Weight loss and dizziness in a 29-year-old man

Review of Systems

  • General: 12-kg weight loss and slightly decreased appetite. No fever or chills.

  • Skin: Recent onset darkening of his nipples and the knuckles of his hands. No rash or lesions.

  • HEENT: Noncontributory

  • Pulmonary: Mild exertional shortness of breath, which is new. No cough.

  • Cardiovascular: Occasional palpitations and lightheadedness on standing up, which resolves after a few minutes. No chest pain, no peripheral edema.

  • Gastrointestinal: Bowel movement once daily with normal stool, morning nausea with occasional non-bloody vomiting, and generalized mild abdominal pain that is unrelated to meals, position, or activity.

  • Genitourinary: No dysuria or increased urinary frequency or volume.

  • Musculoskeletal: Generalized mild weakness; he struggles to get through a day’s work as a builder. No swelling or pain in legs, joints, or muscles.

  • Neurologic: Noncontributory

  • Psychiatric: Low mood for the last 2 months due to tiredness.