por What is constitutional syndrome?
He constitutional syndromeor 3 A syndrome, is a disease characterized by 3 components: asthenia, anorexia, and significant weight loss or weight loss, which is involuntary.
ANDThis syndrome must occur without being accompanied by another symptom or sign that guides the diagnosis towards a disease of a certain organ or system.
Constitutional syndrome is a clinical challenge for professionals, as it can be difficult to diagnose and requires extensive evaluation to detect it. Also, you can have various Causes.
The constitutional syndrome can present different levels of severity, where the maximum degree is cachexia, which is a significant loss of weight, fatigue, muscle atrophy and malnutrition, and is sometimes linked to the appearance of cancer.
On the other hand, it is a condition that can occur at all ages, although it is more common in advanced ages, since loss of appetite and weakness tend to occur in these stages.
There are different concepts in the literature to define this condition, such as general syndrome, general involvement syndrome, cachexia-anorexia-asthenia syndrome, cachectic syndrome, etc.
Components of the constitutional syndrome
Asthenia
It means lack of energy or physical and mental weakness to carry out daily activities that were previously carried out normally, and it is the least obvious manifestation of the syndrome.
Approximately 25% of the patients who come to the consultation say they have fatigue or weakness, although it does not mean that they are going to present this syndrome.
If it appears in isolation, without other symptoms, it can even be functional because it gives the signal for our body to rest in the face of long periods of stress. However, in this syndrome it is accompanied by other manifestations, which is why it constitutes a problem to be treated.
Organic and functional asthenia differ in that they have different causes, in duration (the functional one lasts longer), the fluctuating course, the resistance to physical exercise, and other symptoms (in the functional one it appears imprecise, poorly delimited).
In this situation, the professional will try to rule out possible organic causes first.
Anorexy
In this case, it is defined as a significant lack of appetite not caused by other problems, such as those associated with the oral cavity, loss of teeth, or lack of smell. That is, it is verified if it is due to other specific causes.
To find out if a person has reached cachexia, the following criteria are used:
– Unintentional weight loss of more than or equal to 5% in less than 6 months.
– Body mass index (BMI) less than 20 in those under 65 years of age, and less than 22 in those over 65.
– Low body fat index (less than 10%).
– Low albumin levels.
– Elevated blood cytokines.
The lack of appetite is associated with the next component, that of weight loss or slimming.
slimming
It leads to involuntary weight loss, mainly fatty tissue. This begins to be considered serious when 2% of the weight is lost in a month involuntarily, in 3 months more than 5% and in 6 months, more than 10%.
This weight loss can be associated, as we said, to the previous point (lack of appetite), to problems in the digestive system, poor absorption of nutrients, sitophobia or fear of eating or dementia.
If it continues to be given despite increasing caloric intake, it may be due to diabetes mellitus, hyperthyroidism, or diarrhea.
In cancer, this weight loss may be due to multifactorial causes: digestive tumors that compress the organs, activation of necrosis factors, or side effects of other treatments.
In constitutional syndrome it is important to know that this loss is not due to a period of voluntary diet, diuretics or other diseases. To calculate how much weight has been lost, this formula is used:
Percentage of body weight lost = Usual weight – Current weight x 100 / Usual weight
Types of constitutional syndrome
The typical classification consists of:
– Complete constitutional syndrome: presents the 3 components explained above.
– incomplete constitutional syndrome: weight loss, which is an essential symptom, is accompanied either only by asthenia, or only by anorexia.
Causes
The main causes consist of:
Non-tumor organic diseases (in 40% of patients)
The syndrome is often due to gastrointestinal diseases, such as intestinal inflammation, ulcers, celiac disease, swallowing problems, pancreatitis, etc.
It can also be associated with diseases of the endocrine system, such as hyper or hypothyroidism, diabetes mellitus or, in rarer cases, pheochromocytoma or hyperparathyroidism.
On the other hand, it can arise from infections such as tuberculosis, fungemia, parasites, HIV, etc. Or be related to connective tissue, lung or kidney diseases. In the latter, weight loss associated with hemodialysis is the situation that produces more morbidity and mortality.
