determination of the maximum galvanic current at metallic contacts and screening for contact allergy to dental materials, various oral diagnoses could be established. Most of the patients exhibited functional disturbances of the masticatory system, periodontitis, smarting of the oral mucosa, xerostomia, pulpitis and pulpal necrosis and mucosal lesions. The medical illnesses the patients reported themselves to be suffering from or had been treated for included cardiovascular disorders, high and low blood pressure, asthma, rheumatic disorders, diabetes, pernicious anaemia, gastritis and peptic ulcer. Seventy-six patients took drugs regularly. In most cases there were several oral, dental and medical explanations for the symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Results obtained from patients referred for the investigation of complaints related to oral galvanism. 345 16

A 69-year-old woman was admitted to the hospital because of coughing, dyspnea, generalized fatigue, and pretibial edema. A chest X-ray film revealed cardiac enlargement, a left hilar mass, and a small nodule in the right middle lung field. Echocardiography showed a massive pericardial effusion. A chest CT scan showed pericardial effusion, an anterior mediastinal mass, and a small nodule in the right upper lobe. Examination of a percutaneous biopsy specimen showed round and spindle-shaped tumor cells and lymphocyte infiltration, which was consistent with mixed-cell-type thymoma. Hematological examination showed macrocytic anemia, and the concentration of vitamin B12 was 65 pg/ml (249-938 pg/ml). A test for anti-parietal cell antibodies was positive. Our diagnosis was pernicious anemia and stage IVb invasive thymoma (by Masaoka's classification). Because of the intrapulmonary metastasis and pericardial effusion, the patient underwent chemotherapy. The tumor shrank, so a thoracotomy was done. However, the tumor was found to have invaded the heart and large vessels, and it could not be removed. After surgery the thorax was irradiated. Invasive thymoma complicated by pernicious anemia is rare.
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PMID:[Invasive thymoma in patient with pernicious anemia and pericardial effusion]. 929 2

A 32-year-old student reported fatigue and malaise since two months in the absence of specific symptoms. Clinical examination and extensive laboratory testing revealed no abnormalities at his first presentation. Some weeks thereafter, on re-admission, hyperpigmentation suggestive of Addison's disease was observed and pathognomonic autoantibodies directed against the thyroid gland and the adrenal cortex were detected. Further evaluation led to the diagnosis autoimmune polyglandular deficiency syndrome, also named "Schmidt syndrome", comprising adrenocortical insufficiency (Addison's disease) and lymphocytic thyroiditis (Hashimoto thyroiditis). The diagnosis of polyglandular insufficiency is often delayed due to non-specific symptoms at early disease stages and progression may be rapid, culminating in Addisonian crisis under physical stress or infection, requiring immediate high-dose hormone replacement therapy. Hence, careful re-examination is mandatory to ensure adequate treatment before life-threatening complications occur. Nowadays this type of disease is classified as autoimmune polyglandular syndrome type II (APS type II) with an increased risk of developing insulin-dependent diabetes mellitus (IDDM), vitiligo, alopecia, pernicious anaemia, coeliac disease, myasthenia gravis and primary hypogonadism. The cause of the disease remains obscure but in addition to an autosomal dominant trait with variable penetrance some hints at viral infection triggering the disease process exist.
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PMID:32-year old patient presenting with autoimmune polyglandular syndrome. 1131 87

A 81-year-old woman was diagnosed as having diabetes mellitus (DM) at 58 years of age. She started insulin therapy the following year, but her blood sugar levels were poorly controlled. At the age of 75, she tested positive for the anti-GAD antibody (7.8 U/ml) and was diagnosed as having slowly progressive type 1 DM (SPIDDM), as well as vitiligo vulgaris. At 78 years of age, chronic thyroiditis was diagnosed after positive tests for anti-thyroid peroxidase antibody and anti-thyroglobulin antibody. At the age of 81, general fatigue and jaundice appeared concomitantly with severe anemia, with Hb levels at 5.2 g/dl. Low serum vitamin B12 levels and the finding of erythroblastic hyperplasia with megaloblasts in bone marrow led to the diagnosis of pernicious anemia. Anemia was alleviated by intramuscular injections of vitamin B12. The patient developed chronic thyroiditis, vitiligo vulgaris, and pernicious anemia concomitantly with SPIDDM, and was diagnosed as having polyglandular autoimmune syndrome type III. Attention should be paid to these potentially associated autoimmune diseases in daily practice during the follow-up of SPIDDM patients.
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PMID:Slowly progressive type 1 diabetes mellitus associated with vitiligo vulgaris, chronic thyroiditis, and pernicious anemia. 1564 55

