GPAtlas🧭 When to suspect
Tiredness or fatigue is one of the highest-volume presentations in primary care.
• It is a persistent, subjective lack of energy that is not relieved by rest and that interferes with work, social or daily functioning.
• Fatigue is a non-specific symptom with a very wide differential, ranging from everyday lifestyle and psychological causes through to serious organic disease.
Read the pattern of the fatigue to direct the work-up, and never miss a red flag.
Triage early by separating three patterns, because each points to a different group of causes and a different management route:
• sleepiness (a tendency to doze off)
• physical fatigue (“no energy”)
• mental fatigue (“can’t be bothered”).
| Pattern of fatigue | Typical pointers | Think about |
|---|---|---|
| Sleepiness/hypersomnolence | Dozing off in the day, unrefreshing sleep, snoring, witnessed apnoeas | Obstructive sleep apnoea, poor sleep hygiene, shift work, sedating drugs |
| Physical or “no energy” | Breathlessness, exertional limitation, pallor, weight change, cold intolerance | Anaemia, hypothyroidism, diabetes, cardiac, respiratory, renal or hepatic disease, malignancy |
| Mental or “can’t be bothered” | Low mood, anhedonia, poor concentration, anxiety, identifiable life stress | Depression, anxiety, burnout, psychosocial stress |
| Activity-triggered (PEM) | Disproportionate, often delayed “crash” after minimal exertion, prolonged recovery | ME/CFS, frequently post-viral |
Investigate unexplained fatigue that has persisted beyond around a month and cannot be attributed to an obvious recent cause – an acute illness, a period of sleep loss, an identifiable stressor or a culprit medication.
Raise the index of suspicion for serious organic disease where there is:
• unintentional weight loss
• fever or night sweats
• focal symptoms
• abnormal examination findings.
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.