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Asthenia

Weakness, loss of strength or lack of energy is described as Asthenia. This weakness results in reduced strength thus making it difficult for a person to perform or complete a task. This condition may be indicative of a larger problem/disease. Asthenia is experienced differently by different people thus making it difficult to understand the underlying problem.


The entire body may be affected or only a part of the body may be affected. Asthenia can affect people belonging to any age group. A person suffering from asthenia may not be in a position to complete any task. Asthenia as a condition may be continuos, chronic or temporary. It is more a symptom than a condition itself. It is not life threatening; but it does affect the quality of life. The weakness experienced can either be perceived or true.


Weakness is classified as true weakness when there is an actual loss in muscle strength and capability that may have been caused due to an injury or muscle defect. Weakness is termed as perceived weakness when the muscles of a person are functioning well and yet he feels unable to complete the task. This type of weakness is non-neuromuscular weakness.


Asthenia symptoms

Symptoms may vary depending on how much of the body is affected; part of the body or the entire body. The symptoms also vary depending on the underlying condition and other symptoms that exist. When the entire body is affected, the symptoms include:


  • Tiredness
  • Flu/Fever
  • Lack of energy
  • Loss of muscle strength
  • Physical discomfort
  • Inability to complete tasks
  • Feeling unsteady/wobbly sensation
  • Slow movements

When only part of the body is affected, the symptoms include slow movement, muscle twitching and muscle cramps. If asthenia is present along with other symptoms like extreme pain, slurred speech, confusion, change in vision etc, it needs immediate medical attention.


Common causes for asthenia include:

Sedentary lifestyle: Leads to muscle waste, muscle fibers are replaced by fat due to inactivity thereby reducing muscle fitness.

Advancing age: With age, the muscles in the body loosen or weaken.

Infection: Infection leads to muscle inflammation thus making it weak.

Chronic diseases: Chronic diseases may reduce blood and nutrient supply to muscles thus making them weak.

Vitamin deficiency; in particular vitamin B9

Anxiety or depression

Adverse effects of certain medicines

Treatment for other diseases like radiation therapy or chemotherapy

Chronic lung disease

Drug abuse.


Asthenia classified as per cause

Asthenia can be classified based on what causes the condition. Common types include:


Infectious asthenia: Any prolonged infection in the body like tuberculosis, hepatitis, infective endocarditis can cause this condition. Asthenia neoplastic: Caused due to cancer.

Asthenia neurological: Parkinson's disease, narcolepsy, multiple sclerosis may cause asthenia.

Asthenia endocrine and metabolic: Hypothyroidism, hyperparathyroidism, misunderstood or unbalanced diabetes, kidney failure and anemia

Asthenia digestive origin: Celiac disease, non-infectious hepatitis, cirrhosis, Hemochromatosis, inflammatory bowel disease

Systemic disease: Auto-immune diseases can affect multiple organs and lead to this condition.

Asthenia cardiovascular: Heart failure, chronic respiratory disorder, arrhythmia, sleep apnea.

Asthenia original toxic or drug: Psychotropic drugs, beta-blockers, calcium channel blockers.

When no cause is identified, asthenia is classified as functional asthenia.


Asthenia treatment

The underlying cause of asthenia determines the treatment. Based on what has caused asthenia, treatment is prescribed.


  • Antibiotics or corticosteroids are prescribed depending on the underlying cause.

  • Correction of hormonal deficiency and vitamin deficiency also helps.

  • Unhealthy lifestyle can lead to functional asthenia. A balanced diet, sufficient sleep and a healthy lifestyle can help overcome the condition.

Paraneoplastic Syndrome

The first report of Paraneoplastic syndrome is attributed to a French physician, M Auche, who described the involvement in a peripheral nervous system in cancer patients in 1890. This syndrome is a group of signs and symptoms caused by a substance that is produced by a tumor, or in reaction to a tumor. Paraneoplastic syndrome is defined as a rare disorder triggered by a response to neoplasm of an immune system that is altered. These are clinical syndromes produced by tumor although they occur remotely from the tumor itself.


The symptoms may be of any nature – endocrine, neuromuscular or musculoskeletal, cardiovascular, cutaneous, hematologic, gastrointestinal, renal or miscellaneous. Fever is the most common sign. Other clinical symptoms may be benign but syndromes could be varied; from a malignant carcinoid syndrome to Cushing syndrome. In cancer patients, the central nervous system involvement can be detected and it is a prominent manifestation of cancer.

Because of their protean manifestations, Paraneoplastic syndromes are managed by a medical team of physicians, including medical oncologists, surgeons, radiation oncologists, endocrinologists, hematologists, neurologists and dermatologists.


