The underlying cause shocked the patient and confounded her doctors.
The 67-year-old woman slipped off her shoes before stepping onto her doctor’s scale. At her home, in Maplewood, N.J., the bathroom scale had documented the same 25-pound weight loss she and her internist now saw. It happened suddenly, over the past few months. Initially she blamed a bout of Covid-19 that she picked up during a trip with friends to Morocco three months earlier. But that seemed unlikely: The illness felt like no more than a bad cold and lasted only one week.
It wasn’t as if she were wasting away, and she rather liked the way she looked at this new weight. Still, she hadn’t been dieting, so it worried her. Just a few weeks earlier, a friend lost weight unintentionally like this and was diagnosed with metastatic cancer.
By the time she got to this appointment with her primary-care doctor, the woman, an emergency-room physician, had already done some investigating. She saw her ob-gyn, who gave her the all-clear. A recent colonoscopy and mammogram were normal. Still, she wanted to hear what her internist, Dr. James Rommer, would make of her unintended weight loss.
Rommer had known the woman for many years. He saw her before her left-knee replacement surgery the previous year; not long afterward, she called to tell him that her blood pressure was high. He started her on a blood-pressure medication and had increased it at each of her follow-up visits.
She didn’t feel sick, the patient told Rommer. She had no nausea, no stomach pain. Her appetite was good. Maybe she was a little more tired than usual, but that could be left over from the holidays, she said.
Her blood pressure was elevated but otherwise her exam was normal. Rommer agreed the weight loss was concerning; patients don’t usually lose weight by accident. He outlined his plan: For the weight loss, he would order some basic lab tests — blood count, chemistries, liver and thyroid studies. And for her new and persistent high blood pressure, he would look for a couple of unusual tumors that can raise blood pressure by putting out excessive cortisol or epinephrine, the fight-or-flight hormones made by the adrenal glands. If all that was normal, he would get a CT scan of her chest, abdomen and pelvis to make sure he wasn’t missing anything.