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  • Nonvoluntary Weight Loss With Increased Appetite

    This circumstance is attributable to increased energy consumption or calorie loss in the urine or stool. While appetite is enhanced, the increased food intake is insufficient to surmount the shortage in energy balance.

    Hyperthyroidism - Hyperthyroidism is a dramatic illustration of autonomic weight loss with enhanced appetite. In one study of patients with Graves' thyrotoxicosis (n = 880), 61 percent had weight loss, and 42 percent had inflated appetite [3]. Weight loss in hyperthyroidism is mainly due to increased energy outlay, on occasion compounded by malabsorption affiliated with increased gastrointestinal motility. Some hyperthyroid patients may lose weight but not have an increase in appetite. Frank anorexia also may occur, particularly in senior patients with "apathetic" hyperthyroidism.

    The degree of weight loss is variable. In one series of 88 hyperthyroid patients, pretreatment weight was 16 percent lower than the premorbid weight. Some young patients have an increment in appetite that exceeds the rise in energy consumption, resulting in weight gain instead of weight loss.

    Uncontrolled diabetes mellitus - Uncontrolled diabetes mellitus is the most familiar cause of weight loss with increased appetite. These findings are particularly conspicuous in patients with new-onset type 1 diabetes mellitus. The weight loss is a consequence of insulin deficiency associated with severe hyperglycemia and the resultant glycosuria. When severe, glycosuria also causes an osmotic diuresis, leading to extracellular fluid volume depletion and further loss of weight.

    Weight loss and elevated appetite in treated patients with diabetes are indicators of poor metabolic control, easily corroborated by measurement of hemoglobin A1c.

    Some young adult females with type 1 diabetes may purposely decrease their insulin dosage in an endeavor to lose weight; this is occasionally accompanied by binge-eating syndrome. This demeanor is rarely mentioned impromptu by the patient and should be looked at in any young patient with diabetes who is losing weight and has poor metabolic control.

    Malabsorption - Patients with malabsorption of any cause may have weight loss with increased appetite. Most, but not all, of these patients have diarrhea, or at least large volume or frequent bowel movements. Malabsorption induced by inflammatory bowel disease, however, most frequently causes weight loss in the context of poor appetite.

    Pheochromocytoma - The exaggerated adrenergic activity in patients with pheochromocytoma may lead to enhanced fundamental metabolic rate and weight loss with increased appetite.

    Pronounced increase in physical activity - Persons who engage in intense training must increment their intake of calories substantially to maintain their weight and muscle mass. Sometimes appetite does not increase sufficiently to maintain body weight, resulting in temporary or persistent weight loss.

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