CASE 85: TIREDNESS AND IRRITABILITY
History
A 33-year-old housewife has noticed that she is becoming tired and having difficulty cop-
ing with her two children, aged 6 and 4 years. She goes to see her general practitioner (GP)
because she feels she may be suffering from anxiety and depression. She says that she has
felt more irritable and anxious than usual. Her sleep is normal. Her appetite has been nor-
mal but she has lost some weight. Her change in personality has been noticed by her hus-
band and friends. She feels constantly restless and has difficulty concentrating on a subject
for more than a few moments. Her increased anxiety has developed over the past 3 months.
She has also noticed an increased frequency of bowel movements. Her periods have become
lighter and shorter. She feels extremely tired, and thinks that she has been prone to sweat
more than usual. She has had no significant illnesses previously. She is a non-smoker and
drinks 10 units of alcohol per week.
Examination
She appears agitated and her hands are sweaty and tremulous. Her pulse is 104 and regular,
her blood pressure 130/70 mmHg. Her proximal muscles seem a little weak. There are no
abnormalities in the cardiovascular, respiratory, abdominal or nervous systems. Investigations
are organized by her GP.
NormalHaemoglobin 13.3 g/dL 11.7–15.7 g/dL
White cell count 4.7% 109 /L 3.5–11.0% 109 /L
Platelets 246 % 109 /L 150–440% 109 /L
Sodium 142 mmol/L 135–145 mmol/L
Potassium 4.6 mmol/L 3.5–5.0 mmol/L
Bicarbonate 22 mmol/L 24–30 mmol/L
Urea 5.2 mmol/L 2.5–6.7 mmol/L
Creatinine 78 &mol/L 70–120&mol/L
Glucose 4.2 mmol/L 4.0–6.0 mmol/LUrinalysis: no blood; no proteinINVESTIGATIONS
Questions
- What is the most likely diagnosis?
- How would you manage this patient?