Cardiovascular alterations can be part of the etiology of the constitutional syndrome, causing the individual to lose weight for multiple reasons, such as hypercatabolism (protein synthesis or degradation very rapidly) or lack of appetite.
It is linked on several occasions to mesenteric ischemia (causing lack of blood supply to the small intestine). On the other hand, cachexia has been associated with severe heart failure.
Interestingly, a person who takes many drugs can also develop this syndrome, mainly causing weight loss in the elderly.
Tumors or neoplasms
The constitutional syndrome can be caused by tumors (about 25% of those affected) or neoplasias, which consists of the development of new tissue in some part of the organism, which can be malignant or benign.
In 50% of patients with tumors have metastases when diagnosed. The most common are gastrointestinal, followed by genitourinary and then oncohematological.
Neurological diseases
Neurological deterioration is producing visceral dysfunction and, therefore, a reduction in food intake. The most frequent associated with the syndrome are cerebrovascular accidents, dementia, multiple sclerosis or Parkinson’s.
psychiatric causes
Mental disorders, surprisingly, can also set up a cause for constitutional syndrome.
For example, depression can lead to this condition in 1 in 5 affected. Mainly these disorders include eating disorder, dementia or somatization disorder.
Social causes
It is important to take into account that, in disadvantaged areas of the world, especially older adults can present this syndrome due to not being able to access adequate food.
Diagnosis
To diagnose it, the criteria that we have previously exposed must be met, classifying it as complete or incomplete.
Once the professional makes sure that these diagnostic criteria are met, he asks the patient about his personal history (diseases, occupation, housing…) and family history (if there is a history of other diseases, cancer or mental disorders).
Data will be obtained on physical activity, or if you lead a sedentary or active life, the way you eat, if you consume drugs or drugs. To know the severity of the symptoms, the duration of these will be questioned and in what way it is affecting the person’s life.
As for the physical examination, a blood test, a urinalysis, a basic biochemical test, checking for hidden blood in the stool, and an abdominal ultrasound are usually performed.
If it has not been possible to reach a specific diagnosis even after exhaustive exploration, a diagnosis of constitutional syndrome of unknown origin can be reached (after a minimum of 3 weeks of study in hospital).
And it is recommended that a follow-up be carried out every two months at the beginning, and later, every six.
Treatment
Obviously, the treatment of constitutional syndrome is individual, that is, it is completely adapted to the symptoms and problems that each patient presents.
For this, in addition to taking into account the symptoms, the etiology, the phase of the disease, the therapeutic options that exist, the impact of the problem on the functioning of the person, etc. will be assessed.
multidisciplinary intervention
The best way to address constitutional syndrome is through a multidisciplinary intervention, involving several professionals: doctors, nurses, nutritionists, occupational therapists, physiotherapists, psychiatrists, etc.
In the first place, a nutritional change of the patient supervised by a professional is insisted on.
Efforts are made for the affected person to increase the amount of calories they consume through a high-calorie diet adjusted to their preferences and needs, avoiding food restrictions. In some cases, it may be advisable to take nutritional supplements.
Drugs
In general, certain drugs may be useful, such as megestrol acetate or low doses of corticosteroids (such as dexamethasone or prednisone), which serve to improve symptoms of anorexia and loss of energy (asthenia). Other drugs used are cyproheptadine and metoclopramide.
However, since this syndrome can be so variable in each individual, the risks and benefits of taking these drugs should be assessed individually, since they can have adverse effects, such as hypertension, insomnia, adrenal insufficiency, gastrointestinal disorders, etc.
It is also important that if there are complications that have generated the disease, action is taken on them.
That is why it is essential to know what has caused the syndrome, because that is where the treatment will focus: if there is hyperthyroidism, neoplasms, neurological diseases, gastrointestinal problems, etc.
References
Castro Alvirena, J., & Verdejo Bravo, C. (2014). Diagnostic protocol and treatment of constitutional syndrome in the elderly. Medicine. General syndrome (sf). Retrieved from the University of Cantabria. Suárez-Ortega, S., Puente-Fernández, A., Santana-Baez, S., Godoy-Díaz, D., Serrano-Fuentes, M., & Sanz-Peláez, O. (2013). Constitutional syndrome: clinical entity or catch-all. IMSS Medical Journal.