A case of baffling fatigue with a spectral twist.

Mr Gee was so tired of feeling so tired. And his seasoned internists and subspecialists were exhausted by their futile attempts to establish a diagnosis for his debilitating fatigue. Sure, they were treating their 50-year-old patient for diabetes, hypertension, heart disease, and renal insufficiency. But, informed by their collective clinical acumen, they knew that, on any clinical scale, his fatigue outweighed any plausible measure. Besides, Mr Gee’s blood chemistries and cell counts doggedly remained near normal limits all the while his profound fatigue relentlessly progressed. Although reporting that he retired to bed every night for an eight-hour minimum, he still easily nodded off throughout the day—often at inopportune moments—which impaired his capacity for work and socialization. Despite his increasing debilitation and isolation, his physicians did not think he was depressed, and they could not implicate any of his usual medications. No evidence supported a causal role for a host of inflammatory, autoimmune, thyroid, adrenal, and sleep disorders. Mr Gee’s primary physician was even more concerned about a second diagnostic conundrum. Reportedly, for weeks, Mr Gee had experienced abrupt elevations of his systolic blood pressure to worrisome levels—beyond 200 mmHg—that tended to occur at night. During those “episodes” he also experienced headaches, tinnitus, nausea, and fear about succumbing to a stroke. Laboratory and radiographic tests in pursuit of secondary causes like pheochromocytoma failed to yield an explanation for these episodes. Multiple antihypertensive trials—with which Mr Gee had been compliant—had not diminished their frequency or severity.