Evaluating adolescents with fatigue: ever get tired of it?

Abstract

1. Robert M. Cavanaugh Jr, MD* 1. *Associate Professor, Director of Adolescent Medicine, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY. After completing this article, readers should be able to: 1. Describe the key elements of the history and physical examination in adolescents who are fatigued. 2. Develop a differential diagnosis for fatigue in adolescents. 3. Delineate appropriate laboratory and radiologic studies to evaluate adolescents who are fatigued. 4. Describe specific treatments and supportive therapy for adolescents who are fatigued. Unexplained fatigue in adolescents is a common and frustrating complaint that can pose a challenge for even the most experienced physicians. Although the cause usually is benign and self-limited, occasionally there is a serious underlying disorder. This symptom cannot be dismissed without performing a thorough medical history, detailed psychosocial profile, and careful physical examination. Selective use of laboratory and radiologic studies should be considered when specifically indicated. If the cause remains unclear, sequential visits often provide clues for the practitioner and reassurance for the family. The purpose of this article is to offer guidelines to the clinician caring for adolescents who have prolonged, unexplained fatigue and to stress the value of a thorough history and physical examination. For purposes of this discussion, fatigue will be defined as abnormal exhaustion after usual activities. An arbitrary cutoff of 1 month is used to distinguish acute from chronic fatigue. The term chronic fatigue syndrome is avoided because criteria for this condition are not clearly established in children or adolescents, and data must be extrapolated from studies in adults. The term neurally mediated hypotension is used to describe a fall in blood pressure in response to assuming the upright posture, physical events, and emotional stressors. Affected patients may be syncopal or presyncopal. Neurally mediated hypotension also is referred to in the literature as neurocardiogenic syncope, vasovagal reflex, vasodepressor syncope, and autonomic dysfunction. The best way to approach a problem of this nature is to establish a good relationship with …