EVALUACIÓN DEL
PACIENTE CON
PÉRDIDA DE PESO
DRA. MAUREIRA PAMELA
DRA. CORRADO ROSINA
DEFINICIÓN
La pérdida de más del 5 % del peso
corporal inicial durante un período
de 6 a 12 meses.
Es el resultado de la disminución en
la ingesta energética, el aumento del
gasto, o la pérdida por orina o heces.
CLASIFICACIÓN
INVOLUNTARIA
VOLUNTARIA
CLASIFICACIÓN
Involuntaria: con disminución o aumento
del apetito, es casi siempre un signo de
una grave enfermedad, psiquiátrica o
médica
 Voluntaria: paciente con sobrepeso, o
puede ser una manifestación de
enfermedad psiquiátrica

IMPORTANTE
Historia Clínica
Examen Físico
Es la pérdida de peso voluntaria o
involuntaria?
 El apetito se encuentra aumentado o
disminuido?
 Cuál es la magnitud de la pérdida de peso,
en números absolutos y en porcentaje?
 En qué medida el paciente ha cambiado de
peso durante la vida adulta?
 En cuánto tiempo el paciente ha ido
perdiendo peso?

Pérdida de
Peso
Voluntaria
Involuntaria
Con apetito
Sin apetito
VOLUNTARIO
 Obesidad
 Anorexia
nerviosa – bulimia
 Drogas anorexígenas
 Profesiones
INVOLUNTARIA
Con aumento de apetito
 Hipertiroidisimo
 Diabetes mellitus no contolada
 Malabsorción
 Feocromocitoma
 Aumento de la actividad física
HIPERTIROIDISMO
61% perdieron de peso
 42% aumento de apetito
 16% disminución del peso
 Ancianos

To determine if aging modifies the clinical presentation of
hyperthyroidism and the signs of thyrotoxicosis in older
people.
DESIGN: Prospective cohort study. SETTING: A French
university hospital. SUBJECTS: Eighty-four new patients with
overt hyperthyroidism confirmed chemically between
January 1992 and January 1993. Controls were 68 older
euthyroid patients matched to the older hyperthyroid
patients. MEASUREMENTS: Comparison of 19 classical
signs of hyperthyroidism between 34 older patients (> or =
70 years; mean age 80.2) and 50 younger patients (< or =
50 years; mean age 37.4). Older patients were also
compared with controls (mean age 81.3). RESULTS: Three
signs were found in more than 50% of older patients:
tachycardia, fatigue, and weight loss. Seven signs were
found significantly less frequently in older patients (P <
.001): hyperactive reflexes, increased sweating, heat
intolerance, tremor, nervousness, polydipsia, and increased
appetite. Only anorexia (32% vs 4%) and atrial fibrillation
(35% vs 2%) were more found frequently in older people (P
< .001). A goiter was present in 94% of the younger and in
50% of the older patients (P < .001). The mean number of
clinical signs found in the older subjects was significantly
smaller than the number found in younger patients (6 vs
10.8; P < .001). Comparison with older controls showed
three signs that were highly associated with thyrotoxicosis
in older people: apathy (Odd ratio (OR): 14.8), tachycardia
(OR: 11.2), and weight loss (OR: 8.7). CONCLUSION: This
study confirms the paucity of clinical signs of
hyperthyroidism in older adults. These results suggest the
necessity of routine screening for thyroid disease in this
age group
(Arch Intern Med 1988 Mar;148(3):626-31.)
DIABETES MELLITUS
Causa más común
 Diabetes tipo 1 + trastornos de la
alimentación

Eating disorders and IDDM. A problematic association.
IDDM and eating disorders are common conditions in young
women. Whether a specific association exists between these two
disorders remains controversial. Some studies have suggested an
increased incidence of eating disorders in young women with
IDDM, whereas others have not detected such an increase. These
differences may be attributable, at least in part, to methodological
issues in study design, measurement tools, and relatively small
sample sizes. Whether the prevalence of eating disorders in IDDM
is increased will be resolved only by larger studies that use
standardized diagnostic interviews. We suspect that certain
aspects of IDDM and its management may trigger the expression of
an eating disorder in susceptible individuals. Required dietary
restraint and weight gain related to diabetes management are the
factors most likely to be implicated. Eating disorders are relatively
common in young women with IDDM and may contribute to
impaired metabolic control with hypoglycemia and DKA, and to
long-term microvascular complications of diabetes. Omission or
reduction of required insulin, an extremely common means of
weight control in these young women, is likely an important factor
in this regard. Further research is required to determine more
precisely the relationship between IDDM and eating disorders, and
the effects of eating disorders on metabolic control and chronic
complications of IDDM
( Diabetes Care 1992 Oct;15(10):1402-12.)
INVOLUNTARIA
Con pérdida de apetito
Cáncer
 Infección por HIV
 Endocrinopatías
 Enfermedad Cardiopulmonar
 Enfermedad Crónica
 Alteraciones Psiquiátricas
 Abuso de sustancias y medicación

INFECCIÓN POR HIV
Pérdida gradual: enfermedad intestinal
 Pérdida rápida: enfermedad secundaria

ENDOCRINOPATÍAS
Insuficiencia suprarrenal
 Hipercalcemia
 Hipertiroidismo
 Diabetes Mellitus

CÁNCER
36% pérdida de peso
 + frec tracto digestivo

Unintentional Weight Loss
A Retrospective Analysis of 154 Cases
Unintentional weight loss (UWL) was documented in 154
patients (2.8%)admitted to an internal medicine department
during a two-year period. A retrospective analysis of the clinical
charts showed that more than one third 36.3% were found to
have a neoplasm, involving preponderantly the gastrointestinal
tract. Patients with neoplasia were older and more frequently
Had abnormal physical findings and significantly lower values of
serum albumin as well as higher values of alkaline
phosphatase
than other patients. Despite extensive investigations, in 36
patients 23.3% UWL remained unexplained even after
Prolonged follow-up periods. The remaining 62 patients had a
variety of disorders, preponderantly gastrointestinal tract (26
patients) and psychiatric (16 patients) diseases. Endocrinologic
disorders such as diabetes mellitus and hyperthyroidism were
relatively uncommon 3.8%). Unintentional weight loss is a
relatively common problem in clinical practice.Familiarity with
the spectrum of disorders associated with UWL as well as
Selected clinical and laboratory values may help in the initial
examination of these patients.
(Arch Intern Med 1986;146:186-187)
Paciente de 65
años
Pérdida de peso - hiporexia
Infección HIV
Cáncer
Enfermedad
Cardiopulmonar
Enfermedad
Crónica
Pérdida de peso
involuntaria
con pérdida de
apetito
anemia
ldh
albúmina
DBT
controlada
Laparotomía
Exploradora
Alt. psiquiátricas
Abuso de
sustancias
Endócrinopatías
Linfoma Intestinal
GRACIAS