This article is more than 5 years old. Information may no longer be current.
What is the cause of the anorexia?
Click Here to Manage Email Alerts
In 1995 my patient had a successful renal transplant made necessary by his polycystic kidney disease. He has done well since until a few moths ago when he presented with acute pancreatitis that required total pancreatectomy. The etiology of the pancreatitis remains unknown.
Since that surgery he has been maintained on tube feeding for 12 hours every night, initially in the hospital and subsequently at home. Attempts to wean him off this have not been successful because he has absolutely no appetite and takes only very small amounts from each meal. For the past two months he has not gone 48 hours without tube feeding.
My involvement in his care came when he recently presented with marked hyperglycemia, ~ 650 mg/dL. Glycemic control has been very satisfactory since then but he still cannot be weaned from the tube feeding and the reason for this escapes me.
The patient is a 61-year-old single man who retired shortly after his transplant but does not seem to have much life outside his home and not many friends or companions. He has a hobby as a collector of antiques and seems quite satisfied with his lot. I could not convince myself that he was markedly depressed. His only medications are insulin, a statin and prednisone (which he has been on since his transplant).
When he started prednisone he gained 50 lb in six months but has gradually lost that extra poundage and his weight is stable. He has no change in bowel habits, no abdominal discomfort and generally feels well aside from the two episodes (pancreatitis and marked hyperglycemia) that landed him in hospital. He appears well nourished but that of course is the effect of tube feeding.
He has no neurologic abnormalities by history or physical examination. He is clinically euthyroid and eugonadal, although he has no libido — a long-standing non-issue for him. Labs are pending. Abdominal examination was normal. Estimated glomerular filtration rate has been stable at ~ 80 for more than a year aside from the two acute episodes resulting in admission to hospital. None of the many radiologic evaluations has offered any additional diagnostic clues.
What major diagnosis am I missing?