Chronische Müdigkeit

Fatigue investigation panel with broad metabolic, haematological, hormonal, and micronutrient coverage. Tests full CBC, liver function, electrolytes, cortisol, ferritin, glucose, selenium, TSH, vitamin B12, and protein electrophoresis. At €161.73 all-in, a systematic workup for persistent unexplained tiredness.

Chronic fatigue is one of the most common presenting complaints in primary care, yet its causes range from the mundane (iron deficiency, subclinical hypothyroidism) to the serious (haematological malignancy, adrenal insufficiency, multiple myeloma). The Chronische Müdigkeit panel is designed as a systematic diagnostic sieve that covers the most common and most important treatable causes of persistent unexplained tiredness. The full CBC with differential is the foundation of any fatigue workup. Anaemia — whether from iron deficiency, B12 deficiency, chronic disease, or bone marrow pathology — is the single most common organic cause of fatigue. The differential white count can reveal infection, leukaemia, or autoimmune conditions. Elevated eosinophils may suggest parasitic infection or allergic disease, both fatigue-causing conditions that are otherwise easily missed. Ferritin is the most sensitive marker for iron stores and can identify iron depletion well before overt anaemia develops. Iron deficiency without anaemia is extremely common, particularly in premenopausal women and athletes, and causes fatigue, poor concentration, and exercise intolerance even when haemoglobin is normal. TSH screens for thyroid dysfunction — hypothyroidism is one of the most frequent and most treatable causes of fatigue. Even subclinical hypothyroidism (TSH 4-10, normal free T4) can cause clinically significant fatigue, particularly in older adults. Cortisol assesses adrenal function. Both excess cortisol (Cushing syndrome) and cortisol deficiency (adrenal insufficiency) cause fatigue, though through different mechanisms. Morning cortisol below 100 nmol/L strongly suggests adrenal insufficiency and warrants urgent further investigation. Mildly low cortisol may indicate the need for a Synacthen stimulation test. Vitamin B12 deficiency causes fatigue through impaired red cell production and direct neurological effects. It is particularly common in vegans, vegetarians, older adults, and metformin users. Neurological symptoms (numbness, tingling, cognitive changes) may precede anaemia by years. Selenium is an increasingly recognised micronutrient in fatigue investigation. It is essential for thyroid hormone conversion (T4 to active T3) via the deiodinase enzymes, and for antioxidant defence via the glutathione peroxidase system. Selenium deficiency is more common in Northern European soils than Mediterranean soils. The liver panel (GPT, GOT, GGT) screens for liver disease — chronic hepatitis, fatty liver disease, and alcohol-related liver damage all cause fatigue as an early symptom. Electrolytes identify derangements (particularly hyponatraemia and hypokalaemia) that directly cause fatigue and weakness. Protein electrophoresis is the investigation that elevates this panel from routine to genuinely thorough. It separates serum proteins into fractions and can detect monoclonal gammopathies — the signature of multiple myeloma and related plasma cell disorders. Myeloma is an important cause of fatigue in adults over 50 and is frequently diagnosed late because its symptoms (fatigue, bone pain, recurrent infections) are non-specific. Glucose screens for diabetes, where fatigue is often the presenting symptom, particularly in type 2 diabetes where hyperglycaemia develops gradually.