Cachexia

Definition

Cachexia is a medical condition in which severe weight loss occurs without the person intending to achieve such an objective. The syndrome is accompanied by a wide range of other symptoms, as you will have the opportunity to find out in this article. It should be noted that the weight loss that results from cachexia cannot be recuperated through nutrition. Even if the patient is administered an increased number of calories, the loss of lean body mass is going to continuously occur, which is significant of an underlying pathology.

Cachexia Symptoms

These are the most common symptoms that are encountered in patients with cachexia:

• Significant weight loss (body fat)
• Atrophy of the muscles
• State of general fatigue and weakness
• Severe appetite loss
• Asthenia
• Early satiety sensation
• Anorexia
• Nausea
• Changes in the taste
• Anemia symptoms
• Hormonal imbalances
• Patient – characteristic appearance for chronic illness (emaciated)
• In terms of fever, the patient can be normothermic, febrile or hypothermic
• Changes of the skin – modified texture, loose folds
• Bony protuberances become more obvious, as the body fat is lost
• Gum atrophy
• Sagging and shriveled breasts (due to the loss of fat)
• High heart rates
• Eschars and ulcerations appear on the skin, due to the loss of fat and circulatory problems
• Slow growth of the nails and hair.

Causes

These are the most common causes that lead to cachexia:

• Different types of cancer
  • Common seen in patients who are terminal (end-stage cancer)
• HIV/AIDS
  • Involuntary weight loss (wasting)
  • Severe protein energy malnutrition
  • Cachexia can contribute to the progression of the condition
• Chronic obstructive lung disease
  • Patients experience shortness of breath, cough and excess mucus
  • Systemic inflammation is present, contributing to the appearance of cachexia
  • The metabolism is affected by the inflammation at the level of the lungs
• Multiple sclerosis
  • Cachexia is present in those with advanced stages of multiple sclerosis
• Congestive heart failure
  • Cardiac cachexia syndrome
  • Cachexia appears as a complication of the chronic congestive heart failure
  • The nutrition and metabolism are affected, with severe weight loss and other symptoms of cachexia becoming obvious
• Tuberculosis
  • Cachexia – pathognomonic sign of pulmonary tuberculosis
  • Poor prognosis
• Familial amyloid polyneuropathy
  • Rare autosomal dominant disease
  • Affects the autonomic nervous system
  • Cachexia is one of the symptoms
• Gadolinium poisoning
  • Can cause severe toxicity, interfering with the metabolism and leading to the appearance of cachexia symptoms
• Mercury poisoning (acrodynia)
  • Mercury cachexia leads to systemic exhaustion and changes in the mental status
• Hormonal deficiency
  • Often encountered in those who also suffer from congestive heart failure
• Metabolic acidosis
  • Decrease protein synthesis and increased protein consumption
  • Encountered in patients diagnosed with rare types of cancer
• Chronic pancreatitis
  • Loss of pancreatic function can impair the overall metabolism and lead to the appearance of cachexia symptoms
• Autoimmune conditions
  • Rheumatoid arthritis
  • Autoimmune arthritis
• Amphetamine addiction
  • Cachexia appears due to the physical wasting caused by the excess amphetamine consumptions
• Chronic kidney disease
  • Systemic inflammation – cachexia symptoms appear
• Cystic fibrosis
  • Cachexia symptoms appear in the more severe stages of the disease
• Motor neuron disease
  • Cachexia may be caused by the appearance of symptoms such as dysphagia
• Neurodegenerative diseases
  • Parkinson’s disease
  • Dementia.

Treatment

First of all, it is important to understand that the treatment of cachexia depends on the cause that led to its appearance. In many patients, given the fact that they are terminally ill, it is more about the management rather than the treatment. If there are certain causes that can be reversed, these will be treated, improving the symptoms of cachexia and the overall quality of life for the patient. Apart from the administration of the medication, the treatment of cachexia and its symptoms includes nutritional counselling, physiotherapy and psychological counselling.

It is believed that a single course of therapy is not efficient in treating the symptoms of cachexia. This is why the recommended therapeutic approach for cachexia includes the administration of medication, nutritional counseling and other non-drug therapies. Corticosteroids can be administered as a short-term therapy (increasing the appetite) but their administering cannot be prolonged, as it leads to serious side-effects. For example, methylprednisolone might be used for a period of 2 weeks, in a patient who suffers from refractory cachexia. If a person suffers from cachexia, with anorexia as the primary concern, the symptoms can be ameliorated through the administration of synthetic progestogens (progestins). Studies have shown that megestrol, a synthetic progestogen, may contribute to an increase in both the appetite and the overall weight.

The medication that can be administered in patients suffering from cachexia includes but is not limited to the following choices:

• Thalidomide (cytokine antagonist)
• Cannabinoids (dronabinol)
  • Increase the appetite but not the overall weight
• Omega-3 fatty acids – eicosapentaenoic acid
  • Reduce the release of cytokines
• NSAIDs
  • Recommended in those who present high levels of CRP (C-Reactive protein)
  • More useful in patients who suffer from cachexia caused by other medical problems than cancer
  • Not beneficial in patients who suffer from refractory cachexia
• Prokinetics
• Ghrelin + ghrelin receptor agonists – stimulate the appetite
• MT-102 (anabolic catabolic transforming agents)
• Selective androgen receptor modulators
• Cyproheptadine
• Hydrazine

In some parts of the United States, it is acceptable for marijuana to be used as a treatment for the symptoms of cachexia, as it improves the appetite like the other cannabinoids. Oral fish oil has also been proposed as a potential natural remedy but studies demonstrating its efficacy remain inconclusive.

Parenteral nutritional support is recommended to reduce the risk of morbidity in patients who are suffering from cachexia. The decision to provide such kind of support depends on the swallowing abilities. Normal eating is encouraged in terminal patients, so as to reduce the level of stress. Antioxidants might be used in order to reduce the levels of the oxidative stress. Vitamin and mineral supplements may be administered in less severe cases of cachexia. Physical therapy might reduce the wasting of the muscle mass, reducing the risk of eschars and ulcers due to the prolonged decubitus.