Type I gastric carcinoid tumors result from hypergastrinemia in 1%-7% of patients with pernicious anemia. We diagnosed pernicious anemia in a 48-year-old female patient with complaint of fatigue for three months. She had no gastrointestinal symptoms. Endoscopic examination ot the upper gastrointestinal tract revealed atrophic gastritis and a polypoid lesion in the corpus of 3-4 mm in size. Endoscopic polypectomy was performed. Histopathological examination of the specimen revealed positive chromogranin A and synaptophysin stainings compatible with the diagnosis of a carcinoid tumor. Serum gastrin level was increased, urinary 5-hydroxyindoleacetic acid was within the normal range. There was no other symptom, sign, or laboratory finding of a carcinoid syndrome in the patient. No metastasis was found with indium-111 octreotide scan, computed tomographies of abdomen and thorax. Type I gastric carcinoid tumors are only rarely solitary and patients with tumors < 1 cm in size may benefit from endoscopic polypectomy.
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PMID:Treatment of solitary gastric carcinoid tumor by endoscopic polypectomy in a patient with pernicious anemia. 1683 Mar 92

We report about a 27-year-old female with type I diabetes who was admitted with progressive fatigue and a sudden onset of icterus. As the underlying cause, we found pernicious anemia with hemolytic activity as part of polyglandular autoimmune syndrome (PAS) type II. Under vitamin B(12) substitution we saw a quick rise in hemoglobin and improvement of complaints. Type I diabetes is the most frequent component of PAS II, whereas pernicious anemia is a rather rare component; however, a latent form is seen in about 12% of patients with type I diabetes. Therapy for pernicious anemia consists of parenteral vitamin B(12) substitution. Because of an increased incidence of gastric cancer in chronic atrophic gastritis, endoscopic follow-ups of the chronic atrophic autoimmune gastritis seem to be recommended. Due to the diverse characteristic of PAS II, with development of additional components after years of latency, regular follow-up clinical examinations and lab work are mandatory to detect further need of hormone and vitamin replacement that may sometimes be substantial for survival.
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PMID:[Fatigue and icterus in a 27-year-old patient with diabetes mellitus type I]. 1696 70

Pernicious anemia and Vitamin B12 deficiency have a wide range of symptoms and are a common finding in the elderly. A 73 year old female is admitted to the hospital because of dyspnea, fatigue and loss of appetite and weight. While previous medical history and physical examination are inconspicuous, laboratory findings show severe pancytopenia with macrocytosis, low reticulocyte count and marked signs of hemolysis. A very low serum level of vitamin B12 and chronic atrophic type A gastritis upon endoscopy with presence of parietal cell antibodies in the serum lead to the diagnosis of pernicious anemia. Complete restitution is achieved by parenteral vitamin B12 substitution. Nowadays, severe pernicious anemia is only rarely seen. The differential diagnosis of pancytopenia (with macrocytic anemia) combined with hemolysis and the essential hints to the diagnosis of pernicious anemia are discussed, and thereby practical aspects including therapy actualized.
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PMID:[Pancytopenia and hemolysis--diagnosis, differential diagnosis and therapy of pernicious anemia]. 1758 31

A 27-year-old male, who had developed diabetes mellitus type 1 (DMT1) since the age of eighteen and alopecia areata universalis nine months later, attended the outpatient clinics complaining of general fatigue and shortness of breath. A Schilling test was indicative of pernicious anemia. Antigastric parietal cell (AGPA) and anti-intrinsic factor antibodies were positive, confirming diagnosis of pernicious anemia. Thyroid and Addison's disease were excluded. Gastroscopy revealed atrophic gastritis without any evidence of carcinoid tumors. The aim of this case, which, to our knowledge, is the first one to describe a correlation between diabetes mellitus Type 1 (DMT1), pernicious anaemia, and alopecia areata universalis, is to remind the clinician of the increased risk of pernicious anaemia and gastric carcinoids in DMT1 patients. Screening for AGPA followed by serum gastrin and vitamin B(12) levels constitute the most evidence-based diagnostic approach.
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PMID:Pernicious anemia in a patient with Type 1 diabetes mellitus and alopecia areata universalis. 1861 80


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