230 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE
PHYSICAL FINDINGS
- Elevated resting HR (usually >10 bpm over baseline);
decreased LBM; depressed mood on various evalua-
tion tools; otherwise essentially normal examination.
DIFFERENTIAL DIAGNOSIS (HAWLEY
AND SCHOENE, 2003)
COMMONCAUSES
- Caffeine withdrawal, environmental allergies, exercise-
induced asthma, infectious mononucleosis, insufficient
sleep, iron deficiency with or without anemia, over-
training, performance anxiety, mood disorder (anxiety,
depression, adjustment reaction), psychosocial stress,
and upper respiratory infection.
LESSCOMMONCAUSES
- Dehydration, diabetes mellitus, eating disorder, hep-
atitis (A, B, or C), hypothyroidism, inadequate car-
bohydrate or protein intake, lower respiratory
infection, medication side effect (antidepressants,
antihistamines,anxiolytics, beta-blockers), post con-
cussive syndrome, pregnancy, and substance abuse.RELATIVELYRARE, BUTIMPORTANT- Adrenocortical insufficiency or excess, congenital or
acquired heart disease, arrhythmia, bacterial endocardi-
tis, congestive heart failure, coronary heart disease,
hypertrophic cardiomyopathy, myocarditis/pericarditis,
HIV, malabsorbtion, lung disease, Lyme disease,
malaria, malignancy, neuromuscular disorder, renal
disease, and syphilis.
EVALUATION (FIG. 38-1)FIRSTVISIT
•A thorough history focusing on chief complaint, train-
ing program, diet, medications, nutrition, illness,
review of systems, and an assessment of the goals of
the athletes training program.- Initial lab studies to consider include complete blood
count (CBC), erythrocyte sedimentation rate(ESR),
metabolic panel, thyroid-stimulating hormone(TSH),
FIG. 38-1 Evaluation of fatigue in an athlete.