Cachexia

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Cachexia
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ICD-10 R64
ICD-9 799.4

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Cachexia (pronounced /kəˈkɛksiə/) is loss of weight, muscle atrophy, fatigue, weakness and significant loss of appetite in someone who is not actively trying to lose weight. It can be a sign of various underlying disorders; when a patient presents with cachexia, a doctor will generally consider the possibility of cancer, certain infectious diseases (e.g. tuberculosis, AIDS) and some autoimmune disorders, or addiction to drugs such as amphetamines or cocaine. Cachexia physically weakens patients to a state of immobility stemming from loss of appetite, asthenia, and anemia, and response to standard treatment is usually poor.

Disease settings

Cachexia is often seen in end-stage cancer, and in that context is called "cancer cachexia". It was also prevalent in AIDS patients before the advent of triple-therapy for that condition; now it is seen less frequently in those countries where such treatment is available. In those patients who have Congestive Heart Failure, there is also a cachectic syndrome. Also, a cachexia co-morbidity is seen in patients that have any of the range of illnesses classified as "COPD" (chronic obstructive pulmonary disease), particularly emphysema. Some severe cases of schizophrenia can present this condition where it is named vesanic cachexia.[1]

In each of these settings there is full-body wasting, which hits the skeletal muscle especially hard, resulting in muscle atrophy.

Mechanism

The exact mechanism in which these diseases cause cachexia is poorly understood, but there is probably a role for inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α) -which is also nicknamed cachexin for this reason-, Interferon gamma (IFNɣ), and Interleukin 6 (IL-6), as well as the tumor secreted proteolysis inducing factor (PIF).

Related malnutrition syndromes are kwashiorkor and marasmus, although these do not always have an underlying causative illness; they are most often symptomatic of severe malnutrition.

Those suffering from the eating disorder anorexia nervosa appear to have high plasma levels of ghrelin. Ghrelin levels are also high in patients who have cancer-induced cachexia (Garcia et al 2005).

Causes

Common Causes

Causes by Organ System

Cardiovascular Cardiac cachexia, Congestive heart failure, Endocarditis, Polyarteritis nodosa
Chemical / poisoning Mercury
Dermatologic No underlying causes
Drug Side Effect Amphetamine, Cidofovir, Pergolide, Pramipexole
Ear Nose Throat No underlying causes
Endocrine Addison's disease, Paraneoplastic syndrome
Environmental No underlying causes
Gastroenterologic Celiac disease, Chronic diarrhea, Crohn's disease
Genetic Andrade's disease, Cystic fibrosis
Hematologic No underlying causes
Iatrogenic Chemotherapy, Radiotherapy
Infectious Disease AIDS, Atypical pneumonia, Brucellosis, Hepatitis B, Leishmaniasis, Lung abscess, Mycobacterium tuberculosis, Sepsis, Trypanosomiasis, Tuberculosis, Visceral leishmaniasis
Musculoskeletal / Ortho Riley-Shwachman syndrome
Neurologic Familial amyloid polyneuropathy, Multiple sclerosis, Riley-Shwachman syndrome
Nutritional / Metabolic Metabolic acidosis
Obstetric/Gynecologic No underlying causes
Oncologic Acute myelosclerosis, Breast cancer, Cancer cachexia, Chronic lymphocytic leukaemia, Colorectal cancer, Kaposi sarcoma, Leukemia, Liver cancer, Malignancy, Metastatic neoplasm, Myeloma, Pancreatic cancer, Paraneoplastic syndrome, Stomach cancer
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric Anorexia nervosa, Depression
Pulmonary COPD, Atypical pneumonia, Lung abscess
Renal / Electrolyte Chronic renal failure
Rheum / Immune / Allergy Mastocytosis, Sarcoidosis, Systemic lupus erythematosus, Polyarteritis nodosa
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Starvation

Causes in Alphabetical Order


References

  1. "Vesanic" means demented.

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