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Was ist zu tun bei unklarem Gewichtsverlust?

Weight loss of unknown origin

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Zusammenfassung

□ Differentialdiagnose

Ungewollter Gewichtsverlust ist mit erhöhter Mortalität und Morbidität verbunden. Die Differentialdiagnose umfaßt mehr als 50 Erkrankungen, daher wird die diagnostische Strategie weitgehend von anderen, organbezogenen Symptomen bestimmt.

□ Gewichtsverlust als Einzelsymptom

Das Syndrom der „konsumierenden Erkrankung”, also Gewichtsverlust als Einzelsymptom oder im Rahmen eines unspezifischen allgemeinen Krankheitsgefühls, kann wegweisend sein für Tumoren (Bronchial-, Pankreas-, Nierenkarzinom, maligne Lymphome), Infektionen (Tuberkulose, HIV), Systemerkrankungen (Lupus erythematodes, Vaskulitiden), Hyperthyreose, extraintestinalen Morbus Crohn oder psychische Störungen (Depression, psychogene Eßstörungen).

□ Schlußfolgerung

Die Erkennung der Grundkrankheit wird nicht selten verzögert durch eine fehlende Aufmerksamkeit von Arzt oder Patient für das Symptom Gewichtsverlust. Eine Ernährungsberatung und -therapie sollte rechtzeitig begonnen werden.

Abstract

□ Differential Diagnosis

Involuntary weight loss is associated with increased mortality and morbidity. Differential diagnosis includes more than 50 disease entities; therefore the diagnostic strategy is determined by additional symptoms.

□ The syndrome of „consumption”

i. e. weight loss as an isolated symptom or together with malaise, may indicate tumors (lung, pancreas, kidney cancer, malignant lymphoma), infections (tuberculosis, HIV), immunologic diseases (lupus erythematosus, vasculitis), hyperthyroidism, extraintestinal Crohn’s disease, or psychogenic diseases (depression, psychogenic eating disorders).

□ Conclusion

Recognition of the underlying disease is often delayed by a lack of awareness for weight changes, both by physicians and by patients. Nutritional counselling and treatment should be initiated in time.

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  1. Klinik I für Innere Medizin der Universität, Joseph-Stelzmann-Straße, D-50924, Köln

    Achim Schwenk

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Schwenk, A. Was ist zu tun bei unklarem Gewichtsverlust?. Med Klin 93, 719–725 (1998). https://doi.org/10.1007/BF03044808

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