A 54-year-old man comes to the office due to concerns about having pancreatic cancer after a coworker died of the disease 6 months ago. The patient has no epigastric pain, jaundice, or weight loss. However, he worries constantly because in researching the illness he read that it may not have obvious symptoms in early stages and can be rapidly fatal. The patient saw another physician 2 months ago, who performed a physical examination, laboratory evaluation, and abdominal CT scan. The results were normal and the physician reassured the patient that he did not have cancer. However, the patient reports that he has noticed occasional stomach noises after eating and would like to have additional testing done. Which of the following is the most likely diagnosis?

Question

A 54-year-old man comes to the office due to concerns about having pancreatic cancer after a coworker died of the disease 6 months ago.  The patient has no epigastric pain, jaundice, or weight loss.  However, he worries constantly because in researching the illness he read that it may not have obvious symptoms in early stages and can be rapidly fatal.  The patient saw another physician 2 months ago, who performed a physical examination, laboratory evaluation, and abdominal CT scan.  The results were normal and the physician reassured the patient that he did not have cancer.  However, the patient reports that he has noticed occasional stomach noises after eating and would like to have additional testing done.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec160b_362a_d21d_9249_1fa46a095bcc_MD0001_00 This patient's excessive worry about having pancreatic cancer despite negative medical evaluation is consistent with illness anxiety disorder (IAD, [hypochondriasis]). Patients with IAD are preoccupied with fears of having a serious, undiagnosed illness and are rarely reassured by negative findings on physical examination or laboratory testing. Their fears of illness often become a dominant feature of their lives and lead to high health care utilization (eg, doctor shopping, requests for repeated testing). These patients often have catastrophic interpretations of normal physical sensations (eg, this patient thinking that stomach noises could signify cancer). IAD is differentiated from somatic symptom disorder in that patients with IAD have minimal or no somatic symptoms. In contrast, patients with somatic symptom disorder have prominent and typically multiple somatic symptoms (Choice G). Initial management of IAD consists of scheduling regular visits, limiting diagnostic tests and referrals, and focusing on coping and functional improvement. (Choice A) Although this patient's anxiety about pancreatic cancer was triggered by his coworker's death, adjustment disorder is not diagnosed when symptoms are better explained by another disorder. (Choice B) Conversion disorder (functional neurologic symptom disorder) is characterized by neurologic symptoms (eg, weakness, nonepileptic seizures) that are inconsistent with any known condition. (Choice C) Patients with IAD are not delusional and can acknowledge the possibility that they do not have the disease. In contrast, patients with delusional disorder, somatic type, have false, fixed beliefs about the body. (Choice D) Factitious disorder involves the intentional falsification of illness with the goal of assuming the sick role. (Choice E) This patient's anxiety appears to be restricted to fears of having a serious illness. Patients with generalized anxiety disorder worry excessively about multiple everyday issues (eg, relationships, work, finances), not just health anxiety. Educational objective: Illness anxiety disorder is characterized by excessive concern about having a serious, undiagnosed disease, despite few or no symptoms and negative medical workup. __________ References: DSM-5 illness anxiety disorder and somatic symptom disorder: comorbidity, correlates, and overlap with DSM-IV hypochondriasis. (http://www.ncbi.nlm.nih.gov/pubmed/28867421)

A 54-Year-Old Man Comes to the Office Due to Concerns