Causes

This syndrome can be due to a number of causes, including hormones or biologically active products, made by tumor, which blocks normal hormone, autoimmunity, immune-complex production and immune suppression. But, this is not caused by the primary tumor itself, or by its metastases, or by compression, infection, nutritional deficiency, or treatment of tumor.

Patients with family history of malignancies are at an increased risk and should be screened for cancer. Paraneoplastic syndromes occur typically among middle-aged to older patients. They are mostly diagnosed with cancers of the lung, breast, ovaries, or lymphatic system or lymphoma.

These symptoms sometimes appear before the diagnosis of a malignancy. When the tumor breaks immune tolerance and begins to attack the normal tissue expressing that protein, this syndrome become prominent.


Types of Paraneoplastic Syndrome

Due to the complexity of this syndrome, its clinical presentations may vary greatly. Hence, Paraneoplastic syndromes is divided into four main categories - endocrine, neurological, mucocutaneous, and hematological syndromes as well as a host of others including rheumatologic, renal, gastrointestinal, Cutaneous and miscellaneous.


Fever, dysgeusia, anorexia, and cachexia are included under miscellaneous category. Fever is associated with lymphomas, acute leukemias, sarcoma and carcinomas.

Rheumatologic syndrome includes polyarthritis, particularly in patients with myelomas, lymphomas, acute leukemia, malignant tumors of the colon, pancreas, prostrate. Scleroderma may precede the evidence of tumor. Widespread form of malignancies of breast, uterus and lung can be observed.

Renal syndrome is characterized by hypokalemic nephropathy, and it occurs in 50% of individuals with ACTH secreting tumors of the lung. Nephrotic syndrome is observed in patients with Hodgkin lymphoma, non Hodgkin lymphoma, malignancies of lung, thyroid, colon, breast, ovary and pancreatic head.

Watery diarrhea and electrolyte imbalance, leads to asthenia, confusion and exhaustion, all characteristic of gastrointestinal syndromes. Severe prostaglandins lead to malabsorption and unavailability of nutrients.


Hematologic syndromes are related to anemia, thrombocytosis, disseminated intravascular coagulation, and leukemoid reactions from several types of cancers. Leukemoid reactions due to immature white blood cells in the blood stream are accompanied by hypereosinophilia and itching.

Cutaneous syndromes are manifested by itching and flushes, alopecia, or hypertrichosis. Blackish pigmentation of the skin usually occurs in patients with metastatic melanomas or pancreatic tumors.

Endocrine syndromes resemble common endocrine disorders. Increased serum and urine cortisol concentrations are common examples of this malignancy.


Neurologic or neuromuscular syndromes relate to cancers and such disorders affect 6% of all patients with cancer. Neuromuscular symptoms mimic common neurological conditions. Myasthenia gravis is a common Paraneoplastic syndrome in patients with thymoma, a malignancy arising from epithelial cells of the thymus.

Paraneoplastic limbic encephalitis is characterized by depression, seizures, irritability and short term memory loss and neurologic symptoms rapidly resemble dementia.

Paraneoplastic cerebellar degeneration causes gait difficulties, dizziness, nausea and diplopia. Sensory neuropathy affects lower and upper extremities and there is progressive memory loss, either symmetric or asymmetric.


Diagnosis

As Paraneoplastic syndromes may evolve over weeks to months, they usually stabilize regardless whether the patient's underlying condition improves or worsens. Since this is the first manifestation of cancer, patients should undergo investigation for cancer. Other diagnoses are membrane disease, dementia, encephalopathy, encephalitis, myelitis, anemia, bone marrow failure, chronic fatigue syndrome, mixed connective tissue disease, polycythemia vera and polymyalgia rheumatica among others.

Complete laboratory tests in blood, urine, cerebrospinal fluid, protein electrophoresis, assays for auto antibodies, Endoscopy and imaging studies including whole body scans and FDG-PET scans are prescribed to detect extremely small tumors especially useful for patients with neurologic diseases.


Treatment of Paraneoplastic Syndrome

Treatment for this syndrome varies depending upon the type and location of tumors. The first option of treatment of the underlying tumor is by therapeutic protocols, a combination of surgery, radiation, chemotherapy. Second therapeutic option is for patients with clearly identifiable antibodies by intravenous immunoglobulins, steroids, or plasma exchange.

Surgical treatment is typically directed toward the underlying neoplasm although some Paraneoplastic disorders may resolve rapidly without surgery on the primary tumor.



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Bibliography / Reference

Collection of Pages - Last revised Date: November 22, 2019