Night Sweats and Weight Loss: Your Symptoms and Next Steps

Night sweats and persistent weight loss?

Hello Doctor, in early October, I visited the gastroenterology department due to issues with bowel sounds, bloating, and diarrhea.
The physician diagnosed me with functional dyspepsia.
Later, feeling uneasy, I went to another hospital for an upper endoscopy; I had undergone a colonoscopy at the end of last year, and both physicians advised against repeating it.
However, I insisted on having an abdominal CT scan, which showed no abnormalities.
After taking medication, I experienced some improvement, but the bowel sounds issue persists (very frequent, three to four times a minute when lying down).
By the end of November, I noticed I started having night sweats, and my weight has gradually decreased (from 71 kg in September to 64 kg now, height 170 cm).
In early December, I consulted an endocrinologist, and after blood and urine tests, everything was normal except for ketones at 4+.
Last week, I visited the infectious disease and hematology-oncology departments at Taipei Medical University, where they ruled out HIV, syphilis, white and red blood cell counts, CRP, LDH, ESR, IGG, IGM, IGA, IGG4, thyroid, adrenal, and liver function, all of which were normal.
However, I still experience night sweats while sleeping, and my weight continues to decrease (I am making an effort to eat).
Additionally, the bowel sounds issue has not improved, and I have recently developed a slight cough and low-grade fever (37.0-37.5°C).
I am really feeling overwhelmed and would like to ask which specialty I should consult next...
(I have also visited a psychosomatic medicine department).
Currently, I have been taking anxiety medication for five days with little effect.

A-Zhen, 20~29 year old female. Ask Date: 2021/12/19

Dr. Ye Qianyu reply Family Medicine

Hello! Based on your description, I recommend that you consult a pulmonologist.

Reply Date: 2021/12/19

More Info

It sounds like you are experiencing a complex set of symptoms that are causing you significant distress. Based on your description, you have been dealing with gastrointestinal issues, night sweats, and unintentional weight loss, which can be concerning. Let's break down your symptoms and discuss potential next steps.

Understanding Your Symptoms
1. Gastrointestinal Issues: You mentioned experiencing bowel sounds, bloating, and diarrhea, which were initially diagnosed as functional dyspepsia. Functional gastrointestinal disorders can often be exacerbated by stress, dietary choices, and lifestyle factors. It is good that you have undergone various tests, including endoscopy and CT scans, which have ruled out serious conditions.

2. Night Sweats: The onset of night sweats can be attributed to several factors, including hormonal changes, infections, or even anxiety. Since you have already ruled out infections and other serious conditions, it may be worth considering whether stress or anxiety could be contributing to your symptoms.

3. Weight Loss: A significant weight loss of about 7 kg (from 71 kg to 64 kg) over a few months is concerning, especially if it is unintentional. Weight loss can occur due to a variety of reasons, including decreased appetite, malabsorption, or increased metabolic demands. Given your gastrointestinal symptoms, it is possible that your body is not absorbing nutrients effectively.

4. Dry Cough and Low-Grade Fever: The presence of a dry cough and low-grade fever could indicate an underlying infection or inflammatory process. However, since you have already been evaluated for various infections, it may be necessary to consider other causes, such as allergies or even a reaction to medications.

Next Steps
Given the complexity of your symptoms, it is essential to approach this systematically:
1. Follow-Up with a Gastroenterologist: Since your gastrointestinal symptoms are persistent, a follow-up with a gastroenterologist may be beneficial. They may consider further testing, such as a hydrogen breath test to check for conditions like small intestinal bacterial overgrowth (SIBO) or food intolerances.

2. Endocrinology Consultation: Since you have experienced significant weight loss and night sweats, it may be worthwhile to consult an endocrinologist to evaluate your hormonal levels further. Conditions such as hyperthyroidism or adrenal insufficiency can lead to similar symptoms.

3. Psychiatric Evaluation: Since you have already visited a mental health professional, it may be helpful to explore whether anxiety or depression could be contributing to your physical symptoms. Sometimes, psychological stress manifests as physical symptoms, and addressing mental health can lead to improvements in physical health.

4. Nutritional Support: Given your weight loss and gastrointestinal issues, consulting with a nutritionist may help you develop a tailored eating plan that ensures you are getting adequate nutrition while managing your symptoms.

5. Symptom Diary: Keeping a detailed diary of your symptoms, dietary intake, and any potential triggers can help you and your healthcare providers identify patterns and correlations that may not be immediately apparent.

Conclusion
Your symptoms are multifaceted and warrant a comprehensive approach to diagnosis and treatment. It is crucial to communicate openly with your healthcare providers about all your symptoms and concerns. By taking a proactive approach and seeking the appropriate specialists, you can work towards finding relief and improving your overall health. Remember, it’s essential to prioritize your well-being and seek help when needed.

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