RESUMO
In this article we describe the causes and diagnostic work-up of unintentional weight loss. It is defined as loss of weight of at least 5% in 6 months. There is both attention to somatic and functional causes of weight loss, as well as iatrogenic causes like side-effects of medication. Referrals to medical specialists for diagnostics are discussed and also the role of dieticians in screening and treatment. Special attention is given to weight loss by malabsorption. Although malignancies as a reason of weight loss is rare in primary care, in secondary care it may be present up to 30%. Treatment of unintentional weight loss may be necessary by high caloric dietary foods when functional decline is obvious, although there is hardly indication for prescribed medication, guidelines for treatment is given.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Neoplasias , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Humanos , Neoplasias/complicações , Encaminhamento e Consulta , Redução de PesoRESUMO
Insulin can be measured by immunochemical methods using polyclonal or monoclonal antibodies. Monoclonal antibodies are specific in the detection of pure human insulin, and may show little to no cross reactivity with pro-insulin or recombinant insulin. Polyclonal antibodies, however, do show such cross reactivity. Most medical laboratories use commercial (monoclonal) methods to measure insulin 75% of which are not capable of detecting pro-insulin or exogenous insulin. This pitfall in diagnostics may lead to prolonged uncertainty for both patient and physician, which we illustrate with two patients. The first patient was a 45-year-old woman with DM type 1 who for years suffered from hypoglycaemic attacks. Factitious hypoglycaemia went undiagnosed because our monoclonal assay did not detect the overdose insulin analogues. The second patient was a 47-year-old woman with recurrent hypoglycaemic attacks. An insulinoma, which produced pro-insulin, was only detected after using polyclonal insulin and specific pro-insulin assays.